EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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

<2>
Accession Number
612669984
Author
Gaspari R.; Weekes A.; Adhikari S.; Noble V.E.; Nomura J.T.; Theodoro D.;
Woo M.; Atkinson P.; Blehar D.; Brown S.M.; Caffery T.; Douglass E.;
Fraser J.; Haines C.; Lam S.; Lanspa M.; Lewis M.; Liebmann O.; Limkakeng
A.; Lopez F.; Platz E.; Mendoza M.; Minnigan H.; Moore C.; Novik J.; Rang
L.; Scruggs W.; Raio C.
Institution
(Gaspari, Blehar, Mendoza) University of Massachusetts Medical School,
Worcester, MA, United States
(Weekes, Lewis) Carolinas Medical Center, Charlotte, NC, United States
(Adhikari) University of Arizona, Tucson, AZ, United States
(Noble, Douglass) Massachusetts General Hospital, Boston, MA, United
States
(Nomura) Christiana Care Health System, Newark, DE, United States
(Theodoro) Washington University School of Medicine, St. Louis, MO, United
States
(Woo) University of Ottawa, Ottawa, ON, Canada
(Atkinson, Fraser) Dalhousie University, Saint John, NB, Canada
(Brown, Lanspa) Intermountain Medical Center and University of Utah, Salt
Lake City, UT, United States
(Caffery) LSU Health Sciences Center, Baton Rouge, LA, United States
(Haines, Raio) North Shore University Hospital, Manhasset, NY, United
States
(Lam) Advocate Christ Medical Center, Chicago, IL, United States
(Liebmann) Brown University, Providence, RI, United States
(Limkakeng, Lopez) Duke University School of Medicine, Durham, NC, United
States
(Platz) Brigham and Women's Hospital, Boston, MA, United States
(Minnigan) Indiana University, Indianapolis, IN, United States
(Moore) Yale University School of Medicine, New Haven, CT, United States
(Novik) NYU Bellevue Hospital, New York, NY, United States
(Rang) Kingston General Hospital, Kingston, ON, Canada
(Scruggs) Castle Hospital, Kailua, HI, United States
Title
Emergency department point-of-care ultrasound in out-of-hospital and in-ED
cardiac arrest.
Source
Resuscitation. 109 (pp 33-39), 2016. Date of Publication: 01 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Point-of-care ultrasound has been suggested to improve outcomes
from advanced cardiac life support (ACLS), but no large studies have
explored how it should be incorporated into ACLS. Our aim was to determine
whether cardiac activity on ultrasound during ACLS is associated with
improved survival. Methods We conducted a non-randomized, prospective,
protocol-driven observational study at 20 hospitals across United States
and Canada. Patients presenting with out-of-hospital arrest or in-ED
arrest with pulseless electrical activity or asystole were included. An
ultrasound was performed at the beginning and end of ACLS. The primary
outcome was survival to hospital admission. Secondary outcomes included
survival to hospital discharge and return of spontaneous circulation.
Findings 793 patients were enrolled, 208 (26.2%) survived the initial
resuscitation, 114 (14.4%) survived to hospital admission, and 13 (1.6%)
survived to hospital discharge. Cardiac activity on US was the variable
most associated with survival at all time points. On multivariate
regression modeling, cardiac activity was associated with increased
survival to hospital admission (OR 3.6, 2.2-5.9) and hospital discharge
(OR 5.7, 1.5-21.9). No cardiac activity on US was associated with
non-survival, but 0.6% (95% CI 0.3-2.3) survived to discharge. Ultrasound
identified findings that responded to non-ACLS interventions. Patients
with pericardial effusion and pericardiocentesis demonstrated higher
survival rates (15.4%) compared to all others (1.3%). Conclusion Cardiac
activity on ultrasound was the variable most associated with survival
following cardiac arrest. Ultrasound during cardiac arrest identifies
interventions outside of the standard ACLS algorithm. Copyright &#xa9;
2016 Elsevier Ireland Ltd

<3>
Accession Number
612630766
Author
Blazing M.A.; Giugliano R.P.; de Lemos J.A.; Cannon C.P.; Tonkin A.;
Ballantyne C.M.; Lewis B.S.; Musliner T.A.; Tershakovec A.M.; Lokhnygina
Y.; White J.A.; Reist C.; McCagg A.; Braunwald E.
Institution
(Blazing, Lokhnygina, White, Reist) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Giugliano, Cannon, McCagg, Braunwald) TIMI Study Group, Boston, MA,
United States
(de Lemos) University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Tonkin) Monash University, Melbourne, Victoria, Australia
(Ballantyne) Baylor College of Medicine and Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Musliner, Tershakovec) Merck & Co, Inc., Kenilworth, NJ, United States
Title
On-treatment analysis of the Improved Reduction of Outcomes: Vytorin
Efficacy International Trial (IMPROVE-IT).
Source
American Heart Journal. 182 (pp 89-96), 2016. Date of Publication: 01 Dec
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background We aimed to determine the efficacy and safety of adding
ezetimibe (Ez) to simvastatin (S) in a post-acute coronary syndrome (ACS)
population in a prespecified on-treatment analysis. Methods We evaluated
17,706 post-ACS patients from the IMPROVE-IT trial who had low-density
lipoprotein cholesterol values between 50 and 125 mg/dL and who received
Ez 10 mg/d with S 40 mg/d (Ez/S) or placebo with simvastatin 40 mg/d
(P/S). The primary composite end point was cardiovascular death,
myocardial infarction, unstable angina, coronary revascularization >30
days postrandomization, or stroke. The on-treatment analysis included
patients who received study drug for the duration of the trial or
experienced a primary end point or noncardiovascular death within 30 days
of drug discontinuation. Results Mean low-density lipoprotein cholesterol
values at 1 year were 71 mg/dL for P/S and 54 mg/dL for Ez/S (absolute
difference -17 mg/dL = -24%; P <.001). The 7-year Kaplan-Meier estimate of
the primary end point occurred in 32.4% in the P/S arm and 29.8% in the
Ez/S arm (absolute difference 2.6%; HR<inf>adj</inf> 0.92 [95% CI
0.87-0.98]; P =.01). The absolute treatment effect favoring Ez/S was 30%
greater than in the intention-to-treat analysis of IMPROVE-IT. Conclusions
This analysis provides additional support for the efficacy and safety of
adding Ez to S in this high-risk, post-ACS population. Copyright &#xa9;
2016 Elsevier, Inc.

<4>
Accession Number
612630764
Author
Lee S.-E.; Chang H.-J.; Rizvi A.; Hadamitzky M.; Kim Y.-J.; Conte E.;
Andreini D.; Pontone G.; Volpato V.; Budoff M.J.; Gottlieb I.; Lee B.K.;
Chun E.J.; Cademartiri F.; Maffei E.; Marques H.; Leipsic J.A.; Shin S.;
Choi J.H.; Chung N.; Min J.K.
Institution
(Lee, Chang, Chung) Division of Cardiology, Severance Cardiovascular
Hospital, Integrative Cardiovascular Imaging Center, Yonsei University
Health System, Seoul, South Korea
(Rizvi, Min) Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medical College, New York,
NY, United States
(Hadamitzky) Division of Cardiology, University of Munich, Munich, Germany
(Kim) Seoul National University Hospital, South Korea
(Conte, Andreini, Pontone, Volpato) Centro Cardiologico Monzino, IRCCS,
Milan, Italy
(Budoff) Department of Medicine, Harbor UCLA Medical Center, Los Angeles,
CA, United States
(Gottlieb) Department of Radiology, Casa de Saude Sao Jose, Rio de
Janeiro, Brazil
(Lee) Gangnam Severance Hospital, South Korea
(Chun) Seoul National University Bundang Hospital, South Korea
(Cademartiri, Maffei) Department of Radiology, Montreal Heart
Institute/Universite de Montreal, Montreal, Quebec, Canada
(Marques) Hospital da Luz, Lisbon, Portugal
(Leipsic) Department of Radiology, St Paul's Hospital, University of
British Columbia, Vancouver, Canada
(Shin) National Health Insurance Service Ilsan Hospital, South Korea
(Choi) Busan University Hospital, South Korea
Title
Rationale and design of the Progression of AtheRosclerotic PlAque
DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM)
registry: A comprehensive exploration of plaque progression and its impact
on clinical outcomes from a multicenter serial coronary computed
tomographic angiography study.
Source
American Heart Journal. 182 (pp 72-79), 2016. Date of Publication: 01 Dec
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
The natural history of coronary artery disease (CAD) in patients with
low-to-intermediate risk is not well characterized. Although earlier
invasive serial studies have documented the progression of atherosclerotic
burden, most were focused on high-risk patients only. The PARADIGM
registry is a large, prospective, multinational dynamic observational
registry of patients undergoing serial coronary computed tomographic
angiography (CCTA). The primary aim of PARADIGM is to characterize the
natural history of CAD in relation to clinical and laboratory data. Design
The PARADIGM registry (ClinicalTrials.gov NCT02803411) comprises >2,000
consecutive patients across 9 cluster sites in 7 countries. PARADIGM sites
were chosen on the basis of adequate CCTA volume, site CCTA proficiency,
local demographic characteristics, and medical facilities to ensure a
broad-based sample of patients. Patients referred for clinically indicated
CCTA will be followed up and enrolled if they had a second CCTA scan.
Patients will also be followed up beyond serial CCTA performance to
identify adverse CAD events that include cardiac and noncardiac death,
myocardial infarction, unstable angina, target vessel revascularization,
and CAD-related hospitalization. Summary The results derived from the
PARADIGM registry are anticipated to add incremental insight into the
changes in CCTA findings in accordance with the progression or regression
of CAD that confer prognostic value beyond demographic and clinical
characteristics. Copyright &#xa9; 2016 Elsevier Inc.

<5>
Accession Number
609147989
Author
Zhou X.; Yu J.; Li L.; Gloy V.L.; Nordmann A.; Tiboni M.; Li Y.; Sun X.
Institution
(Zhou, Yu, Li, Li, Sun) Chinese Evidence-based Medicine Center, West China
Hospital, Sichuan University, Chengdu, China
(Li, Li, Sun) Clinical Research and Evaluation Unit, West China Hospital,
Sichuan University, Chengdu, China
(Gloy, Nordmann) Basel Institute of Clinical Epidemiology & Biostatistics,
University Hospital Basel, Hebelstrasse 10, Basel, Switzerland
(Tiboni) Saint Joseph's Hospital and McMaster University, Hamilton, ON,
Canada
(Sun) Center for Evidence-Based Medicine and Clinical Research, Taihe
Hospital, Hubei University of Medicine, Shiyan, Hubei 44200, China
Title
Effects of Bariatric Surgery on Mortality, Cardiovascular Events, and
Cancer Outcomes in Obese Patients: Systematic Review and Meta-analysis.
Source
Obesity Surgery. 26 (11) (pp 2590-2601), 2016. Date of Publication: 01 Nov
2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The long-term effects of bariatric surgery have yet to be
established, and a number of important studies have recently emerged. This
systematic review aimed to assess the effects of bariatric surgery on
all-cause mortality, cardiovascular events, and cancer compared to
non-surgical treatment. Methods: We searched PubMed, EMBASE, and CENTRAL
up to July 13, 2015, and included randomized controlled trials (RCTs) and
non-randomized controlled studies comparing bariatric surgery versus
non-surgical treatment and reporting data on the three defined outcomes at
1 year or longer. We analyzed RCTs and non-randomized controlled studies,
respectively. Results: Eleven RCTs, 4 non-randomized controlled trials,
and 17 cohort studies were included. The randomized evidence suggested
substantial uncertainty regarding the effects on all-cause mortality
(0/382 vs. 1/287; 7 studies), cancer (OR 0.77, 95 % CI 0.22 to 2.71; 4
studies), and cardiovascular events (no data). The pooled adjusted
estimates from non-randomized studies suggested that, compared to the
control, the surgical group had lower risk of all-cause mortality (OR
0.55, 95 % CI 0.46 to 0.65; 10 studies), cancer (OR 0.74, 95 % CI 0.65 to
0.85; 2 studies), and cardiovascular events (MI: OR 0.71, 95 % CI 0.54 to
0.94; stroke: OR 0.66, 95 % CI 0.49 to 0.89; and their composite: OR 0.67,
95 % CI 0.54 to 0.83; 1 study). Conclusions: In conclusion, bariatric
surgery could reduce all-cause mortality and probably reduce the risk of
any type of cancer. The inference was, however, based on studies with
limited methodological rigor. Uncertainty remains regarding the effects on
cardiovascular events. Copyright &#xa9; 2016, Springer Science+Business
Media New York.

<6>
Accession Number
613187630
Author
De Sandes Kimura O.; Freitas E.; Linhares Garcia P.B.; Leal D.D.C.; Cury
Fernandes M.B.
Institution
(De Sandes Kimura, Freitas, Linhares Garcia, Leal, Cury Fernandes)
Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Title
Tranexamic acid in high risk transfusion group: A comparative study.
Source
HIP International. Conference: 12th Congress of the European Hip Society,
EHS 2016. Germany. Conference Start: 20160906. Conference End: 20160909.
26 (pp S42), 2016. Date of Publication: September 2016.
Publisher
Wichtig Publishing Srl
Abstract
Introduction/objectives: Total hip replacement (THR) is one of the
surgical procedures that has the highest success rate in functional
improvement and patient satisfaction. The procedure is associated with
significant blood loss leading to acute anaemia and transfusion
requirements in 29.8% of cases. Antifibrinolytic agents, such as aprotinin
and tranexamic acid, have proven to be effective in reducing blood loss,
especially in cardiac surgery. Methods: This is a prospective, randomized
study conducted with 256 patients between December 2013 and March 2014.
The sample was divided into two groups: patients who received tranexamic
acid (ATX group, n = 128) and patients who did not (Control group, n =
128). The drug administration was carried out by intravenous infusion
bolus at a dose of 15 mg/kg. Results: The ATX group showed less decline in
Hb and Ht postoperative (p<0.0001), as well as the blood loss volume
during surgery, 652.9 mL in the ATX group and 1163.0 mL in the control
group (p<0.0001). The need for blood transfusion was reduced from 32% in
the control group to 14.1% in the ATX group (p = 0.001). Among the
patients who underwent blood transfusion, the use of tranexamic acid
resulted in a significant decrease in the infused blood volume (p<0.0001).
There was a significant reduction in rates of blood transfusion and blood
volume transfused in the group with risk factor for blood transfusion
(preoperative Hb less than 13 g/dL). The hospital length stay was lower in
the group using the ATX, including the group with risk for blood
transfusion. Conclusions: The use of tranexamic acid intravenously in a
single dose before surgery is safe, reduces the operative blood loss and
the need for transfusion in patients undergoing THR.

<7>
Accession Number
613192081
Author
Bustamante Munguira J.; Gomez-Sanchez E.; Figuerola-Tejerina A.;
Heredia-Rodriguez M.; Fierro I.; Alvarez F.J.; Tamayo E.
Institution
(Bustamante Munguira) Departament of Cardiac Surgery, Hospital
Universitario la Princesa, Madrid, Spain
(Gomez-Sanchez, Heredia-Rodriguez, Tamayo) Department of Anaesthesiology
and Reanimation, Universitary Clinic Hospital, Valladolid, Spain
(Figuerola-Tejerina) Hospital Universitario la Princesa, Department of
Infection Control, Madrid, Spain
(Fierro, Alvarez) University of Valladolid, Faculty of Medicine,
Department of Pharmacology and Therapeutics, Valladolid, Spain
Title
An ultraviolet air sterilizer, can it be reduced the rate of infections in
patients underwent to cardiac surgery?.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 296), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Nosocomial infections represent the most common
postoperative complications in the intensive care unit (ICU) associated
with longer hospital stay, higher mortality rates, and increased
healthcare costs. Pathogens are transmitted by the direct contact
person-to-person, with the skin, clothes, or when manipulating instruments
and medical devices, and through the air. When surfaces have not been
successfully disinfected pathogens can survive. Several studies have
demonstrated that standard cleaning methods are currently ineffective.
Novel disinfection technologies, based on hydrogen peroxide vapor, ozone
mists, or ultramicrofiber cloths, have emerged to solve this situation.
Purpose: The objective was to evaluate the impact of an ultraviolet air
sterilizer (UVAS) on clinical outcomes of patients, who underwent to
cardiac surgery, in the ICU. Methods: We designed a prospective,
comparative, randomized, and non-interventional study. 1097 patients
underwent to cardiac surgery were included, 522 and 575 stayed in an ICU
room with and without the UVAS, respectively. Results: The mean age was
68.3+/-11.1 years and 67.4% was male. The principal comorbidities were
hypertension (50.2% of total) and diabetes (21.3%). EuroSCORE was similar
between groups, 6.90+/-6.1 points in patients with the UVAS and 7.02+/-3.8
points in those without it. Sepsis occurred in fewer patients with the
UVAS (3.4% of total) than without it (6.7%; P = 0.02). VAP was slightly
lower in patients with the UVAS but not statistically significant. The
length of stay in the ICU and at the hospital was similar in both groups.
The 30- day in-hospital mortality rate was significantly lower in patients
with UVAS. Kaplan-Meier survival analysis revealed that the percentage of
survival was different between patients with the UVAS without it (Log
rank=3.880; P = 0.049) Conclusion: Novel UV-C technology has demonstrated
its effectiveness in reducing the incidence of sepsis in cardiac surgery
patients during his period in the ICU and contributed to decrease the
30-day mortality rate. This technology, in concurrence with standard
methods, should be included in the routine for the prevention of
nosocomial infections.

<8>
Accession Number
613192052
Author
Shams-Ul-Islam S.; Shuja Uddin M.; Shuja M.; Habib S.; Baig N.; Ishtiaq
S.; Khan W.; Dar M.; Soomro K.
Institution
(Shams-Ul-Islam, Shuja Uddin, Shuja, Baig, Baig, Ishtiaq, Ishtiaq) Dow
University of Health Sciences, Dow Institute of Medical Technology,
Karachi, Pakistan
(Habib, Habib) National Institute of Cardiovascular Diseases, Karachi,
Pakistan
(Khan, Khan) Tabba Heart Institute, Karachi, Pakistan
(Dar, Dar, Soomro, Soomro) Civil Hospital Karachi, Karachi, Pakistan
Title
Efficacy of ICU scoring systems at coronary care and intensive care
(Cardiac surgery) in 3 different hospitals.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 59-60), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications Inc.
Abstract
Purpose: By using ICU scoring systems, enhancing the care treatment and
risk of mortality of a patient in intensive care unit. Introduction: ICU
scoring systems are used for assessment of severity of disease. ICU
scoring system has wide patient applicability, high sensitivity and having
a wide range of mortality prediction. But some models assess mortality,
some predict long term morbidity and some functional status, so no scoring
system currently incorporate of all these features. APACHE II, APACHE IV,
SAPS III, SOFA, MODS, LODS, ODIN were selected for our research study.
Method: It is a multicentre cross-sectional cohort study conducted in
three different hopsitals. The entire consecutive cardiac surgical and
non-surgical patients were admitted to ICU and CCU during the time period
of July to December 2015. Purpose sampling was adopted on the basis of
patient ventilated during the first 24 hours or maximum 72 hours. 140 out
of 170 patients data were selected for analysis. proforma was based on the
parameters of all seven calculators. online calculators were also used for
computing the predicted mortality and length of stay. data was analysed
using SPSS software (paired sample T-test and one-way anova). 97%
confidence interval was taken in account of these scores which are well
developed and used in well developed setups so the chance of error is very
low. Result: 60.7% CABG patients and 39.3% non-CABG patients were
observed, Also 88% were shifted from the ICU while 12% were expired.
Highest data percentage of all scoring systems fall in high survival rate
group except LODS i.e, highest data percentage fall in death group. APACHE
IV and MODS showed the good predictive efficacy of length of stay. High
predictive efficacy of mortality has also been showed by all the scores
except APACHE IV. Conclusion: All scoring system show good calibration and
discrimination of length of stay and mortality except APACHE IV which
showed low predictive efficacy of mortality.

<9>
Accession Number
613192046
Author
Garcia Granja P.E.; Lopez J.; Ladron R.; Vilacosta I.; Olmos C.; Ortiz
Bautista C.; Sevilla T.; Ferrera C.; Gomez I.; San Roman J.A.
Institution
(Garcia Granja, Lopez, Ladron, Ortiz Bautista, Sevilla, Gomez, San Roman)
Institute of Heart Sciences (ICICOR), Valladolid, Spain
(Vilacosta, Olmos, Ferrera) Hospital Clinic San Carlos, Madrid, Spain
Title
Influence of valve culture in prognosis of leftsided infective
endocarditis.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 384-385), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications Inc.
Abstract
Introduction: growing cardiac tissues removed during cardiac surgery, is a
common practice. In the context of infective endocarditis (IE), it is
known its importance as diagnostic criteria and antibiotic treatment
guide, nevertheless, its importance as outcome marker has not been
explored. Objective: to define the importance of the cardiac tissue
culture's result in the outcome of patients with left-side infective
endocarditis. Methods: along 732 cases of IE consecutively diagnosed in
two tertiary centres between 1996 and 2016, we selected those with
positive blood cultures, who underwent surgery during active phase of the
disease and in whom surgical biological tissues were cultured (n=254).
From microbiology results we constructed 2 groups: negative valve culture
(n=176) and positive valve culture (n=60). Those with positive valve
culture with different microorganism from blood culture (n=18) were
excluded because contamination could not be rule out. We compared main
features of patients with positive and negative valve cultures and
performed a multivariate analysis to asses the influence of valve
culture's result in short term outcome. Results: there were no
epidemiologically significant differences, apart from the presence of more
prosthesis in positive culture group (45 vs 30%, p=0.035). Clinically,
they had more septic shock at admission (12 vs 3%, p=0.021) and during
hospitalization (23 vs 9%, p=0.004). Blood cultures persisted positive at
48-72 hours from antibiotic onset more frequently (76 vs 33%, p<0.001).
Streptococcus spp were less frequent in valve culture (10 vs 42%, p<0.001)
in contrary to Staphylococcus spp (63 vs 44%, p=0.011). There were no
differences in echocardiographic findings, but in short outcomes, with
earlier surgery in positive valve group (6 [1-6.5] vs 16 [6-17] days from
admission, p<0.001) and higher in-hospital mortality (37 vs 21%, p=0.012).
Multivariate analysis showed as independent factors of in-hospital
mortality: positive valve culture (OR 1.99, CI 95% 1.01-3.93), heart
failure (OR 1.95, CI 95% 1.02-3.72), renal failure (OR 3.09 CI 95%
1.54-6.22) and Staphylococcus aureus (OR 2.09, CI 95% 1.04-4.22), with an
area under ROC curve of 0.723. Conclusions: a positive result in valve
culture of IE patients operated during active phase of the disease, is a
marker of bad clinical evolution due to non controlled infection and an
independent predictor which duplicate inhospital mortality.

<10>
Accession Number
613191966
Author
Shugushev Z.; Maximkin D.; Goloshchapov-Aksenov R.; Chernigina T.;
Gitelzon E.
Institution
(Shugushev, Maximkin, Goloshchapov-Aksenov, Chernigina, Gitelzon) Peoples
Friendship University of Russia (RPFU), Moscow, Russian Federation
Title
Efficiency of endovascular treatment of patients with NSTEMI.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 204-205), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications Inc.
Abstract
Aims: to estimate results of endovascular treatment in NSTEMI patients
with multivessel diseases, depending on depending on the volumeof
myocardial revascularization. Methods and Results: 346 patients were
included in the study and divided into 3 groups. In I group (n=100), who
were underwent complete myocardial revascularization during primary PCI
procedure;in II group (n=124) - complete myocardial revascularization
during hospitalization and III group(n=122) - complete myocardial
revascularization in the delayed period following hospitalization. The
average period of execution complete revascularization in this group was
4.5+/-0.2 months.The randomization was performed depending on the
selection of arterial access. All patient shave been randomized into 2
subgroups. In I subgroup were included 155 patient who had PCI performed
transfemoral access. In IIsubgroup were included 191 patient whohad PCI
performed transradial access. All patients underwent PCI only with drug
eluting stents. Criteria for evaluation the immediate results:MACE (death,
MI, repeat intervention); major bleeding (BARC 3 or 5). Criteria for
evaluation the long-term results (12months):MACE (death, MI, TLR, TVR),
restenosis and late stent thrombosis. Secondary endpoints: vascular access
site complications and a switch to another arterial access. Cumulative
MACE were 4, 4.8and 4.9% respectively in group I, II and III (p>0.05).
Major bleeding (BARC 3 or 5) were 1, 2.4 and 1.6% respectively in group I,
II and III (p>0.05). However, when we analyzed the results depending on
the type of arterial access, ratio of major bleeding (BARC 3 or 5) were
significantly higher in subgroup I and were 3.2%,whereas in subgroup II it
were 0.52% (p=0.032).The cumulative MACE were 8.4and 1.6% respectively in
subgroup I and II (p=0.001). The ratio of vascular complication were 3.87%
in subgroup I and 7.33% in subgroup II (p=0.024). Survival in long term
period was 100% in I and II group, 91.8% in group 3 (p=0.0017). The ratio
of restenosis was 6.0, 4.03 and 4.92% respectively in group I, II and III
(p>0.05). Late stent thrombosis were 2.0, 0 and 0.8% respectively
(p>0.05). TLR were 3.0, 2.5 and 4.1% respectively (p>0.05). TVR were 2.0,
2.5 and 1.7% respectively (p>0.05), at that cumulative MACE were 5 and
4.8%respectively in group I and II (p>0.05), but in group III MACE were
12.3% (p<0,001).The cumulative MACE in subgroup I and II also were 12.2
and 3.7% respectively (p<0.001). Conclusions: the transradial access
should be recommended as first-choice vascular access in patients with
NSTEMI undergoing cardiac catheterization. Performing a complete
myocardial revascularization in the delayed period following
hospitalizationin NSTEMI patients with multivessel disease differs power
clinical outcomes, compared with the results of revascularization
performed during hospitalization.

<11>
Accession Number
613191953
Author
Mustafa A.; El-Naggar W.; Mahdy M.; Al-Kaffas S.
Institution
(Mustafa, El-Naggar, Mahdy, Al-Kaffas) Cairo University Hospitals,
Cardiology, Cairo, Egypt
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 PCI.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 29-30), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications 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 intrathrombus 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 post PCI (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.

<12>
Accession Number
613191898
Author
Hammami R.; Ben Kahla S.; Zouari A.; Mallek S.; Abid L.; Kammoun S.
Institution
(Hammami, Ben Kahla, Zouari, Mallek, Abid, Kammoun) Hedi Cheker Hospital,
Department of Cardiology, Sfax, Tunisia
Title
Prognosis of Ischemic mitral regurgitation.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 83-84), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Ischemic mitral regurgitation (IMR) is a common and a severe
complication. It can be acute following an myocardial infarction (MI) or
chronic occurring during the development of coronary artery disease. The
aim of this work is to describe the clinical features determine the
prognosis of patients with ischemic mitral regurgitation Material and
methods: we perform a retrospective study including 106 coronary hospital
our department during the period from January 2008 to the month of
December 2014, with an ischemic mitral regurgitation diagnosed in
echocardiography Results: The mean age of our patients was 65.36 +/- 12
years with a male predominance. The main cardiovascular risk factors were
smoking (72.6%), diabetes (50%) and hypertension (43.4%). The MR was acute
as a result of MI in 55.7% and chronic in the remaining cases. For
patients with acute MI, headquarters of MI was mostly inferior (52.5%)
with a basal extension in 18 cases, in 12 cases lateral and to the right
ventricle in 9 cases. The presence of ischemic MR was associated to
several arrhythmia and hemodynamic complications (cardiac failure (48.7%),
atrial fibrillation (23.1%) and ventricular rhythm disorder (18%)). The
main mechanism of the MR was a restriction of the small valve (28.3%)
followed by bivalvular restriction with tenting of the mitral valve
(21.7%) and dilatation of the mitral annulus (11.3%). The IMR was moderate
in 86.8% of cases and major (SOR> 20mm2) in 21% of cases . A LV
dysfunction (LVEF <45%) was noted in 69 patients (65.7%) with high filling
pressures in 43.8%. Only 73 patients underwent coronary angiography who
had objectified a single vessel disease (17 cases), double vessels (24
cases) and three vessel disease (32 cases). The LDA was the main culprit
artery (34.2%), the right coronary artery in 22.4% and the circumflex or
marginal branches in 24.6%. During a mean follow-up of 17 months, the rate
of MACCE was important (30.1%), mortality was 5.7% reinfarction (8.4%),
TVR (8.4%), TLR (1 , 8%) and stroke (4.7%). Unfortunately only 5 patients
underwent mitral valvuloplasty with an acceptable result. Some predictors
of mortality were identified such as recurrent MI (6 vs.3, p = 0.008, OR =
15.5 [2.56-93.8]) and TVR (7 vs.2, p = 0.026, OR = 6.57 [ 1.02-42.35])
Conclusion: Ischemic mitral regurgitation is a frequent and serious
complication in patients with coronary disease, however this is generally
not well managed because of clear consensus lack and the frequent
association to severe LV dysfunction limiting the possibility of surgery.
The advent of new percutaneous mitral valve repair techniques would be a
great contribution to the treatment of ischemic MR. (Figure Presented).

<13>
Accession Number
613191611
Author
Mitrovic P.; Stefanovic B.; Radovanovic M.; Radovanovic N.; Matic G.;
Rajic D.; Lasica R.; Subotic I.; Mijic N.
Institution
(Mitrovic, Stefanovic, Radovanovic, Radovanovic, Lasica) University
Institute for Cardiovasculari Diseases, School of Medicine, University of
Belgrade, Belgrade, Serbia
(Matic, Rajic, Subotic, Mijic) Clinical Center of Serbia, Institute for
Cardiovascular Diseases, Belgrade, Serbia
Title
Thrombolysis in acute myocardial infarction after previous
revascularization: 28-year experience of the POP study.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 191), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications Inc.
Abstract
There is a lack of data about patients (pts) who received thrombolytic
therapy (TT) in acute myocardial infarction (AMI) after previous coronary
artery bypass surgery (CABS). The primary aim of the POP study
(PostOperative Prognosis study) is analyze, follow-up and making scores
using clinical, angiographic, and procedural variables available 30-day
after intervention. The aim of this substudy was to analyze influence of
TT after 25 years of follow-up period in pts with AMI after previous CABS
who were randomized to either treatment with TT or conventional therapy.
Methods: From April 1988 - January 2016 we studied 1124 pts, who developed
AMI after CABS, mean age 61.2+/-4.0 years, mainly men (82.8%). The pts
with early perioperative AMI were excluded from the study. The average
time interval from CABS to AMI was 94.2 +/- 10.0 months. The average
number of grafts was 3.2 grafts/pts. All pts were divided in two groups:
group I - 447/1124 (39.8%) allocated to TT and group II - 677/1124 (60.2%)
conventionally treated pts. Results: Reinfarction and repeated CABS were
more frequently after TT. On 5-year follow-up periods, after 25-year
approximately 28% of the pts was free of subsequent cardiac events. The
cumulative 1, 5, 10, 15, 20 and 25-year survival rates were 93%, 80%, 67%,
51%, 50% and 48% in pts treated with TT and 86%, 70%, 54%, 44%, 41% and
40% in the control group, respectively (p<0.05). Significant determinants
of mortality in multivariate proportional hazards analysis were elderly
age, diabetes, previous AMI, indicators of impaired residual left
ventricular function and multivessel disease. Conclusion: Improved
survival after TT is maintained beyond the first 25 years. Age, diabetes,
previous AMI, left ventricular function and multivessel disease were
independent predictors for long-term mortality.

<14>
Accession Number
613191511
Author
Mora G.; Diaz C.D.
Institution
(Mora, Diaz) Universidad Nacional de Colombia, Bogota, Colombia
Title
Prognostic value to 6 months of the OESIL risk score in a Colombian cohort
of Emergency Department patients with syncope.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 245), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications Inc.
Abstract
Objectives: To stablish de prognostic value with sensitivity, specificity,
positive predictive value, negative predictive value for the OESIL syncope
risk score to predict de presentation of severe outcomes (death, invasive
interventions and readmission) within 6 months of observation in adults
who consult to the emergency department Methods: Observational,
prospective and multicenter study with enrolment of subjects 18 years old
and above who came to the emergency department because of syncope.
Demographic and clinical information was asked, OESIL risk score was
calculated and telephone contacts were done for 6 months follow up for
registration of severe outcomes. Results: 161 patients met the inclusion
criteria and were followed for 6 months. A score above or equal of 2
points in the risk score was classified as high risk and was present in
72% of patients. With a score of 2 or more, the characteristics of the
risk score to predict the combined outcome of mortality, invasive
interventions and readmission were 75,7%, 30,5%, 43,1%, and 64,4% for
sensitivity, specificity, positive predictive value and negative
predictive value respectively. Conclusions: A score of 2 or more in the
OESIL risk score applied in Colombian people from Bogota has a limited
utility for the prediction of severe outcomes (mortality, re-admissions
and invasive cardiovascular procedures combined) which would not allow to
discriminate patients benefited of early admission an additional studies.

<15>
Accession Number
613191445
Author
Fernandez Gonzalez L.; Garcia San Roman K.; Blanco Mata R.; Astorga Burgo
J.C.; Arriola Meabe J.; Horrillo N.; Alcibar Villa J.C.
Institution
(Fernandez Gonzalez, Garcia San Roman, Blanco Mata, Astorga Burgo, Arriola
Meabe, Horrillo, Alcibar Villa) Hospital de Cruces, Baracaldo, Spain
Title
Experiences of removal of intra-aortic balloon pumps with the angio-seal.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 387-388), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications Inc.
Abstract
Due to the big experience with Angio-Seal Device in our center to close
femoral puncture during cardiac catheterization, we investigated whether
the Angio-Seal could be used safely and could achieve hemostasis fastly
when removing an IABP. We prospectely studied 33 consecutive patients
(Age: mean 64,1 years (50-83 years)) in which the Angio-Seal 8F device was
planned to be used to achieve vascular hemostasis after removal of an IABP
between January to December of 2015 in the Cardiac Intensive care unit of
our University Hospital. IABP was implanted due to several causes
(cardiogenic shock due to STEMI, after cardiac surgery, high risk PCI...).
Once hemodynamic condition stabilised, heparin was stopped before the
deployment of Angio-Seal, a 0,20 inch guidewire was inserted through the
central lumen of the IABP, and both the IABP and sheath were removed. The
Angio-Seal sheath was inserted through the attached guidewire and it was
deployed with the common steps and finally we manteined controlled tension
of the collagen for aproximately 20 seconds and was taken off in the
absence of oozing of blood. The primary endpoint was a composite of any
type of major (retroperitoneal bleeding, vessel occlusion, loss of distal
pulses, vascular surgery and death) and minor vascular complication
(hematoma, AV fistula or pseudoaneurism) IABP was continued for 1-7 days
(mean 4 days). The device was successfully deployed in all of the
patients. There were no major and only 2 minor complications (hematoma >
10 cm). No patients required additional compression although most of them
were treated with antiplatelet drugs. Removal of IABP with the Angio-Seal
8F device is a fast, effective and safe procedure that could improve the
hemostasis and the confort of the patients compared with the manual
compression or other compression decides. We need further randomized
studies comparing Angio-Seal with conventional methods of compression to
recommend routine use.

<16>
Accession Number
613191369
Author
Lazaro Mendes A.S.; Oliveira-Santos M.; Leite L.; Alves P.M.; Moura
Ferreira J.; Marques J.; Ferreira M.J.; Ramos D.; Macario F.; Bastos C.A.;
Mota A.; Pego M.
Institution
(Lazaro Mendes, Oliveira-Santos, Leite, Alves, Moura Ferreira, Marques,
Ferreira, Ramos, Macario, Bastos, Mota, Pego) Coimbra University Hospital,
Coimbra, Portugal
Title
Who is the population the patients with end-stage renal disease undergoing
renal transplantation?.
Source
European Heart Journal: Acute Cardiovascular Care. Conference: Acute
Cardiovascular Care 2016. Portugal. Conference Start: 20161015. Conference
End: 20161017. 5 (pp 412-413), 2016. Date of Publication: October 2016.
Publisher
SAGE Publications Inc.
Abstract
Background: The inextricable link between the heart and the kidneys
predestines that significant cardiovascular disease (CVD) ensues in the
face of end-stage renal disease (ESRD). Despite the enormous
cardiovascular burden that ESRD poses, few randomized control studies have
included these patients. In this study we sought to evaluate the
prevalence and the types of CVD in patients with ESRD undergoing renal
transplantation. Methods: The data of 226 consecutive patients who
underwent renal transplantation from January 2009 to December 2010 were
evaluated. Data regarding demographic, clinical, blood test and
echocardiographic parameters as well as myocardial perfusion scintigraphy
and cardiac angiogram results were collected. Continuous data are
presented as the mean +/- standard deviation (SD) or median (interquartile
range), as appropriate. Categoric data are given as group percentages.
Results: The median age of patients was 57 (52 - 61) years, of whom 65.5%
were male. The prevalence of major atherosclerotic risk factors was as
follows: arterial hypertension 90.9%, dyslipidemia 68.3%, diabetes
mellitus 32.1% and smoking 21.3%. Heart failure occurred in 4.4%, 5.5% had
a history of peripheral arterial disease, 8.8% had prior stroke and 4.9%
patients had previous myocardial infarction. Regarding to medication, the
percentage of patients treated with antiplatelet drug was 56.5%,
angiotensin-converting enzyme inhibitors 28.1%, beta blocker 28.6%, and
statin 26.1%. According to American Society of Transplantation and the
European Renal Association - European Dialyses and Transplant Association,
198 patients (87.6%) were considered as intermediate to high risk
probability of coronary artery disease (CAD). Electrocardiogram was
performed on all patients and myocardial perfusion scintigraphy on 136
(60.2%). CAD was identified in 15 of 34 patients (44.1%) who had undergone
angiography. Seven patients underwent percutaneous coronary intervention,
and coronary bypass surgery was performed on four cases prior to renal
transplantation. On echocardiography examination median ejection fraction
was 64.5% (60-68%). Wall motion abnormality was detected in 10 patients
(5.2%), left ventricular hypertrophy in 81 patients (41.8%) and mitral
annulus calcification in 34 patients (16.8%). The most prevalent valvular
disease was mitral regurgitation (35.8%). Conclusions: The findings of
this study indicate that CVD and atherosclerotic risk factors are common
in patients with ESRD undergoing renal transplantation. As a result risk
stratification is a difficult task, prospective randomized, controlled
trials with long-term follow-up are needed to reach more concrete
conclusions about the impact of preoperative cardiovascular disease and
the best strategy able to minimize cardiovascular events in these
patients.

<17>
Accession Number
613189706
Author
Guerin F.; Sarnacki S.; Varlet F.; Delagausie P.; Rod J.; Demarche M.;
Alkhamis M.; Rodesch G.; Luis Huertas A.L.; Habonanima E.; Martelli H.;
Irtan S.
Institution
(Guerin, Alkhamis, Martelli) Bicetre Hospital, Pediatric Surgery, Le
Kremlin Bicetre, France
(Sarnacki) Necker Hospital, Pediatric Surgery, Paris, France
(Varlet) Hopital Nord, Pediatric Surgery, Saint-Etienne, France
(Delagausie) Hopital la Timone Enfants, Pediatric Surgery, Marseille,
France
(Rod) Centre Hospitalier Universitaire Cote de Nacre, Pediatric surgery,
Caen, France
(Demarche) Centre Hospitalier Regional Citadelle, Pediatric Surgery,
Liege, Belgium
(Rodesch) Hopital Universitaire des Enfants Reine Fabiola, Pediatric
Surgery, Bruxelles, Belgium
(Luis Huertas) Hospital Universitario Infantil Nino Jesus, Pediatric
Surgery, Madrid, Spain
(Habonanima) Centre Hospitalier Universitaire de Rennes, Pediatric
Surgery, Rennes, France
(Irtan) Hopital Armand Trousseau, Pediatric Surgery, Paris, France
Title
An appraisal of minimally invasive surgery for thoracic neurogenic tumour.
A multicenter study.
Source
Pediatric Blood and Cancer. Conference: 47th Congress of the International
Society of Paediatric Oncology, SIOP 2015. South Africa. Conference Start:
20151008. Conference End: 20151011. 62 (pp S188), 2015. Date of
Publication: November 2015.
Publisher
John Wiley and Sons Inc.
Abstract
Background/Objectives: To assess the outcome and efficacy of thoracoscopy
for children with mediastinal neurogenic tumours. Design/Methods:
Retrospective review from 9 centres between 2000 and 2014 of patients who
underwent thoracoscopy for a neurogenic mediastinal tumour. We assessed
preoperative data, operative complications, and outcome. Results are
expressed in median and range. Results: We identified 68 patients aged 3
years [5 months-15 years]. The median diameter at diagnosis was 5cm
[1.5-15]. INRG stratification was L1: n=41, L2 n= 16, Ms n= 3, M n= 8.
Eighteen patients with image defined risk factors (IDRF) had a
preoperative chemotherapy which allowed a 12% decrease of the largest
diameter in 13 patients. Among them, 7 had still IDRF preoperatively.
Median diameter at surgery was 4.7cm [1-12]. Thoracoscopy was performed
with insufflation in 19 patients. Tumour spillage occurred in 10 patients
and conversion to thoracotomy was necessary in 8 patients: for vascular
encasement in 4 and a difficult location or dissection in 4. Median
operative time was 2 hours [1-6]. Fifty-seven patients had a chest drain
for 2 days [1-11]. Pathology was 32 Neuroblastomas, 17 Intermixed
Ganglioneuroblastoma, and 19 Ganglioneuromas). Immediate post-operative
adverse events consisted of 3 Horner syndromes, 5 Pneumothorax, 3
chylothorax. Length of hospital stay was 4 days [2-15]. Median follow-up
was 23 months [1-109]. Long term complications consisted of 2 more Horner
syndromes, 3 scoliosis/back pain, and 1 delayed chylothorax. Forty
patients had a residual disease on post-operative imaging, among them 5 (4
were L1 and 1 Mestatatic) had a recurrence at 10 months [2-60]: 1 local, 3
local plus metastatic, 1 pure metatstaic. Two patients died at 9 and 10
months after surgery. Conclusion: Minimally invasive surgery is safe for
thoracic neurogenic tumours without vascular IDRF, however, relapse is
mainly local without identified preoperative risk factor.

<18>
Accession Number
613163607
Author
Calais J.; Touati A.; Grall N.; Benali K.; Mahida B.; Hyafil F.; Iung B.;
Duval X.; Le Guludec D.; Rouzet F.
Institution
(Calais, Touati, Grall, Benali, Mahida, Hyafil, Iung, Duval, Le Guludec,
Rouzet) Hopital Bichat, Paris, France
Title
Respective role of 18F-FDG PET/CT and WBC SPECT/CT in the diagnosis of
cardiac implantable electronic devices infection.
Source
European Journal of Nuclear Medicine and Molecular Imaging. Conference:
29th Annual Congress of the European Association of Nuclear Medicine, EANM
2016. Spain. Conference Start: 20161015. Conference End: 20161019. 43 (1
Supplement 1) (pp S206-S207), 2016. Date of Publication: 2016.
Publisher
Springer Berlin
Abstract
Rationale: Although the role of nuclear imaging in the management of
cardiovascular infections is acknowledged, its diagnostic value in CIEDs
infection remains debated and nuclear techniques have not been included in
the recently issued ESC/EANM joint guidelines. Some studies showed good
diagnostic values of both FDG PET/CT and radio labelled WBC scan in
patients with high prevalence of the disease. The aim of the study was to
evaluate the respective role of both techniques in a population with
intermediate prevalence of CIEDs infection. Methods: Our institution's
database has been reviewed for a 3-year period to identify patients with a
suspicion of CIEDs infection who underwent both FDG PET/CT and
radiolabelled WBC scan in a time span of <1 month. Whole-body PET/ CT was
acquired 1 h after injection of FDG. SPECT/CT acquisitions were performed
4 and 24 hours after reinjection of 99mTc-HMPAO labelled WBC, included
planar and SPECT/CT. The final diagnosis of CIEDs infection was based on
the modified Duke classification after 3-month follow- up (rated as:
definite, possible or rejected) with the addition of positive culture of
the extracted material and clinically patent pocket infection as major
criteria for infection. The readers of FDG PET and WBC SPECT were blinded
to the results of the other technique and to the patients' clinical
record. Each scan was rated for diagnosis of infection as positive or
negative. Results: 48 consecutive patients were included (age 70+/-11
years; female: 50%; prosthetic heart valve: 60%; Staphylococcus species:
38%). Thirty-two (67%) patients were receiving antibiotic therapy at the
time of imaging (mean duration >1 month). The final diagnosis of CIED
infection was: definite in 29%, possible in 23% and rejected in 48%. The
diagnostic sensitivity, specificity, PPV, NPV and accuracy of FDG PET were
respectively: 71%, 82%, 71%, 82%, 78% and of WBC SPECT: 50%, 100%, 100%,
76%, 77%. WBC SPECT was always negative when FDG PET was negative. By
combining FDG PET as a first line modality with WBC SPECT only when PET
was positive, the diagnostic sensitivity, specificity, PPV, NPV and
accuracy were respectively: 70%, 100%, 100%, 57%, 79%. Conclusion: In a
study population with intermediate prevalence of CIEDs infection, FDG PET
has a good overall diagnostic value although the sensitivity may have been
decreased by prior antibiotherapy. WBC SPECT is highly specific of
infection and thus strongly supports CIED extraction when positive.

<19>
Accession Number
613122989
Author
Ono S.; Kato T.; Nakamura H.; Kajimoto K.; Matsushita S.; Dohi S.; Kuwaki
K.; Morita T.; Yamamoto T.; Amano A.
Institution
(Ono, Kato, Nakamura, Kajimoto, Matsushita, Dohi, Kuwaki, Morita,
Yamamoto, Amano) Department of Cardiovascular Surgery, Juntendo Urayasu
Hospital, Chiba, Japan
Title
The effect of tolvaptan on renal excretion of electrolytes and urea
nitrogen in patients undergoing coronary artery bypass surgery.
Source
Journal of Cardiac Failure. Conference: 20th Annual Scientific Meeting of
the Japanese Heart Failure Society, JHFS 2016. Japan. Conference Start:
20161007. Conference End: 20161009. 22 (9 Supplement 1) (pp S172), 2016.
Date of Publication: September 2016.
Publisher
Churchill Livingstone Inc.
Abstract
Background: Adequate fluid management is an important therapeutic strategy
following cardiac surgery. 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 tolvaptan treatment or conventional
loop diuretics. Fractional excretions of sodium (FENA), potassium (FEK)
and urea nitrogen (FEUN) were serially measured during post-surgical
hospitalization in both groups. Results: In tolvaptan groups, serum sodium
concentrations were unchanged. However, postoperative FENA values did not
decrease, and the values were not different between groups. Serum
potassium levels stayed lower and FEK values higher than preoperative
values only in loop diuretics groups. BUN increased postoperatively in
both groups, but it remained higher than its preoperative value only in
loop diuretics groups. In tolvaptan groups, the increase in BUN peaked and
decreased again to its preoperative value within a week. The FEUN
increased postoperatively in both groups, but the change was more apparent
and higher in tolvaptan groups. Conclusions: In loop diuretics groups,
continuous excretion of sodium and potassium occurred, resulting in
electrolyte imbalance. UN renal elimination was more prominent in
tolvaptan groups. Our findings suggest that tolvaptan is an effective
diuretic that minimally affect serum electrolytes and adequately
eliminates UN from the kidneys in patients undergoing coronary artery
bypass surgery.

<20>
Accession Number
613122901
Author
Suzuki T.; Mori E.; Nakazawa A.; Koizumi R.
Institution
(Suzuki, Mori, Nakazawa, Koizumi) Cardiovascular Center, Kin-Ikyo Chuo
Hospital, Sapporo, Japan
Title
A case of fulminant myocarditis fully recovered after four weeks pcps
support.
Source
Journal of Cardiac Failure. Conference: 20th Annual Scientific Meeting of
the Japanese Heart Failure Society, JHFS 2016. Japan. Conference Start:
20161007. Conference End: 20161009. 22 (9 Supplement 1) (pp S221), 2016.
Date of Publication: September 2016.
Publisher
Churchill Livingstone Inc.
Abstract
A20-year-old female was admitted to our hospital with chief complaints of
pre syncope and fever. On the second hospital day, chest pain appeared and
ST segments were elevated. Due to her symptoms, we performed an emergent
cardiac catheter procedure. It showed coronary arteries were normal. Then,
we performed a myocardium biopsy. After those procedures, she was under
ICU care. However, she went in shock on that day. She was diagnosed with
fulminant myocarditis. PCPS, IABP and Ventilator were attached, and TPM
was also inserted. At that time, LVEF was less than 10%. PCPS weaning
failed on the 18th hospital day. We realized that the patient depended on
ventricular pacing. We implanted a DDD pacemaker to improve her
hemodynamics on the 25th hospital day. On 29th hospital day, PCPS weaning
was successfully done. Three months after admission, her cardiac function
was improved to 50% of LVEF. However, she still required long physical
rehabilitation because of ossifying myositis. Seven months since she
admitted to hospital, she discharged from our hospital on foot and fully
recovered. We experienced a case of fulminant myocarditis patient who
fully recovered from long term assisted circulation device use.

<21>
Accession Number
612897544
Author
Vershinina E.; Ryabova T.R.; Repin A.N.
Institution
(Vershinina, Ryabova, Repin) State Research Institute of Cardiology of
Tomsk, Department of Rehabilitation, Tomsk, Russian Federation
Title
Pharmaco-invasive approach aimed at preservation of the left ventricular
function in patients with stable coronary artery disease on the top of
carbohydrate metabolism disorders.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2016.
France. Conference Start: 20160614. Conference End: 20160615. 23 (pp S11),
2016. Date of Publication: September 2016.
Publisher
SAGE Publications Inc.
Abstract
Topic: Cardiac rehabilitation Introduction: the coronary artery disease
(CAD) treatment in type 2 DM patients remains a major issue for
cardiologists. Despite significant advances in medical and invasive
treatment, including implantation of drug-eluting stents, the patients
still have high morbidity and mortality due to progression of
atherosclerosis and HF even after percutaneous or surgical
revascularization. Purpose: the aim of our study was to investigate the
effect of the metabolic agent trimetazidine (TMZ) on the left ventricular
function in patients with CAD on the top of carbohydrate metabolism
disorders, who underwent elective percutaneous coronary intervention
(PCI). Methods: an open label, prospective, randomized clinical trial was
conducted in 63 patients stable CAD on the top of carbohydrate metabolism
disorders. All patients underwent elective coronary stenting. The patients
of the main group (n = 32) received TMZ 35 mg bid in addition to standard
therapy for 2 weeks before and 1 year after the procedure. In control
group patients (n = 31), PCI and the following follow-up were performed on
the top of standard therapy only, without the use of metabolic agents. At
baseline, two groups did not differ significantly in terms of the severity
of myocardial ischemia, clinical and medical history data, degree of
carbohydrate metabolism disorder, as well as concomitant treatments,
pharacteristics of coronary artery lesions and performed PCI. The
echocardiography was performed twice: at baseline and at 12 months of
follow-up. Results: despite the performed PCI, the carbohydrate metabolism
disorders in CAD are associated with a significant deterioration in the
regional contractility of myocardium and reduction in the LV pump function
at the follow-up (WMSI increase by 8.3% and LV SVI decrease by 7.25% at 12
months after the intervention, compared with baseline). Long-term
treatment with myocardial cytoprotector in this patients results in a
significant improvement in the contractile function of the LV myocardium
in the long-term, according to the EchoCG data (LV EDI decrease by 5.5%,
LV ESI decrease by 4.4%, LVEF increase by 2.5% at 12 months after the
intervention, compared with baseline). The improvement in the myocardial
function during the long-term treatment with TMZ is evidenced clinically
by a longer distance walked during the 6MWT (+18.4% vs. the standard
treatment group). Conclusion: the pharmaco-invasive approach, namely the
addition of a metabolic agent trimetazidine to the standard therapy in
patients with carbohydrate metabolism, undergoing the elective PCI,
contributes to the preservation of myocardial function.

<22>
Accession Number
612897488
Author
Marina Breysse M.; Navarro Claros E.; Lopez Lluva M.T.; Piqueras Flores
J.; Jurado Roman A.; Sanchez Perez I.; Pinilla Echeverri N.; Focaccio
Tejada C.A.; Gonzalez Garcia A.; Alfonso J.M.; Rayo Gutierrez M.; Crespin
Crespin M.; Morales Acuna F.; Benezet J.; Lozano Ruiz-Poveda F.
Institution
(Marina Breysse, Piqueras Flores) University General Hospital of Ciudad
Real, Cardiology Department, Ciudad Real, Spain
(Navarro Claros) University General Hospital of Ciudad Real, Department of
Family and Community Medicine, Ciudad Real, Spain
(Lopez Lluva, Jurado Roman, Sanchez Perez) University General Hospital of
Ciudad Real, Intervencional Cardiology Department, Ciudad Real, Spain
(Pinilla Echeverri) Mcmaster University, Interventional Cardiology Fellow,
ON, Canada
(Focaccio Tejada) University Hospital Dr Negrin, Anesthesiology
Department, Las Palmas De Gran Canaria, Spain
(Gonzalez Garcia) University Hospital Ramon y Cajal De Madrid, Heart
Failure and Vascular Risk Unit, Department of Internal Medicine, Madrid,
Spain
(Alfonso) National Centre for Cardiovascular Research (CNIC), Madrid,
Spain
(Rayo Gutierrez, Crespin Crespin) Hospital Santa Barbara, Cardiology
Department, Puertollano, Spain
(Morales Acuna) Indiana State University, Applied Medicine and
Rehabilitation Department, Terre Haute, United States
(Benezet) General Hospital of Jerez, Interventional Cardiology Department,
Cadiz, Spain
(Lozano Ruiz-Poveda) Hospital General De Ciudad Real, University of
Castilla-La Mancha (UCLM), Interventional Cardiology Department, Ciudad
Real, Spain
Title
Treatment cessation of dual antiplatelet therapy after percutaneous
coronary intervention and clinical events during follow-up.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2016.
France. Conference Start: 20160614. Conference End: 20160615. 23 (pp S37),
2016. Date of Publication: September 2016.
Publisher
SAGE Publications Inc.
Abstract
Topic: Cardiac rehabilitation Introduction: dual antiplatelet therapy
duration after percutaneous coronary angioplasty is controversial.
Purpose: this study aims to quantify antiplatelet therapy duration in
clinical practice and to assess associations between different modes of
dual antiplatelet therapy cessation and cardiovascular events. Methods:
multicenter prospective observational registry of patients undergoing
percutaneous coronary angioplasty with stent implantation in 4 Spanish
hospitals between January 2010 and January 2015. Out off 6086 coronary
angiogram procedures and 2325 patients undergoing angioplasty with stent
implantation, 669 patients were randomized. We examined the effect of dual
antiplatelet therapy cessation mode on adverse events: mortality, hospital
readmission, myocardial infarction, new coronary revascularisation,
stroke, major bleeding and stent thrombosis. Results: over 2.6+/-1.5 years
follow-up, 310 (50.9%) patients were classified as recommended therapy
discontinuation (group I), 92 (15.1%) as disruption (group II) and 207
(34%) as prolonged maintenance of dual antiplatelet therapy (group III).
They maintained double antiplatelet therapy for 13.7+/-9.6, 7.7+/-6.1 and
26.3+/-12.4 months respectively. Differences were observed on:
cardiovascular readmission 33(10.6%), 11(12.0%) and 45(21.7%) in groups I,
II and III (p=0.002); new revascularisation 11(3.5%), 6(6.5%) and
33(15.9%) respectively (p<0.001); all-cause mortality 14(4.5%), 10(10.9%)
and 41(19.8%) (p <0.001) and cardiovascular mortality 2(0.6%), 2(2.2%) and
8(3.9%) (p=0.035). After multivariate analysis, age OR 1.09 (95% CI
1.06-1.12) and belonging to group III OR 6.68 (95% CI 3.39- 13.16) were
predictors of mortality whereas beta-blocker treatment was protective OR
0.37 (95% CI 0.20-0.70). Conclusions: for patients undergoing percutaneous
coronary intervention, no-adherence to dual antiplatelet therapy medical
recommendations increases morbidity and mortality.

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

<24>
Accession Number
612897228
Author
Asmussen S.; Przkora R.; Maybauer D.M.; Sanfilippo F.; Jennings K.; Fraser
J.F.; Maybauer M.O.
Institution
(Asmussen) Department of Anaesthesiology, University Hospital of Ruhr,
University Bochum, Bochum, Germany
(Asmussen, Maybauer, Jennings, Maybauer) University of Texas Medical
Branch, Galveston, TX, United States
(Asmussen, Fraser, Maybauer) University of Queensland, Australia
(Przkora) University of Florida, Gainesville, FL, United States
(Sanfilippo) St. George Hospital, London, United Kingdom
(Maybauer) Manchester University Hospitals NHS FT, Manchester Heart
Centre, Manchester Royal Infirmary and University of Manchester,
Manchester, United Kingdom
Title
Assisted electro acupuncture reduces inflammatory response after open
heart surgery.
Source
Shock. Conference: 8th Congress of the International Federation of Shock
Societies. Japan. Conference Start: 20161003. Conference End: 20161005. 46
(4 Supplement 2) (pp 60-61), 2016. Date of Publication: October 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Acupuncture treatment is well known in China for over 2,500
years and is used worldwide as analgesic treatment in patients with acute
and chronic pain. Previous studies showed that acupuncture might be
beneficial as a supplement to general anesthesia (GA). Aim of this study
was to perform a systematic review and meta-analysis to assess the level
of evidence for the clinical use of electro acupuncture (EA) in addition
to GA in regard of the response of the inflammatory system in patients
undergoing open-heart surgery. Methods: The systematic literature search
in Medline yielded a total of 220 citations, published between 1965 and
December 31st, 2015. No systematic review or meta-analyses on this topic
matched our search criteria. Each article of any language was assessed and
rated for the methodological quality of the studies, using the
recommendation of the Oxford Centre for Evidence Based Medicine (OCEBM).
Results: Three prospective randomized controlled clinical trials of
evidence level 2 with a total of 120 patients matched our search criteria.
Three pro-inflammatory markers Interleukin 2 (IL-2), IL-6, and tumor
necrosis factor alpha (TNFa) where investigated as well as one
anti-inflammatory cytokine. Each trial studied three of the four markers.
IL-10 was examined by three trials, the remaining markers were studied by
two trials each. The results for the pro-inflammatory cytokines IL-6 and
TNFa showed a tendency towards lower values in patients received EA+GA vs
GA, only TNFa reached significant levels: EA+GA 49 patients, Control 51
patients, Standardized difference in means 0.753, SE 0.284, Variance
0.080, lower limit 0.197, upper limit 1.309, Z-Value 2.656, P-Value 0.008.
This result was consistent with significantly higher values of
anti-inflammatory IL-10 for EA+GA vs GA: EA+GA 59 patients, Control 61
patients, Standardized difference in means -0.893, SE 0.447, Variance
0.196, lower limit -1.760, upper limit -0.026, Z-Value -2.018, P-Value
0.044. Whereas the level of the IL-2 presented significantly higher values
in EA+GA (P < 0.05). Conclusions: We conclude that electro acupuncture in
combination with general anesthesia can be beneficial in regard of
reducing the immune response compared to the sole use of general
anesthesia in patients undergoing cardiac surgery. Further prospective
investigations are needed to study these effects in regard of length of
hospital stay and potential additional economical benefits.

<25>
Accession Number
612897136
Author
Asmussen S.; Maybauer D.M.; Przkora R.; Sanfilippo F.; Jennings K.; Fraser
J.F.; Maybauer M.O.
Institution
(Asmussen) University Hospital of Ruhr, University Bochum, Bochum, Germany
(Asmussen, Maybauer, Jennings, Maybauer) University of Texas Medical
Branch, Galveston, TX, United States
(Asmussen, Fraser, Maybauer) University of Queensland, Australia
(Przkora) University of Florida, Gainesville, FL, United States
(Sanfilippo) St. George Hospital, London, United Kingdom
(Maybauer) Manchester University Hospitals, NHS FT, Manchester Heart
Centre, Manchester Royal Infirmary and University, Manchester, United
Kingdom
Title
Electro acupuncture reduces need for vasoactive drugs after cardiac
surgery.
Source
Shock. Conference: 8th Congress of the International Federation of Shock
Societies. Japan. Conference Start: 20161003. Conference End: 20161005. 46
(4 Supplement 2) (pp 54), 2016. Date of Publication: October 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Acupuncture has a long history in China for over 2,500 years
and is used worldwide as analgesic treatment in patients with acute and
chronic pain. Recent studies showed that acupuncture might also be
beneficial as a analgesic supplement to general anesthesia (GA). Aim of
this study was to perform a systematic review and metaanalysis to assess
the level of evidence for the clinical use of electro acupuncture (EA) in
addition to GA in patients that underwent openheart surgery about the need
for vasoactive drugs on ICU post surgery and the levels for myocardial
tissue marker Troponin I following cardiac surgery. Methods: The
systematic literature search in Medline, Cochrane Library, and Web of
Science yielded a total of 220 citations, published between 1965 and
December 31st, 2015. No systematic review or metaanalyses on this topic
matched our search criteria. Each article of any language was assessed and
rated for the methodological quality of the studies, using the
recommendation of the Oxford Centre for Evidence Based Medicine (OCEBM).
Results: Three prospective randomized controlled clinical trials with a
total of 180 patients matched our search criteria. The need for
postoperative vasoactive drugs in cardiac surgery was significantly lower
in the group that received EA+GA vs. GA alone: Odds ratio 5.618, lower
limit 2.166, upper limit 14.571, Z-Value 3.550, P-Value <0.001. The
amounts of cardiac Troponin I measured 24hrs post surgery were
significantly lower in EA+GA group vs GA (n = 89 vs n = 91). Std
difference in means 0.761, SE 0.256, Lower limit 0.259, upper limit 1.262,
P-Value 0.003. Conclusions: We conclude that electro acupuncture in
combination with general anesthesia can be beneficial in regard of
reducing postoperative circulatory instability shown by lower need for
vasoactive drug support. In the following significantly lower values of
cardiac tissue marker Troponin I might represent a less severe myocardial
tissue damage. Further prospective investigations are needed to study
these effects in regard of length of hospital stay and potential
additional economical benefits.

<26>
Accession Number
612897903
Author
Prijic S.; Kosutic J.; Vukomanovic V.; Prijic A.; Vujic A.; Jovicic B.;
Ninic S.; Kuburovic V.
Institution
(Prijic, Kosutic, Vukomanovic, Jovicic, Ninic, Kuburovic) Mother and Child
Health Institute of Serbia, Belgrade, Serbia
(Prijic) Medical Center Dr D. Misovic - Dedinje, Belgrade, Serbia
(Vujic) Clinical Center Kragujevac - Pediatric Clinic, Serbia
Title
Meta-analysis of carvedilol versus conventional treatment in children with
systemic ventricle systolic dysfunction.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S169-S170), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Numerous randomized clinical trials in adults with chronic
heart failure demonstrated favorable effect of beta-blockers. Treatment in
children with systemic ventricle systolic dysfunction includes
betablockers (carvedilol), although benefit was not recognized
sufficiently (mainly due to limited number of pediatric patients).
Methods: We performed meta-analysis, aimed to compare carvedilol and
conventional treatment (i.e. digoxin, diuretics, ACE inhibitors) with
respect to clinical and echocardiographic outcome in children with chronic
heart failure due to impaired systemic ventricle systolic function. We
have systematically searched the Medline/PubMed and Cochrane Library for
the prospective/observational clinical trials on carvedilol and standard
treatment efficacy in pediatric (up to 18 years) heart failure patients.
Mean differences for continuous variables, odds ratios for dichotomous
outcomes, heterogeneity between studies and publication bias were
calculated using Cochrane Review Manager (Rev Man 5.2). Results: After
screening of 391 publications, total of 8 prospective/ observational
studies (with 516 patients)met established criteria. At the start of
studies, there were no differences in the left ventricular enddiastolic
diameter (p=0.17), ejection fraction (p=0.99) and fractional shortening
(p=0.30) between groups. However, at the end of studies, significantly
better ejection fraction (difference 5.2%; 95% CI: 2.4- 7.9%; p=0.0003)
and fractional shortening (difference 3.4%; 95% CI: 1.7-5.1%; p <0.0001)
was demonstrated in the carvedilol vs. control group. Decrease in the
end-diastolic diameter was better during the carvedilol treatment, but
without statistical significance. Odds ratio for chronic heart failure
related mortality/heart transplantation secondary to carvedilol was 0.52
(95% CI: 0.28-0.97; p=0.04), with non-significant heterogeneity between
studies and no impact of publication bias. Our analysis showed that
carvedilol could prevent 1 death/heart transplantation by treating 14
pediatric patients with impaired systemic ventricle systolic function. In
addition, odds ratios for clinical improvement and worsened clinical
outcome secondary to carvedilol were 1.54 (95% CI: 0.98-2.43; p=0.06) and
0.60 (95% CI: 0.36-1.00; p=0.05) respectively. Conclusions: To the best of
our knowledge, our meta-analysis demonstrated, for the first time,
clinical outcome and mortality/ heart transplantation benefits in
carvedilol vs. conventional treatment group of pediatric patients with
chronic heart failure.

<27>
Accession Number
612897830
Author
Villemain O.; Bonnet D.; Vergnat M.; Ladouceur M.; Lambert V.; Jalal Z.;
Vouhe P.; Et Belli E.
Institution
(Villemain, Bonnet, Ladouceur, Jalal, Vouhe) M3C-Necker Enfants malades,
Universite Paris Descartes, Sorbonne, Paris Cite, Paris, France
(Vergnat, Lambert, Et Belli) Centre Chirurgical Marie Lannelongue, M3C,
Universite Paris Sud, Le Plessis Robinson, France
Title
Double outlet right ventricle with non-committed ventricular septal
defect.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S167), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Objective: The management of Double Outlet Right Ventricle (DORV)
associated with anatomically non-committed Ventricular Septal Defect
(NCVSD) constitutes a surgical challenge. The limits for, and the specific
outcomes after anatomical versus univentricular repair still remain to be
established. Methods: Between 1993 and 2011, 35 consecutive patients
presenting with DORV/NC-VSD and 2 adequately sized ventricles were
included into the study at two centers forming the National Referral
Center. The selection criteria included the absence of outflow tract VSD:
21 inlet (4 complete atrio-ventricular septal defect (AVSD)), 9 muscular
and 5 perimembraneous. RVOTO was present in 18/35 (51%). Twenty patients
had undergone 25 initial palliative procedures. Results: Anatomical repair
by means of intraventricular baffle construction was performed in 23
(Group l) at a median age of 10.5 months. VSD was surgically enlarged in
11 (48%). An associated RVOT reconstruction was required in 11 and
Arterial Switch Operation (ASO) was done in 5. The remaining 12 patients
underwent univentricular palliative repair (Group ll). There were 4
hospital deaths (11.4%): 3 in Group l and one in Group ll (p= .06). 8/20
survivors of group l patients underwent 13 reoperations after a median
delay of 24 months, with subaortic stenosis being the main cause for
reoperation (6/8). There was one late death in group 2. At last visit, all
survivors were in NYHA class l-ll. Ten years actuarial survival rate and
freedom from reoperation were respectively 74.7+/-5% and 58+/-5% in Group
l, and, 80 +/-7% and 71 +/-7% in Group ll. Univariate analysis showed that
AVSD and/or isolated mitral cleft were associated with death (p=.04) and
need for reoperation (p= .038). Conclusions: Despite the need for complex
procedure and the high incidence of reoperation for subaortic obstruction,
our results suggested the long-term advantages of anatomical repair in
DORV with NCVSD. The presence of associated AVSD and/or isolated mitral
cleft was the only risk factors for mortality and reoperation.

<28>
Accession Number
612897829
Author
Helm P.; Korten M.-A.; Abdul-Khaliq H.; Asfour B.; Baumgartner H.; Diller
G.-P.; Tutarel O.; Kececioglu D.; Bauer U.M.M.
Institution
(Helm, Korten, Bauer) National Register for Congenital Heart Defects,
Berlin, Germany
(Abdul-Khaliq) Saarland University Medical Center, Department of
Paediatric Cardiology, Homburg, Germany
(Asfour) Children's Heart Centre Sankt Augustin, Department of Paediatric
Cardiothoracic Surgery, Sankt Augustin, Germany
(Baumgartner, Diller) Munster University Hospital, Center for Adults with
Congenital Heart Defects, Munster, Germany
(Tutarel) Hannover Medical School, Centre for Internal Medicine,
Department of Cardiology and Angiology, Hannover, Germany
(Kececioglu) Heart and Diabetes Center NRW, Center for Congenital Heart
Defects, Bad Oeynhausen, Germany
(Bauer) Competence Network for Congenital Heart Defects, Berlin, Germany
Title
The German national register for congenital heart defects: A clinical
register that can serve as an important basis for studies on rare
diseases.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S30-S31), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Congenital heart defects (CHD) represent the most frequent
congenital disease in humans. They are characterised by a high variability
of different heart malformations, of which each single group is extremely
rare. Due to this, multicenter research is necessary to achieve
significant results. For this purpose, a nationwide clinical register has
been initiated by the German societies of paediatric cardiology,
cardiology and heart surgery. Methods: The National Register for
Congenital Heart Defects is an individual-related clinical register
featuring a broad informed consent given by its participants. Congenital
and acquired cardiac diagnoses, as well as courses of disease, operations
and catheter based interventions are recorded on the basis of medical
reports. Coding takes place according to the International Paediatric and
Congenital Cardiac Code. A central database system facilitates contacting
patients and relatives for surveys and studies at any time. The range of
diagnoses of currently 32,079 living patients is presented here. Results:
The average age is 15.6 years (SD= 13.1, minimum< 1 year; maximum 94
years). The sex distribution is well-balanced (16,182 [50.4%] male; 15,897
[49.6%] female). The distribution of main diagnoses approximates
prevalence data as assumed according to available literature. Thus,
representative studies are feasible. Among the secondary diagnoses,
chromosome anomalies such as Down's syndrome, Turner syndrome and DiGeorge
syndrome stand out. Preterm delivery and Eisenmenger's syndrome can be
cited as significant concomitant features. Conclusions: The clinical
register comprises data on a variety of patients with CHD. These data can
be used as a basis for epidemiological, clinical and genetic studies. Due
to its considerable extent and thus the option to reach unusually high
patient numbers for even rare diagnoses, the register also represents a
unique platform for research projects beyond Germany. (Table Presented).

<29>
Accession Number
612897789
Author
Duong P.; Smith J.H.; Ferguson L.P.
Institution
(Duong, Smith, Ferguson) Freeman Hospital, Newcastle upon Tyne, United
Kingdom
Title
Extracorporeal membrane oxygenation (ECMO) to aid cardiopulmonary
resuscitation in children for cardiac arrest occurring on the paediatric
cardiology ward.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S165), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: The use of ECMO rescue therapy for children suffering
cardiac arrest (ECPR) has been mostly limited to arrests occurring within
the ICU, operating room or catheterisation laboratory. At present,
published evidence does not support ECPR for arrest occurring on the ward.
We hypothesised that with good quality CPR and rapid ECPR deployment,
similar survival would be achievable in patients with cardiac disease who
arrest on the ward. Since 2005, we have had a policy of activating ECPR
for paediatric cardiology ward arrests. Our objective is to review the
outcome in this population. Methods: Freeman Hospital is a paediatric
cardiac surgical centre that undertakes 250-300 open surgical cases per
year and one of two centres in UK undertaking heart transplantation. Ward
nursing and medical staff underwent simulation training in ECPR and were
taught to activate the team for cardiac arrest of duration >5 min.
Perfusion and surgical staff were in-house during weekdays and on-call
during weekday out-of-hours and weekends. Patients were transferred to ICU
or operating room for cannulation. Patients aged<16 years who suffered
cardiac arrest on paediatric cardiology ward and received ECPR between
2005 and 2015 were identified. ECPR was defined as ECMO established during
CPR. In addition, a patient suffering intermittent multiple arrests during
cannulation was also defined as ECPR. Survival and Paediatric Cerebral
Performance Category at hospital discharge were determined from the
medical record. Results: Five children, aged 2d to 13 y, received ECPR
after cardiac arrest on the cardiology ward during 10-year period. Of
these, 2 had end-stage heart failure complicating congenital heart
disease, 2 were medical patients and one was post-surgery. The median
duration of CPR prior to ECMO was 57 min (range 45-93 min). Of the five
patients, 2 (40%) survived to discharge. The two survivors were
neurologically intact at hospital discharge (PCPC 1). Both survivors
underwent transplantation during the admission following ECPR. Two
patients developed brain death complicating cerebral oedema and one
patient died due to VAD-related haemorrhage during bridge to
transplantation. Conclusion: Although a rare event, children who suffer
cardiac arrest on cardiology ward can survive neurologically intact with
ECPR despite prolonged periods of resuscitation.

<30>
Accession Number
612897725
Author
El Kaffas R.M.H.; El Sisi A.; Mamdouh N.; Esmat A.; Al Sisi H.
Institution
(El Kaffas, El Sisi) Department of Pediatric Cardiology MD, Cairo
University Pediatric Hospital, Cairo, Egypt
(Mamdouh, Esmat) Department of Pediatric Cardiology, Ain Shams University
Pediatric Hospital, Cairo, Egypt
(Al Sisi) Department of Cardiothoracic Surgery, Cairo University Hospital,
Egypt Kids Hospital, Cairo, Egypt
Title
Long term follow up of bidirectional cavopulmonary anastomosis patients:
Multi-institutional study.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S107), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Background: The bidirectional cavopulmonary shunt is a step towards the
Fontan operation in palliation of patients with singleventricle heart. The
Fontan procedure is performed with children between three and five years
of age. In Egypt, there is a delayed age of children undergoing Fontan
procedure due to long waiting lists and budget restraints on pediatric
cardiac surgeries. Aim of the work: To assess long term follow up of
patients with bidirectional cavopulmonary shunt and to determine the
clinical and hemodynamic effects of delayed Fontan procedure. Methods: A
total of 125 patients with bidirectional cavopulmonary shunts from three
centers: Cairo university, Ain Shams university and Egypt kids hospital
were followed up from January 2012 till July 2014. At follow up, mean age
was 7.5 (1.7-16 years) and weight was 23.05 (9-58 kg). Males were 61.5%,
64% had single ventricle morphology, 76% had additional pulmonary flow and
38.5% had prior palliative cardiac surgery. Results: The mean age at
Cavopulmonary shunt was 2.98 years (0.4 - 12 years). NYHA was class I in
82% and II in 15%, mean oxygen saturation was 81% (60-95). Cardiac
catheterization was done in 45%, mean Glenn pressure was 15.5 (6-28 mmHg)
and mean Nakata index was 287 (108-910). Catheter interventions were done
in 15%; seven patients had procedures to minimize the extrapulmonary flow:
closure of the shunts, collaterals, patent ductus arteriosuus and/or
device occlusion of the forward flow, while eight patients had balloon
and/or stent of pulmonary arteries, superior vena cava (SVC) or pulmonary
veins. Three patients had occlusion of venoatrial collaterals and/or left
SVC to coronary sinus. The only significant difference was intensive care
unit (ICU) stay which was shorter in patients with additional pulmonary
flow (P value 0.016), and mean Glenn pressure which was lower in patients
with single ventricle (P value less than 0.001). Mean survival was 11.33
years with 4% late mortality. Conclusion: Cavopulmonary shunt can be a
long term palliative procedure for patients with single ventricle
morphology in developing countries when Fontan operation cannot be done on
time due to economic restraints.

<31>
Accession Number
612897698
Author
Walavalkar V.; Evers E.; Pujar S.; Viralam K.; Mayia S.; Frerich S.;
Collin John C.; Shekhar Rao S.; Chinnaswamy Reddy C.; Prinzen F.W.;
Delhaas T.; Vanagt W.Y.
Institution
(Walavalkar, Pujar, Viralam, Mayia, Collin John, Shekhar Rao, Chinnaswamy
Reddy) Narayana Hrudayalaya Institute of Cardiac Sciences, Bangalore,
India
(Evers, Frerich, Prinzen, Delhaas, Vanagt) Cardiovascular Research
Institute Maastricht CARIM, Maastricht University Medical Center MUMC,
Maastricht, Netherlands
Title
Pre-operative Sildenafil administration in children undergoing cardiac
surgery; a randomized placebo-controlled preconditioning study.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S162), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Sildenafil has strong cardiac preconditioning properties in
animal studies and is known to have a safe side effect profile in
children. Therefore, we evaluated the use of sildenafil preconditioning to
reduce postoperative myocardial injury in children undergoing surgical
ventricular septum defect (VSD) closure. Methods: Randomized, double blind
study. Children (1-17 years) undergoing VSD closure were randomized into
three groups: Placebo (Control group), preconditioning with 0.06 mg/kg
(Sild- L group) or 0.6 mg/kg sildenafil (Sild-H group). Measurements of
cardiac injury (CK-MB and troponin I), inflammatory response (IL-6 and
TNF-alpha), bypass and ventilation weaning times, inotropy score, and
echocardiographic function were made pre-and postoperatively. Data
expressed as median (range), p< 0.05 considered significant. Results:
Thirty-nine patients were studied (13/group). Aortic cross clamp time was
similar with 27 (18-85) and 27 (12-39) minutes in the Control and Sild-L
groups, respectively, but significantly longer with 39 (20-96) minutes in
the Sild-H group. Area under the curve of CK-MB release was 1105
(620-1855) ng/mL in the Control group, showed a tendency to be higher in
the Sild-L group with 1672 (564-2767) ng/mL, and was significantly higher
in the Sild-H group with 1695 (1252-3377) ng/mL. There were no differences
in inflammatory response markers, cardiopulmonary bypass and ventilation
weaning times, inotropy scores, and echocardiographic function between the
groups. Conclusion: Sildenafil does not reduce myocardial injury in
children undergoing cardiac surgery, nor does it alter cardiac function,
inotropic needs, or postoperative course. A paradoxical subclinical
increase in cardiac enzyme release after sildenafil preconditioning cannot
be excluded.

<32>
Accession Number
612897676
Author
Bonnet M.; Laux D.; Di Filippo S.; Vaksmann G.; Iserin L.; Thambo J.-B.;
Bonnet D.; Godart F.
Institution
(Bonnet, Godart) Centre Hospitalier Regional, Universitaire De Lille,
Lille, France
(Laux) Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
(Di Filippo) Centre Hospitalier, Universitaire De Lyon, Lyon, France
(Vaksmann) Cabinet De Cardiologie Vendome-Cardio, Lille, France
(Iserin) Hopital Europeen Georges Pompidou, Paris, France
(Thambo) Centre Hospitalier, Universitaire De Bordeaux, Bordeaux, France
(Bonnet) Hopital Necker - Enfants Malades, Paris, France
Title
Outcomes after protein-losing enteropathy in univentricular hearts: A
multicenter study.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S3), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Background: Protein-losing enteropathy (PLE) is a rare but severe
complication after Fontan surgery in patients with univentricular hearts
(UVH). Outcomes are compromised since mortality is high and treatment
efficiency appears limited. Methods: This was a retrospective
observational study carried out in sixteen Pediatric Cardiology Centres in
France. All UVH patients diagnosed with PLE after Fontan type surgery such
as atriopulmonary/ atrioventricular anastomosis or
intracardiac/extracardiac total cavopulmonary connection were included.
The study period went from 1988 until 2014. Results: PLE was diagnosed in
thirty-five patients at a median age of 9.7 years. Median delay after
Fontan type surgery was 3.6 years. At diagnosis, cardiac catheterization
revealed a hemodynamic dysfunction of the Fontan circulation in 63% (n=
22/35). Treatment modalities included medical treatment alone (e.g.
oral/topic steroids, Calciparine, sildenafil) in 46% (n=16/25) or combined
treatment options (interventional or/and surgical therapy associated to
medical treatment) in the other 54% (n= 19/35). Treatment was considered
to be efficient in case of normalization of albumin level (>30 g/l).
Medical treatment alone led to complete recovery in 13% (n = 2/16), to
transient improvement in 31% (n= 5/16) and to no improvement in 56% of
patients (n= 9/ 16). No patient treated medically died but two (13%) were
finally transplanted (one recovery, one transient improvement). Combined
treatment modalities led to 21% recoveries (n= 4/19) and to 37% transient
improvements (n =7/19). No improvement was noted in 42% of patients (n
=8/19). 21% (n= 4/19) in this treatment group died.16% (n =3/19) finally
underwent heart transplantation but all three subsequently died (one early
death, two late deaths). Five and 10 years survival of the whole cohort
were 89.7% (CI95%:+/- 11.3%) and 74.9% (CI95%:+/-21.3%) respectively.
Median follow-up was 4.5 years [0.5-21.7]. At last visit, 75% of survivors
(n =21/28) were in functional NYHA class I/II. However, 75% still had
patent hypoalbuminemia and 61% received specific medical therapy for PLE.
Conclusions: Despite decreased mortality, PLE remains a significant burden
after Fontan surgery since complete recovery is rare and treatment
modalities remain unsatisfying. Heart transplantation is an ultimate
therapeutic option but carries a high risk. Further studies are needed to
develop innovative treatment strategies and improve outcomes.

<33>
Accession Number
612897639
Author
Kovacevic A.; Ohman A.; Tulzer G.; Herberg U.; Dangel J.; Bartrons J.;
Carvalho J.S.; Fesslova V.; Jicinska H.; Sarkola T.; Toler A.J.; Mellander
M.; Gardiner H.M.
Institution
(Kovacevic, Carvalho, Gardiner) Department of Paediatric and Congenital
Cardiology, Royal Brompton and Harefield Hospital, NHS Foundation Trust,
London, United Kingdom
(Kovacevic) Department of Paediatric and Congenital Cardiology, University
of Heidelberg, Heidelberg, Germany
(Ohman) Department of Women's and Children's Health, Uppsala University,
Sweden
(Tulzer) Department of Paediatric Cardiology, Children's Heart Centre,
Linz, Austria
(Herberg) Department of Paediatric Cardiology, University Hospital Bonn,
Germany
(Dangel) Perinatal Cardiology Clinic, 2nd Department of Obstetrics and
Gynecology, Medical University of Warsaw, Poland
(Bartrons) Department of Paediatric Cardiology, Hospital Clinic, Sant
Johan de Deu, Barcelona, Spain
(Carvalho) Fetal Medicine Unit, St. George's Hospital NHS Trust, London,
United Kingdom
(Fesslova) Center of Fetal Cardiology, Policlinico San Donato IRCSS,
Milan, Italy
(Jicinska) University Hospital, Masaryk University Brno, Czech Republic
(Sarkola) Children's Hospital, University of Helsinki, Central Hospital,
Helsinki, Finland
(Toler) Department of Data Analytics, Southern New Hampshire University,
Manchester, NH, United States
(Mellander) Department of Paediatric Cardiology, Queen Silva Children's
Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
(Gardiner) Department of Reproductive Biology, Faculty of Medicine, Queen
Charlotte's and Chelsea Hospital, United Kingdom
(Gardiner) Fetal Center Children's Memorial Hermann Hospital, University
of Texas, Houston, TX, United States
Title
Does reversal of flow in the fetal aortic arch in second trimester aortic
stenosis predict hypoplastic left heart syndrome?.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S1-S2), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Fetal aortic valvuloplasty (FV) has been proposed as an
effective therapy to prevent progression from aortic stenosis to
hypoplastic left heart syndrome (HLHS). Reversal of aortic arch flow in
second trimester is thought predictive of HLHS without FV. We hypothesized
that reversed arch flow does not predict HLHS. Methods: In a retrospective
multicenter and multinational study (2005-2012) 214 fetuses with aortic
stenosis were enrolled into a hybrid case-control and repeated samples
cohort. Liveborn surgical candidates undergoing FV or without FV (natural
history, NH) were matched for between +/- one Z-score for mitral valve
(MV) and aortic valve (AoV) diameters, left ventricular inlet length (LV)
and retrograde arch flow at 23+/-3 gestational weeks, producing best match
cohorts for each. Outcome measures were survival with biventricular
circulation (BV) at four years. We analysed outcomes using Cox
proportional hazards regressions and Kaplan Meier curves. Results: FV was
performed in 67/214, technically successful in 59 (88.0%). FV-related
deaths occurred in 7/67 (10.4%). Overall 151/214 (71%) were live-born,
including unknown outcomes in 5 and no surgery in 16. Kaplan Meier curves
show no significant difference in survival and in BV for case-control
groups matched for retrograde arch flow and mitral valve, aortic valve or
left ventricle inlet length Z-scores at 4 years after birth (Figure 1
a-c). Conclusions: The results from this multicenter study, matching for
similar morphology and reversed arch flow in second trimester, showed that
those with and without FV had similar BV outcomes and failed to show that
reversed arch flow predicts HLHS. (Figure Presented).

<34>
Accession Number
612897622
Author
Chuang Y.-C.
Institution
(Chuang) National Taiwan University Hospital, Taiwan (Republic of China)
Title
A narrative review of early nutrition in infant after cardiovascular
surgery.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S179), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Early nutrition is important for neonate or infant with
congenital heart disease. However, few have been known about the knowledge
of nutrition in neonate or infant after their complex heart surgery in
critical care. Methods: This study was conducted in a narrative literature
review method. A comprehensive search of four electronic databases
(PUBMIED, MEDLINE, CIHNAL, Cochrane Library) was undertaken between 1990
to 2014. Inclusion criteria were research papers related to outcomes in
pediatric patients after cardiovascular surgery, incorporating enteral
feeding or nutrition in critic care. Results: Eighteen research articles
and two review articles met the criteria were selected to be discussed.
Three themes were emerged from the literature review: (1) Variance affects
the weight in congenital heart infants. (2) Implementing advancement and
progressive feeding protocol after surgery could be benefit on decreasing
hospital or ICU length of stay, gaining weight at discharge, avoiding on
incidence of necrotizing enterocolitis and better life of quality on
sleep. (3) Addressing on home-monitoring or project after discharge to
Norwood stage II. Conclusions: Most research has been addressed on the
nutrition in infant with congenital heart disease in their recovery period
after cardiovascular surgery except for patients in critical care. The
future research could be focused on approaching the knowledge of factors
associated successful enteral feeding or initial feeding time in neonate
or infant after cardiovascular surgery in critical care.

<35>
Accession Number
612898171
Author
Van Den Hoven A.; Eicken A.; Aboulhosn J.; De Bruin C.; Duijnhouwer A.L.;
Demulier L.; Chessa M.; Uebing A.; Van Den Bosch A.E.; Witsenburg M.;
Roos-Hesselink J.W.
Institution
(Van Den Hoven, Van Den Bosch, Witsenburg, Roos-Hesselink) Erasmus MC,
Netherlands
(Eicken) German Heart Centre Munich, Germany
(Aboulhosn) UCLA, United States
(De Bruin) CCHMC, United States
(Duijnhouwer) UMC Radboud, Netherlands
(Demulier) UZ Gent, Belgium
(Chessa) IRCCS Policlinico San Donato, Italy
(Uebing) RBHT, United Kingdom
Title
Stent implantation in aortic coarctation in turner syndrome: A safety
analysis.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S59-S60), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Stent implantation has proven to be a safe and effective way
for the treatment of coarctation in adolescents and adults. Turner
Syndrome is a genetic disorder marked by a partial or complete absence of
one X-chromosome. CoA occurs in approximately 17% of Turner patients.
Also, the aortic wall composition is abnormal in Turner Syndrome (TS).
Changes in vascular smooth muscle cells, elastin and Figure. collagen
fiber and cystic medial wall necrosis, as found in Marfan syndrome, make
patients with TS vulnerable to aortic dissection. Therefore concerns exist
about coarctation stenting in TS. Methods: In this multi-center
retrospective study, all patients with Turner syndrome and a coarctation
of the aorta, treated with percutaneous stent implantation, were included.
The adverse events at short and long-term follow-up and qualitative
parameters concerning the stent implantation were assessed. Results: A
total of 17 patients with 18 stenting procedures from 8 centers were
included. Age at intervention (mean+/- sd) was 22 (+/-17,4) years. The
coarctation diameter preintervention was 8,1 (+/-3) mm and increased to
13,1 (+/-4,2). The peak gradient decreased (median (range)) from 24 (6-45)
to 0 (0-20) mmHg. Baseline and intervention characteristics are included
in table 1. At short term (<30days after the intervention) dissection of
the descending aorta occurred in 2 patients (11%), of which 1 was fatal
(5,5%). Both of these patients underwent covered stent implantation. The
mean follow-up was approximately 8 years. Two additional patients died
during follow-up due to non-related cardiac causes. One patient died
awaiting aortic valve replacement showing a large thrombus located near
the mitral valve at autopsy, the other patient died due to progressive
heart failure. Conclusions: These results suggest that, despite the use of
covered stents, coarctation stenting in TS carries a higher risk than in
non TS individuals. A prospective study is warranted, including evaluation
with pre and post procedural CT or MR imaging to better define specific
risk factors. (Figure Presented).

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

<37>
Accession Number
612898098
Author
Pickardt T.; Abdul-Khaliq H.; Berger F.; Cesnjevar R.; Daehnert I.;
Dittrich S.; Hoff K.; Horer J.; Kececioglu D.; Korten M.; Kramer H.H.;
Krane M.; Laser K.T.; Photiadis J.; Poryo M.; Rentzsch A.; Salameh A.;
Schalinski A.; Scheewe J.; Schubert S.; Stiller B.; Toka O.; Bauer U.M.M.
Institution
(Pickardt, Korten, Schalinski, Bauer) Register and Competence Network for
Congenital Heart Defects, Berlin, Germany
(Abdul-Khaliq, Poryo, Rentzsch) Saarland University/Homburg, Dep. of
Pediatric Cardiology, Germany
(Berger, Schubert) German Heart Institute Berlin, Dep. of Congenital Heart
Disease/Pediatric Cardiology, Germany
(Cesnjevar) Universitatsklinikum Erlangen, Dep. of Pediatric Cardiac
Surgery, Germany
(Daehnert, Salameh) Heart Center Universitat Leipzig, Dep. of Pediatric
Cardiology, Germany
(Dittrich, Toka) Universitatsklinikum Erlangen, Dep. of Pediatric
Cardiology, Germany
(Hoff, Kramer, Scheewe) Universitatsklinikum Schleswig- Holstein/Kiel,
Dep. of Congenital Heart Disease and Pediatric Cardiology, Germany
(Horer, Krane) German Heart Center Munich, Dep. of Cardiovascular Surgery,
Division of Experimental Surgery, Germany
(Kececioglu, Laser) HDZ-NRW Bad Oeynhausen, Dep. of Pediatric Cardiology
and Congenital Heart Disease, Germany
(Photiadis) German Heart Institute Berlin, Dep. of Surgery for Congenital
Heart Disease/Pediatric Cardiac Surgery, Germany
(Stiller) Universitatsklinikum Freiburg, Dep. of Congenital Heart Disease
and Pediatric Cardiology, Germany
(Berger, Hoff, Horer, Kramer, Krane, Photiadis, Scheewe, Schubert) DZHK
(German Centre for Cardiovascular Research) Partner Site, Germany
Title
A German biobank for congenital heart defects.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S99), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
A multicentre biobank infrastructure was established in order to support
current and future scientific investigations in the field of congenital
heart defects (CHD) and cardiovascular diseases. The biobank is an
integral part of the German Registry for congenital heart defects and
collects DNA from patients plus parents (trios) and affected families, and
cardiac tissue from patients undergoing heart surgery. So far, eight
ethics committees in Germany have approved the CHDBiobank concept that
implies indefinite storage of samples and their use in on-going and in
still undefined future studies. Compliance with data privacy regulations
have been confirmed by the BerlinOfficial for Data Protection. Currently,
pediatric cardiology/heart surgery departments of eight hospitals in
Germany are involved. The CHD-Biobank is centrally managed by the Registry
team that is responsible for the validation of clinical/phenotype data,
the compliance with legal and ethical regulations, the implementation of
state-of-the-science protocols for sample acquisition, processing and
storage, and the implementation and efficient use of software solutions
for data and biomaterial management. The CHD-Biobank operates 1. a central
ID management using uniform coding systems (including barcoded sample
containers) and a central onlineaccessible database platform 2. a central
facility for blood/DNA processing, storage and dissemination of samples
(partnership with the Charite-Berlin centralized Biomaterialbank ZeBanC)
3. a decentralized sample collection structure for cardiac tissue samples
that need to be stored in liquid nitrogen gas phase (below -150oC). The
DNA collection currently comprises samples from approximately 3,600
participants covering a wide range of CHDphenotypes. The collection
includes 420 trios and 150 families with more than one affected member.
The cardiac tissue collection comprises approx. 1200 tissue samples from
500 patients with open heart surgery. The rising number of requests for
collaboration from numerous research institutions (in addition to various
German institutions also Newcastle Genetic Medicine, WT Sanger Institute
Cambridge) can be regarded as an indication for the high quality of the
CHDBiobank infrastructure, sample logistics and phenotype database.

<38>
Accession Number
612898007
Author
Weber R.W.; Oxenius A.; Attenhofer C.H.; Greutmann M.; Biaggi P.;
Burkhardt B.; Tobler D.; Valsangiacomo Buechel E.R.
Institution
(Weber, Oxenius, Burkhardt, Valsangiacomo Buechel) Children's Heart
Center, University Children's Hospital, Zurich, Switzerland
(Weber, Oxenius, Burkhardt, Valsangiacomo Buechel) Children's Research
Center, University Children's Hospital, Zurich, Switzerland
(Oxenius, Attenhofer, Greutmann) University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Attenhofer, Biaggi) Cardiovascular Center, Klinik im Park, Zurich,
Switzerland
(Tobler) Department of Cardiology, University Hospital Basel, Basel,
Switzerland
Title
Volume and function of the right ventricle in ebstein anomaly:
Knowledge-based three dimensional reconstruction of echocardiographic
images compared to cardiac magnetic resonance.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S14), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Objectives: Quantification of right ventricular (RV) volume in Ebstein
anomaly is challenging, given the different degrees of displacement of the
tricuspid valve (TV). Echocardiographic knowledge-based 3D reconstruction
(3DR) of RV volumes has been validated in normal and dilated RV. We sought
to assess feasibility of 3DR in Ebstein patients and to compare the RV
volumes with volumes obtained by cardiac magnetic resonance (CMR).
Methods: Ebstein patients with and without TV reconstruction were
prospectively recruited in 4 centres and underwent 3DR and CMR in our core
lab on the same day. Patients with pacemaker or Fontan palliation were
excluded. Knowledge-based 3DR was performed with VentripointTM
Diagnostics, USA. RV volumes were calculated using 3DR and the summation
disc method on short axis images (saCMR) and on axial images (axCMR) by
two independent experienced observers. Intermodality differences were
assessed using correlation coefficient and Bland-Altman analysis and
expressed as % mean difference +/-standard deviation and 95% limits of
agreement. Results: Eighteen patients underwent 3DR and CMR examination.
3DR was feasible in 78% of the patients, image quality being insufficient
in 4/18. In 14 patients significant correlation was present for all RV
volumes among all imaging modalities. RVEDV in 3DR correlated best with
saCMR with a mean difference of 0.6+/- 5.4% (-11/10). Agreement between
3DR and axCMR was 4.8 +/- 9.4% (-23/13.6), between axCMR and saCMR 4.2
+/-6.8% (-9/17). For RVESV agreement was good between 3DR and saCMR -1.9
+/- 9.4% (-20/16), weaker between 3DR and axCMR was 6.5 +/-13% (-32/19),
and between both CMR methods 4.6 +/-14% (-24/33). Reasonable agreement was
found for RV EF% between 3DR and saCMR 0.9 +/-5.1% (-9/11). In contrast
wide limits of agreement were observed between 3DR and axCMR 1.7+/- 8.9%
(-16/19) and between saCMR and axCMR -0.9+/- 9.7% (-19/18). Conclusions:
3DR echocardiography is feasible in Ebstein anomaly patients. 3DR RVEDV
measurements show good agreement with saCMR and axCMR. Limits of agreement
for RVESV and RV EF% are wider, but still comparable with published ranges
obtained by CMR. Since volumes obtained by different techniques are not
interchangeable, we recommend to use consistently the same modality for
follow up of Ebstein anomaly patients.

<39>
Accession Number
612897974
Author
Latus H.; Nassar M.; Hachmann P.; Wong J.; Hussain T.; Apitz C.; Akintuerk
H.; Salih C.; Austin C.; Anderson D.; Bauer J.; Razavi R.; Schranz D.;
Greil G.
Institution
(Latus, Hachmann, Apitz, Akintuerk, Bauer, Schranz) Pediatric Heart
Center, University Children's Hospital, Giessen, Germany
(Nassar, Salih, Austin, Anderson) Department of Pediatric Cardiac Surgery,
Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust,
London, United Kingdom
(Wong, Hussain, Razavi, Greil) Division of Imaging Sciences and Biomedical
Engineering, King's College London, London, United Kingdom
(Wong, Hussain, Razavi, Greil) Department of Pediatric Cardiology, Evelina
Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London,
United Kingdom
Title
Cardiac magnetic resonance assessment of right ventricular performance
after stage 2 palliation for hypoplastic left heart syndrome: A dual
center study comparing the Norwood and Hybrid approach.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S13-S14), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Objectives: Stage 1 palliation of hypoplastic left heart syndrome (HLHS)
can be achieved either by the Norwood (NW) procedure or the Hybrid (HY)
approach. These procedures result in different hemodynamic profiles that
may have an impact on ventricular performance in the long term.
Accordingly, the aim of this study was to compare CMR data of HLHS
patients after stage 2 who underwent either a NW or the HY strategy in two
European centres. Methods: HLHS patients after stage 2 palliation who
underwent an initial classic NW operation using a BT shunt (n =38, mean
age 2.4 +/- 0.7 years) or the HY approach consisting of bilateral
pulmonary artery banding and arterial duct stenting (n = 38, mean age 2.1
+/-1.0 years, p =0.12) were included. The CMR protocol consisted of cine
assessment of right ventricular (RV) size and function. Feature tracking
analysis was performed to quantify RV strain and intraventricular
synchrony parameters. Results: NW patients had significantly larger RV
enddiastolic volumes (91 +/-24 vs 84+/- 33 ml/m²; p= 0.03) and
higher indexed stroke volumes (53+/-12 vs 47+/- 12 ml/m², p=
0.01) compared to the HY group whereas global pump function (ejection
fraction 59+/- 10 vs 58+/- 9%; p =0.71) and cardiac output (4.8 +/- 1.2 vs
4.9 +/-1.2 l/min/m², p =0.27) did not differ between the two
groups. In the HY group RV circumferential (-15.1+/- 6.2 vs -18.4 +/-5.8%,
p= 0.01) and radial strain (13.1 +/-7.8 vs 21.1+/- 9.7%, p< 0.001) was
lower and intraventricular dysynchrony significantly increased (88+/- 48
vs 51+/-24 ms, p< 0.001 and 97+/-59 vs 59+/- 49 ms, p <0.001). No
difference was found in longitudinal strain (-14.3+/- 5.4 vs -16.5
+/-5.7%, p =0.08) and dysynchrony (85.4+/-31.9 vs 81.6+/-38.1 ms, p=
0.78). Conclusions: The initial palliative strategy in HLHS patients has
significant effects on ventricular size and performance at mid-term
follow-up. Future studies comparing the two approaches are necessary to
assess whether the observed differences determine functional outcome in
the long-term.

<40>
Accession Number
612898314
Author
Wright P.
Institution
(Wright) Royal Brompton Hospital, London, United Kingdom
Title
First UK multicenter study to review the Efficacy of Nutritional Treatment
Strategies in the Management of Post-cardiothoracic surgical chylothorax.
Source
Cardiology in the Young. Conference: 49th Annual Meeting of the
Association for European Paediatric and Congenital Cardiology, AEPC with
Joint Sessions with the Japanese Society of Pediatric Cardiology and
Cardiac Surgery, Asia-Pacific Pediatric Cardiology Society, European
Association for Cardio-Thoracic Surgery and Canadian Pediatric Cardiology
Association. Czech Republic. Conference Start: 20150520. Conference End:
20150523. 25 (pp S177-S178), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Background: *Incidence of chylothorax has increased 0.9%-1.5% to 6.6% *No
agreement regarding efficacy of Long Chain Triglyceride (LCT) reduction in
reducing chylous output Aim: 1 - Primary aim: Investigate daily LCT
intakes throughout the entire course of diet therapy and compare against
the nationally accepted guidelines. 2 - Secondary Aims: To investigate the
efficacy of diet therapy changes and reducing LCT intakes upon drain
output. To compare participating centre guidelines Methods: A multi-centre
prospective observational study conducted between January 2013 and January
2014 reviewing routine diet therapy of paediatric congenital heart
patients diagnosed with chylothorax. Daily LCT intakes and drain outputs
were recorded. Regression analysis investigated relationships between feed
type and drain output, the effect of age and LCT intakes on the
relationship between feed and output and the effect of LCT intake on
output. Results: 51 children enrolled <18 months of age. 5 children died.
68% of chylothoraces resolved with standard first line diet therapy.20%
resolved with> 2 changes to diet therapy. Feeds: Feed 1:Reduced LCT
formula (Monogen), Feed 2: Fat free modular feed with IV intralipids, Feed
3: TPN and Feed 4=Reduced LCT (solid diet) *When feed 1 and 4 were
compared: Feed 4 had a significant effect (p=0.005) on output. When
correcting for the effect of LCT and age, feed 4 gives a higher output
than feed 1 by 0.58mls for every unit increase in age, therefore the
effects of LCT are marginally significant. *In patients who received >2
types of diet therapy but only received feeds 1,3 and 4 there was a
significant (p=<0.001) decrease in drain output with feed 3 after
correcting for the effect of LCT intake *In patients that received> 2
types of diet therapy and received feed type 2 there was a decrease in
drain output but this was not significant (p=0.13) however the small
sample size was 8 children in the group that received feed 2 *Logistic
regression showed there was no effect of output on survival after
correcting for LCT and age *This investigation identified that the Royal
Brompton Hospital was the only hospital to use a three staged diet therapy
approach thereby avoiding direct transition to TPN. All other centres
proceeded to TPN if standard diet therapy failed. Conclusion: 1. Children
who respond to standard diet therapy all exceeded the nationally accepted
guideline with no reoccurrence of symptoms. 2. LCT free enteral feeds can
reduce drain output and avoid the use of TPN as per step 2 of the Royal
Brompton guideline. 3. The duration and timing of diet therapy could
potentially be reduced to 4 weeks in patients that respond to standard
diet therapy treatment. 4. Further investigation is required to establish
evidence based effective guidelines for the management of this high risk
post operative complication.

<41>
Accession Number
612870483
Author
Hejazi R.; Kandel P.; DeVault K.R.
Institution
(Hejazi, Kandel, DeVault) Mayo Clinic, Jacksonville, FL, United States
Title
Prevalence and incidence of gastroparesis in post lung and heart/lung
transplantation: A systematic review and mata-analysis.
Source
American Journal of Gastroenterology. Conference: 81st Annual Scientific
Meeting of the American College of Gastroenterology. United States.
Conference Start: 20161021. Conference End: 20161026. 111 (pp S250), 2016.
Date of Publication: October 2016.
Publisher
Nature Publishing Group
Abstract
Introduction: Gastrointestinal complications including gastroesophageal
reflux, esophageal dysmotility and gastroparesis are common in lung &
heart/lung transplantation (LT & H/LT) and may negatively influence
long-term outcome. The prevalence (P) and incidence (I) of DGE in post LT
and H/LT is not well defined and may vary according to the criteria used
to define its presence and the population under study. We sought to
perform a systematic review to answer this question. Methods: A systematic
review/meta-analysis to estimate the P & I of DGE/GP in LT and H/LT.
MEDLINE and EMBASE were searched up to May 2016. Studies were eligible if
they contained >10 adults (>16 years) and reported P or I of GP.
Eligibility assessment and data extraction were performed independently by
2 reviewers in a double-blind fashion. Data were extracted to estimate the
P and I of GP using a broad definition of typical GP symptoms and
confirmed with gastric emptying study (GES) measured by a standardized
scintigraphic method. Data were pooled to give overall P & I of GP with a
95% confidence interval (CI) of all eligible studies. Results: The search
yielded 1579 citations. A total of 14 studies were eligible for inclusion
and provided data for this analysis. Eleven studies were from US and 3
others from Spain, Switzerland and Netherlands. Mean age was 40 +/- 12
(SD) years with 54% male. The pooled P of GP in total of 1421 patient with
LT was 26% (95% CI; 23%-28%) and of 57 patients with H/LT was 64% (95% CI;
51%-76%). Single or double lung transplant did not differ in P of GP (p<
0.05). The pooled I of new onset GP in 561 LT (4 studies wih pre &post
transplant GES)was 20% (95% CI; 16%- 23%). Only one study provided the I
of 50% of GP in combined H/LT. Presence of GP did not correlate with the
etiologies of LT and H/LT, except an increased rate of GP in LT due to
cystic fibrosis (p < 0.05) Conclusion: The P of GP, using a combination of
symptoms and GES, is 26 and 57 percent in LT and H/ LT, respectively.
Higher rate of GP in H/LT could be explained by more comorbidities,
vigorous immunosuppressive therapy and more complex nature of surgery with
higher chance of post-surgical GP. LT secondary to cystic fibrosis has a
higher rate of GP and could be due to reported higher rate of GP in
pre-transplant status. There is a need for population-based prevalence
studies with standardized pre & post-transplant GES to properly estimate
the clinical significance of GP in LT and H/LT.

<42>
Accession Number
612964847
Author
Okita Y.; Minakata K.; Yasuno S.; Uozumi R.; Sato T.; Ueshima K.; Konishi
H.; Morita N.; Harada M.; Kobayashi J.; Suehiro S.; Kawahito K.;
Okabayashi H.; Takanashi S.; Ueda Y.; Usui A.; Imoto K.; Tanaka H.;
Okamura Y.; Sakata R.; Yaku H.; Tanemoto K.; Imoto Y.; Hashimoto K.; Bando
K.
Institution
(Okita) Division of Cardiovascular Surgery, Department of Surgery, Kobe
University Graduate School of Medicine, Kobe, Japan
(Minakata, Uozumi) Kyoto University Graduate School of Medicine, Kyoto,
Japan
(Yasuno, Ueshima) Kyoto University Hospital, Kyoto, Japan
(Sato) Kyoto University School of Public Health, Kyoto, Japan
(Konishi) Konishi Cardio-Vascular Medical Clinic, Shimonoseki, Japan
(Morita, Kobayashi) National Cerebral and Cardiovascular Center, Osaka,
Japan
(Harada) University of Tokushima, Tokushima, Japan
(Suehiro) Osaka City University Graduate School of Medicine, Osaka, Japan
(Kawahito) Jichi Medical University, Shimotsuke, Japan
(Okabayashi) Iwate Medical University, Morioka, Japan
(Takanashi) Sakakibara Heart Institute, Okayama, Japan
(Ueda) Nara Prefecture General Medical Center, Nara, Japan
(Usui) Nagoya University Graduate School of Medicine, Nagoya, Japan
(Imoto) Yokohama City University Medical Center, Yokohama, Japan
(Tanaka) Kurume University School of Medicine, Kurume, Japan
(Okamura) Wakayama Medical University, Wakayama, Japan
(Sakata) Kobe City Medical Center General Hospital, Kobe, Japan
(Yaku) Kyoto Prefectural University of Medicine, Kyoto, Japan
(Tanemoto) Kawasaki Medical School, Kurashiki, Japan
(Imoto) Kagoshima University Graduate School of Medical and Dental
Sciences, Kagoshima, Japan
(Hashimoto, Bando) Jikei University School of Medicine, Tokyo, Japan
Title
Optimal timing of surgery for active infective endocarditis with cerebral
complications: A Japanese multicentre study.
Source
European Journal of Cardio-thoracic Surgery. 50 (2) (pp 374-382), 2016.
Article Number: ezw035. Date of Publication: 01 Aug 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The aim of this study was to investigate the effect of the
timing of valve surgery on the clinical outcomes of patients with active
infective endocarditis (IE) accompanied by cerebral complications.
METHODS: We retrospectively analysed a cohort of 568 patients, comprising
118 with non-haemorrhagic cerebral infarction (CI), 54 with intracranial
haemorrhage (ICH) and 396 without cerebral events (C; control), who
underwent surgery for left-sided active IE in 15 Japanese institutes from
2000 to 2011. The mean age was 58.4 +/- 16.9 years in the CI group; 54.5
+/- 17.4 years in the ICH group and 56.9 +/- 16.0 years in the C group.
Clinical outcomes were analysed according to the timing of surgery after
the diagnosis of CI or ICH was made. RESULTS: In the CI group, there were
9 (7.6%) hospital deaths, 13 (11%) new cerebral events and 1 (0.8%) redo
valve surgery. In the ICH group, there were 3 (5.6%) hospital deaths, 8
(14.8%) new cerebral events and 2 (3.7%) redo valve surgeries. In the C
group, there were 36 (9.1%) hospital deaths, 23 (5.8%) new cerebral events
and 9 (2.3%) redo valve surgeries. Risk factors for hospital death were
prosthetic valve endocarditis (P = 0.045), high C-reactive protein (CRP; P
< 0.001) and the elderly (P < 0.001) in the CI group. Delayed surgery (2
weeks after CI) seemed result in a higher incidence of hospital death in
the CI group. Patients who had surgery between 15 and 28 days or after 29
days from the onset of CI had higher incidences of hospital death [odds
ratio 5.90 (P = 0.107) and 4.92 (P = 0.137), respectively] compared with
those who had surgery within 7 days. In the ICH group, risk factors for
hospital death were high CRP (P = 0.002) and elderly (P < 0.001). Contrary
to CI patients, patients who had surgery between 8 and 21 days or after 22
days after the onset of ICH had lower incidences of hospital death [odds
ratio 0.79 (P = 0.843) and 0.12 (P = 0.200), respectively] compared with
those who had surgery within 7 days. CONCLUSIONS: Although statistically
insignificant, early surgery in active IE patients with CI is safe, but
very early surgery (within 7 days) should be avoided in patients with ICH.
Copyright &#xa9; The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<43>
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.

<44>
Accession Number
612964738
Author
Urbanski P.P.; Luehr M.; Di Bartolomeo R.; Diegeler A.; De Paulis R.;
Esposito G.; Bonser R.S.; Etz C.D.; Kallenbach K.; Rylski B.; Shrestha
M.L.; Tsagakis K.; Zacher M.; Zierer A.
Institution
(Urbanski, Diegeler, Zacher) Cardiovascular Clinic Bad Neustadt, Bad
Neustadt, Germany
(Luehr) Department of Cardiac Surgery, Ludwig-Maximilians University
Munich, Munich, Germany
(Di Bartolomeo) Department of Cardiac Surgery, S. Orsola-Malpighi
Hospital, University of Bologna, Bologna, Italy
(De Paulis) Cardiovascular Department, European Hospital, Rome, Italy
(Esposito) Cardiovascular Department, Cliniche Humanitas Gavazzeni,
Bergamo, Italy
(Bonser) Department of Cardiovascular Medicine, University of Birmingham,
Birmingham, United Kingdom
(Etz) Department of Cardiac Surgery, Leipzig Heart Centre, University of
Leipzig, Leipzig, Germany
(Kallenbach) Clinic for Cardiac Surgery, University Hospital Heidelberg,
Germany
(Rylski) Heart Center Freiburg University, Freiburg, Germany
(Shrestha) Clinic for Heart, Thoracic and Vascular Surgery, Medical
University of Hannover, Germany
(Tsagakis) Department of Thoracic and Cardiovascular Surgery, West-German
Heart and Vascular Center Essen, University of Duisburg-Essen, Essen,
Germany
(Zierer) Division of Thoracic and Cardiovascular Surgery,
Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany
Title
Multicentre analysis of current strategies and outcomes in open aortic
arch surgery: Heterogeneity is still an issue.
Source
European Journal of Cardio-thoracic Surgery. 50 (2) (pp 249-255), 2016.
Article Number: ezw055. Date of Publication: 01 Aug 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The study was conducted to evaluate, on the basis of a
multicentre analysis, current results of elective open aortic arch surgery
performed during the last decade. METHODS: Data of 1232 consecutive
patients who underwent aortic arch repair with reimplantation of at least
one supra-aortic artery between 2004 and 2013 were collected from 11
European cardiovascular centres, and retrospective statistical examination
was performed using uni- and multi-variable analyses to identify
predictors for 30-day mortality. Acute aortic dissections and arch
surgeries not involving the supra-aortic arteries were not included.
RESULTS: Arch repair involving all 3 arch arteries (total), 2 arch
arteries (subtotal) or 1 arch artery (partial) was performed in 956
(77.6%), 155 (12.6%) and 121 (9.8%) patients, respectively. The patients'
characteristics as well as the surgical techniques, including the method
of cannulation, perfusion and protection, varied considerably between the
clinics participating in the study. The in-hospital and 30-day mortality
rates were 11.4 and 8.8% for the entire cohort, respectively, ranging
between 1.7 and 19.0% in the surgical centres. Multivariable logistic
regression analysis identified surgical centre, patient's age, number of
previous surgeries with sternotomy and concomitant surgeries as
independent risk factors of 30-day mortality. The follow-up of the study
group was 96.5% complete with an overall follow-up duration of 3.3 +/- 2.9
years, resulting in 4020 patient-years. After hospital discharge, 176
(14.3%) patients died, yielding an overall mortality rate of 25.6%. The
actuarial survival after 5 and 8 years was 72.0 +/- 1.5% and 64.0 +/- 2.0,
respectively. CONCLUSIONS: The surgical risk in elective aortic arch
surgery has remained high during the last decade despite the advance in
surgical techniques. However, the patients' characteristics, numbers of
surgeries, the techniques and the results varied considerably among the
centres. The incompleteness of data gathered retrospectively was not
effective enough to determine advantages of particular cannulation,
perfusion, protection or surgical techniques; and therefore, we strongly
recommend further prospective multicentre studies, preferably registries,
in which all relevant data have to be clearly defined and collected.
Copyright &#xa9; The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<45>
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.

<46>
Accession Number
609613559
Author
Patel A.N.; Henry T.D.; Quyyumi A.A.; Schaer G.L.; Anderson R.D.; Toma C.;
East C.; Remmers A.E.; Goodrich J.; Desai A.S.; Recker D.; DeMaria A.
Institution
(Patel) University of Utah Health Care, Salt Lake City, UT, United States
(Henry) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Quyyumi) Emory University Hospital, Atlanta, GA, United States
(Schaer) Rush University Medical Center, Chicago, IL, United States
(Anderson) University of Florida, Gainesville, FL, United States
(Toma) University of Pittsburgh, Pittsburgh, PA, United States
(East) Baylor University Medical Center, Dallas, TX, United States
(Remmers, Goodrich, Recker) Vericel Corporation, Cambridge, MA, United
States
(Desai) Brigham & Women's Hospital, Boston, MA, United States
(DeMaria) University of California San Diego, San Diego, CA, United States
Title
Ixmyelocel-T for patients with ischaemic heart failure: a prospective
randomised double-blind trial.
Source
The Lancet. 387 (10036) (pp 2412-2421), 2016. Date of Publication: 11 Jun
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Ixmyelocel-T is an expanded, multicellular therapy produced
from a patient's own bone marrow by selectively expanding two key types of
bone marrow mononuclear cells: CD90+ mesenchymal stem cells and CD45+
CD14+ auto-fluorescent+ activated macrophages. Early phase clinical trials
suggest that intramyocardial delivery of ixmyelocel-T might improve
clinical, functional, symptomatic, and quality-of-life outcomes in
patients with heart failure due to ischaemic dilated cardiomyopathy. We
aimed to assess the safety and efficacy of catheter-based transendocardial
injection of ixmyelocel-T cell therapy in patients with heart failure and
reduced ejection fractions. Methods In this randomised, double-blind,
placebo-controlled phase 2B trial (ixCELL-DCM), patients from 31 sites in
North America with New York Heart Association class III or IV symptomatic
heart failure due to ischaemic dilated cardiomyopathy, who had left
ventricular ejection fraction 35% or less, an automatic implantable
cardioverter defibrillator, and who were ineligible for revascularisation
procedures were randomly assigned (1:1) to receive ixmyelocel-T or placebo
at the time of bone marrow aspiration and followed for 12 months.
Randomisation was done through an interactive (voice/web) response system.
The pharmacist, treating physician, and coordinator at each site were
unblinded, but the the follow-up team was completely blinded. The primary
endpoint was a composite of all-cause death, cardiovascular admission to
hospital, and unplanned clinic visits to treat acute decompensated heart
failure based on the blinded adjudication of an independent clinical
endpoint committee. Primary efficacy endpoint analyses and safety analyses
were done by modified intention to treat. This trial is registered with
ClinicalTrials.gov, number NCT01670981. Findings Between April 2, 2013,
and Jan 28, 2015, 126 participants were randomly assigned to receive
either ixmyelocel-T (n=66) or placebo (n=60). 114 (90%) patients comprised
the modified intention-to-treat population and 109 (87%) patients were
included in the per-protocol primary efficacy analysis (58 in the
ixmyelocel-T group and 51 in the placebo group). The primary efficacy
endpoint was observed in 47 patients: 50 events in 25 (49%) of 51 patients
in the placebo group and 38 events in 22 (38%) of 58 patients in the
ixmyelocel-T group, which represents a 37% reduction in cardiac events
compared with placebo (risk ratio 0.63 [95% CI 0.42-0.97]; p=0.0344). 41
(75%) of 51 participants in the placebo group had serious adverse events
versus 31 (53%) of 58 in the ixmyelocel-T group (p=0.0197). Interpretation
To the best of our knowledge, ixCELL-DCM is the largest cell therapy study
done in patients with heart failure so far. The transendocardial delivery
of ixmyelocel-T in patients with heart failure and reduced ejection
fraction due to ischaemic dilated cardiomyopathy resulted in a significant
reduction in adjudicated clinical cardiac events compared with placebo
leading to improved patient outcomes. Funding Vericel Corporation.
Copyright &#xa9; 2016 Elsevier Ltd

<47>
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.

<48>
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

<49>
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.

<50>
Accession Number
611851515
Author
Cannon C.P.; Gropper S.; Bhatt D.L.; Ellis S.G.; Kimura T.; Lip G.Y.H.;
Steg P.G.; ten Berg J.M.; Manassie J.; Kreuzer J.; Blatchford J.; Massaro
J.M.; Brueckmann M.; Ferreiros Ripoll E.; Oldgren J.; Hohnloser S.H.
Institution
(Cannon) Harvard Clinical Research Institute, Boston, MA, United States
(Cannon, Bhatt) Cardiovascular Division, Brigham and Women's Hospital,
Boston, MA, United States
(Cannon, Bhatt) Harvard Medical School, Boston, MA, United States
(Gropper, Kreuzer, Brueckmann, Ferreiros Ripoll) Boehringer Ingelheim
Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Kimura) Department of Cardiovascular Medicine, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
(Lip) University of Birmingham Institute of Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom
(Steg) FACT (French Alliance for Cardiovascular Trials), an F-CRIN
network, Departement Hospitalo-Universitaire FIRE, AP-HP, Hopital Bichat,
Universite Paris-Diderot, Sorbonne Paris-Cite, INSERM U-1148, Paris,
France
(Steg) NHLI Imperial College, ICMS Royal Brompton Hospital, London, United
Kingdom
(ten Berg) St. Antonius Hospital, Nieuwegein, Netherlands
(Manassie, Blatchford) Medical Division Boehringer Ingelheim Ltd,
Bracknell, Berkshire, United Kingdom
(Kreuzer) Faculty of Medicine, University of Heidelberg, Heidelberg,
Germany
(Massaro) Boston University School of Public Health, Boston, MA, United
States
(Brueckmann) Faculty of Medicine Mannheim of the University of Heidelberg,
Mannheim, Germany
(Oldgren) Department of Medical Sciences and Uppsala Clinical Research
Centre, Uppsala University Hospital, Uppsala, Sweden
(Hohnloser) Department of Cardiology, J.W. Goethe University, Frankfurt,
Germany
Title
Design and Rationale of the RE-DUAL PCI Trial: A Prospective, Randomized,
Phase 3b Study Comparing the Safety and Efficacy of Dual Antithrombotic
Therapy With Dabigatran Etexilate Versus Warfarin Triple Therapy in
Patients With Nonvalvular Atrial Fibrillation Who Have Undergone
Percutaneous Coronary Intervention With Stenting.
Source
Clinical Cardiology. 39 (10) (pp 555-564), 2016. Date of Publication: 01
Oct 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Antithrombotic management of patients with atrial fibrillation (AF)
undergoing coronary stenting is complicated by the need for anticoagulant
therapy for stroke prevention and dual antiplatelet therapy for prevention
of stent thrombosis and coronary events. Triple antithrombotic therapy,
typically comprising warfarin, aspirin, and clopidogrel, is associated
with a high risk of bleeding. A modest-sized trial of oral anticoagulation
with warfarin and clopidogrel without aspirin showed improvements in both
bleeding and thrombotic events compared with triple therapy, but large
trials are lacking. The RE-DUAL PCI trial (NCT 02164864) is a phase 3b, a
strategy of prospective, randomized, open-label, blinded-endpoint trial.
The main objective is to evaluate dual antithrombotic therapy with
dabigatran etexilate (110 or 150 mg twice daily) and a P2Y12 inhibtor
(either clopidogrel or ticagrelor) compared with triple antithrombotic
therapy with warfarin, a P2Y12 inhibtor (either clopidogrel or ticagrelor,
and low-dose aspirin (for 1 or 3 months, depending on stent type) in
nonvalvular AF patients who have undergone percutaneous coronary
intervention with stenting. The primary endpoint is time to first
International Society of Thrombosis and Hemostasis major bleeding event or
clinically relevant nonmajor bleeding event. Secondary endpoints are the
composite of all cause death or thrombotic events (myocardial infarction,
or stroke/systemic embolism) and unplanned revascularization; death or
thrombotic events; individual outcome events; death, myocardial
infarction, or stroke; and unplanned revascularization. A hierarchical
procedure for multiple testing will be used. The plan is to randomize ~
2500 patients at approximately 550 centers worldwide to try to identify
new treatment strategies for this patient population. Copyright &#xa9;
2016 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

<51>
Accession Number
613127366
Author
Tanboga I.H.; Topcu S.; Aksakal E.; Kurt M.; Kaya A.; Oduncu V.; Sevimli
S.
Institution
(Tanboga, Topcu, Aksakal, Sevimli) Department of Cardiology, Faculty of
Medicine, Ataturk University, Erzurum, Turkey
(Kurt) Department of Cardiology, Faculty of Medicine, Mustafa Kemal
University, Hatay, Turkey
(Kaya) Department of Cardiology, Faculty of Medicine, Ordu University,
Ordu, Turkey
(Oduncu) Department of Cardiology, Faculty of Medicine, Bahcesehir
University, Istanbul, Turkey
Title
Thrombus aspiration in patients with ST elevation myocardial infarction:
Meta-analysis of 16 randomized trials.
Source
Anatolian Journal of Cardiology. 15 (3) (pp 175-187), 2015. Date of
Publication: 2015.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: The mortality rate is high in some patients undergoing primary
percutaneous coronary intervention (PPCI) because of ineffective
epicardial and myocardial perfusion. The use of thrombus aspiration (TA)
might be beneficial in this group but there is contradictory evidence in
current trials. Therefore, using PRISMA statement, we performed a
meta-analysis that compares PPCI+TA with PPCI alone. Methods: Sixteen
studies in which PPCI (n=5262) versus PPCI+TA (n=5256) were performed,
were included in this meta-analysis. We calculated the risk ratio (RR) for
epicardial and myocardial perfusion, such as the Thrombolysis In
myocardial Infarction (TIMI) flow, myocardial blush grade (MBG) and stent
thrombosis (ST) resolution (STR), and clinical outcomes, such as all-cause
death, recurrent infarction (Re-MI), target vessel
revascularization/target lesion revascularization (TVR/TLR), stent
thrombosis (ST), and stroke. Results: Postprocedural TIMI-III flow
frequency, postprocedural MBG II-III flow frequency, and postprocedural
STR were significantly high in TA+PPCI compared with the PPCI alone group.
However, neither all-cause mortality [6.6% vs. 7.4%, RR=0.903, 95%
confidence interval (CI): 0.785-1.038, p=0.149] nor Re-MI (2.3% vs. 2.6%,
RR=0.884, 95% CI: 0.693-1.127, p=0.319), TVR/TLR (8.2% vs. 8.0%, RR=1.028,
95% CI: 0.900-1.174, p=0.687), ST (0.93% vs. 0.90%, RR=1.029, 95% CI:
0.668-1.583, p=0.898), and stroke (0.5% vs. 0.5%, RR=1.073, 95% CI:
0.588-1.959, p=0.819) rates were comparable between the groups.
Conclusion: This meta-analysis is the first updated analysis after
publishing the 1-year result of the "Thrombus Aspiration during ST-Segment
Elevation Myocardial Infarction" trial, and it showed that TA did not
reduce the rate of all-cause mortality, Re-MI, TVR/TLR, ST, and stroke.
Copyright &#xa9; 2015 by Turkish Society of Cardiology.

<52>
Accession Number
608527890
Author
Lauschke J.; Schneider R.; Wissmann J.; Tischer T.; Bansch D.
Institution
(Lauschke, Schneider, Wissmann, Tischer, Bansch) Department of Cardiology,
University Medical Center, Ernst-Heydemann-Str. 6, Rostock 18059, Germany
Title
Single-catheter approach to pulmonary vein reisolation in selected
patients: Data from a prospective registry.
Source
Herz. 41 (7) (pp 625-629), 2016. Date of Publication: 01 Nov 2016.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: In addition to different types of single-tip ablation
catheters for pulmonary vein (PV) reisolation, a newly developed circular
mapping and ablation catheter (nMARQ) has been available since
2013 and is currently used only in initial PV isolation procedures. In
this prospective registry we present feasibility and efficacy data for PV
reisolation procedures with a single-catheter approach (nMARQ)
compared with a standard approach using a single-tip ablation catheter and
a circular mapping catheter. Methods: We included 35 carefully selected
patients in this prospective registry and assigned them in a 2:1 ratio to
undergo either PV reisolation with a single-tip ablation catheter together
with a steerable circular mapping catheter (group 1) or with the
nMARQcatheter only (group 2). The recurrence rate was
calculated for atrial tachyarrhythmias with a duration of > 30 s during a
mean follow-up of 12.7 months. Results: Reisolation of all PVs was
achieved in all patients of both groups. In group 2, all gaps could be
correctly identified with the nMARQ catheter. PV isolation was
clearly visible on the nMARQ catheter in all targeted veins.
With the nMARQ catheter the ablation time decreased
significantly (6.3 +/- 3.0 vs. 18.6 +/- 13.9 min, p < 0.05). The
recurrence rate of atrial fibrillation did not differ significantly
between the two groups (37.5 vs. 45.5 %, p = 0.66). Conclusion: In
selected patients, a complete PV reisolation procedure is feasible with a
singular circular mapping and ablation catheter. The 12-months success
rate is comparable to a classic approach with a combination of a
single-tip ablation catheter and a circular mapping catheter. Copyright
&#xa9; 2016, Springer Medizin Verlag.

<53>
Accession Number
612936805
Author
Glaser N.; Jackson V.; Holzmann M.J.; Franco-Cereceda A.; Sartipy U.
Institution
(Glaser, Jackson, Franco-Cereceda, Sartipy) Department of Cardiothoracic
Surgery and Anesthesiology, Karolinska University Hospital, Stockholm
SE-171 76, Sweden
(Glaser, Jackson, Franco-Cereceda, Sartipy) Department of Molecular
Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
(Holzmann) Department of Emergency Medicine, Karolinska University
Hospital, Stockholm, Sweden
(Holzmann) Department of Internal Medicine, Karolinska Institutet,
Stockholm, Sweden
Title
Aortic valve replacement with mechanical vs. biological prostheses in
patients aged 50-69 years.
Source
European Heart Journal. 37 (34) (pp 2658-2667), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims: The objective was to investigate the long-term all-cause mortality
in patients aged 50-69 years after aortic valve replacement (AVR) with
bioprosthetic or mechanical valves. Methods and results: All patients aged
50-69 years who had undergone AVR in Sweden 1997-2013 were identified from
the SwedishWebsystem for Enhancement and Development of Evidence-based
care in Heart disease Evaluated According to Recommended Therapies
register. Subsequent patient-level record linkage with national
health-data registers provided patient characteristics, vital status, and
clinical outcomes. Of the 4545 patients, 60% (2713/4545) had received
mechanical valves and 40% (1832/4545) bioprostheses. In 1099 propensity
score-matched patient pairs, 16% (180/1099) had died in the mechanical
valve group and 20% (217/1099) in the bioprosthetic group; mean follow-up
6.6 (maximum 17.2) years. Survival was higher in the mechanical than in
the bioprosthetic group: 5-, 10-, and 15-year survival 92, 79, and 59% vs.
89, 75, and 50%; hazard ratio 1.34; 95% confidence interval (CI)
1.09-1.66; P = 0.006. There was no difference in stroke [subdistribution
hazard ratio (sHR) 1.04; 95% CI 0.72-1.50, P = 0.848]; however, the risk
for aortic valve reoperation was higher (sHR 2.36; 95% CI 1.42-3.94, P =
0.001), and for major bleeding lower (sHR 0.49; 95% CI 0.34-0.70, P <
0.001), in patients who had received bioprostheses than in those with
mechanical valves. Conclusion: Patients aged 50-69 years who received
mechanical valves had better long-term survival after AVR than those with
bioprostheses. The risk of stroke was similar; however, patients with
bioprostheses had a higher risk of aortic valve reoperation and a lower
risk of major bleeding. Copyright &#xa9; The Author 2016.

<54>
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.

<55>
[Use Link to view the full text]
Accession Number
611873297
Author
Ferrick A.M.; Tian D.; Vudathaneni V.; Shevchuk O.L.; Ferrick N.J.;
Frishman W.
Institution
(Ferrick, Frishman) Division of Cardiology, Westchester Medical Center,
Macy Pavilion, Department of Medicine, New York Medical College, 100 Wood
Road, Valhalla, NY 10592, United States
(Tian) Cardiology Section, Department of Medicine, Boston University
Medical Center, Boston, MA, United States
(Vudathaneni, Shevchuk) Department of Medicine, Mount Vernon Hospital
Center, Mount Vernon, NY, United States
(Ferrick) Ross University, School of Medicine, Miramar, FL, United States
Title
Wearable cardioverter defibrillators.
Source
Cardiology in Review. 24 (6) (pp 282-287), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The use of implantable cardioverter defibrillators (ICD) has favorably
impacted the prevention and treatment of sudden cardiac death (SCD)
associated with ventricular arrhythmias. However, there are situations
where an ICD cannot be immediately implanted, even though the patient is
at high risk for SCD. The wearable cardioverter defibrillator (WCD) is a
unique technology that can bridge this gap for patients. The WCD has been
demonstrated to terminate ventricular tachycardia/fibrillation if worn and
used correctly. With proper training, it is relatively easy to put on,
maintain, and use. Most patients are compliant and are able to
consistently wear the device. The WCD negates the infection risk or
procedural complications associated with insertion and possible extraction
of leads, as with an ICD. In terms of primary prevention of ventricular
tachycardia/fibrillation in patients with a left ventricular ejection
fraction <35%, prospective, randomized studies evaluating the survival of
patients utilizing the WCD will need to be performed before
evidenced-based criteria for its use can be established. On the basis of
current data, WCD use for those awaiting heart transplant, for those with
ICD indications status post-ICD explant, and for high-risk SCD patients
with possible reversible cardiomyopathy appears to be a reasonable
approach on the basis of current data. Copyright &#xa9; 2016 Wolters
Kluwer Health, Inc.

<56>
Accession Number
611738405
Author
Madeira M.; Teixeira R.; Costa M.; Goncalves L.; Klein A.L.
Institution
(Madeira, Teixeira, Costa, Goncalves) Servico de Cardiologia, Centro
Hospitalar e Universitario de Coimbra - Hospital Geral, Coimbra, Portugal
(Teixeira, Goncalves) Faculty of Medicine, University of Coimbra, Coimbra,
Portugal
(Klein) Heart and Vascular Institute, Center for the Diagnosis and
Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, OH, United
States
Title
Two-dimensional speckle tracking cardiac mechanics and constrictive
pericarditis: systematic review.
Source
Echocardiography. 33 (10) (pp 1589-1599), 2016. Date of Publication: 01
Oct 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Transthoracic echocardiography has a pivotal role in the diagnosis of
constrictive pericarditis (CP). In addition to the classic M-mode,
two-dimensional and Doppler indices, newer methodologies designed to
evaluate myocardial mechanics, such as two-dimensional speckle tracking
echocardiography (2DSTE), provide additional diagnostic and clinical
information in the context of CP. Research has demonstrated that cardiac
mechanics can improve echocardiographic diagnostic accuracy of CP and aid
in differentiating between constrictive and restrictive ventricular
physiology. 2DSTE can also be used to assess the success of
pericardiectomy and its impact on atrial and ventricular mechanics. In the
course of this review, we describe cardiac mechanics in patients with CP
and summarize the influence of pericardiectomy on atrial and ventricular
mechanics assessed using 2DSTE. Copyright &#xa9; 2016, Wiley Periodicals,
Inc.

<57>
Accession Number
609108399
Author
Li Y.-L.; Qiao S.-B.; Wang J.-Y.; Chen Y.-M.; Luo J.; Zhang H.-F.
Institution
(Li, Luo, Zhang) Health Division of Guard Bureau, General staff Department
of Chinese PLA, Beijing, China
(Qiao) Department of Cardiology, The People's Hospital of Rizhao, Rizhao,
Shandong, China
(Wang) Department of Cardiovascular Surgery, The Second People's Hospital
of Yunnan Province, Kunming, Yunnan, China
(Chen) Department of Pediatrics, Beijing Chao-Yang Hospital, Capital
Medical University, Beijing, China
Title
Colchicine in addition to conventional therapy for pericarditis
recurrence: An update meta-analysis.
Source
Herz. 41 (7) (pp 630-638), 2016. Date of Publication: 01 Nov 2016.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: Randomized controlled trials (RCTs) have investigated the use
of colchicine and conventional therapy for reducing the recurrence of
pericarditis in patients with acute pericarditis or post-pericardiotomy
syndrome. However, the benefits of these treatments are variable. Methods:
Studies were retrieved from PubMed, the Cochrane Library, and the EMBASE
database. Results: We identified nine RCTs with 1832 patients and a mean
follow-up of 13.1 months. Overall, colchicine therapy significantly
decreased the risk of pericarditis recurrence (odds ratio, OR 0.42; 95 %
confidence interval, CI 0.33-0.52; P < 0.001; I² = 17.0 %).
Colchicine therapy was associated with significantly lower rates of
pericarditis-associated rehospitalization (OR 0.29; 95 % CI 0.16-0.53; P <
0.0001; I² = 0.0 %) and persistence of symptoms (OR 0.29; 95 %
CI, 0.21-0.41; P = 0.000; I² = 0.0 %) at 72 h. Adverse events
were higher in the colchicine group (relative risk, RR 1.48; 95 % CI,
1.06-2.07; P = 0.02; I² = 0.0 %). Subgroup analysis showed that
recurrence of pericarditis was significantly lower in the colchicine
therapy group, irrespective of prednisone use and the cause of
pericarditis. Conclusion: Colchicine significantly decreases the rate of
pericarditis recurrence, regardless of prednisone use and the cause of
pericarditis. Larger studies are needed to confirm this effect. Copyright
&#xa9; 2016, Springer Medizin Verlag.

<58>
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.

<59>
Accession Number
613084042
Author
Matte G.S.; Connor K.R.; Liu H.; DiNardo J.A.; Faraoni D.; Pigula F.
Institution
(Matte, Connor, Liu) Department of Cardiac Surgery, Boston Children's
Hospital, Boston, MA, United States
(DiNardo, Faraoni) Department of Anesthesiology, Perioperative and Pain
Medicine, Harvard Medical School, Boston, MA, United States
(Pigula) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
Title
Arterial limb microemboli during cardiopulmonary bypass: Observations from
a congenital cardiac surgery practice.
Source
Journal of Extra-Corporeal Technology. 48 (1) (pp 5-10), 2016. Date of
Publication: 2016.
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
Gaseous microemboli (GME) are known to be delivered to the arterial
circulation of patients during cardiopulmonary bypass (CPB). An increased
number ofGME delivered during adult CPB has been associated with brain
injury and postoperative cognitive dysfunction. The GME load in children
exposed to CPB and its consequences are not well characterized. We sought
to establish a baseline of arterial limb emboli counts during the conduct
of CPB for our population of patients requiring surgery for congenital
heart disease. We used the emboli detection and counting (EDAC) device to
measure GME activity in 103 consecutive patients for which an EDAC machine
was available. Emboli counts for GME < 40 mu and > 40 mu were quantified
and indexed to CPB time (minutes) and body surface area (BSA) to account
for the variation in patient size and CPB times. Patients of all sizes had
a similar embolic burden when indexed to bypass time and BSA. Furthermore,
patients of all sizes saw a three-fold increase in the < 40 mu embolic
burden and a five-fold increase in the > 40 mu embolic burden when regular
air was noted in the venous line. The use of kinetic venous-assisted
drainage did not significantly increase arterial limb GME. Efforts for
early identification and mitigation of venous line air are warranted to
minimize GME transmission to congenital cardiac surgery patients during
CPB.

<60>
Accession Number
612908366
Author
Vallakati A.; Reddy S.; Dunlap M.E.; Taylor D.O.
Institution
(Vallakati) Division of Cardiovascular Diseases, Ohio State University
Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, United States
(Reddy, Dunlap) Division of Cardiovascular Diseases, Metrohealth Medical
Center, Case Western Reserve University, Cleveland, OH, United States
(Taylor) Department of Cardiovascular Medicine, Heart and Vascular
Institute Cleveland Clinic, Cleveland, OH, United States
Title
Impact of Statin Use after Heart Transplantation.
Source
Circulation: Heart Failure. 9 (10) (no pagination), 2016. Article Number:
e003265. Date of Publication: 01 Oct 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Although various studies revealed the beneficial effects of
statins in post-cardiac transplant patients, these were relatively small
and low-powered studies. We performed a meta-analysis of published studies
to evaluate the role of statins in post-cardiac transplant patients,
specifically examining the effects on hemodynamically significant/fatal
graft rejection, coronary vasculopathy, terminal cancer, and overall
survival. Methods and Results - We searched PubMed, Cochran CENTRAL, and
Web of Science databases using the search terms "cardiac transplant" or
"heart transplant," and "statin" for a literature search. A random-effects
model with Mantel-Haenszel method was used to pool the data. We identified
10 studies, 4 randomized controlled trials, and 6 nonrandomized studies,
which compared outcomes in heart transplant recipients undergoing statin
therapy to statin-naive patients. A pooled analysis of 9 studies reporting
mortality revealed that the use of statins was associated with significant
reduction in all-cause mortality (odds ratio, 0.26; 95% confidence
interval, 0.20-0.35; P<0.0001). Statins also decreased the odds of
hemodynamically significant/fatal rejection (odds ratio, 0.37; 95%
confidence interval, 0.21-0.65; P=0.0005), incidence of coronary
vasculopathy (odds ratio, 0.33; 95% confidence interval, 0.16-0.68;
P=0.003), and terminal cancer (odds ratio, 0.30; 95% confidence interval,
0.15-0.63; P=0.002). Conclusions - The evidence from a pooled analysis
suggests that statins improve survival in heart transplant recipients.
Statins may prevent fatal rejection episodes, decrease terminal cancer
risk, and reduce the incidence of coronary vasculopathy. Additional
prospective studies are needed to further investigate and explain this
association. Copyright &#xa9; 2016 American Heart Association, Inc.

<61>
Accession Number
612915973
Author
Pelliccia F.; Rollini F.; Marazzi G.; Greco C.; Gaudio C.; Angiolillo
D.J.; Rosano G.
Institution
(Pelliccia, Greco, Gaudio) Department 'Attilio Reale', Sapienza
University, Rome, Italy
(Rollini, Angiolillo) Division of Cardiology, Department of Medicine,
University of Florida College of Medicine, Jacksonville, FL, United States
(Marazzi, Rosano) IRCCS San Raffaele Pisana, Rome, Italy
(Gaudio) Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy
(Rosano) Cardiovascular and Cell Sciences Research Institute, St.
George's, University of London, London, United Kingdom
Title
New oral anticoagulants and dual antiplatelet therapy: Focus on apixaban.
Source
International Journal of Cardiology. 225 (pp 154-158), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
The combination of AF and coronary artery disease not only is a common
clinical setting, it is also a complex setting to deal with
anticoagulation and antiplatelet therapy, and it is associated with
significantly higher mortality rates. Unfortunately, there are no
sufficient data available to optimally guide clinical practice in such
settings. This review focuses specifically on newer oral anticoagulants
(NOACs) associated with dual antiplatelet therapy (DAPT) in patients with
coronary artery disease undergoing percutaneous coronary intervention
(PCI). There are no randomized studies comparing vitamin K antagonists and
NOACs in patients with AF undergoing PCI either for acute coronary
syndromes or for stable patients, i.e. those patients who have an
indication to receive DAPT. Moreover, new antiplatelet agents such as
ticagrelor and prasugrel have entered the market for acute coronary
syndromes. So far, there are no large-scale randomized studies published
evaluating these newer antiplatelet agents in patients with AF receiving
either vitamin K antagonists or NOACs, adding to the uncertainty on how to
use these antithrombotics in combination when both coronary artery disease
(unstable or stable patients) and AF converge in a given patient. The lack
of large outcome trials and the large number of possible combinations are
reflected in the wide variety of practices in the real world. To date,
given the lack of data, watchfulness when using NOACs as component of DAPT
or triple oral antithrombotic therapy is warranted. Copyright &#xa9; 2016
Elsevier Ireland Ltd

<62>
Accession Number
612903022
Author
Eisenberger M.; Bulava A.; Kautzner J.; Neuzil P.; Mokracek A.; Hanis J.;
Dusek L.
Institution
(Eisenberger, Mokracek, Hanis) South Bohemia Cardiac Centre, Budweis
Hospital, B. Nemcove 54, Budweis, Czech Republic
(Eisenberger) South Bohemia University, Faculty of Health and Social
Studies, J. Boreckeho 27, Budweis, Czech Republic
(Kautzner) Institute for Clinical and Experimental Medicine, Department of
Cardiology, Videnska 1958/9, Prague, Czech Republic
(Neuzil) Department of Cardiology, Na Homolce Hospital, Roentgenova 2,
Prague, Czech Republic
(Dusek) The Institute of Biostatistics and Analyses, Masaryk University,
Kamenice 5, Brno, Czech Republic
(Bulava) Palacky University Olomouc, Faculty of Medicine and Dentistry,
Olomouc, Czech Republic
Title
Sequential Hybrid CryoMaze Ablation versus Surgical CryoMaze Alone for the
Treatment of Atrial Fibrillation (SurHyb): Study protocol for a randomized
controlled trial.
Source
Trials. 17 (1) (no pagination), 2016. Article Number: 518. Date of
Publication: 24 Oct 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial fibrillation is common in patients with structural
heart disease who are undergoing cardiac surgery. Surgical CryoMaze has
been shown to be an effective treatment in several trials, but success
rates have varied considerably, between 47-95 %. The sequential hybrid
approach, combining surgical CryoMaze followed by radiofrequency catheter
ablation, can achieve high freedom from atrial arrhythmias, even when
rigorous methods to detect arrhythmias after the procedure are used.
However, data from randomized trials comparing hybrid ablations to
surgical ablations alone are lacking. Methods/Design: The SurHyb study is
a prospective, multicenter, randomized study. Patients with persistent or
long-standing persistent atrial fibrillation will be randomized to either
surgical CryoMaze alone or surgical CryoMaze followed by catheter ablation
3 months post-surgery. The primary outcome measure is arrhythmia-free
survival without class I or III antiarrhythmic drugs, which will be
evaluated using 7-day ECG Holter monitoring at 24 months. A total of 260
patients will be investigated from three medical centers in the Czech
Republic to obtain the relevant information. Discussion: This is the first
randomized study that compares surgical CryoMaze alone with the staged
hybrid surgical CryoMaze followed by catheter ablation in patients with
persistent or long-standing persistent atrial fibrillation. These results
will contribute to the optimization of the treatment for these patients.
Trial registration: Czech Clinical Trials Registry, cz-301020151253.
Registered on 30 October 2015. Copyright &#xa9; 2016 The Author(s).

<63>
Accession Number
613105969
Author
Lee M.S.; Shlofmitz E.; Mansourian P.; Sethi S.; Shlofmitz R.A.
Institution
(Lee, Shlofmitz, Shlofmitz) UCLA Medical Center, 100 Medical Plaza, Suite
630, Los Angeles, CA 90095, United States
(Mansourian) Northwell Health, Manhasset, NY, United States
(Sethi) Heart Center, St. Francis Hospital, Roslyn, NY, United States
Title
Gender-based differences in outcomes after orbital atherectomy for the
treatment of de novo severely calcified coronary lesions.
Source
Journal of Invasive Cardiology. 28 (11) (pp 440-443), 2016. Date of
Publication: November 2016.
Publisher
HMP Communications
Abstract
OBJECTIVES: We evaluated the relationship between gender and angiographic
and clinical outcomes in patients with severely calcified lesions who
underwent orbital atherectomy. BACKGROUND: Female gender is associated
with increased risk of adverse clinical events after percutaneous coronary
intervention (PCI). Severe coronary artery calcification increases the
complexity of PCI and increases the risk of adverse cardiac events.
Orbital atherectomy is effective in plaque modification, which facilitates
stent delivery and expansion. Whether gender differences exist after
orbital atherectomy is unclear. METHODS: Our analysis retrospectively
analyzed 458 consecutive real-world patients (314 males and 144 females)
from three centers who underwent orbital atherectomy. The primary endpoint
was the major adverse cardiac and cerebrovascular event (MACCE) rate,
defined as the composite of death, myocardial infarction (MI),
target-vessel revascularization (TVR), and stroke, at 30 days. RESULTS:
The primary endpoint of MACCE was low and similar in females and males
(0.7% vs 2.9%; P<.14). The individual endpoints of death (0.7% vs 1.6%;
P<.43), MI (0.7% vs 1.3%; P<.58), TVR (0% vs 0%; P>.99), and stroke (0% vs
0.3%; P<.50) were low in both groups and did not differ. Angiographic
complications were low: perforation (0.8% vs 0.7%; P>.90), dissection
(0.8% vs 1.1%; P<.80), and no-reflow (0.8% vs 0.7%; P>.90). CONCLUSION:
Plaque modification with orbital atherectomy was safe and provided similar
angiographic and clinical outcomes between females and males. Randomized
trials with longer-Term follow-up are needed to support our results.

<64>
Accession Number
613101748
Author
Gripari P.; Tamborini G.; Bottari V.; Maffessanti F.; Carminati M.C.;
Muratori M.; Vignati C.; Bartorelli A.L.; Alamanni F.; Pepi M.
Institution
(Gripari, Tamborini, Bottari, Carminati, Muratori, Vignati, Bartorelli,
Alamanni, Pepi) Centro Cardiologico Monzino IRCCS, Milan, Italy
(Maffessanti) Department of Medicine, Section of Cardiology, University of
Chicago, Chicago, Illinois, United States
(Maffessanti) Center for Computational Medicine in Cardiology, Institute
of Computational Sciences, Universita della Svizzera Italiana, Lugano,
Switzerland
(Bartorelli, Alamanni) Department of Clinical Sciences and Community
Health, Cardiovascular Section, University of Milan, Milan, Italy
Title
Three-Dimensional Transthoracic Echocardiography in the Comprehensive
Evaluation of Right and Left Heart Chamber Remodeling Following
Percutaneous Mitral Valve Repair.
Source
Journal of the American Society of Echocardiography. 29 (10) (pp 946-954),
2016. Date of Publication: 01 Oct 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Percutaneous mitral valve repair (PMVR) is an alternative
treatment in patients with significant mitral regurgitation (MR) who are
denied surgery. Although in surgical patients, outcomes have been related
both to acute hemodynamic favorable results and to positive cardiac
remodeling in the midterm, in the case of PMVR the effect on cardiac
chamber remodeling has never been extensively studied. The aims of this
study were (1) to evaluate the short- and mid-term remodeling induced by
PMVR on cardiac chamber volume using two- and three-dimensional (3D)
transthoracic echocardiographic (TTE) imaging and (2) to assess changes in
left ventricular (LV) shape on the basis of 3D TTE data. Methods Patients
undergoing PMVR were prospectively enrolled. Two-dimensional and 3D TTE
data sets acquired at baseline, and at 30 days and 6 months after PMVR
were analyzed to assess LV and right ventricular (RV) volumes and ejection
fraction and left atrial and right atrial volumes. Moreover, 3D
endocardial surfaces were extracted to compute 3D shape indexes of LV
sphericity and conicity at end-diastole and end-systole. Results Six of
the 64 enrolled patients did not reach follow-up and were excluded. The
analysis was feasible in all 58 patients considered (26 with functional MR
and 32 [55%] with degenerative MR). PMVR resulted in significant reduction
of MR and in favorable remodeling: (1) effective PMVR was mainly
associated with decreased LV loading, (2) PMVR-related reverse remodeling
was observed in patients with degenerative MR and those with functional MR
at 30 days and continued at 6-month follow-up, (3) favorable remodeling in
LV shape from abnormally spherical to more normal conical took place in
both groups after PMVR, and (4) RV volumes and systolic function were
preserved after PMVR. Conclusions A comprehensive two-dimensional and 3D
TTE analysis allows investigation from a double perspective (volume and
morphology) of the entity and modality of changes following PMVR. In
high-risk patients undergoing PMVR, postprocedural heart remodeling
involves all cardiac chambers, occurs in the short term, and further
improves at midterm follow-up. Copyright &#xa9; 2016 American Society of
Echocardiography

<65>
Accession Number
613110328
Author
Mansourian S.; Bina P.; Fehri A.; Karimi A.A.; Boroumand M.A.; Abbasi K.
Institution
(Mansourian, Bina, Fehri, Karimi, Boroumand, Abbasi) Department of Cardiac
Surgery, Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Preoperative oral pentoxifylline in case of coronary artery bypass
grafting with left ventricular dysfunction (Ejection fraction equal
to/less than 30%).
Source
Anatolian Journal of Cardiology. 15 (12) (pp 1014-1019), 2015. Date of
Publication: 2015.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Most coronary artery bypass grafts are done by applying
cardiopulmonary bypass, which usually induces unwanted inflammatory
reactions and impairs the outcomes. In order to minimize the perilous
response of cardiopulmonary bypass, pentoxifylline was getting used
orally. Methods: In a prospective, placebo-controlled, randomized clinical
trial, 178 coronary artery bypass graft candidates with ejection fraction
lower/equal to 30%, divided into two equal groups (pentoxifylline and
control), participated in the study. Pentoxifylline patients received 400
mg pentoxifylline 3 times a day for 3 days before operation. The outcomes
were compared between groups using student's t-test, Mann-Whitney U-test,
Pearson chi-square, or Fisher's exact test. Results: Pentoxifylline
administration did not significantly affect troponin-T (p=0.68), but it
reduced tumor necrosis factor-alpha (p=0.01) and inter-leukin-6 (p=0.01).
It improved left ventricular ejection fraction significantly (p=0.01).
White blood cell and platelet counts, hemoglobin, and hematocrit were not
influenced by pentoxifylline. The drug did not affect blood urea nitrogen
and creatinine, occurrence of renal failure, cere-brovascular accidents,
and in-hospital mortality rate. The need for an intra-aortic balloon pump,
cardiopulmonary bypass, and aortic cross-clamp times were not affected,
either. Pentoxifylline decreased the intensive care unit stay (p<0.001),
ventilation time, 10.4 hours in the pentoxifylline group against 14.7
hours in the control group (p=0.01), and the requirement of inotropic
agents (p=0.02) and blood transfusion (p=0.01). Conclusion: Pentoxifylline
has more beneficial potencies in reducing adverse events after coronary
artery bypass graft using cardiopulmonary bypass, than what are known.
Copyright &#xa9; 2015 by Turkish Society of Cardiology.

<66>
Accession Number
601050581
Author
Bethlehem I.; Wierda K.; Visser C.; Jekel L.; Koopmans M.; Kuiper M.A.
Institution
(Bethlehem, Wierda, Visser) Department of Extracorporeal Circulation,
Medical Centre Leeuwarden, Leeuwarden, Netherlands
(Jekel) Department of Cardiothoracic Surgery, Medical Centre Leeuwarden,
Leeuwarden, Netherlands
(Koopmans, Kuiper) Department of Intensive Care, Medical Centre
Leeuwarden, Leeuwarden, Netherlands
Title
Influence of two colloidal extracorporeal primes on coagulation of cardiac
surgical patients: A prospectively randomized open-label pilot trial.
Source
Journal of Extra-Corporeal Technology. 46 (4) (pp 293-299), 2014. Date of
Publication: 2014.
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
The search for the ideal priming fluid continues as more evidence is
discovered about side effects of volume expanders.With the availability
ofmodern, balanced hydroxyethyl starch (HES) solutions with less side
effects than former HES solutions, we considered to replace our gelatin-
(modified gelatin) based extracorporeal circuit prime for a HES (130/.42)
prime. Therefore, we studied the influence of two colloidal priming fluids
on postoperative coagulation in patients undergoing cardiac surgery. The
primary endpoint was to compare clot formation time between the HES group
and the gelatin group with rotational thromboelastometry (ROTEM).
Additionally we compared colloid osmotic pressure and fluid balance of
both groups. Forty patients, undergoing elective first time coronary
artery bypass grafting or single-valve surgery, were included in this
prospectively randomized open-label pilot study. Laboratory data and ROTEM
data were collected and analyzed for differences between the two groups.
ROTEM data show significantly more prolongation in Extem clot formation
time and significant more decrease in Extem alpha in the HES group. Fibtem
maximum clot firmness was significantly smaller in the HES group; this was
consistent with fibrinogen concentration measurement, which decreased more
in the HES group than in the gelatin group and recovered more over time in
the gelatin group. We found no significant difference in colloid osmotic
pressure between the groups. In this trial, HES (130/.42) impairs
coagulation significantly more compared with gelatin. These differences in
influence on coagulation did not lead to a difference in blood loss or
fluid balance, so clinical relevance could not be proven.

<67>
Accession Number
610536631
Author
Cutrell J.B.; Barros N.; McBroom M.; Luby J.; Minhajuddin A.; Ring W.S.;
Greilich P.E.
Institution
(Cutrell, Barros, McBroom, Luby, Minhajuddin, Ring, Greilich) University
of Texas Southwestern Medical Center, Dallas, TX, United States
(Cutrell) Veterans Affairs North Texas Health Care System, Dallas, TX,
United States
(Barros, Luby) Parkland Health and Hospital System, Dallas, TX, United
States
Title
Risk factors for deep sternal wound infection after cardiac surgery:
Influence of red blood cell transfusions and chronic infection.
Source
American Journal of Infection Control. 44 (11) (pp 1302-1309), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Deep sternal wound infection (DSWI) following cardiac surgery
is a serious complication, but risk factors associated with DSWI have not
been fully elucidated. Methods We analyzed all DSWI cases at our
institution from 2010-2013 in adult cardiac median sternotomy cases, based
on Society of Thoracic Surgeons or National Healthcare Safety Network
definitions, but with 1-year surveillance postsurgery. Controls were
matched 3:1 per case for procedure, age, and year of surgery. Demographic
and operative data were pulled from Society of Thoracic Surgeons database
and chart review. Potential variables were evaluated using univariate and
multivariate conditional logistic regression. Results Out of 1,894
surgeries performed, 39 DSWI cases (2%) and 117 controls were identified.
In univariate analyses, patients with red blood cell (RBC) transfusion>4
units, any platelet transfusion, previous infections, and chronic
infections were associated with higher DSWI. RBC transfusion>4 units
(P=.037) and chronic infections (P=.029) remained significant risk factors
for DSWI in multivariate analysis. Preoperative anemia alone was not
associated with more DSWI, but its interaction with RBC transfusion>4
units was significant. Conclusions High-volume RBC transfusions and
chronic infections were strongly associated with DSWI in our population
and represent potentially modifiable areas for improvement. Copyright
&#xa9; 2016 Association for Professionals in Infection Control and
Epidemiology, Inc.

<68>
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

<69>
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

<70>
Accession Number
613090450
Author
Shah R.; Berzingi C.; Mumtaz M.; Jasper J.B.; Goswami R.; Morsy M.S.;
Ramanathan K.B.; Rao S.V.
Institution
(Shah, Jasper, Goswami, Morsy, Ramanathan) Section of Cardiology, School
of Medicine, University of Tennessee, Memphis, Tennessee, United States
(Shah, Ramanathan) Veterans Affairs Medical Center, Memphis, Tennessee,
United States
(Berzingi) West Virginia University Heart Institute, Morgantown, West
Virginia, United States
(Mumtaz) Pinnacle Health, Wormleysburg, Pennsylvania, United States
(Rao) The Duke Clinical Research Institute, Durham, North Carolina, United
States
Title
Meta-Analysis Comparing Complete Revascularization Versus Infarct-Related
Only Strategies for Patients With ST-Segment Elevation Myocardial
Infarction and Multivessel Coronary Artery Disease.
Source
American Journal of Cardiology. 118 (10) (pp 1466-1472), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Several recent randomized controlled trials (RCTs) demonstrated better
outcomes with multivessel complete revascularization (CR) than with
infarct-related artery-only revascularization (IRA-OR) in patients with
ST-segment elevation myocardial infarction. It is unclear whether CR
should be performed during the index procedure (IP) at the time of primary
percutaneous coronary intervention (PCI) or as a staged procedure (SP).
Therefore, we performed a pairwise meta-analysis using a random-effects
model and network meta-analysis using mixed-treatment comparison models to
compare the efficacies of 3 revascularization strategies (IRA-OR, CR-IP,
and CR-SP). Scientific databases and websites were searched to find RCTs.
Data from 9 RCTs involving 2,176 patients were included. In
mixed-comparison models, CR-IP decreased the risk of major adverse cardiac
events (MACEs; odds ratio [OR] 0.36, 95% CI 0.25 to 0.54), recurrent
myocardial infarction (MI; OR 0.50, 95% CI 0.24 to 0.91),
revascularization (OR 0.24, 95% CI 0.15 to 0.38), and cardiovascular (CV)
mortality (OR 0.44, 95% CI 0.20 to 0.87). However, only the rates of
MACEs, MI, and CV mortality were lower with CR-SP than with IRA-OR.
Similarly, in direct-comparison meta-analysis, the risk of MI was 66%
lower with CR-IP than with IRA-OR, but this advantage was not seen with
CR-SP. There were no differences in all-cause mortality between the 3
revascularization strategies. In conclusion, this meta-analysis shows that
in patients with ST-segment elevation myocardial infarction and
multivessel coronary artery disease, CR either during primary PCI or as an
SP results in lower occurrences of MACE, revascularization, and CV
mortality than IRA-OR. CR performed during primary PCI also results in
lower rates of recurrent MI and seems the most efficacious
revascularization strategy of the 3. Copyright &#xa9; 2016

<71>
Accession Number
613090414
Author
Popovic B.; Girerd N.; Rossignol P.; Agrinier N.; Camenzind E.; Fay R.;
Pitt B.; Zannad F.
Institution
(Popovic, Girerd, Camenzind, Zannad) CHU Nancy, Departement de
Cardiologie, Nancy, France
(Girerd, Rossignol, Fay, Zannad) INSERM, Centre d'Investigation Clinique
CIC-P 9501, Nancy, France
(Agrinier) CHU Nancy, Epidemiologie et Evaluation Cliniques, Nancy, France
(Pitt) University of Michigan School of Medicine, Ann Arbor, Michigan,
United States
Title
Prognostic Value of the Thrombolysis in Myocardial Infarction Risk Score
in ST-Elevation Myocardial Infarction Patients With Left Ventricular
Dysfunction (from the EPHESUS Trial).
Source
American Journal of Cardiology. 118 (10) (pp 1442-1447), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The Thrombolysis in Myocardial Infarction (TIMI) risk score remains a
robust prediction tool for short-term and midterm outcome in the patients
with ST-elevation myocardial infarction (STEMI). However, the validity of
this risk score in patients with STEMI with reduced left ventricular
ejection fraction (LVEF) remains unclear. A total of 2,854 patients with
STEMI with early coronary revascularization participating in the
randomized EPHESUS (Epleronone Post-Acute Myocardial Infarction Heart
Failure Efficacy and Survival Study) trial were analyzed. TIMI risk score
was calculated at baseline, and its predictive value was evaluated using
C-indexes from Cox models. The increase in reclassification of other
variables in addition to TIMI score was assessed using the net
reclassification index. TIMI risk score had a poor predictive accuracy for
all-cause mortality (C-index values at 30 days and 1 year <0.67) and
recurrent myocardial infarction (MI; C-index values <0.60). Among TIMI
score items, diabetes/hypertension/angina, heart rate >100 beats/min, and
systolic blood pressure <100 mm Hg were inconsistently associated with
survival, whereas none of the TIMI score items, aside from age, were
significantly associated with MI recurrence. Using a constructed
predictive model, lower LVEF, lower estimated glomerular filtration rate
(eGFR), and previous MI were significantly associated with all-cause
mortality. The predictive accuracy of this model, which included LVEF and
eGFR, was fair for both 30-day and 1-year all-cause mortality (C-index
values ranging from 0.71 to 0.75). In conclusion, TIMI risk score
demonstrates poor discrimination in predicting mortality or recurrent MI
in patients with STEMI with reduced LVEF. LVEF and eGFR are major factors
that should not be ignored by predictive risk scores in this population.
Copyright &#xa9; 2016 Elsevier Inc.

<72>
Accession Number
612910321
Author
Cavalcante J.L.; Marek J.; Sheppard R.; Starling R.C.; Mather P.J.; Alexis
J.D.; Narula J.; McNamara D.M.; Gorcsan J.
Institution
(Cavalcante, Marek, McNamara, Gorcsan) Heart and Vascular Institute-UPMC,
UPMC/University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA S-558,
United States
(Sheppard) Jewish General Hospital, McGill University, Montreal, Canada
(Starling) Cleveland Clinic Foundation, Cleveland, OH, United States
(Mather) Jefferson Medical College of Thomas Jefferson University,
Philadelphia, PA, United States
(Alexis) University of Rochester Medical Center, Rochester, NY, United
States
(Narula) Mount Sinai Hospital, New York, NY, United States
Title
Diastolic function improvement is associated with favourable outcomes in
patients with acute non-ischaemic cardiomyopathy: Insights from the
multicentre IMAC-2 trial.
Source
European Heart Journal Cardiovascular Imaging. 17 (9) (pp 1027-1035),
2016. Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Patients with recent onset non-ischaemic cardiomyopathy have a
variable clinical course with respect to recovery of left ventricular
ejection fraction (LVEF). The aim of this study was to understand whether
temporal changes in diastolic function (DF) are associated with clinical
outcomes independent of LVEF recovery. Methods and results The
Intervention in Myocarditis and Acute Cardiomyopathy (IMAC)-2 study was a
prospective, multicentre trial investigating myocardial recovery in
subjects with symptoms onset of ,6 months and LVEF ?40% of non-ischaemic
dilated cardiomyopathy related to idiopathic cardiomyopathy or
myocarditis. LVEF and DF were measured at presentation and at 6-month
follow-up. Of 147 patients (mean age 46+14 years, 40% female), baseline
LVEF was 23+8%. At 6 months, LVEF improved to 41+12%, with 71% increasing
by at least 10% ejection fraction units. DF improved in 58%, was unchanged
in 28%, and worsened in 14%. Over a mean follow-up of 1.8+1.2 years, there
were 18 events: 11 heart failure (HF) hospitalizations, 3 deaths, and 4
heart transplants. LVEF (HR 0.94, 95% CI 0.91-0.98, P 0.002) and DF
improvements at 6 months (HR 0.32, 95% CI 0.11-0.92, P 0.03) were
independently associated with lower likelihood for the combined end point
of death, transplantation, and HF hospitalization. Diastolic functional
improvement at 6-month follow-up was as prognostically important as LVEF
recovery for these patients, and provided incremental prognostic value to
the risk stratification (X2 increased from 12.6 to 18, P 0.02). Conclusion
In patients with recent onset non-ischaemic cardiomyopathy, DF recovery
was associated with favourable outcomes independent of LVEF improvement,
adding incremental prognostic value to these patients. Copyright &#xa9;
The Author 2015.

<73>
Accession Number
612908922
Author
Thongprayoon C.; Cheungpasitporn W.; Gillaspie E.A.; Greason K.L.; Kashani
K.B.
Institution
(Thongprayoon, Cheungpasitporn, Kashani) Division of Nephrology and
Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
United States
(Gillaspie, Greason) Division of Cardiovascular Surgery, Department of
Surgery, Mayo Clinic, Rochester, MN, United States
(Kashani) Division of Pulmonary and Critical Care Medicine, Mayo Clinic,
Rochester, MN, United States
Title
The risk of acute kidney injury following transapical versus transfemoral
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Clinical Kidney Journal. 9 (4) (pp 560-566), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background: The aim of this systematic review is to examine the literature
for the risk of acute kidney injury (AKI) in patients who underwent
transcatheter aortic valve replacement (TAVR) based on transapical (TA)
versus transfemoral (TF) approaches. Methods: A literature search was
conducted utilizing Embase, Medline, Cochrane Database of Systematic
Reviews and ClinicalTrials.gov from inception through December 2015.
Studies that reported relative risk, odds ratio or hazard ratio comparing
the AKI risk in patients who underwent TA-TAVR versus TF-TAVR were
included. Pooled risk ratio (RR) and 95% confidence interval (CI) were
calculated using a random effect, generic inverse variance method.
Results: Seventeen cohort studies with 5085 patients were enrolled in the
analysis to assess the risk of AKI in patients undergoing TA-TAVR versus
TF-TAVR. The pooled RR of AKI in patients who underwent TA-TAVR was 2.26
(95% CI 1.79-2.86) when compared with TF-TAVR. When meta-analysis was
confined to the studies with adjusted analysis for confounders evaluating
the risk of AKI following TAVR, the pooled RR of TA-TAVR was 2.89 (95% CI
2.12-3.94). The risk for moderate to severe AKI [RR 1.02 (95% CI
0.57-1.80)] in patients who underwent TA-TAVR compared with TF-TAVR was
not significantly higher. Conclusions: Our meta-analysis demonstrates an
association between TA-TAVR and a higher risk of AKI. Future studies are
required to assess the risks of moderate to severe AKI and mortality
following TA-TAVR versus TF-TAVR. Copyright &#xa9; The Author 2016.

<74>
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.

<75>
Accession Number
611262810
Author
Petroni T.; Zaman A.; Georges J.-L.; Hammoudi N.; Berman E.; Segev A.;
Juliard J.-M.; Barthelemy O.; Silvain J.; Choussat R.; Le Feuvre C.; Helft
G.
Institution
(Petroni, Hammoudi, Berman, Barthelemy, Silvain, Choussat, Le Feuvre,
Helft) Cardiology Institute, Pitie-Salpetriere Hospital, UPMC, Paris
75013, France
(Zaman) Freeman Hospital, Institute of Cellular Medicine, Newcastle
University, Newcastle Upon Tyne, United Kingdom
(Georges) Centre Hospitalier de Versailles, Andre Mignot Hospital, Le
Chesnay, France
(Segev) Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
(Juliard) Bichat Hospital, APHP, Paris, France
Title
Primary percutaneous coronary intervention for ST elevation myocardial
infarction in nonagenarians.
Source
Heart. 102 (20) (pp 1648-1654), 2016. Date of Publication: 15 Oct 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To assess outcomes following primary percutaneous coronary
intervention (PCI) for ST-segment elevation acute myocardial infarction
(STEMI) in nonagenarian patients. Methods We conducted a multicentre
retrospective study between 2006 and 2013 in five international highvolume
centres and included consecutive all-comer nonagenarians treated with
primary PCI for STEMI. There were no exclusion criteria. We enrolled 145
patients and collected demographic, clinical and procedural data. Severe
clinical events and mortality at 6 months and 1 year were assessed.
Results Cardiogenic shock was present at admission in 21%. Median (IQR)
delay between symptom onset and balloon was 3.7 (2.4-5.6) hours and 60% of
procedures were performed through the transradial approach. Successful
revascularisation of the culprit vessel was obtained in 86% of the cases
(thrombolysis in myocardial infarction flow of 2 or 3). Major or
clinically relevant bleeding was observed in 4% of patients. Median left
ventricular ejection fraction post PCI was 41.5% (32.0-50.0). The
in-hospital mortality was 24%, with 6 months and 1-year survival rates of
61% and 53%, respectively. Conclusions In our study, primary PCI in
nonagenarians with STEMI was achieved and feasible through a transradial
approach. It is associated with a high rate of reperfusion of the
infarct-related artery and 53% survival at 1 year. These results suggest
that primary PCI may be offered in selected nonagenarians with acute
myocardial infarction. Copyright &#xa9; 2016 Published by the BMJ
Publishing Group Limited.

<76>
Accession Number
612943013
Author
Eichler S.; Voller H.
Institution
(Eichler, Voller) Center of Rehabilitation Research, University of
Potsdam, Am Neuen Palais 10, Potsdam 14469, Germany
(Voller) Department of Cardiology, Klinik am See, Rudersdorf, Germany
Title
Advances in cardiac rehabilitation: Cardiac rehabilitation after
transcatheter aortic valve implantation.
Source
Monaldi Archives for Chest Disease - Cardiac Series. 86 (1-2) (no
pagination), 2016. Article Number: 758. Date of Publication: 2016.
Publisher
Fondazione Salvatore Maugeri (Via Ferrata 8, Pavia 27100, Italy)
Abstract
For more than a decade, transcatheter aortic valve implantation (TAVI) has
become a promising treatment modality for patients with severe aortic
stenosis and a high surgical risk. To improve exercise capacity and
quality of life, cardiac rehabilitation (CR) including physical activity
is a well-established treatment for patients after cardiac valve surgery.
First studies have shown that CR could also be a helpful tool to maintain
independency for activities of daily living and participation in
socio-cultural life in patients after TAVI. Strength and balance training
are important parts of physical activity in octogenarians and have been
investigated in healthy older adults in several studies, but need to be
widened and investigated for TAVI patients. Hence, for this older patient
group, there are more prospective multicentre studies needed. &#xa9; 2016
Copyright M. Ambrosetti, Tipografia PI-ME Editrice, Italy.

<77>
Accession Number
612783338
Author
Huygens S.A.; Rutten-VanMolken M.P.M.H.; Bekkers J.A.; Bogers A.J.J.C.;
Bouten C.V.C.; Chamuleau S.A.J.; DeJaegere P.P.T.; Pieter Kappetein A.;
Kluin J.; Vanmieghem N.M.D.A.; Versteegh M.I.M.; Witsenburg M.; Takkenberg
J.J.M.
Institution
(Huygens, Bekkers, Bogers, Pieter Kappetein, Takkenberg) Department of
Cardio Thoracic Surgery, Erasmus University Medical, Rotterdam,
Netherlands
(Huygens, Rutten-VanMolken) Institute for Medical Technology Assessment,
Erasmus University, Rotterdam, Netherlands
(Huygens, Rutten-VanMolken) Department of Health Policy and Management,
Erasmus University, Rotterdam, Netherlands
(Bouten) Department of Biomedical Engineering, Eindhoven University of
Technology, Eindhoven, Netherlands
(Chamuleau) Department of Cardiology, University Medical Centre, Utrecht,
Netherlands
(DeJaegere, Vanmieghem) Department of Cardiology, Erasmus University
Medical, Rotterdam, Netherlands
(Kluin) Department of Cardio Thoracic Surgery, Academic Medical Centre,
Amsterdam, Netherlands
(Versteegh, Witsenburg) Department of Cardio Thoracic Surgery, Leiden
University Medical, Leiden, Netherlands
Title
Conceptual model for early health technology assessment of current and
novel heart valve interventions.
Source
Open Heart. 3 (2) (no pagination), 2016. Article Number: e000500. Date of
Publication: 01 Oct 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Advances in the field of heart valve interventions, like tissue-engineered
heart valves (TEHV). Prior to introduction in clinical practice, it is
essential to perform early health technology assessment. We aim to develop
a conceptual model (CM) that can be used to investigate the performance
and costs requirements for TEHV to become cost-effective. Methods: After
scoping the decision problem, a workgroup developed the draft CM based on
clinical guidelines. This model was compared with existing models for
cost-effectiveness of heart valve interventions, identified by systematic
literature search. Next, it was discussed with a Delphi panel of
cardiothoracic surgeons, cardiologists and a biomedical scientist (n=10).
Results: The CM starts with the valve implantation. If patients survive
the intervention, they can remain alive without complications, die from
non-valve-related causes or experience a valve-related event. The events
are separated in early and late events. After surviving an event, patients
can experience another event or die due to non-valve-related causes.
Predictors will include age, gender, NYHA class, left ventricular function
and diabetes. Costs and quality adjusted life years are to be attached to
health conditions to estimate long-term costs and health outcomes.
Conclusions: We developed a CM that will serve as foundation of a
decision-analytic model that can estimate the potential cost-effectiveness
of TEHV in early development stages. This supports developers in deciding
about further development of TEHV and identifies promising interventions
that may result in faster take-up in clinical practice by clinicians and
reimbursement by payers.

<78>
Accession Number
613014793
Author
Pourier V.E.C.; de Borst G.J.
Institution
(Pourier, de Borst) Department of Vascular Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
Title
Technical options for treatment of in-stent restenosis after carotid
artery stenting.
Source
Journal of Vascular Surgery. 64 (5) (pp 1486-1496), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective This review summarizes the available evidence and analyzes the
current trends on treatments for carotid in-stent restenosis (ISR) after
carotid artery stenting (CAS). Methods An update of a 2010 review of the
literature (which included 20 articles) was conducted using PubMed and
Embase. All studies published from inception until January 2016 reporting
original data on ISR treatments were included. Treatment trends before and
after 2005 were compared. Results We found 22 new articles reporting ISR
treatments in 138 patients, of which two (case series) were published
before 2005. With the inclusion of the 20 articles of the 2010 report (n =
96 patients), a total of 42 articles were included (23 case reports and 19
case series) reporting 239 interventions for ISR in 234 patients. Of these
42 studies, 14 (including 10 case series) were published before 2005. The
interventions were percutaneous transluminal angioplasty (PTA) in 136,
repeat CAS in 51, carotid endarterectomy in 39, carotid artery bypass in
10, or brachytherapy in 3. Compared with the articles published before
2005, PTA with regular balloon remains the most practiced treatment (26%
before 2005, 40% after 2005). PTA with drug-coated balloons started after
2005. Carotid endarterectomy with stent removal was the second most
reported treatment before 2005 but moved to the third place of reported
interventions after 2005 owing to an increase in repeat CAS treatment. Of
the treated patients, 140 were asymptomatic, 72 were symptomatic, and for
22 the symptomology was unclear. ISR treatment averaged 18 months after
CAS, and the follow-up thereafter was 16 months. Treatment for recurrent
ISR was performed in 48 of 239 treated arteries, mostly after PTA (n = 35)
and repeat CAS (n = 8). Conclusions The available evidence for ISR
treatment is still limited owing to methodologic heterogeneity; therefore,
no recommendation on the optimal intervention can be provided. Although
PTA is the common treatment for ISR, recurrent ISR seems to limit the
durability, leading to recurrent interventions and cost implications. A
uniform definition for ISR is needed with a standardized workup to compare
the treatment options based on individual patient data analysis.
Drug-eluting techniques are emerging and may become the preferred
treatment option, but long-term follow-up is needed to evaluate their
efficacy. Further study and understanding of the effect of drug-eluting
technologies on the brain and neurologic function is warranted. Copyright
&#xa9; 2016 Society for Vascular Surgery

<79>
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.

<80>
Accession Number
612704050
Author
Chieffo A.; Petronio A.S.; Mehilli J.; Chandrasekhar J.; Sartori S.;
Lefevre T.; Presbitero P.; Capranzano P.; Tchetche D.; Iadanza A.;
Sardella G.; Van Mieghem N.M.; Meliga E.; Dumonteil N.; Fraccaro C.;
Trabattoni D.; Mikhail G.W.; Sharma S.; Ferrer M.C.; Naber C.; Kievit P.;
Faggioni M.; Snyder C.; Morice M.C.; Mehran R.
Institution
(Chieffo) Department of Cardiology, San Raffaele Scientific Institute,
Milan, Italy
(Petronio, Faggioni) Department of Cardiology, AOUP Cisanello, University
Hospital, Pisa, Italy
(Mehilli) Department of Cardiology, Ludwig-Maximilians-University of
Munich, Munich, Germany
(Chandrasekhar, Sartori, Faggioni, Snyder, Mehran) The Zena and Michael A.
Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai,
New York, New York, United States
(Lefevre, Morice) Department of Cardiology, Institut Hospitalier Jacques
Cartier, Ramsay Generale de Sante, Massy, France
(Presbitero) Department of Cardiology, Istituto Clinico Humanitas; Milan,
Italy
(Capranzano) Department of Cardiology, University of Catania, Catania,
Italy
(Tchetche) Department of Cardiology, Clinique Pasteur, Toulouse, France
(Iadanza) Department of Cardiology, Azienda Ospedaliera Universitaria
Senese, Policlinico Le Scotte, Siena, Italy
(Sardella) Department of Cardiology, Policlinico "Umberto I", "Sapienza"
University of Rome, Rome, Italy
(Van Mieghem) Department of Cardiology, Erasmus Medical Center,
Thoraxcenter, Rotterdam, Netherlands
(Meliga) Department of Cardiology, Mauriziano Hospital, Turin, Italy
(Dumonteil) Department of Cardiology, Rangueil University Hospital,
Toulouse, France
(Fraccaro) Department of Cardiology, University of Padova, Padova, Italy
(Trabattoni) Department of Cardiology, Centro Cardiologico Monzino, Milan,
Italy
(Mikhail) Department of Cardiology, Imperial College Healthcare NHS Trust,
Hammersmith Hospital, London, United Kingdom
(Sharma) Department of Cardiology, Mount Sinai Hospital, New York, New
York, United States
(Ferrer) Department of Cardiology, Hospital Universitario Miguel Servet,
Zaragoza, Spain
(Naber) Department of Cardiology, Contilia Heart and Vascular Centre,
Elisabeth Krankenhaus, Essen, Germany
(Kievit) Department of Cardiology, Radboud University Nijmegen Medical
Center, Nijmegen, Netherlands
Title
Acute and 30-Day Outcomes in Women After TAVR: Results From the WIN-TAVI
(Women's INternational Transcatheter Aortic Valve Implantation) Real-World
Registry.
Source
JACC: Cardiovascular Interventions. 9 (15) (pp 1589-1600), 2016. Date of
Publication: 08 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to examine the safety and performance of
transcatheter aortic valve replacement (TAVR) using an all-female registry
and to further explore the potential impact of female sex-specific
characteristics on clinical outcomes after TAVR. Background Although women
comprise 50% of patients with symptomatic severe aortic stenosis
undergoing TAVR, the optimal treatment strategy remains undetermined.
Methods The WIN-TAVI (Women's INternational Transcatheter Aortic Valve
Implantation) registry is a multinational, prospective, observational
registry of women undergoing TAVR for aortic stenosis, conducted without
any external funding. The primary endpoint was the Valve Academic Research
Consortium (VARC)-2 early safety endpoint at 30 days (composite of
mortality, stroke, major vascular complication, life-threatening bleeding,
stage 2 or 3 acute kidney injury, coronary artery obstruction, or repeat
procedure for valve-related dysfunction). Results Between January 2013 and
December 2015, 1,019 women were enrolled across 19 European and North
American centers. The mean patient age was 82.5 +/- 6.3 years, mean
EuroSCORE I was 17.8 +/- 11.7% and mean Society of Thoracic Surgeons score
was 8.3 +/- 7.4%. TAVR was performed via transfemoral access in 90.6% and
new-generation devices were used in 42.1%. In more than two-thirds of
cases, an Edwards SAPIEN 23 mm (Edwards Lifesciences, Irvine, California)
or Medtronic CoreValve <26 mm (Medtronic Inc., Minneapolis, Minnesota)
device was implanted. The 30-day VARC-2 composite endpoint occurred in
14.0% with 3.4% all-cause mortality, 1.3% stroke, 7.7% major vascular
complications, and 4.4% VARC life-threatening bleeding. The independent
predictors of the primary endpoint were age (odds ratio [OR]: 1.04; 95%
confidence interval [CI]: 1.00 to 1.08), prior stroke (OR: 2.02; 95% CI:
1.07 to 3.80), left ventricular ejection fraction <30% (OR: 2.62; 95% CI:
1.07 to 6.40), new device generation (OR: 0.59; 95% CI: 0.38 to 0.91), and
history of pregnancy (OR: 0.57; 95% CI: 0.37 to 0.85). Conclusions Women
enrolled in this first ever all-female TAVR registry with collection of
female sex-specific baseline parameters, were at intermediate-high risk
and experienced a 30-day VARC-2 composite safety endpoint of 14.0% with a
low incidence of early mortality and stroke. Randomized assessment of TAVR
versus surgical aortic valve replacement in intermediate risk women is
warranted to determine the optimal strategy. Copyright &#xa9; 2016
American College of Cardiology Foundation

<81>
Accession Number
612895019
Author
Cosmi B.
Institution
(Cosmi) Department of Angiology & Blood Coagulation 'Marino Golinelli',
University Hospital S. Orsola-Malpighi, Bologna, Italy
Title
An update on the pharmaceutical management of thrombosis.
Source
Expert Opinion on Pharmacotherapy. 17 (16) (pp 2149-2164), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Introduction: Anticoagulants such as heparins and vitamin K antagonists
(VKA) are effective for thrombosis prevention and treatment, but are
associated with the risk of bleeding and other limitations, spurring the
search for improved drugs. Areas covered: to evaluate the newer
anticoagulants, focusing on those tested in phase III clinical trials such
as direct oral anticoagulants (DOACs), antisense oligonucleotides (ASO)
and warfarin analogues. DOACs such as dabigatran, rivaroxaban, apixaban
and edoxaban are licensed for stroke prevention in atrial fibrillation and
treatment of venous thromboembolism, dabigatran, rivaroxaban and apixaban
for postoperative thromboprophylaxis in patients undergoing elective hip
or knee arthroplasty and rivaroxaban for secondary prevention of acute
coronary syndromes. ASO interfering with Factor XI hepatic synthesis were
effective and safe for thromboprophylaxis in elective knee arthroplasty.
Expert opinion: DOACs have overcome some limitations of anticoagulants
such as VKA, but are still associated with a risk of bleeding and they
lack both standardized and widely available tests measuring their
anticoagulant effect and a reversal agent, except for idarucizumab,
specific for dabigatran, in case of major or life threatening bleeding or
emergency surgery. Agents targeting Factor XI and possibly Factor XII may
be ideal anticoagulants, as they can prevent thrombosis with low bleeding
risk. Copyright &#xa9; 2016 Informa UK Limited, trading as Taylor &
Francis Group.

<82>
[Use Link to view the full text]
Accession Number
612344068
Author
Karkouti K.; Callum J.; Wijeysundera D.N.; Rao V.; Crowther M.; Grocott
H.P.; Pinto R.; Scales D.C.; Achen B.; Brar S.; Morrison D.; Wong D.;
Bussieres J.S.; De Waal T.; Harle C.; De Medicis E.; McAdams C.; Syed S.;
Tran D.; Waters T.
Institution
(Karkouti) Department of Anesthesia and Pain Management, Toronto General
Hospital, University Health Network, University of Toronto, 3EN, Toronto,
ON M5G 2C4, Canada
(Callum) Department of Laboratory Medicine and Pathobiology, Sunnybrook
Health Sciences Centre, University of Toronto, Canada
(Wijeysundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, University Health Network, University of Toronto, Li Ka
Shing Knowledge Institute of St. Michael's Hospital, Canada
(Rao) Division of Cardiac Surgery, Department of Surgery, Toronto General
Hospital, University Health Network, University of Toronto, Canada
(Crowther) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, Canada
(Pinto) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, University of Toronto, Canada
(Scales) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, Interdepartmental Division of Critical Care, University of
Toronto, Canada
(Karkouti, Wijeysundera, Rao) Peter Munk Cardiac Centre, University Health
Network, Toronto, Canada
(Achen) Department of Anesthesia, University Hospital, Edmonton, AB,
Canada
(Brar, Morrison, Wong) Department of Anesthesia, Royal Columbian Hospital,
New Westminster, BC, Canada
(Bussieres) Department of Anesthesia, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
(De Waal) Department of Anesthesia, Southlake Regional Health Centre,
Newmarket, ON, Canada
(Harle) Department of Anesthesia, London Health Sciences Centre (LHSC),
University Hospital, London, ON, Canada
(De Medicis) Department of Anesthesia, Sherbrooke Hopital Fleurimont
(CHUS), Sherbrooke, QC, Canada
(McAdams) Department of Anesthesia, Alberta Health Science Centre,
Calgary, AB, Canada
(Syed) Department of Anesthesia, Hamilton Health Sciences Centre (HHSC),
McMaster University, Hamilton, ON, Canada
(Tran) Department of Anesthesia, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Waters) Department of Anesthesia, VCH Vancouver Coastal Health (UBC),
Vancouver, BC, Canada
Title
Point-of-Care Hemostatic Testing in Cardiac Surgery: A Stepped-Wedge
Clustered Randomized Controlled Trial.
Source
Circulation. 134 (16) (pp 1152-1162), 2016. Date of Publication: 18 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Cardiac surgery is frequently complicated by coagulopathic
bleeding that is difficult to optimally manage using standard hemostatic
testing. We hypothesized that point-of-care hemostatic testing within the
context of an integrated transfusion algorithm would improve the
management of coagulopathy in cardiac surgery and thereby reduce blood
transfusions. Methods: We conducted a pragmatic multicenter stepped-wedge
cluster randomized controlled trial of a point-of-care-based transfusion
algorithm in consecutive patients undergoing cardiac surgery with
cardiopulmonary bypass at 12 hospitals from October 6, 2014, to May 1,
2015. Following a 1-month data collection at all participating hospitals,
a transfusion algorithm incorporating point-of-care hemostatic testing was
sequentially implemented at 2 hospitals at a time in 1-month intervals,
with the implementation order randomly assigned. No other aspects of care
were modified. The primary outcome was red blood cell transfusion from
surgery to postoperative day 7. Other outcomes included transfusion of
other blood products, major bleeding, and major complications. The
analysis adjusted for secular time trends, within-hospital clustering, and
patient-level risk factors. All outcomes and analyses were prespecified
before study initiation. Results: Among the 7402 patients studied, 3555
underwent surgery during the control phase and 3847 during the
intervention phase. Overall, 3329 (45.0%) received red blood cells, 1863
(25.2%) received platelets, 1645 (22.2%) received plasma, and 394 (5.3%)
received cryoprecipitate. Major bleeding occurred in 1773 (24.1%)
patients, and major complications occurred in 740 (10.2%) patients. The
trial intervention reduced rates of red blood cell transfusion (adjusted
relative risk, 0.91; 95% confidence interval, 0.85-0.98; P=0.02; number
needed to treat, 24.7), platelet transfusion (relative risk, 0.77; 95%
confidence interval, 0.68-0.87; P<0.001; number needed to treat, 16.7),
and major bleeding (relative risk, 0.83; 95% confidence interval,
0.72-0.94; P=0.004; number needed to treat, 22.6), but had no effect on
other blood product transfusions or major complications. Conclusions:
Implementation of point-of-care hemostatic testing within the context of
an integrated transfusion algorithm reduces red blood cell transfusions,
platelet transfusions, and major bleeding following cardiac surgery. Our
findings support the broader adoption of point-of-care hemostatic testing
into clinical practice. Clinical Trial Registration: URL:
http://www.clinicaltrials.gov. Unique identifier: NCT02200419. Copyright
&#xa9; 2016 American Heart Association, Inc.

<83>
Accession Number
610572794
Author
Olmos-Temois S.G.; Santos-Martinez L.E.; Alvarez-Alvarez R.;
Gutierrez-Delgado L.G.; Baranda-Tovar F.M.
Institution
(Olmos-Temois, Santos-Martinez, Alvarez-Alvarez, Gutierrez-Delgado,
Baranda-Tovar) Departamento de Cuidados Intensivos Posquirurgicos
Cardiovasculares, Instituto Nacional de Cardiologia <<Ignacio Chavez>>,
Mexico D.F., Mexico
(Santos-Martinez) Unidad Medica de Alta Especialidad, Departamento de
Hipertension Pulmonar y Funcion Ventricular Derecha, Hospital de
Cardiologia del Centro Medico Nacional Siglo XXI, Instituto Mexicano del
Seguro Social, Mexico D.F., Mexico
Title
Interobserver agreement on the echocardiographic parameters that estimate
right ventricular systolic function in the early postoperative period of
cardiac surgery.
Source
Medicina Intensiva. 40 (8) (pp 491-498), 2016. Date of Publication: 01 Nov
2016.
Publisher
Ediciones Doyma, S.L. (E-mail: suscripciones@doyma.es)
Abstract
Primary objective To know the variability of transthoracic
echocardiographic parameters that assess right ventricular systolic
function by analyzing interobserver agreement in the early postoperative
period of cardiovascular surgery. Secondary objective To assess the
feasibility of these echocardiographic measurements. Design A
cross-sectional study, double-blind pilot study was carried out from May
2011 to February 2013. Setting Cardiovascular postoperative critical care
at the National Institute of Cardiology "Ignacio Chavez", Mexico City,
Mexico. Patients Consecutive, non-probabilistic sampling. Fifty-six
patients were studied in the postoperative period of cardiac surgery.
Intervention The first echocardiographic parameters were obtained between
6-8 hours after cardiac surgery, followed by blinded second measurements.
Main variables Tricuspid annular plane systolic excursion (TAPSE),
tricuspid annular peak systolic velocity on tissue Doppler imaging
(VSPAT), diameters and right ventricular outflow area, tract fractional
shortening. The agreement was analyzed by the Bland-Altman method, and its
magnitude was assessed by the intraclass correlation coefficient (95%
confidence interval). Results Both observers evaluated TAPSE and VSPAT in
48 patients (92%). The average TAPSE was 11.68 +/- 4.53 mm (range 4-27
mm). Right ventricular systolic dysfunction was observed in 41 cases (85%)
and normal TAPSE in 7 patients (15%). The average difference and its
limits according to TAPSE were -0.917 +/- 2.95 (-6.821, 4.988), with a
magnitude of 0.725 (0.552, 0.837); the tricuspid annular peak systolic
velocity on tissue Doppler imaging was -0.001 +/- 0.015 (-0.031, 0.030),
and its magnitude 0.825 (0.708, 0.898), respectively. Conclusions VSPAT
and TAPSE were estimated by both observers in 92% of the patients, these
parameters exhibiting the lowest interobserver variability. Copyright
&#xa9; 2016 Elsevier Espana, S.L.U. y SEMICYUC

<84>
[Use Link to view the full text]
Accession Number
612076428
Author
Resor C.D.; Nathan A.; Kereiakes D.J.; Yeh R.W.; Massaro J.M.; Cutlip
D.E.; Steg P.G.; Hsieh W.-H.; Mauri L.
Institution
(Resor, Mauri) Department of Medicine, Division of Cardiology, Center for
Clinical Biometrics, Harvard Medical School, Cardiovascular Medicine,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
(Yeh, Cutlip, Hsieh, Mauri) Harvard Clinical Research Institute, Boston,
MA, United States
(Yeh, Mauri) Harvard Medical School, Boston, MA, United States
(Nathan) Division of Cardiology, University of Pennsylvania Medical
Center, Philadelphia, United States
(Yeh, Cutlip) Smith Center for Outcomes Research in Cardiology, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Massaro) Department of Biostatistics, Boston University School of Public
Heath, MA, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Steg) Universite Paris-Diderot, INSERM U-1148, Hopital Bichat,
Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodeling, Assistance Publique-Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Institute of Cardiovascular
Medicine and Science, Royal Brompton Hospital, Imperial College, London,
United Kingdom
Title
Impact of Optimal Medical Therapy in the Dual Antiplatelet Therapy Study.
Source
Circulation. 134 (14) (pp 989-998), 2016. Date of Publication: 04 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Continued dual antiplatelet therapy and optimal medical
therapy (OMT) improve outcomes in selected patient populations with
established coronary heart disease, but whether OMT modifies the treatment
effect of dual antiplatelet therapy is unknown. Methods: The DAPT (Dual
Antiplatelet Therapy) Study, a double-blind trial, randomly assigned 11
648 patients who had undergone coronary stenting and completed 1 year of
dual antiplatelet therapy without major bleeding or ischemic events to an
additional 18 months of continued thienopyridine or placebo. OMT was
defined as a combination of statin, beta-blocker, and
angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use
in patients with an American College of Cardiology/American Heart
Association class I indication for each medication. Per protocol, all
patients were treated with 75 to 325 mg aspirin daily. End points included
myocardial infarction, major adverse cardiovascular and cerebrovascular
events, and Global Utilization of Streptokinase and Tissue Plasminogen
Activator for Occluded Arteries moderate or severe bleeding events.
Results: Of 11 643 randomly assigned patients with complete medication
data, 63% were on OMT. Between 12 and 30 months, continued thienopyridine
reduced myocardial infarction in comparison with placebo in both groups
(on OMT 2.1% versus 3.3%, hazard ratio [HR], 0.64; 95% confidence interval
[CI], 0.48-0.86; P=0.003; off OMT 2.2% versus 5.2%, HR, 0.41; CI,
0.29-0.58; P<0.001; interaction P=0.103). Comparing continued
thienopyridine versus placebo, rates of major adverse cardiovascular and
cerebrovascular events were 4.2% versus 5.0% among patients on OMT (HR,
0.82; CI, 0.66-1.02; P=0.077) and 4.5% versus 7.0% among those off OMT
(HR, 0.63; CI, 0.49-0.82; P<0.001; interaction P=0.250); rates of bleeding
for thienopyridine versus placebo in patients on OMT were 2.2% versus 1.0%
(HR, 2.13; CI, 1.43-3.17; P<0.001), and in patients off OMT were 2.8%
versus 2.2% (HR, 1.30; CI, 0.88-1.92; P=0.189; interaction P=0.073).
Overall, patients on OMT had lower rates of myocardial infarction (2.7%
versus 3.7%, P=0.003), major adverse cardiovascular and cerebrovascular
events (4.6% versus 5.7%, P=0.007), and bleeding (1.6% versus 2.5%,
P<0.001) in comparison with patients off OMT. Rates of stent thrombosis
(0.8% versus 1.0%, P=0.171) and death (1.6% versus 1.9%, P=0.155) did not
differ. Conclusions: Continued thienopyridine therapy reduced the rate of
myocardial infarction regardless of OMT status and had consistent effects
on reduction in major adverse cardiovascular and cerebrovascular events
and increased bleeding. Copyright &#xa9; 2016 American Heart Association,
Inc.

<85>
Accession Number
612703977
Author
Schulze I.; Poos E.M.; Meyer H.; List A.K.; Kaestner S.B.R.; Rehage J.
Institution
(Schulze, Poos, Meyer, List, Rehage) Clinic for Cattle, University of
Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, Hannover
D-30173, Germany
(Kaestner) Clinic for Small Animals (Kaestner), University of Veterinary
Medicine Hannover, Foundation, Bunteweg 9, Hannover D-30559, Germany
Title
Effects of preoperative carprofen on cardio-respiratory, hormonal and
metabolic stress response in calves during umbilical surgery under
isoflurane inhalation anaesthesia.
Source
Veterinary Journal. 216 (pp 18-24), 2016. Date of Publication: 01 Oct
2016.
Publisher
Bailliere Tindall Ltd
Abstract
The aim of this study was to examine the effects of preoperative carprofen
on the cardiorespiratory, hormonal and metabolic stress response during
umbilical surgery under isoflurane anaesthesia combined with local
anaesthesia, in calves. A randomised, blinded experimental study was
conducted in 24 calves. Carprofen (n=12; 1.4mg/kg) or physiological saline
solution (controls; n=12) was administered 1h prior to surgery.
Anaesthesia was induced with xylazine (0.1mg/kg, IM) and, after the onset
of sedation (i.e. after 5-8min), ketamine was administered (2mg/kg, IV).
Anaesthesia was then maintained with isoflurane (ISO) in oxygen to effect
and completed by infiltration of the incision line with 20mL of 2%
procaine. Cardiorespiratory, endocrine and metabolic parameters were
examined before, during and after surgery at short intervals. In both
groups, anaesthesia appeared adequate for the surgical intervention. Heart
rate, stroke index and arterial blood pressure were significantly elevated
after the onset of surgery. Oxygen partial pressure and oxygen delivery
increased, while the oxygen extraction ratio decreased intraoperatively,
ensuring sufficient oxygen supply. In the control group, the mean surge in
serum cortisol concentrations tended to be higher (P=0.089) and systemic
vascular resistance (SVR) was significantly greater (P<0.05) than in the
carprofen group during surgery. In conclusion, the anaesthetic protocol
used in this study induced reliable analgesia in both groups. The lower
serum cortisol levels and SVR may indicate a reduced surgical stress
response in calves undergoing umbilical surgery under ISO anaesthesia
after administering carprofen preoperatively. Copyright &#xa9; 2016
Elsevier Ltd

<86>
Accession Number
613174275
Author
Kang D.-H.; Lee S.; Kim Y.-J.; Kim S.-H.; Kim D.-H.; Yun S.-C.; Song
J.-M.; Chung C.-H.; Song J.-K.; Lee J.-W.
Institution
(Kang, Lee, Kim, Kim, Yun, Song, Chung, Song, Lee) Division of Cardiology,
Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center,
College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu,
Seoul 05505, South Korea
(Kim) Cardiovascular Center, Seoul National University Hospital,
Department of Internal Medicine, Seoul National University College of
Medicine, Seoul, South Korea
Title
Long-term results of early surgery versus conventional treatment for
infective endocarditis trial.
Source
Korean Circulation Journal. 46 (6) (pp 846-850), 2016. Date of
Publication: November 2016.
Publisher
Korean Society of Circulation (E-mail: herz4@circulation.or.kr)
Abstract
Background and Objectives: Compared with conventional treatment, early
surgery significantly reduced the composite end point of allcause death
and embolic events during hospitalization, but long-term data in this area
are lacking. This study sought to compare longterm outcomes of early
surgery with a conventional treatment strategy in patients with infective
endocarditis (IE) and large vegetations. Subjects and Methods: The Early
Surgery versus Conventional Treatment in Infective Endocarditis (EASE)
trial randomly assigned patients with left-sided IE, severe valve disease
and large vegetation to early surgery (37 patients) or conventional
treatment groups (39 patients). The pre-specified end points were
all-cause death, embolic events, recurrence of IE and repeat
hospitalizations due to the development of congestive heart failure
occurring during follow-up. Results: There were no significant differences
between the early surgery and the conventional treatment group in
all-cause mortality at 4 years (8.1% and 7.7%, respectively; hazard ratio
[HR] 1.04; 95% CI, 0.21 to 5.15; p=0.96). The rate of the composite end
point of death from any cause, embolic events or recurrence of IE at 4
years was 8.1% in the early surgery group and 30.8% in the conventional
treatment group (HR, 0.22; 95% CI, 0.06-0.78; p=0.02). The estimated
actuarial rate of end points at 7 years was significantly lower in the
early surgery group than in the conventional treatment group (log-rank
p=0.007). Conclusion: There was a substantial benefit in having early
surgery for patients with IE and large vegetations whose health was
sustained up to 7 years, and late clinical outcome after surgery was
excellent in survivors of IE. Copyright &#xa9; 2016 The Korean Society of
Cardiology.

<87>
Accession Number
613174223
Author
Ekeloef S.; Alamili M.; Devereaux P.J.; Gogenur I.
Institution
(Ekeloef, Alamili, Gogenur) Department of Surgery, Center for Surgical
Science, Zealand University Hospital, Koege and Roskilde, Denmark
(Devereaux) Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, ON, Canada
(Devereaux) Department of Medicine, McMaster University, Hamilton, ON,
Canada
Title
Troponin elevations after non-cardiac, non-vascular surgery are predictive
of major adverse cardiac events and mortality: A systematic review and
meta-analysis.
Source
British Journal of Anaesthesia. 117 (5) (pp 559-568), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background: Patients undergoing non-cardiac, non-vascular surgery are at
risk of major cardiovascular complications. In non-cardiac surgery,
troponin elevation has previously been shown to be an independent
predictor of major adverse cardiac events and postoperative mortality;
however, a majority of studies have focused on vascular surgery patients.
The aim of this meta-analysis was to determine whether troponin elevation
is a predictor of major adverse cardiac events and mortality within 30
days and 1 yr after non-cardiac, non-vascular surgery. Methods: A
systematic review and meta-analysis was conducted in January 2016
according to the Meta-analysis Of Observational Studies in Epidemiology
guidelines. Both interventional and observational studies measuring
troponin within the first 4 days after surgery were eligible. A systematic
search was performed in PubMed, EMBASE, Scopus, and the Cochrane Central
Register of Controlled Trials. Results: Eleven eligible clinical studies
(n=2193) were identified. A postoperative troponin elevation was a
predictor of 30 day mortality, odds ratio (OR) 3.52 [95% confidence
interval (CI) 2.21-5.62; I²=0%], and an independent predictor
of 1 yr mortality, adjusted OR 2.53 (95% CI 1.20-5.36; I²=26%).
A postoperative troponin elevation was associated with major adverse
cardiac events at 30 days, OR 5.92 (95% CI 1.67-20.96; I²=86%),
and 1 yr after surgery, adjusted OR 3.00 (95% CI 1.43-6.29;
I²=21%). Conclusions: Postoperative myocardial injury is an
independent predictor of major adverse cardiac events and mortality within
30 days and 1 yr after non-cardiac, non-vascular surgery. The
meta-analysis provides evidence that supports troponin monitoring as a
cardiovascular risk stratification tool. Copyright &#xa9; 2016 The Author.
Published by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved.

<88>
Accession Number
613173404
Author
Sannino A.; Gargiulo G.; Schiattarella G.G.; Perrino C.; Stabile E.; Losi
M.-A.; Galderisi M.; Izzo R.; De Simone G.; Trimarco B.; Esposito G.
Institution
(Sannino, Gargiulo, Schiattarella, Perrino, Stabile, Losi, Galderisi,
Izzo, Trimarco, Esposito) Division of Cardiology, Department of Advanced
Biomedical Sciences, Federico II University, Via Pansini 5, Naples 80131,
Italy
(Perrino, Stabile, Losi, Galderisi, Izzo, De Simone, Trimarco, Esposito)
Hypertension Research Center, Federico II University, Naples, Italy
Title
A meta-analysis of the impact of pre-existing and new-onset atrial
fibrillation on clinical outcomes in patients undergoing transcatheter
aortic valve implantation.
Source
EuroIntervention. 12 (8) (pp e1047-e1056), 2016. Date of Publication:
October 2016.
Publisher
EuroPCR
Abstract
Aims: Little is known about the prognostic role of pre-existing atrial
fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve
implantation (TAVI). Therefore, the aim of this meta-analysis was to
compare the short-and long-term clinical outcomes of patients undergoing
TAVI with and without preexisting and new-onset AF. Methods and results:
Twenty-six studies, enrolling 14,078 patients undergoing TAVI, of whom
33.4% had pre-existing AF and 17.5% had NOAF, were analysed for early and
long-term all-cause mortality, cardiovascular mortality and
cerebrovascular events (CVE). In patients with pre-existing AF, 30-day
all-cause mortality was similar to patients in sinus rhythm (SR).
Conversely, long-term all-cause and cardiovascular mortality were
significantly greater in pre-existing AF patients than in patients with SR
(20 studies; 8,743 patients; HR: 1.68; p<0.00001, and three studies; 1,138
patients; HR: 2.07; p=0.01, respectively). Pre-existing AF was not a
predictor of CVE at long-term follow-up. NOAF patients showed similar
shortand long-term all-cause mortality when compared to patients in SR,
whereas they experienced a significantly higher incidence of CVE at
short-term follow-up (six studies; 2,025 patients; HR: 2.86; p<0.00001). A
non-significant increase in the incidence of CVE was observed at long-term
follow-up. Conclusions: Pre-existing AF is a predictor of all-cause
mortality in patients undergoing TAVI. NOAF is related to the occurrence
of CVE at short-term follow-up. Similarly to surgical aortic valve
replacement (SAVR), the optimal management and risk stratification of
these patients should be further investigated. Copyright &#xa9; 2016
Europa Digital & Publishing. All rights reserved.

<89>
Accession Number
613173393
Author
Kovac J.; Schuler G.; Gerckens U.; Muller R.; Serruys P.W.; Bonan R.;
Labinaz M.; Den Heijer P.; Mullen M.; Tymchak W.; Grube E.
Institution
(Kovac) Cardiovascular Biomedical Research Unit, University of Leicester,
Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom
(Schuler) University of Leipzig, Leipzig, Germany
(Gerckens, Muller, Grube) HELIOS Heart Center Siegburg, Siegburg, Germany
(Serruys) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Bonan) Institut de Cardiologie de Montreal, Montreal, Canada
(Labinaz) University of Ottawa Heart Institute, Ottawa, Canada
(Den Heijer) Amphia Hospital, Breda, Netherlands
(Mullen) Royal Brompton and Harefield NHS Trust, London, United Kingdom
(Tymchak) University of Alberta, Edmonton, Canada
Title
Four-year experience with the CoreValve transcatheter heart valve.
Source
EuroIntervention. 12 (8) (pp e1039-e1046), 2016. Date of Publication:
October 2016.
Publisher
EuroPCR
Abstract
Aims: Our aim was to evaluate the long-term device performance and
clinical outcomes of patients with symptomatic, severe aortic valve
stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI)
with the CoreValve bioprosthesis. Methods and results: The CoreValve CE
Pivotal Study was a prospective, multicentre, single-arm TAVI trial using
the CoreValve system. Valve performance, patient quality of life (QoL),
New York Heart Association (NYHA) class, and mortality at four years were
analysed in 126 patients (mean age 82.4 years, 42.9% male, mean logistic
EuroSCORE 23.4%) with severe AS. Mean aortic valve gradient decreased from
46.9+/-16.1 mmHg at baseline to 9.8+/-4.1 mmHg at discharge and to
7.8+/-2.7 mmHg at four years. Mean effective orifice area increased from
0.7+/-0.2 cm² to 1.8+/-0.4 cm² after TAVI and was
1.6+/-0.5 cm² at four years. There were no reports of
structural valve deterioration or valve migration. There was sustained
improvement in QoL and NYHA class in surviving patients. All-cause and
cardiac survival was 45.3% and 62.6%, respectively, at four years.
Conclusions: The CoreValve bioprosthesis demonstrates long-term
durability, stable haemodynamic function, and no evidence of structural
deterioration. Most surviving patients continued to have improved NYHA
class and QoL at four years. Copyright &#xa9; 2016 Europa Digital &
Publishing. All rights reserved.

<90>
Accession Number
613173107
Author
Biedrzycka A.; Kowalik M.; Pawlaczyk R.; Jagielak D.; Swietlik D.;
Szymanowicz W.; Lango R.
Institution
(Biedrzycka) Department of Anaesthesiology and Intensive Care, Medical
University of Gdansk, Gdansk, Poland
(Kowalik, Szymanowicz, Lango) Department of Cardiac Anaesthesia, Medical
University of Gdansk, Debinki Street 7, Gdansk 80-211, Poland
(Pawlaczyk, Jagielak) Department of Cardiac and Vascular Surgery, Medical
University of Gdansk, Gdansk, Poland
(Swietlik) Intrafaculty College of Medical Informatics and Biostatistics,
Medical University of Gdansk, Gdansk, Poland
Title
Aortic cross-clamping phase of cardiopulmonary bypass is related to
decreased microvascular reactivity after short-term ischaemia of the
thenar muscle both under intravenous and volatile anaesthesia: A
randomized trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 770-778),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES The purpose of the present study was to assess, by
near-infrared spectroscopy with an INVOS oximeter during the vascular
occlusion test (VOT), the influence of cardiopulmonary bypass (CPB) on
tissue saturation in the thenar muscle. The secondary aim was to compare
the effects of propofol and sevoflurane anaesthesia on tissue saturation.
METHODS This was a prospective, randomized, open-label study. Sixty
cardiac surgery patients received either propofol or sevoflurane
anaesthesia. Three-minute VOT was performed at the following time points:
30 min after anaesthesia induction, directly after sternotomy, 20 and 40
min after aortic cross-clamping, 20 min after aortic cross-clamp removal
and 45 min after weaning of cardiopulmonary bypass. Group and time effects
on tissue saturation were analysed with RM-ANOVA and the post hoc Tukey
test. RESULTS In both groups at baseline, the lowest and the highest
tissue saturation and the rate of saturation recovery during the
reperfusion phase of the vascular occlusion test were lower during aortic
cross-clamping in comparison to the values before CPB. Lower nadir tissue
saturation during ischaemia was observed under propofol in comparison to
sevoflurane anaesthesia (P = 0.018). CONCLUSIONS This study demonstrated
that the aortic cross-clamping phase of CPB cardiac surgery is associated
with lower values of tissue saturation and a decreased rate of saturation
recovery under both propofol and sevoflurane anaesthesia. Aortic
cross-clamp release is followed by accelerated tissue desaturation during
VOT. Propofol anaesthesia for CPB cardiac surgery results in greater
reduction of nadir tissue saturation during the ischaemic phase of VOT in
comparison to that of sevoflurane. TRIAL REGISTRATION NUMBER NCT02593448
Copyright &#xa9; 2016 The Author 2016. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<91>
Accession Number
613172482
Author
Anastasiadis K.; Antonitsis P.; Vranis K.; Kleontas A.; Asteriou C.;
Grosomanidis V.; Tossios P.; Argiriadou H.
Institution
(Anastasiadis, Antonitsis, Vranis, Kleontas, Asteriou, Grosomanidis,
Tossios, Argiriadou) Cardiothoracic Department, AHEPA University Hospital,
S. Kyriakidi 1, Thessaloniki 546 36, Greece
Title
Effectiveness of prophylactic levosimendan in patients with impaired left
ventricular function undergoing coronary artery bypass grafting: A
randomized pilot study.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 740-747),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES Perioperative low cardiac output syndrome occurs in 3-14% of
patients undergoing isolated coronary artery bypass grafting (CABG),
leading to significant increase in major morbidity and mortality.
Considering the unique pharmacological and pharmacokinetic properties of
levosimendan, we conducted a prospective, double-blind, randomized pilot
study to evaluate the effectiveness of prophylactic levosimendan in
patients with impaired left ventricular function undergoing CABG. METHODS
Thirty-two patients undergoing CABG with low left ventricular ejection
fraction (LVEF < 40%) were randomized to receive either a continuous
infusion of levosimendan at a dose of 0.1 mug/kg/min for 24 h without a
loading dose or a placebo. The primary outcome of the study was the change
in the LVEF assessed with transthoracic echocardiography on the seventh
postoperative day. Secondary outcomes included the physiological and
clinical effects of levosimendan. RESULTS All patients tolerated
preoperative infusion of levosimendan well. The LVEF improved in both
groups; this increase was statistically significant in the levosimendan
group (from 35.8 +/- 5% preoperatively to 42.8 +/- 7.8%, P = 0.001)
compared with the control group (from 37.5 +/- 3.4% preoperatively to 41.2
+/- 8.3%, P = 0.1). The cardiac index, SvO<inf>2</inf>, pulmonary
capillary wedge pressure and right ventricular stroke work index showed a
similar trend, which was optimized in patients treated with levosimendan.
Moreover, an increase in extravascular lung water was noticed in this
group during the first 24 h after surgery. CONCLUSIONS This pilot study
shows that prophylactic levosimendan infusion is safe and effective in
increasing the LVEF postoperatively in patients with impaired cardiac
function undergoing coronary surgery. This finding may be translated to
'optimizing' patients' status before surgery. Copyright &#xa9; 2016 The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<92>
Accession Number
613172447
Author
Kowalowka A.R.; Onyszczuk M.; Wanha W.; Deja M.A.
Institution
(Kowalowka, Onyszczuk, Deja) Department of Cardiac Surgery, Medical
University of Silesia, School of Medicine in Katowice, Katowice, Poland
(Wanha) Third Department of Cardiology, Medical University of Silesia,
School of Medicine in Katowice, Katowice, Poland
Title
Do we have to operate on moderate functional mitral regurgitation during
aortic valve replacement for aortic stenosis?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 806-809),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Do we have to operate on
moderate functional mitral regurgitation (FMR) during aortic valve
replacement (AVR) for aortic stenosis (AS)?' Altogether 325 papers were
found using the reported search, of which 9 represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. The current evidence obtained from
these papers revealed that the significant predictors of improvement
outcome include lower preoperative mitral regurgitation and lower
preoperative left ventricle fractional area change. We also know that
persistent atrial fibrillation, enlarged left atrium, increased indexed
left ventricular mass, pulmonary hypertension and preoperative peak aortic
valve gradient <60 mmHg are predictors of deterioration. Generally, we
observed a trend towards improvement or non-progression of FMR following
AVR for AS. In the six papers that suggest conservative treatment of FMR,
the degree of mitral regurgitation (MR) improved in 45-95%, remained
unchanged in 19-38% and deteriorated in 1-14%. In the three papers
favoring surgical treatment of MR, the degree of MR improved in 46-69%,
stay unchanged in 34-53% and deteriorated in 10%. The current evidence
suggests that moderate or less grade of FMR without predictors of
deterioration should be treated conservatively and moderate-severe and
severe FMR warrants additional surgical procedure. A clearly randomized
study, especially in patients with moderate and moderate-severe FMR for
AS, seems appropriate to further elucidate surgical strategy. Copyright
&#xa9; 2016 The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<93>
Accession Number
613171983
Author
Lex J.R.; Naidu B.
Institution
(Lex, Naidu) University of Birmingham, Medical School, Birmingham, United
Kingdom
(Naidu) Department of Thoracic Surgery, Heart of England NHS Foundation
Trust, Birmingham, United Kingdom
Title
In patients with resectable non-small-cell lung cancer, is video-assisted
thoracoscopic segmentectomy an appropriate alternative to video-assisted
thoracoscopic lobectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 826-831),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'In patients with
resectable non-small-cell lung cancer, is video-assisted thoracoscopic
segmentectomy an appropriate alternative to video-assisted thoracoscopic
lobectomy?' Two hundred papers were found using the reported search, of
which 8 represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
In one meta-analysis identified, there was no significant difference
observed between groups in overall survival (HR = 0.808, 95% CI
0.556-1.174). All other studies identified also found no significant
difference in overall survival. As well, local and distant recurrence
rates and disease-free survival were similar in all studies. Two studies
identified a significantly greater number of lymph nodes dissected with
the video-assisted thoracosopic surgery (VATS) lobectomy procedure;
however, all other studies noted no significant difference. There was
evidence from two studies that VATS segmentectomy is associated with a
shorter length of hospital stay than lobectomy. Between both groups, there
was an overall low number of postoperative complications and 30-day
mortality (highest n = 2), highlighting the safety of both procedures.
Three studies compared patient groups with similar tumour sizes; the
average tumour size was 17 +/- 1 mm. However, in the four other
observational studies, the tumour size in the VATS lobectomy group was
significantly larger. From the limited evidence currently available, VATS
segmentectomy appears to be a valid alternative to VATS lobectomy. The
included studies were mainly retrospective observational studies, with one
meta-analysis; however, there are currently two large randomized trials
ongoing with results expected to be reported in 2021. Copyright &#xa9;
2016 The Author 2016. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<94>
Accession Number
612986971
Author
Anonymous
Title
Correction: 2016 ACC/AHA GuidelineFocused Update on Duration ofDual
Antiplatelet Therapy in PatientsWith Coronary Artery Disease (Journal of
the American College of Cardiolog (2016) 68(10) (1082-1115)
(S0735109716016995) (10.1016/j.jacc.2016.03.513)).
Source
Journal of the American College of Cardiology. 68 (10) (pp 1150-1151),
2016. Date of Publication: 06 Sep 2016.
Publisher
Elsevier USA
Abstract
Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger
CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O'Gara
PT, Sabatine MS, Smith PK, Smith SC, Jr. 2016 ACC/AHA Guideline Focused
Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary
Artery Disease: A Report of the American College of Cardiology/American
Heart Association Task Force on Clinical Practice Guidelines: An Update of
the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention,
2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012
ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management
of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline
for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC
Guideline for the Management of Patients With Non-ST-Elevation Acute
Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative
Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac
Surgery J Am Coll Cardiol 2016;68:1082-115. 1. Page 1084, in the section
titled "Modernization", paragraph 1, the second sentence previously read,
"This process entails delineation of a recommendation addressing a
specific clinical question, followed by concise text (ideally <500 words)
and hyperlinked to supportive evidence." The sentence now reads, "This
process entails delineation of a recommendation addressing a specific
clinical question, followed by concise text (ideally <250 words per
recommendation) and hyperlinked to supportive evidence."2. Page 1086, in
the section titled "Methodology and Evidence Review", paragraph 2, the
last sentence previously read, "See the ERC systematic review report,
"Duration of Dual Antiplatelet Therapy: A Systematic Review for the 2016
Guideline Update," for the complete evidence review report (30)." The
title of the systematic review has been corrected. The sentence now reads
"See the ERC systematic review report, "Duration of Dual Antiplatelet
Therapy: A Systematic Review for the 2016 ACC/AHA Guideline Focused Update
on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery
Disease" for the complete evidence review report (30)."3. Page 1087, in
the section titled "Review and Approval", paragraph 2 previously read,
"This document was approved for publication by the governing bodies of the
ACC and the AHA and was endorsed by the American Association for Thoracic
Surgery, American Society of Anesthesiologists, Preventive Cardiovascular
Nurses Association, Society for Cardiovascular Angiography and
Interventions, Society of Cardiovascular Anesthesiologist, and the Society
of Thoracic Surgeons." The sentence now reads, "This document was approved
for publication by the governing bodies of the ACC and the AHA and was
endorsed by the American Association for Thoracic Surgery, American
Society of Anesthesiologists, Preventive Cardiovascular Nurses
Association, Society for Cardiovascular Angiography and Interventions,
Society of Cardiovascular Anesthesiologists, Society of Thoracic Surgeons,
and Society for Vascular Surgery."4. Figure 1, Master treatment algorithm
for duration of P2Y<inf>12</inf> inhibitor therapy in patients with CAD
treated with DAPT, the text in the cell in the top-left corner of the
algorithm previously read, "No Hx PCI or recent CABG". It now reads, "No
Hx of MI, PCI or recent (within 12 mo) CABG".5. Section 4.1. "Duration of
DAPT in Patients With SIHD Treated With PCI: Recommendations" Class I, LOE
A recommendation #1 previously read, "In patients with SIHD treated with
DAPT after BMS implantation, P2Y<inf>12</inf> inhibitor therapy with
clopidogrel should be given for a minimum of 1 month (94,95)." It now
reads, "In patients with SIHD treated with DAPT after BMS implantation,
P2Y<inf>12</inf> inhibitor therapy (clopidogrel) should be given for a
minimum of 1 month (94,95)."6. Section 4.1. "Duration of DAPT in Patients
With SIHD Treated With PCI: Recommendations" Class I, LOE B-R,
recommendation #2 previously read, "In patients with SIHD treated with
DAPT after DES implantation, P2Y<inf>12</inf> inhibitor therapy with
clopidogrel should be given for at least 6 months (17,18,21,30,96,97)." It
now reads, "In patients with SIHD treated with DAPT after DES
implantation, P2Y<inf>12</inf> inhibitor therapy (clopidogrel) should be
given for at least 6 months (17,18,21,30,96,97)."7. Section 4.1. "Duration
of DAPT in Patients With SIHD Treated With PCI: Recommendations" Class I,
LOE B-NR recommendation #3 previously read, "In patients treated with
DAPT, the recommended daily dose of aspirin is 81 mg (range, 75 mg to 100
mg) (56-60,75-78)." It now reads "In patients treated with DAPT, a daily
aspirin dose of 81 mg (range, 75 mg to 100 mg) is recommended
(56-60,75-78)."8. Section 4.2. "Duration of DAPT in Patients With ACS
Treated With PCI: Recommendations" Class I, LOE B-NR recommendation #2
previously read, "In patients treated with DAPT, the recommended daily
dose of aspirin is 81 mg (range, 75 mg to 100 mg) (56-60,75-78)." It now
reads "In patients treated with DAPT, a daily aspirin dose of 81 mg
(range, 75 mg to 100 mg) is recommended (56-60,75-78)."9. Section 5. CABG:
Recommendations. The header for the recommendation table previously read,
"Recommendations for CABG". The header now reads, "Recommendations for
Duration of DAPT in Patients Undergoing CABG".10. Section 6. SIHD:
Recommendations. The header for the recommendation table previously read,
"Recommendations for SIHD". The header now reads, "Recommendations for
Duration of DAPT in Patients With SIHD".11. Section 6. SIHD:
Recommendations. The recommendation that states, "In patients with SIHD
treated with DAPT after DES implantation, P2Y<inf>12</inf> inhibitor
therapy (clopidogrel) should be given for at least 6 months
(17,18,21,30,96,97)." was previously classed LOE "B-NR". It is now classed
LOE "B-R ^SR".12. Section 7.1. "Duration of DAPT in Patients
With ACS Treated With Medical Therapy Alone (Without Revascularization or
Fibrinolytic Therapy): Recommendations", Class I, LOE B-R recommendation
#1 previously read "In patients with ACS who are managed with medical
therapy alone (without revascularization or fibrinolytic therapy) and
treated with DAPT, P2Y<inf>12</inf> inhibitor therapy (either clopidogrel
or ticagrelor) should be continued for at least 12 months
(52,71,140,1414)." It now reads "In patients with ACS who are managed with
medical therapy alone (without revascularization or fibrinolytic therapy)
and treated with DAPT, P2Y<inf>12</inf> inhibitor therapy (clopidogrel or
ticagrelor) should be continued for at least 12 months
(52,71,140,141)."13. Section 7.1. "Duration of DAPT in Patients With ACS
Treated With Medical Therapy Alone (Without Revascularization or
Fibrinolytic Therapy): Recommendations", Class IIa, LOE B-R recommendation
#3 previously read "In patients with NSTE-ACS who are managed with medical
therapy alone (without revascularization or fibrinolytic therapy) treated
with DAPT, it is reasonable to use ticagrelor in preference to clopidogrel
for maintenance P2Y<inf>12</inf> inhibitor therapy (53,71)." It now reads
"In patients with NSTE-ACS who are managed with medical therapy alone
(without revascularization or fibrinolytic therapy) and treated with DAPT,
it is reasonable to use ticagrelor in preference to clopidogrel for
maintenance P2Y<inf>12</inf> inhibitor therapy (53,71)."14. Figure 4,
Treatment Algorithm for Duration of P2Y<inf>12</inf> Inhibitor Therapy in
Patients With SIHD (Without ACS Within the Past Several Years), the text
in the cell in the top-left corner of the algorithm previously read, "No
Hx of MI, PCI or recent CABG". It now reads, "No Hx of MI, PCI or recent
(within 12 mo) CABG".15. Appendix 2, Reviewer Relationships With Industry
and Other Entities (Relevant)-2016 ACC/AHA Guideline Focused Update on
Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery
Disease (December 2015), Joseph S. Alpert's employment was previously
listed as "University of Arizona Health Sciences Center- Professor of
Medicine, Head of Department of Medicine". It is now listed as,
"University of Arizona Health Sciences Center-Professor of Medicine, Head
of Department of Medicine".16. Data Supplement 7, "RCTs Comparing
Antiplatelet Therapy With Anticoagulant Therapy in Patients Undergoing
Coronary Stenting". In the column headed "Study Intervention",
intervention #3 was previously specified to be "ASA + ticagrelor". That
phrase has been corrected to read "ASA + ticlopidine". Additionally in the
column headed "Endpoint Results" the first bullet under "1degree endpoint"
previously read "3.6% with ASA alone; 2.7% with ASA + warfarin; 0.5% with
ASA + ticagrelor (p=0.001 for the comparison of all 3 groups)." The word
"ticagrelor" has been replaced with "ticlopidine" so that the sentence now
reads "3.6% with ASA alone; 2.7% with ASA + warfarin; 0.5% with ASA +
ticlopidine (p=0.001 for the comparison of all 3 groups)." Copyright
&#xa9; 2016 American College of Cardiology Foundation

<95>
Accession Number
613105017
Author
Forni Ogna V.; Menetrey I.; Muller O.; Tousset E.; Guihard L.; Fontana P.;
Eeckhout E.; Eap C.B.; Vrijens B.; Burnier M.; Wuerzner G.
Institution
(Forni Ogna, Menetrey, Guihard, Burnier, Wuerzner) Service of Nephrology
and Hypertension, Department of Medicine, Lausanne University Hospital,
Lausanne, Switzerland
(Muller, Eeckhout) Department of Cardiology, Lausanne University Hospital,
Lausanne, Switzerland
(Tousset, Vrijens) Aardex Group, Vise, Belgium
(Fontana) Division of Angiology and Hemostasis, Geneva University Hospital
and Faculty of Medicine, Geneva, Switzerland
(Eap) Unit of Biochemistry and Clinical Psychopharmacology, Center for
Psychiatric Neuroscience, Department of Psychiatry, Lausanne University
Hospital, Lausanne, Switzerland
Title
Effect of long-term adherence to clopidogrel on the VASP-PRI after
elective coronary stent implantation: a randomized controlled study.
Source
British Journal of Clinical Pharmacology. 82 (6) (pp 1486-1497), 2016.
Date of Publication: 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims: The biological response to clopidogrel is highly variable and a poor
responsiveness is associated with major adverse cardiac events. Adherence
to therapy is a major cause of poor responsiveness but its impact on
long-term platelet inhibition is unknown. The objective of the present
study was to evaluate the effect of different programmes monitoring
adherence to clopidogrel on platelet reactivity. Methods: The study took
the form of a monocentric, parallel group, randomized controlled trial.
Adults treated with clopidogrel 75 mg after elective coronary stenting
were randomized into one of three groups: (i) a standard of care group;
(ii) a standard of care + adherence electronic monitoring group, in which
drug intake was recorded but kept blinded until the study end; or (iii) an
integrated care group, with regular feedback on recorded adherence.
Clopidogrel response was assessed with the vasodilator-stimulated
phosphoprotein-platelet reactivity index (VASP-PRI) at randomization, 3
months and 6 months. Results: A total of 123 adults were enrolled and
randomized. Baseline VASP-PRI was highly variable, with a mean of 48 +/-
18.8%. No difference between groups in VASP-PRI was found at 6 months (P =
0.761), despite better adherence to clopidogrel in the integrated care
group. However, adherence (P = 0.035) and baseline VASP-PRI (P = 0.015)
were associated with VASP-PRI at 3 months and 6 months. The association
between adherence and VASP-PRI was lost in patients with baseline VASP-PRI
> 50%. Diabetes, CYP2C19*2 carrier status and body mass index were
significant predictors of VASP-PRI. Conclusions: The platelet response to
clopidogrel during chronic therapy remained highly variable, despite high
adherence. Different adherence monitoring programmes did not affect
VASP-PRI at 6 months. Poor adherence is associated with lower VASP-PRI
only in initial good responders to clopidogrel. Copyright &#xa9; 2016 The
British Pharmacological Society

<96>
Accession Number
613155978
Author
Aydin U.; Yilmaz M.; Duzyol C.; Ata Y.; Turk T.; Orhan A.L.; Kocogullari
C.U.
Institution
(Aydin, Ata, Turk) Department of Cardiovascular Surgery, Bursa Yuksek
Ihtisas Education and Research Hospital, Bursa, Turkey
(Yilmaz, Orhan) Department of Anesthesiology, Kocaeli Derince Education
and Research Hospital, Kocaeli, Turkey
(Duzyol, Kocogullari) Department of Cardiovascular Surgery, Kocaeli
Derince Education and Research Hospital, Kocaeli, Turkey
Title
Efficiency of postoperative statin treatment for preventing new-onset
postoperative atrial fibrillation in patients undergoing isolated coronary
artery bypass grafting: A prospective randomized study.
Source
Anatolian Journal of Cardiology. 15 (6) (pp 491-495), 2015. Date of
Publication: 2015.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Recent studies have demonstrated that preoperative statin
therapy reduces the incidence of postoperative atrial fibrillation (AF).
The objective of this study was to assess the efficacy of statin therapy
started in the early postoperative period for the prevention from
new-onset AF after isolated coronary artery bypass grafting (CABG).
Methods: This prospective and randomized study consisted of 60 consecutive
patients who underwent elective isolated CABG. Patients were divided into
two groups to examine the influence of statins: Those with postoperative
statin therapy (statin group, n=30) and those without it (non-statin
group, n=30). Patient data were collected and analyzed prospectively. In
the statin group, each extubated patient was given 40 mg of atorvastatin
per day, starting from an average of 6 hours after the operation. Results:
The overall incidence of postoperative AF was 30%. Postoperative AF
occurred in 5 patients (16.7%) in the statin group. This was significantly
lower compared with 13 patients (43.3%) in the non-statin group (p=0.049).
According to the multivariate analysis, postoperative atorvastatin reduced
the risk of postoperative AF by 49% [odds ratio (OR) 0.512, 95% confidence
interval (CI) 0.005 to 0.517, p=0.012]. Also, age was an independent
predictor of postoperative AF (OR 1.299, 95% CI 1.115 to 1.514, p=0.001).
Conclusion: Postoperative statin therapy seems to reduce new-onset AF
after isolated CABG in our study. Copyright &#xa9; 2015 by Turkish Society
of Cardiology.

<97>
Accession Number
612964686
Author
Zhan L.; Er J.; Zhai W.; Liu J.; Han J.
Institution
(Zhan, Er, Zhai, Liu, Han) Department of Anesthesiology, Tianjin Chest
Hospital, Tianjin, China
Title
Overall effect of sufentanil-propofol general anesthesia combined with
paravertebral block on patients with lung cancer resection.
Source
International Journal of Clinical and Experimental Medicine. 9 (10) (pp
20068-20073), 2016. Article Number: IJCEM0031861. Date of Publication: 30
Oct 2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
To study the overall clinical effect of sufentanil-propofol general
anesthesia combined with paravertebral block on patients underwent lung
cancer resection. 122 lung cancer patients underwent the pulmonary
lobectomy at the department of thoracic surgery from May 2014 to May 2015
were enrolled in this study. According to the digital meter method, they
were randomly divided into two groups, patients in observational group
were underwent CTPVB (continuous thoracic paravertebral block) and the
control group received PCIA (patient-controlled intravenous analgesia)
therapy. The operation time, intraoperative blood lose, eyes opening time
after calling, extubation time and the usage amount of sufentanil and
propofol were recorded in patients of two groups. The mean arterial
pressure (MAP) and heart rate (HR) were respectively recorded at different
time points of anesthesia pre-induction (E0), 5 min preoperatively (E1),
10 min after operation initiation (E2), 30 min after operation initiation
(E3) and the time when operation is finished (E4). Visual analogue scale
(VAS) was also recorded at 2 h, 6 h, 12 h and 24 h after operation. In
respect of comparison of general situations during perioperative period,
there were no significant differences in operative duration of two groups
(P>0.05), however the eyes opening time after calling, extubation time and
the usage amount of sufentanil and propofol were significantly less in
observational group than those of control group, with a statistically
significant difference (P<0.05); In the process of anesthesia, the mean
arterial pressure (MAP) and heart rate (HR) recorded at different time
points of anesthesia pre-induction (E0), 5 min preoperatively (E1), 10 min
after operation initiation (E2), 30 min after operation initiation (E3)
and the time when operation is finished (E4) were significantly lower in
observational group than those of control group, with a statistically
significant difference (P<0.05); the usage amount of sufentanil and
propofol needs to be adjusted to deepen anesthesia depth for patients in
control group; analgesia situation was observed after surgery therapy, and
visual analogue scale (VAS) scores at 2 h, 6 h, 12 h and 24 h after
operation in observational group were significantly less than those of
control group, which demonstrates a better analgesic effect of continuous
thoracic paravertebral block (CTPVB) after operation. Introducing
continuous thoracic paravertebral block in lung cancer resection fits
general anesthesia and brings better clinical effect, with high security
and low incidence of complications, this therapy provides a more effective
and everlasting analgesic activity for patients after surgery, reduces the
usage amount of anesthesia medication or opioid during surgery, has lower
effect on hemodynamics, thus it's suitable to be widely used in clinic.
Copyright &#xa9; 2016, E-Century Publishing Corporation. All rights
reserved.

<98>
Accession Number
613139512
Author
Basaran O.; Beton O.; Dogan V.; Tekinalp M.; Aykan A.C.; Kalaycioglu E.;
Bolat I.; Tasar O.; Safak O.; Kalcik M.; Yaman M.; Altun I.; Soylu M.O.;
Kirma C.; Biteker M.; Inci S.; Altintas B.; Kalkan S.; Karadeniz F.O.;
Tekkesin A.I.; Cakilli Y.; Turkkan C.; Hamidi M.; Demir V.; Gursoy M.O.;
Ozturk M.T.; Aksan G.; Seyis S.; Balli M.; Alici M.H.; Bozyel S.; Calik
F.; Karaca O.; Helvaci F.; Akay K.; Canga Y.; Celebi S.; Altuntas E.;
Ayturk M.; Gunes H.M.; Bezgin T.; Aksakal A.; Cakal B.; Colak A.; Kaplan
O.; Tatlisu A.; Gozubuyuk G.; Demirelli S.; Kaya A.; Rencuzogullari I.;
Bayram Z.; Simsek Z.; Civan M.; Batgharel U.; Ata A.E.; Gol G.; Mert G.O.;
Mert K.U.; Degirmencioglu A.; Candan O.; Celebi O.O.; Dogan C.; Yavuz F.;
Ulucan S.; Arisoy A.; Sahin B.D.; Ermis E.; Gokaslan S.; Pektas I.;
Tanindi A.; Tekin K.; Sancar K.M.; Cekic E.G.; Basaran N.F.
Institution
(Basaran, Dogan, Altun, Soylu, Biteker) Department of Cardiology, Faculty
of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
(Beton) Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet
University, Sivas, Turkey
(Tekinalp) Department of Cardiology, Kahramanmaras Necip Fazil State
Hospital, Kahramanmaras, Turkey
(Aykan, Kalaycioglu) Department of Cardiology, Trabzon Ahi Evren Chest
Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
(Bolat) Department of Cardiology, Fethiye State Hospital, Fethiye, Turkey
(Tasar) Department of Cardiology, Elazig Education and Research Hospital,
Elazig, Turkey
(Safak) Department of Cardiology, Burdur State Hospital, Burdur, Turkey
(Kalcik) Department of Cardiology, Iskilip Atif Hoca State Hospital,
Corum, Turkey
(Yaman) Department of Cardiology, Samsun Education and Research Hospital,
Samsun, Turkey
(Kirma) Department of Cardiology, Kartal Kosuyolu Heart Education and
Research Hospital, Istanbul, Turkey
(Inci) AksarayTurkey
(Altintas) DiyarbakirTurkey
(Kalkan) Balikesir-GonenTurkey
(Karadeniz) SanliurfaTurkey
(Tekkesin, Cakilli, Turkkan, Aksan, Bozyel, Karaca, Helvaci, Canga, Gunes,
Bayram, Simsek, Civan, Batgharel, Gol, Degirmencioglu, Gokaslan)
IstanbulTurkey
(Hamidi) BalikesirTurkey
(Demir) YozgatTurkey
(Gursoy) IzmirTurkey
(Ozturk, Celebi, Ayturk, Celebi, Tanindi) AnkaraTurkey
(Seyis, Balli, Calik, Colak, Pektas) MersinTurkey
(Altuntas, Kaya, Yavuz) GaziantepTurkey
(Akay, Bezgin, Cakal) KocaeliTurkey
(Alici, Ata) BingolTurkey
(Aksakal) SamsunTurkey
(Kaplan, Gozubuyuk, Dogan) MalatyaTurkey
(Tatlisu) SivasTurkey
(Demirelli, Sahin, Ermis) ErzurumTurkey
(Rencuzogullari) KarsTurkey
(Mert, Mert, Sancar, Cekic, Basaran) MuglaTurkey
(Candan) UsakTurkey
(Ulucan) KonyaTurkey
(Arisoy) TokatTurkey
(Tekin) BatmanTurkey
Title
ReAl-life multicenter survey evaluating stroke prevention strategies in
non-valvular atrial fibrillation (RAMSES study).
Source
Anatolian Journal of Cardiology. 16 (10) (pp 734-741), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Data regarding stroke prevention strategies in non-valvular
atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs).
This study aimed to evaluate real-life stroke prevention strategies for
NVAF patients in the era of non-VKA oral anticoagulants (NOACs). Methods:
We established a cross-sectional, multicenter, nationwide registry of NVAF
patients. All consecutive atrial fibrillation (AF) patients and without
mechanical heart valves or rheumatic mitral stenosis (but including those
with any degree of mitral regurgitation) were enrolled in the ReAl-life
Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study;
ClinicalTrials.gov identifier NCT02344901) in Turkey. Baseline demographic
data, medical history, and medications prescribed for NVAF treatment were
collected. Univariate analyses were performed for continuous variables,
and the chi-square test was used for categorical variables. Results: In
total, 6273 patients from 29 provinces of Turkey were enrolled in the
study between February and May 2015, with the contribution of 83
investigators. The mean age was 69.6+/-10.7 years; 56% of the patients
were females, and one-fifth of the patients had at least one comorbid
disease, the most common being hypertension (69%). The mean CHA2DS2-VASc
and HAS-BLED scores were 3.3+/-1.6 and 1.6+/-1.1, respectively. The rate
of oral anticoagulant (OAC) therapy use was 72% (37% NOAC and 35% VKA).
Conclusion: The RAMSES study showed a higher prevalence of OAC use among
NVAF patients than that reported in previous studies. Although NOACs were
preferred over VKAs in daily cardiology practice, there is a need for
improved OAC therapies for NVAF patients. Copyright &#xa9; 2016 by Turkish
Society of Cardiology.

<99>
Accession Number
613139992
Author
Aldemir M.; Keles I.; Karalar M.; Tecer E.; Adali F.; Pektas M.B.; Parlar
A.I.; Darcin O.T.
Institution
(Aldemir, Tecer, Adali, Darcin) Department of Cardiovascular Surgery,
Afyon Kocatepe University, Afyonkarahisar, Turkey
(Keles, Karalar) Department of Urology, Afyon Kocatepe University,
Afyonkarahisar, Turkey
(Pektas) Department of Pharmacology, Faculty of Medicine, Afyon Kocatepe
University, Afyonkarahisar, Turkey
(Parlar) Department of Cardiovascular Surgery, Akut Kalp Damar Hospital,
Izmir, Turkey
Title
Nebivolol compared with metoprolol for erectile function in males
undergoing coronary artery bypass graft.
Source
Anatolian Journal of Cardiology. 16 (2) (pp 131-136), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: The aim of this study was to evaluate erectile function in
males undergoing coronary artery bypass graft (CABG) while on two
different adrenoceptor beta-blocker regimens, namely nebivolol and
metoprolol. We hypothesize that the negative effects of cardiopulmonary
bypass on erectile function may be possibly attenuated by preferring a
vasodilating selective beta 1-blocker, nebivolol, to metoprolol as an
antiischemic and antiarrhythmic agent in males undergoing CABG. Methods:
This randomized, double-blind, prospective clinical study was conducted in
patients scheduled for CABG surgery between February 2012 and June 2014. A
total of 60 consecutive patients who met inclusion criteria were
randomized and divided into the following two groups: N group, which
received 5 mg of nebivolol orally for 2 weeks before surgery plus 12 weeks
after surgery or M group, which received 50 mg of metoprolol orally for
the same period. All patients were evaluated by the erectile function
domain of the International Index of Erectile Function-5 (IIEF-5) at the
time of admission (before starting the beta-blocker) and 3 months after
surgery. Results: In the metoprolol group, the mean IIEF-5 score decreased
significantly from a baseline of 15.2+/- 5.8 to 12.9+/- 5.8 (p< 0.001),
but in the nebivolol group, this difference was not significant (from a
baseline 12.9+/- 5.5 to 12.4+/- 5.5, p=0.053). In all patients, the mean
IIEF-5 score decreased significantly from a baseline of 14.0+/- 5.7 to
12.6+/- 5.6 (p< 0.001). Conclusion: Although erectile function in males
undergoing CABG surgery decreases when metoprolol is used, nebivolol
exerts protective effects on erectile function against the disruptive
effects of cardiopulmonary bypass in patients undergoing CABG. Copyright
&#xa9; 2016 by Turkish Society of Cardiology.

<100>
Accession Number
613139897
Author
Salim E.F.; Rezk M.E.
Institution
(Salim, Rezk) Cardiothoracic Surgery Department, Benha University, Benha,
Egypt
Title
Predictors of conversion from thoracoscopic to open surgery in management
of postpneumonic empyema.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (2) (pp
194-199), 2016. Date of Publication: 01 Aug 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) has an important
role in management of pleural empyema. The objective of this study was to
assess the predictors for conversion from VATS to open thoracotomy in an
assumed stage II postpneumonic empyema. Methods: This prospective
randomized study included 120 patients admitted to cardio-thoracic surgery
department, Benha University, between 2011 and 2016. All cases were
enrolled for thoracoscopic debridement for an assumed stage II
postpneumonic empyema. If stage III empyema was diagnosed during
thoracoscopy, conversion to thoracotomy became indicated. Predictors for
conversion to thoracotomy were assessed in a univariate, a bivariate
correlation and a multivariate analysis using several variables like age,
sex, associated comorbidities, duration of symptoms, pleural fluid
analysis, and pleural thickness measured by CT scan. Results: Out of 120
patients, thoracoscopic management was successful in 82 (68%) patients,
while conversion to thoracotomy was done in 38 (32%) patients. Conversion
to thoracotomy was higher in patients with long duration of symptoms (p <
0.001) with cutoff value at 18.1 days, increased pleural thickness (p <
0.001) with cutoff value at 3.95 mm, increased LDH with cutoff value at
1854 IU/L, and Gram-negative infection of pleural fluid (p < 0.001).
Multivariate analysis identified that the duration of symptoms,
gram-negative bacteria, LDH and pleural thickness were the significant
predictors for conversion from VATS to thoracotomy. Conclusion: Predictive
factors for conversion to thoracotomy in an assumed stage II postpneumonic
empyema include long duration, Gram-negative bacterial infection,
increased LDH, and increased pleural thickness. Copyright &#xa9; 2016, The
Egyptian Society of Cardio-thoracic Surgery.

<101>
Accession Number
613139863
Author
Wahby E.A.; Abo Elnasr M.M.; Eissa M.I.; Mahmoud S.M.
Institution
(Wahby, Abo Elnasr) Department of Cardiothoracic Surgery, Faculty of
Medicine, Tanta University, Egypt
(Eissa) Department of Cardiothoracic Surgery, National Heart Institute,
Egypt
(Mahmoud) Department of Internal Medicine, Faculty of Medicine, Tanta
University, Egypt
Title
Perioperative glycemic control in diabetic patients undergoing coronary
artery bypass graft surgery.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (2) (pp
143-149), 2016. Date of Publication: 01 Aug 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: The concept of perioperative glycemic control in cardiac
surgery patients was conducted in many studies, however, it remains
unclear how tight the glycemic control should be. Our aim is to study the
effect of perioperative tight glycemic control versus moderate glycemic
control on the outcome of diabetic patients undergoing coronary artery
bypass graft (CABG) surgery. Methods: This study is a randomized
prospective study conducted on 135 diabetic patients planned for CABG
surgery. Patients were divided into 2 groups: group A subjected to tight
glycemic control during operation to maintain blood glucose level between
110 and 149 mg/dl and group B subjected to conventional moderate glycemic
control to achieve blood glucose level between 150 and 180 mg/dl using
continuous insulin infusion started before anesthesia induction and
continued till the patient is extubated in ICU. Both groups were followed
up till 1 month after operation regarding operative mortality and
postoperative outcome. Results: No significant difference between both
groups in mortality, however there was statistical significant
relationship between tight glycemic control group and lowered incidence of
postoperative atrial fibrillation, sternal wound infection, need for
inotropic support and reduced time spent on mechanical ventilation.We
noticed reduction in incidence of acute renal failure in tight glycemic
control with no difference between both groups in neurological insults,
renal dysfunction and perioperative myocardial infarction. Conclusion:
Tight glycemic control improved perioperative outcome in diabetic CABG
patients. Maintaining perioperative blood glucose level between 110 and
149 mg/dl is safe and should be recommended as a routine practice in
diabetic patients undergoing CABG surgery. Copyright &#xa9; 2016, The
Egyptian Society of Cardio-thoracic Surgery.

<102>
Accession Number
613139849
Author
Elghonemy Y.F.; Hussein M.A.
Institution
(Elghonemy) Mansoura University, Egypt
(Hussein) Cairo University, Egypt
Title
Titanium plate fixation versus wire sternal closure in coronary artery
bypass graft patients: Need for rigid sternal fixation.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (2) (pp
150-158), 2016. Date of Publication: 01 Aug 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Sternal dehiscence and deep sternal wound infection mostly
coincide. Approximation and rigid fixation are cornerstones in supporting
good bony union.Wire cerclage is adequate for approximation butmay be
inadequate for sternal stability. So there is a need to study other
methods of sternal fixation (titanium plate fixation) and to compare with
the traditional wire cerclage method. Methods: Thirty isolated coronary
artery bypass graft (CABG) patients were followed in this study regarding
closure of their sternums; 15 with our method of concern: the Sternalock
plates (group A) and 15 with the conventional stainless steel wiring
(group B). The two groups were compared in a prospective non randomized
study in the period of Jan 2013 to Jan 2015. Patients were followed up
over 6 months postoperatively regarding pain among other factors. Results:
The two groups' demographics and perioperative variables were properly
matched. They were followed in-hospital, at one month and over 6 months
postoperatively: no mortalities; pain was much less in group A during
in-hospital and at 1 month follow but at six months; no significant pain
difference was detectable. Less narcotic need in group A but hospital stay
was almost the same. Both groups demonstrated good healing at the end of
the study with slightly higher incidence of wound infection and need for
refixation in group B. Conclusion: Sternal plating following CABG is
reproducible; easy to apply, not time consuming, easy reopening in case of
emergency, inert, with the benefit of less early postoperative pain and
narcotic use. Copyright &#xa9; 2016, The Egyptian Society of
Cardio-thoracic Surgery.

<103>
Accession Number
613140264
Author
Aldemir M.; Koca H.B.; Baki E.D.; Carsanba G.; Kavrut N.O.; Kavakli A.S.;
Adali F.; Emmiler M.; Darcin O.T.
Institution
(Aldemir, Carsanba, Adali, Darcin) Department of Cardiovascular Surgery,
Faculty of Medicine, Kocatepe University, Afyonkarahisar, Turkey
(Koca) Department of Clinical Biochemistry, Faculty of Medicine, Kocatepe
University, Afyonkarahisar, Turkey
(Baki) Departments of Anesthesiology and Reanimation, Faculty of Medicine,
Kocatepe University, Afyonkarahisar, Turkey
(Kavrut, Kavakli) Departments of Anesthesiology and Reanimation, Antalya
Education and Research Hospital, Antalya, Turkey
(Emmiler) Department of Cardiovascular Surgery, Antalya Education and
Research Hospital, Antalya, Turkey
Title
Effects of N-acetyl cysteine on renal functions evaluated by blood
neutrophil gelatinase-associated lipocalin levels in geriatric patients
undergoing coronary artery bypass grafting.
Source
Anatolian Journal of Cardiology. 16 (7) (pp 504-511), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Recent conflicting studies on the renal effects of N-acetyl
cysteine (NAC) after cardiac surgery have been published. The aim of this
study was to evaluate the renal effects of NAC using neutrophil
gelatinase-associated lipocalin (NGAL) blood levels in elderly patients
undergoing coronary artery bypass grafting (CABG). Methods: This
randomized, double-blinded, placebo-controlled study was conducted among
geriatric patients (>65 years) scheduled to undergo CABG. A total of 60
consecutive patients were randomly assigned to 2 groups. The first group
received I.V. NAC (n=30) and the second group received placebo (n=30) at
induction of anesthesia and then for 20 h. NGAL values were determined and
conventional renal function tests were performed. Statistical analysis was
performed using SPSS 17.0 (IL, Chicago, USA). A p value of <0.05 was
considered statistically significant Results: Plasma creatinine levels at
24 h postoperatively were significantly higher in the placebo group than
in the NAC group (1.41+/-0.63 vs. 1.13+/-0.35; p<0.05). The mean serum
NGAL levels at 3 h postoperatively were higher in the placebo group than
in the NAC group (104.94+/-30.51 vs. 87.82+/-25.18; p<0.05). NGAL levels
were similar between the groups at all other measurement time points.
Plasma creatinine levels of >1.5 mg/dL or >25% of the baseline value at
any time during the study period were observed in 27% of patients in the
NAC group and 37% of patients in the placebo group; the difference was
statistically significant (p<0.05). Conclusion: In the present study, we
found that I.V. NAC infusion in elderly patients undergoing CABG reduced
the incidence of acute kidney injury as determined by blood NGAL and
creatinine levels. Copyright &#xa9; 2016 by Turkish Society of Cardiology.

<104>
Accession Number
613088564
Author
Auffret V.; Regueiro A.; Del Trigo M.; Abdul-Jawad Altisent O.;
Campelo-Parada F.; Chiche O.; Puri R.; Rodes-Cabau J.
Institution
(Auffret, Regueiro, Del Trigo, Abdul-Jawad Altisent, Campelo-Parada,
Chiche, Puri, Rodes-Cabau) Quebec Heart & Lung Institute, Laval
University, Quebec City, Quebec, Canada
(Auffret) Rennes 1 University, Signal and Image Processing Laboratory,
Rennes, France
Title
Predictors of Early Cerebrovascular Events in Patients With Aortic
Stenosis Undergoing Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 68 (7) (pp 673-684), 2016.
Date of Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Identifying transcatheter aortic valve replacement (TAVR)
patients at high risk for cerebrovascular events (CVE) is of major
clinical relevance. However, predictors have varied across studies.
Objectives The purpose of this study was to analyze the predictors of
30-day CVE post-TAVR. Methods A systematic review of studies that reported
the incidence of CVE post-TAVR while providing raw data for predictors of
interest was performed. Data on study, patient, and procedural
characteristics were extracted. Crude risk ratios (RRs) and 95% confidence
intervals for each predictor were calculated. Results Sixty-four studies
involving 72,318 patients (2,385 patients with a CVE within 30 days
post-TAVR) were analyzed. Incidence of CVE ranged from 1% to 11% (median
4%) without significant differences between single and multicenter
studies, or according to CVE adjudication availability. The summary RRs
indicated lower risk for men (RR: 0.82; p = 0.02) and higher risk for
patients with chronic kidney disease (RR: 1.29; p = 0.03) and with
new-onset atrial fibrillation post-TAVR (RR: 1.85; p = 0.005), and for
procedures performed within the first half of center experience (RR: 1.55;
p = 0.003). The use of balloon post-dilation tended to be associated with
a higher risk of CVE (RR: 1.43; p = 0.07). Valve type (balloon-expandable
vs. self-expandable, p = 0.26) and approach (transfemoral vs.
nontransfemoral, p = 0.81) did not predict CVE. Conclusions Female sex,
chronic kidney disease, enrollment date, and new-onset atrial fibrillation
were predictors of CVE post-TAVR. This study provides effect estimates to
identify high-risk TAVR patients for early CVE, providing possible
guidance for tailored preventive strategies. Copyright &#xa9; 2016
American College of Cardiology Foundation

<105>
Accession Number
612966804
Author
Yang J.; Zhang J.; Cui W.; Liu F.; Xie R.; Gu G.; Zheng H.; Lu J.; Yang
X.; Zhang G.; Wang Q.; Geng X.
Institution
(Yang, Zhang, Cui, Liu, Xie, Yang, Gu, Zheng, Lu, Yang, Zhang, Wang, Geng)
Department of Cardiology, The Second Hospital of Hebei Medical University,
Shijiazhuang, China
Title
Cardioprotective effects of single oral dose of nicorandil before
selective percutaneous coronary intervention.
Source
Anatolian Journal of Cardiology. 15 (2) (pp 125-131), 2015. Date of
Publication: 01 Feb 2015.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Nicorandil, an opener of ATP-sensitive K+ channels, was used to
treat angina in patients with coronary artery disease. In this study, we
aim to investigate the cardioprotective effects of single oral dose of
nicorandil in patients undergoing selective percutaneous coronary
intervention (PCI). Methods: One hundred and thirty-eight patients with
acute coronary syndrome undergoing PCI from July 2011 to October 2012 were
randomly divided into control group (group 1, n=47), 10 mg oral nicorandil
group (group 2, n=45), and 20 mg oral nicorandil group (group 3, n=46)
about 2 hours before procedure, respectively. Cardiac troponin I (cTnI)
levels were determined at 20 ~ 24 hours after PCI. Results: There was a
significant difference in the rate of any cTnI elevation among the three
groups (group 1: 36.17%, group 2: 20.00%, group 3: 15.22%, p=0.0176). With
respect to the frequency of cTnI elevation >3 and 5x the upper limit of
normal (ULN), there also had statistical difference among the three groups
(17.02% in group 1, 8.89% in group 2, and 4.35% in group 3, respectively
for cTnI elevation >3x ULN, p=0.0428; 12.77% in group 1, 6.67% in group 2,
and 2.17% in group 3, respectively, for cTnI elevation >5x ULN, p=0.0487).
Logistic regression analysis showed that LVEF (OR=0.915, 95%
CI=0.853-0.981) and the use of nicorandil (OR=0.516, 95% CI=0.267-0.996)
before PCI were independent protective factors of myocardial injury.
Conclusion: Single oral dose of nicorandil (10 mg, 20 mg) 2 hours before
the PCI procedure could decrease the incidence of peri-procedure
myocardial injury and PCI-related myocardial infarction. Copyright &#xa9;
2015 by Turkish Society of Cardiology.

<106>
Accession Number
612986975
Author
Cavalcante R.; Sotomi Y.; Lee C.W.; Ahn J.-M.; Farooq V.; Tateishi H.;
Tenekecioglu E.; Zeng Y.; Suwannasom P.; Collet C.; Albuquerque F.N.;
Onuma Y.; Park S.-J.; Serruys P.W.
Institution
(Cavalcante, Tateishi, Tenekecioglu, Zeng, Albuquerque, Onuma)
Thoraxcenter, Department of Interventional Cardiology, Erasmus University
Medical Center, Rotterdam, Netherlands
(Cavalcante) Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Sotomi, Suwannasom, Collet) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Lee, Ahn, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Farooq) Manchester Heart Centre, Manchester Royal Infirmary, Central
Manchester University Hospitals NHS Trust, Manchester, United Kingdom
(Serruys) International Center for Circulatory Health, Imperial College
London, London, United Kingdom
Title
Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in
Patients With Unprotected Left Main Disease.
Source
Journal of the American College of Cardiology. 68 (10) (pp 999-1009),
2016. Date of Publication: 06 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Currently available randomized data on the comparison between
percutaneous coronary intervention (PCI) and coronary artery bypass graft
(CABG) for the treatment of unprotected left main coronary disease (LMD)
lacks statistical power due to low numbers of patients enrolled.
Objectives This study assessed long-term outcomes of PCI and CABG for the
treatment of LMD in specific subgroups according to disease anatomic
complexity. Methods We conducted a pooled analysis of individual
patient-level data of the LMD patients included in the PRECOMBAT (Bypass
Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With
Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With
TAXUS and Cardiac Surgery) trials. Incidences of major adverse cardiac
events were assessed at 5 years follow-up. Results Study population
comprised 1,305 patients. The incidence of major adverse cardiac and
cerebrovascular events at 5 years was 28.3% in the PCI group and 23.0% in
the CABG group (hazard ratio [HR]: 1.23; 95% confidence interval [CI]:
1.01 to 1.55; p = 0.045). This difference is mainly driven by a higher
rate of repeat revascularization associated with PCI (HR: 1.85; 95% CI:
1.38 to 2.47; p < 0.001). The 2 strategies showed similar rates of the
safety composite endpoint of death, myocardial infarction, or stroke (p =
0.45). In patients with isolated LM or LM + 1-vessel disease, PCI was
associated with a 60% reduction in all-cause mortality (HR: 0.40; 95% CI:
0.20 to 0.83; p = 0.029) and 67% reduction in cardiac mortality (HR: 0.33;
95% CI: 0.12 to 0.88; p = 0.025) when compared with CABG. Conclusions In
patients with unprotected LMD, CABG, and PCI result in similar rates of
the safety composite endpoint of death, myocardial infarction, or stroke.
In patients with isolated LM or LM + 1-vessel disease, PCI is associated
with lower all-cause and cardiac mortality when compared to CABG.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<107>
Accession Number
613145958
Author
Asgar A.; Chandrasekhar J.; Mikhail G.; Webb J.; Lefevre T.; Tamburino C.;
Hildick-Smith D.; Hambrecht R.; Van Belle E.; Widder J.; Dumonteil N.;
Hink U.; Jeger R.; Linke A.; Deliargyris E.; Gao P.; Mehran R.;
Hengstenberg C.; Anthopoulos P.; Dangas G.
Institution
(Asgar) Division of CardiologyMontreal Heart InstituteMontreal Canada
(Chandrasekhar, Mehran, Dangas) Icahn School of Medicine at Mount SinaiThe
Zena and Michael a. Wiener Cardiovascular InstituteNew York, New York
(Mikhail) Imperial College Healthcare NHS Trust, Hammersmith
HospitalLondon United Kingdom
(Webb) Division of CardiologySt. Paul's HospitalVancouver, British
Columbia Canada
(Lefevre) Ramsay Generale De SanteInstitut Hospitalier Jacques
CartierMassy France
(Tamburino) Department of CardiologyUniversity of CataniaCatania Italy
(Hildick-Smith) Sussex Cardiac Centre-Brighton and Sussex University
Hospitals NHS TrustBrighton East Sussex, United Kingdom
(Hambrecht) Department of Cardiology and AngiologyKlinikum Links Der
WeserBremen Germany
(Van Belle) Centre Hospitalier Universitaire De LilleLille France
(Widder) Department of Cardiology and AngiologyHannover Medical
SchoolHannover Germany
(Dumonteil) Department of CardiologyRangueil University HospitalToulouse
France
(Hink) Cardiology DepartmentJohannes Gutenberg University HospitalMainz
Germany
(Jeger) Department of CardiologyUniversity Hospital BaselBasel Switzerland
(Linke) Department of Internal Medicine/CardiologyUniversity of Leipzig,
Heart Centre Germany
(Deliargyris, Gao) The Medicines CompanyParsippany, New Jersey
(Hengstenberg) DZHK (German Centre for Cardiovascular Research), Partner
Site Munich Heart Alliance, Munich, Germany, and Deutsches Herzzentrum
MunchenTechnische Universitat MunchenMunich Germany
(Anthopoulos) The Medicines CompanyZurich Switzerland
Title
Sex-based differences in outcomes with bivalirudin or unfractionated
heparin for transcatheter aortic valve replacement: Results from the
BRAVO-3 randomized trial.
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
Background: Women comprise almost 50% of patients undergoing transcatheter
aortic valve replacement (TAVR) and previous studies have indicated higher
rates of procedural complications and bleeding in women compared to men.
It is unknown whether men and women demonstrate a differential response to
bivalirudin versus unfractionated heparin (UFH) in TAVR. We sought to
evaluate outcomes by sex and type of anticoagulant from the Bivalirudin
Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement
(BRAVO-3) trial of transfemoral TAVR. Methods: BRAVO-3 was a randomized
multicenter trial comparing transfemoral TAVR with bivalirudin versus UFH
(31 centers, n=802). The primary endpoint was 48 h major bleeding defined
as Bleeding Academic Research Consortium (BARC) type >3b. Major adverse
cardiovascular events (MACE) were a composite of 30-day death, myocardial
infarction, or stroke. Net adverse cardiovascular events (NACE) were a
composite of BARC >3b bleeding or 30-day MACE. We examined the outcomes in
men and women. Results: The total cohort included 49% women (n=391, 195
received bivalirudin and 196 UFH) and 51% men (n=411, 209 received
bivalirudin and 202 UFH). Women were older than men with fewer
comorbidities including coronary artery disease, atrial fibrillation,
diabetes but similar EuroSCORE I. Women received smaller sheath and device
sizes compared with men without differences in the use of vascular closure
devices. At 48-hr post-TAVR there was no difference in bleeding or
vascular complications in women compared to men. The use of bivalirudin
did not result in significantly lower bleeding at 48 hr or 30-days
compared to UFH. Conclusions: There was no difference in early outcomes
with bivalirudin versus UFH in men or women undergoing contemporary TAVR.
Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<108>
Accession Number
613145841
Author
Meneguz-Moreno R.A.; Ramos A.I.; Siqueira D.; de Castro-Filho A.; Jatene
T.; Dias Jeronimo A.; Le Bihan D.; Moreira A.; Arrais M.; Abizaid A.;
Sousa A.; Eduardo Sousa J.
Institution
(Meneguz-Moreno, Ramos, Siqueira, de Castro-Filho, Jatene, Dias Jeronimo,
Le Bihan, Arrais, Abizaid, Sousa, Eduardo Sousa) Instituto Dante Pazzanese
de CardiologiaSao Paulo Brazil
(Siqueira, Moreira, Arrais, Abizaid, Sousa, Eduardo Sousa) Hospital do
CoracaoSao Paulo Brazil
Title
Prognostic value of renal function in patients with aortic stenosis
treated with transcatheter aortic valve replacement.
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 objectives of the present study were to analyze the
variation of renal function after transcatheter aortic valve replacement
(TAVR) focused on acute kidney injury (AKI) and its impact on short- and
mid-term mortality. Background: Changes on renal function after TAVR and
their impact on clinical outcomes are incompletely understood until now.
Methods: At two tertiary centers 221 consecutive patients were submitted
to TAVR. Kidney injury was defined according to VARC-2 criteria. Patients
were classified according to the presence (group 1) or absence (group 2)
of AKI. Creatinine values were collected daily until seventh day after
procedure, 1 month, 6 months, and then 1 year after TAVR. Results: At
baseline, groups were similar, except for EuroSCORE II (8.66% vs. 7.34%,
P=0.02) and glomerular filtration rate (GFR) (39.59 vs. 48.49 mL/min.1.73
m², P=0.002). Overall 30 day-mortality and 1-year mortality
were 6.3% and 14.0%, respectively. Both 30-day mortality (23.1% vs. 1.2%,
P<0.001) and 1-year mortality (44.2% vs. 4.7%, P<0.001) were higher in
group 1. After multivariable-adjusted models, the only independent
predictor for AKI after TAVR was baseline GFR (HR: 1.37, 95% CI:
1.08-1.77, P=0.01). The independent risk factors for 1-year mortality were
AKI (HR: 15.66, 95% CI: 6.07-44.63, P<0.001), COPD (HR: 3.14, 95% CI:
1.05-9.40, P=0.04) and aortic regurgitation grade postprocedure>2 (P=0.05)
also after multivariate analysis. Conclusions: In this TAVR cohort,
baseline GFR was the only independent predictor of AKI, which negatively
impacted on 30-day and 1-year mortality. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<109>
Accession Number
613143233
Author
Ladia V.; Panchal H.B.; O'Neil T.J.; Sitwala P.; Bhatheja S.; Patel R.;
Ramu V.; Mukherjee D.; Mahmud E.; Paul T.K.
Institution
(Ladia, Panchal, Sitwala, Bhatheja, Patel, Ramu, Paul) Department of
Internal Medicine, East Tennessee State University, Johnson City,
Tennessee
(O'Neil) Department of Internal Medicine, Mountain Home VA Medical Center,
Johnson City, Tennessee
(Mukherjee) Division of Cardiology, Department of Internal Medicine, Texas
Tech University, El Paso, Texas
(Mahmud) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of California, San Diego, California
Title
Incidence of Renal Failure Requiring Hemodialysis Following TAVR: A
Meta-Analysis of Transfemoral Versus Transapical Approach.
Source
American Journal of the Medical Sciences. (no pagination), 2016. Date of
Publication: October 23, 2015.
Publisher
Elsevier B.V. (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Studies have shown that iodinated radiocontrast use is
associated with acute renal failure especially in the presence of chronic
kidney disease, and multiple factors modulate this risk. The purpose of
this meta-analysis is to compare incidence of renal failure requiring
hemodialysis between transfemoral (TF) and transcatheter aortic valve
replacement (TA-TAVR) using the Edwards valve. Methods: The PubMed
database was searched from January 2000 through December 2014. A total of
10 studies (n = 2,459) comparing TF (n = 1,268) and TA (n = 1,191) TAVR
procedures using the Edwards valve were included. Variables of interest
were baseline logistic EuroSCORE, prevalence of diabetes mellitus,
hypertension, peripheral arterial disease, chronic kidney disease and
amount of contrast used. The primary endpoint was incidence of renal
failure requiring hemodialysis. The odds ratio and 95% CI were computed
and . P < 0.05 was considered as the level of significance. Results: The
LES was significantly higher in TA compared to TF (P = 0.001) TAVR. The
amount of contrast (mL) used was significantly higher in TF group compared
to the TA group (mean difference: 36.9, CI: 25.7-48.1, . P < 0.001). The
incidence of hemodialysis following the procedure was significantly higher
in the TA group compared to TF group (odds ratio = 4.3, CI: 2.4-7.8, . P <
0.00001). Conclusions: This meta-analysis suggests that despite the lower
amount of contrast used in TA-TAVR, the incidence of renal failure
requiring hemodialysis was higher with the Edwards valve. This suggests
that the incidence of renal failure requiring hemodialysis after TAVR is
associated with baseline comorbidities in the TA-TAVR group rather than
the volume of contrast used. Copyright &#xa9; 2016 Southern Society for
Clinical Investigation.

<110>
Accession Number
613137113
Author
Shah A.H.; Horlick E.M.; Eicken A.; Asnes J.D.; Bocks M.L.; Boudjemline
Y.; Cabalka A.K.; Fagan T.E.; Schubert S.; Mahadevan V.S.; Dvir D.; Osten
M.; Mcelhinney D.B.
Institution
(Shah, Horlick, Osten) Toronto General HospitalToronto Canada
(Eicken) German Heart CentreMunich Germany
(Asnes) Yale UniversityNew Haven, Connecticut
(Bocks) University of MichiganAnn Arbor, Michigan
(Boudjemline) Necker Enfants Malades HospitalParis France
(Cabalka) Mayo ClinicRochester, Minnesota
(Fagan) University of Tennessee Health Science Center and Le Bonheur
Children's HospitalMemphis, Tennessee
(Schubert) Deutsches HerzzentrumBerlin Germany
(Mahadevan) University of CaliforniaSan Francisco, California
(Dvir) St. Paul's HospitalVancouver Canada
(Mcelhinney) Stanford UniversityPalo Alto, California
Title
Transcatheter valve implantation for right atrium-to-right ventricle
conduit obstruction or regurgitation after modified Bjork-fontan
procedure.
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
Background: The most common reason for reintervention after a Bjork
modification of the Fontan procedure, in which the right ventricle (RV) is
incorporated into the pulmonary circulation by connecting the right atrial
(RA) appendage to the RV directly or with an extra-anatomic graft, is
obstruction or regurgitation of the RA-RV connection. Transcatheter
implantation of a valved stent is an appealing option for the treatment of
RA-RV conduit dysfunction in these patients. In the present study, we
assessed early and intermediate results after transcatheter valve
implantation within an obstructed or regurgitant RA-RV modified Fontan
pathway. Methods: Through a retrospective multicenter registry, we
collected data from 16 patients with a modified Fontan circulation who
were treated with percutaneous Melody or Sapien valve implantation for
dysfunction of an extra-anatomic RA-RV conduit or valve. Results: All
patients had successful and uncomplicated implantation of a Melody (n=15)
or Sapien 3 (n=1) valve with hemodynamic and, in most cases, clinical
improvement. During a median follow-up of 3.3 years, 3 patients died of
cardiovascular causes unrelated to the procedure or the valve, and no
major valve dysfunction was observed. Conclusion: Percutaneous
transcatheter valve deployment to treat a dysfunctional RA-RV connection
after a Bjork modification of the Fontan procedure is a viable alternative
to surgery, with low procedural risk, and appears to offer good early and
intermediate results. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<111>
Accession Number
613133657
Author
Luni F.K.; Riaz H.; Khan A.R.; Riaz T.; Husnain M.; Riaz I.B.; Khan M.S.;
Taleb M.; Kanjwal Y.; Cooper C.J.; Khuder S.A.
Institution
(Luni, Taleb, Kanjwal) Mercy Saint Vincent Medical CenterToledo, Ohio
(Riaz) Cleveland ClinicCleveland, Ohio
(Khan) University of LouisvilleLouisville, Kentucky
(Riaz) Bronx Lebanon HospitalNew York, New York
(Husnain, Riaz) University of ArizonaTucson, Arizona
(Khan) Dow University of Health SciencesKarachi Pakistan
(Cooper, Khuder) University of Toledo Medical CenterToledo, Ohio
Title
Clinical outcomes associated with per-operative discontinuation of aspirin
in patients with coronary artery disease: A systematic review and
meta-analysis.
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
Background: Postoperative state is characterized by increased thrombotic
risk by virtue of platelet activation. Whether aspirin ameliorates this
risk in patients with established coronary artery disease undergoing
cardiac or noncardiac surgery is unknown. We conducted a systematic review
and meta-analysis to compare the risk of major adverse cardiac events
(MACE) and the risk of bleeding in patients with early (3-5 or more days
before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of
aspirin. Methods: Multiple databases were searched from inception of these
databases until March 2015 to identify studies that reported
discontinuation of aspirin in patients undergoing surgery. The outcomes
measured were all cause mortality, nonfatal myocardial infarction and
other relevant thrombotic events (MACE) which also may include, fatal and
nonfatal MI, stent thrombosis and restenosis, stroke, perioperative
cardiovascular complications (heart failure, MI, VTE, acute stroke) and
perioperative bleeding during the perioperative period to up to 30 days
after surgery. Results: A total of 1,018 titles were screened, after which
six observational studies met the inclusion criteria. Our analysis
suggests that there is no difference in MACE with planned discontinuation
of aspirin (OR=1.17, 95% CI=0.76-1.81; P=0.05; I²=55%). Early
discontinuation of aspirin showed a decreased risk of peri-operative
bleeding (OR 0.82, 95% CI=0.67-0.99; P=0.04; I²=42%).
Conclusion: Our analysis suggests that planned short-term discontinuation
in the appropriate clinical setting appears to be safe in the correct
clinical setting with no increased risk of thrombotic events and with a
decreased risk of bleeding. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<112>
Accession Number
613131351
Author
Reichert M.; Hecker M.; Witte B.; Bodner J.; Padberg W.; Weigand M.A.;
Hecker A.
Institution
(Reichert, Witte, Padberg, Hecker) Department of General and Thoracic
Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7,
Giessen 35392, Germany
(Hecker) Department of Pulmonology and Intensive Care Medicine, Medical
Clinic II, University Hospital of Giessen, Giessen 35392, Germany
(Bodner) Department of Thoracic Surgery, Klinikum Bogenhausen,
Englschalkinger Strasse 77, Munich 81925, Germany
(Bodner) Department of Visceral, Transplant and Thoracic Surgery, Center
of Operative Medicine, Innsbruck Medical University, Innsbruck 6020,
Austria
(Weigand) Department of Anesthesiology, University Hospital of Heidelberg,
Heidelberg 69120, Germany
Title
Stage-directed therapy of pleural empyema.
Source
Langenbeck's Archives of Surgery. (pp 1-12), 2016. Date of Publication: 04
Nov 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Intensivists and surgeons are often confronted with critically
ill patients suffering from pleural empyema. Due to it' s multifactorial
pathogenesis and etiology, medicals should be sensitized to recognize the
different stages of the disease. Besides a whole bundle of different
established classification systems, the progress of pleural effusions can
be subdivided into the early exudative, the intermediate fibropurulent and
the late organized phase according to the classification of the American
Thoracic Society. Results: Rapid diagnosis of pleura empyema is essential
for patients' survival. Due to the importance of stage-adapted therapeutic
decisions, different classification systems were established. Depending on
the stage of pleural empyema, both antimicrobial and interventional
approaches are indicated. For organized empyema, minimally invasive and
open thoracic surgery are gold standard. Surgery is based on the three
therapeutic columns: removal of pleural fluid, debridement and
decortication. In general, therapy must be intended stage-directed
following multidisciplinary concepts including surgeons, intensivists,
anesthesiologists, physiotherapists and antibiotic stewards. Despite an
established therapeutic algorithm is presented in this review, there is
still a lack of randomized, prospective studies to evaluate potential
benefits of minimally invasive (versus open) surgery for end-stage empyema
or of catheter-directed intrathoracic fibrinolysis (versus minimally
invasive surgery) for intermediate-stage pleural empyema. Any delay in
adequate therapy results in an increased morbidity and mortality.
Conclusion: The aim of this article is to review current treatment
standards for different phases of adult thoracic empyema from an
interdisciplinary point of view. Copyright &#xa9; 2016 Springer-Verlag
Berlin Heidelberg