EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
612312537
Author
Bashir J.; Fedoruk L.M.; Ofiesh J.; Karim S.S.; Tyers G.F.O.
Institution
(Bashir, Karim) St Paul's Hospital, Department of Cardiovascular Surgery,
University of British Columbia, No 458B, 1081 Burrard St, Vancouver V6Z
1Y6, Canada
(Fedoruk, Ofiesh) Royal Jubilee Hospital, Department of Cardiovascular
Surgery, University of Victoria, BC, Canada
(Tyers) Vancouver Coastal Health, Department of Cardiovascular Surgery,
University of British Columbia, Vancouver, Canada
Title
Classification and Surgical Repair of Injuries Sustained during
Transvenous Lead Extraction.
Source
Circulation: Arrhythmia and Electrophysiology. 9 (9) (no pagination),
2016. Article Number: e003741. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Injuries to cardiac and venous structures during pacemaker
and defibrillator lead extraction are serious complications that have been
studied poorly. The incidence of these injuries is unknown but likely
underestimated. No systematic multicenter review of these injuries or
their management has been undertaken. Methods and Results - We
interrogated our mandatory administrative database for all excimer laser
extractions that sustained a cardiac or venous injury in the province of
British Columbia. Injuries were classified according to presentation and
compared with respect to nature of injury, type of repair, utilization of
cardiopulmonary bypass, and outcome. Of 1082 excimer laser extractions
over 19 years, 33 sustained an injury (3.0%). The majority of injuries
occurred in women (21/33; 63.6%), and median age of oldest lead extracted
was 10.8 (7.5, 12.2) years. A type 1 presentation, defined as circulatory
collapse, was found in 12/33 patients (36.4%). A type 2 presentation,
defined as progressive hypotension responsive to treatment, was found in
20/33 patients (60.6%). Over half the patients had a moderate or large
injury, and cardiopulmonary bypass was required in 13 patients with
extensive injury. Despite the presence of devastating injuries, the
immediate availability of aggressive salvage measures resulted in a
survival of 87.9% of patients at 30 days. Conclusions - The immediate
availability of a cardiovascular surgeon, perfusionist, and
cardiopulmonary bypass pump facilitates lifesaving repair of injuries
sustained during laser lead extraction. The size and complexity of injury
correlates closely with the presentation, blood loss, and need for
cardiopulmonary bypass to facilitate repair. Copyright &#xa9; 2016
American Heart Association, Inc.

<2>
Accession Number
609720381
Author
Ali F.; Rehman H.; Babayan Z.; Stapleton D.; Joshi D.-D.
Institution
(Ali) Internal Medicine, Guthrie Medical Group, Robert Packer Hospital,
Sayre, PA, United States
(Rehman) Hematology Oncology, Aga Khan University Hospital, Karachi,
Pakistan
(Babayan) Cardiology, Guthrie medical Group, P.C, Sayre, PA, United States
(Stapleton) Department of Medicine, Guthrie Medical Group, P.C, Sayre, PA,
United States
(Joshi) Miller Children's and Women's Hospital, Long Beach, CA, United
States
Title
Energy drinks and their adverse health effects: A systematic review of the
current evidence.
Source
Postgraduate Medicine. 127 (3) (pp 308-322), 2015. Date of Publication: 01
Jan 2015.
Publisher
Taylor and Francis Inc. (325 Chestnut St, Suite 800, Philadelphia PA
19106, United States)
Abstract
Purpose: With the rising consumption of so-called energy drinks over the
last few years, there has been a growing body of literature describing
significant adverse health events after the ingestion of these beverages.
To gain further insight about the clinical spectrum of these adverse
events, we conducted a literature review. Methods: Using PubMed and
Google-Scholar, we searched the literature from January 1980 through May
2014 for articles on the adverse health effects of energy drinks. A total
of 2097 publications were found. We then excluded molecular and
industry-related studies, popular media reports, and case reports of
isolated caffeine toxicity, yielding 43 reports. Conclusion: Energy drink
consumption is a health issue primarily of the adolescent and young adult
male population. It is linked to increased substance abuse and risktaking
behaviors. The most common adverse events affect the cardiovascular and
neurological systems. The most common ingredient in energy drinks is
caffeine, and it is believed that the adverse events are related to its
effects, as well as potentiating effects of other stimulants in these
drinks. Education, regulation, and further studies are required. Copyright
&#xa9; 2015 Informa UK Ltd.

<3>
Accession Number
603518906
Author
Elmariah S.; Mauri L.; Doros G.; Galper B.Z.; O'Neill K.E.; Steg P.G.;
Kereiakes D.J.; Yeh R.W.
Institution
(Elmariah, Yeh) Department of Medicine, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, United States
(Mauri, Galper, O'Neill) Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Elmariah, Mauri, Doros, Yeh) Harvard Clinical Research Institute, Boston,
MA, United States
(Doros) Department of Biostatistics, Boston University, School of Public
Health, Boston, MA, United States
(Steg) Universite Paris-Diderot, Sorbonne Paris-Cite, Paris, France
(Steg) Departement Hospitalo-Universitaire FIRE (Fibrosis Inflammation and
Remodeling), INSERM U-1148 and Hopital Bichat, Assistance
Publique-Hopitaux de Paris, Paris, France
(Steg) National Heart Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Kereiakes) Lindner Research Center, Christ Hospital Heart, Vascular
Center, Cincinnati, OH, United States
Title
Extended duration dual antiplatelet therapy and mortality: A systematic
review and meta-analysis.
Source
The Lancet. 385 (9970) (pp 792-798), 2015. Date of Publication: 28 Feb
2015.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Treatment with aspirin and a P2Y12 inhibitor is commonly used
in patients with cardiovascular disorders. The overall effect of such
treatment on all-cause mortality is unknown. In the Dual Antiplatelet
Therapy (DAPT) Study, continuation of dual antiplatelet therapy beyond 12
months after coronary stenting was associated with an unexpected increase
in non-cardiovascular death. In view of the potential public health
importance of these findings, we aimed to assess the effect of extended
duration dual antiplatelet therapy on mortality by doing a meta-analysis
of all randomised, controlled trials of treatment duration in various
cardiovascular disorders. Methods We searched Medline, Embase, and
Cochrane Central Register of Controlled Trials (CENTRAL) to identify
randomised controlled trials assessing the effect of extended duration
versus no or short duration dual antiplatelet therapy, published before
Oct 1, 2014. We did a meta-analysis to pool results with a hierarchical
Bayesian random-effects model. The primary outcomes were hazard ratios
comparing rates of all-cause, cardiovascular, and non-cardiovascular
death. Findings Including the DAPT Study, we identified 14 eligible trials
that randomly assigned 69 644 participants to different durations of dual
antiplatelet therapy. Compared with aspirin alone or short duration dual
antiplatelet therapy (<6 months), continued treatment was not associated
with a difference in all-cause mortality (hazard ratio [HR] 1.05, 95%
credible interval [CrI] 0;middotmiddot p=0.33). Similarly, cardiovascular
(1.01, 0;middotmiddot p=0.81) and non-cardiovascular mortality (1.04,
0;middotmiddot p=0.66) were no different with extended duration versus
short duration dual antiplatelet therapy or aspirin alone. Interpretation
Extended duration dual antiplatelet therapy was not associated with a
difference in the risk of all-cause, cardiovascular, or non-cardiovascular
death compared with aspirin alone or short duration dual antiplatelet
therapy. Funding None. Copyright &#xa9; 2015 Elsevier Ltd.

<4>
Accession Number
600438268
Author
Sekercioglu N.; Spencer F.A.; Lopes L.C.; Guyatt G.H.
Institution
(Sekercioglu, Guyatt) Department of Clinical Epidemiology and
Biostatistics, McMaster University, 1280 Main Street, Hamilton, ON L8S 4
K1, Canada
(Spencer, Guyatt) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Lopes) Pharmaceutical Sciences Postgraduate Course, University of
Sorocaba (UNISO), Brazil
Title
Culprit vessel only vs immediate complete revascularization in patients
with acute ST-segment elevation myocardial infarction: Systematic review
and meta-analysis.
Source
Clinical Cardiology. 37 (12) (pp 765-772), 2014. Date of Publication: 01
Dec 2014.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Although multivessel coronary artery disease has been associated with poor
health outcomes in patients with acute ST-segment elevation myocardial
infarction (STEMI), the optimal approach to revascularization remains
uncertain. The objective of this review was to determine the benefits and
harms of culprit vessel only vs immediate complete percutaneous coronary
intervention (PCI) in patients with acute STEMI. We searched MEDLINE,
EMBASE, the Cochrane Register of Controlled Trials, and the Cumulative
Index to Nursing and Allied Health Literature (CINAHL) for randomized
controlled trials (RCTs). Teams of 2 reviewers, independently and in
duplicate, screened titles and abstracts, completed full-text reviews, and
abstracted data. We calculated pooled risk ratios (RRs) and associated 95%
confidence intervals (CIs) using random-effect models for nonfatal
myocardial infarction (MI), revascularization, cardiovascular mortality,
all-causemortality, and adverse events, and used the GRADE approach to
rate confidence in estimates of effect. Of 341 patients randomized to
complete revascularization and followed to study conclusion, 31
experienced revascularization, as did 80 of 324 randomized to culprit
vessel only revascularization (RR: 0.35, 95% CI: 0.24-0.53). Ten patients
in the complete revascularization group and 28 patients in the culprit
vessel only revascularization group experienced nonfatal MI (RR: 0.35, 95%
CI: 0.17-0.72). All-cause mortality and cardiac deaths did not differ
between groups (RR: 0.69, 95% CI: 0.40-1.21 for all-cause mortality; RR:
0.48, 95% CI: 0.22-1.04 for cardiac deaths). Pooled data from 3 RCTs
suggest that immediate complete revascularization probably reduces
revascularization in patients with acute STEMI; although results suggest
possible benefits on MI and death, confidence in estimates is low.
Copyright &#xa9; 2014 Wiley Periodicals, Inc.

<5>
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.

<6>
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

<7>
Accession Number
611348294
Author
Li Y.; Wang D.; Hu C.; Zhang P.; Zhang D.; Qin S.
Institution
(Li, Wang, Hu, Zhang, Zhang, Qin) Department of Cardiology, First
Affiliated Hospital, Chongqing Medical University, No. 1 Yixueyuan Road,
Chongqing 400016, China
Title
Efficacy and safety of adjunctive trimetazidine therapy for acute
myocardial infarction: a systematic review and meta-analysis.
Source
Cardiology (Switzerland). 135 (3) (pp 188-195), 2016. Date of Publication:
01 Oct 2016.
Publisher
S. Karger AG
Abstract
Background: Several lines of evidence support the clinical use of
trimetazidine as an adjunctive therapy in cardioischemic patients.
Therefore, we assessed here the efficacy and safety of adjunctive
trimetazidine therapy in acute myocardial infarction (MI) patients by a
systematic review and meta-analysis of the current literature. Methods:
PubMed, the Cochrane Library, and the China National Knowledge
Infrastructure databases were searched for clinical studies comparing
adjunctive trimetazidine therapy against placebo in adult acute MI
patients. Several clinical outcomes [early/short-term all-cause mortality,
long-term all-cause mortality, total major adverse cardiac events (MACE),
recurrent nonfatal MI, in-hospital adverse events, target vessel
revascularization (TVR), and coronary artery bypass graft (CABG)] were
analyzed by the intention-to-treat principle. Odds ratios (OR) and their
95% confidence intervals (CI) were derived from the number of outcome
events in each study arm to estimate the association between adjuvant
trimetazidine administration and the various clinical outcomes. A
random-effects model was applied for all meta-analyses. Results: We found
that adjunctive trimetazidine therapy showed a significant effect upon
total MACE (OR = 0.33, 95% CI = 0.15-0.74; p = 0.007) but showed no
significant effect upon early/short-term all-cause mortality, long-term
all-cause mortality, recurrent nonfatal MI, in-hospital adverse events,
TVR, or CABG (p > 0.05). Conclusions: This is the first meta-analysis to
report that adjunctive trimetazidine therapy has a beneficial effect upon
total MACE in acute MI patients. Clinical investigators should consider
further trials on adjunctive trimetazidine therapy in order to better
define its risks and benefits in acute MI patients. Copyright &#xa9; 2016
S. Karger AG, Basel.

<8>
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.

<9>
Accession Number
611162720
Author
Walpot J.; Sadreddini M.
Institution
(Walpot, Sadreddini) Department of Cardiology, Admiraal De Ruyter
Ziekenhuis, Vlissingen and Goes, Netherlands
Title
Left Atrial Compression Caused by an Intrapericardial Hematoma after
Coronary Artery Bypass Graft Surgery.
Source
Journal of Emergency Medicine. 51 (3) (pp 274-277), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Left atrial compression (LAC) is an uncommon condition that
causes left ventricular inflow obstruction. The clinical and pathologic
features are similar to those of mitral stenosis. Impaired left
ventricular filling may cause hypotension, syncope, or shock. The
increased left atrial pressure causes retrograde increase of the pressure
throughout the pulmonary circulation with subsequent signs of congestion.
Case Report An 84-year-old man presented with LAC caused by a focal
tamponade related to a pericardial hematoma as a complication of coronary
artery bypass graft (CABG) surgery. The formation of the hematoma occurred
3 weeks postsurgery. The echocardiographic study before discharge at day
12 after CABG surgery showed neither a focal hematoma nor a tamponade. The
diagnosis was made 6 days later. Why Should an Emergency Physician Be
Aware of This? Intrapericardial tamponade caused by bleeding is a known
complication of CABG surgery in the early postoperative stage. However,
emergency physicians should be aware that a postoperative hematoma may
also present as a focal tamponade because of postoperative adhesion by
scar formation. The literature of LAC is limited. The most reported causes
of LAC are compression caused by structures of the gastrointestinal tract,
followed by thoracic aortic pathology. A Medline search for the terms
"left atrial compression and hematoma" and "left atrial compression and
intrapericardial hematoma" found only 31 and 4 hits, respectively. We also
briefly discuss the import role of bedside echocardiography in the
diagnostic process of LAC in the emergency medicine department. Copyright
&#xa9; 2016 Elsevier Inc.

<10>
Accession Number
612945026
Author
Pola M.S.; Medina Inojosa J.R.; Terzic C.M.; Goel K.; Vickers D.; Kristin
S.; Thomas R.J.
Institution
(Pola, Medina Inojosa, Terzic, Goel, Vickers, Kristin, Thomas) Mayo
Clinic, United States
Title
The prevalence of musculoskeletal limitations and its effect on cardiac
rehabilitation participation: A cross-sectional survey.
Source
Archives of Physical Medicine and Rehabilitation. Conference: 93rd Annual
Conference of the American Congress of Rehabilitation Medicine, ACRM 2016.
United States. Conference Start: 20161030. Conference End: 20161104. 97
(10) (pp e75), 2016. Date of Publication: October 2016.
Publisher
W.B. Saunders
Abstract
Research Objectives: To examine the prevalence of musculoskeletal
limitations (MSLs) and explore its possible roles as a barrier to patient
enrollment in phase II cardiac rehabilitation (CR). Design:
Cross-sectional survey. Setting: Academic institution. Participants:
Consecutive individuals hospitalized for a CR-eligible cardiac event
(myocardial infarction, percutaneous coronary intervention, or coronary
artery bypass graft) between November 2007 and May 2008 were asked to
complete a mailed survey within 2 weeks of hospital discharge, assessing
demographic factors, Patient Health Questionnaire (PHQ-9), participation
in cardiac rehabilitation and MSLs through a validated Musculoskeletal
Limitations Screening questionnaire. Interventions: Not applicable. Main
Outcome Measure(s): CR participation. Results: Of 862 CR eligible patients
who were sent the survey, 320 (37%) patients responded. Mean age of the
study was 68.0 +/- 10.8, 227 (70.7%) were males and mean PHQ9 score was
5.2 +/- 4.5. Eighty three percent of responders reported a musculoskeletal
disorder. Muscle or joint pain was reported to limit the ability to do
moderate exercise in 60% of the patients. Problems with balance affected
117 (36.6%) of whom 44 (38%) reported a fall within the past year. No
significant difference in CR enrollment was observed between the patients
with MSLs to those without MSLs (OR=1.02 95% CI 0.8-1.09 p value=0.7).
Conclusions: Despite high prevalence of MSLs among CR eligible patients,
we found that MSLs do not serve as a significant barrier to CR enrollment.

<11>
Accession Number
612930683
Author
Leijser L.; Chau V.; Seed M.; Blaser S.; Poskitt K.; Synnes A.; Hickey E.;
Campbell A.; McQuillen P.; Miller S.
Institution
(Leijser) TorontoONCanada
Title
Anticoagulation therapy and the risk of brain injury in neonates with
transposition of the great arteries.
Source
Annals of Neurology. Conference: 45th Annual Meeting of the Child
Neurology Society. Canada. Conference Start: 20161026. Conference End:
20161029. 80 (pp S399), 2016. Date of Publication: October 2016.
Publisher
John Wiley and Sons Inc.
Abstract
Objective: Neonates with transposition of the great arteries (TGA) are at
increased risk of brain injury, particularly stroke. As the management of
pre-operative stroke or thrombosis in neonates with TGA may include
anticoagulation to minimize the risk of subsequent stroke, we sought to
determine the relationship between anticoagulation therapy following
pre-operative brain MRI with the risk of postoperative brain injury.
Methods: In this two-centre cohort study, 61 term-born neonates with TGA
undergoing an arterial switch operation were prospectively studied with
pre- and post-operative brain MRI and scored for: stroke, white matter
injury (WMI) and subdural/intraventricular hemorrhage (SDH/ IVH). Relative
risks (RR) of post-operative brain abnormalities were calculated for
pre-operative stroke and anticoagulation following pre-operative stroke or
thrombosis. Results: Pre-operative stroke was detected in 13(21%)
neonates, of whom 12 had septostomy. Other pre-operative brain injury
included WMI in 9(15%), IVH in 9(15%) and SDH in 9(15%). Post-operatively
additional injury was common: stroke in 5(8%), WMI in 16(26%), SDH in
9(15%) and IVH in 5(8%). In 9(15%) neonates anticoagulation was started
for stroke (n=3) or thrombosis (n=6) between pre-operative MRI and
arterial switch. Among neonates with pre-operative stroke none had new
strokes on post-operative MRI, whether treated with anticoagulation
therapy (n=3) or not (n=10). Among the 9 neonates treated with
anticoagulation, there were trends to more post-operative WMI (RR 1.9;
95%-CI 0.8-4.7) and SDH (RR 2.8; 95%-CI 0.9-9.3). Conclusions: Recurrent
stroke is uncommon in neonates with TGA. Rigorous clinical trials are
needed to determine the appropriate use of anticoagulation therapy in
neonates with TGA.

<12>
Accession Number
612930351
Author
Deregnier R.-A.; Boswell L.; Weck M.; Hayner A.; Stoen R.; Fjortoft T.;
Adde L.; Gaebler-Spira D.
Institution
(Deregnier) Pediatrics, Northwestern University, Feinberg School of
Medicine, Chicago, United States
(Boswell, Weck) Physical Therapy, Ann and Robert H. Lurie Children's
Hospital of Chicago, Chicago, United States
(Hayner) Pediatrics, Ann and Robert H. Lurie Children's Hospital of
Chicago, Chicago, United States
(Stoen, Fjortoft, Adde) Pediatrics, St. Olav's Hospital Trondheim,
Norwegian University of Science and Technology, Trondheim, Norway
(Gaebler-Spira) Pediatrics, Rehabilitation Institute of Chicago,
Northwestern University, Chicago, United States
Title
Abnormal general movements during the fidgety period and abnormal
neurologic examinations at 18-24 months in a high risk United States
population.
Source
Developmental Medicine and Child Neurology. Conference: 27th Annual
Meeting of the European Academy of Childhood Disability. Denmark.
Conference Start: 20160527. Conference End: 20160530. 58 (pp 55), 2016.
Date of Publication: October 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Assessment of General Movements (GMA) appears to be predictive
of neuromotor function in preterm infants but it has not been studied in
diverse groups of infants from the United States (US). Aim: To evaluate
the association between the GMA during the fidgety period and neurologic
examinations at 18- 24 months corrected age (CA) in US infants with a
variety of high risk biomedical and neurologic conditions. Method: Infants
were included if they were preterm (<30 wks gestation, n=44), had
significant brain injury/abnormality (n=49), neonatal cardiac surgery
(n=38) or prolonged hospitalization through 10 weeks post-term (n=17). of
the 121 infants studied, 23 had more than one risk factor. Infants were
videotaped in a quiet alert state and evaluated by 2 blinded, certified
GMA observers. Fidgety Movements (FM) were classified as Normal if present
(continual or intermittent) or Abnormal if absent, sporadic, or abnormal
(exaggerated). A standard neurologic examination was performed at 18-24
months CA in the developmental follow up clinic and coded as normal,
suspect or definite cerebral palsy (CP). The diagnosis of definite CP was
confirmed by a pediatric physiatrist using the Surveillance of Cerebral
Palsy in Europe. Results: FM classification was significantly correlated
with the neurologic examination (p=0.0001). Eight infants had CP and 8
were suspect. for continual FM (n=14), no infants had CP or were suspect.
for intermittent FM (n=78), 2 had CP and 5 were suspect. for sporadic FM
(n=8), no infants had CP or were suspect. for absent FM (n=17), 6 had CP
and 2 were suspect. for abnormal (exaggerated) FM (n=4), no infant had CP;
one was suspect. Conclusion: The GMA correlated with abnormal neurologic
examinations at 18-24 months CA but FM classifications were less
predictive than previously reported. This suggests the development of
general movements in this US group of medically complex infants differs
from infants studied previously.

<13>
Accession Number
612728934
Author
Landoni G.; Zangrillo A.; Lomivorotov V.V.; Likhvantsev V.; Ma J.; De
Simone F.; Fominskiy E.
Institution
(Landoni, Zangrillo, De Simone, Fominskiy) Department of Anaesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60,
Milan 20132, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University of Milan, Italy
(Lomivorotov, Fominskiy) Department of Anaesthesia and Intensive Care,
Academician en Meshalkin Novosibirsk, State Budget Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Likhvantsev) Moscow Regional Clinical and Research Institute, Moscow,
Russian Federation
(Ma) Centre for Anaesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
Title
Cardiac protection with phosphocreatine: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (4) (pp 637-646),
2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Phosphocreatine (PCr) plays an important role in the energy metabolism of
the heart and a decrease in its intracellular concentration results in
alteration of myocardium energetics and work. We conducted a meta-analysis
of all randomized and matched trials that compared PCr with placebo or
standard treatment in patients with coronary artery disease or chronic
heart failure or in those undergoing cardiac surgery. We systematically
searched PubMed/Medline, Embase, Cochrane Central Register of Controlled
Trials and Google Scholar up to 1 November 2015, for pertinent trials. The
primary outcome was all-cause mortality. Secondary outcomes included
inotrope use, ejection fraction (EF), peak creatinine kinase-myocardial
band (CK-MB) release and the incidence of major arrhythmias, as well as
spontaneous recovery of the heart performance in the subgroup of patients
undergoing cardiac surgery with cardiopulmonary bypass. We pooled odds
ratio (OR) and mean difference (MD) using fixed- and random effects
models. We identified 41 controlled trials, of them 32 were randomized.
Patients receiving PCr had lower all-cause mortality when compared with
the control group [61/1731 (3.5%) vs 177/1667 (10.6%); OR: 0.71, 95% CI:
0.51-0.99; P = 0.04; I² = 0%; with 3400 patients and 22 trials
included]. Phosphocreatine administration was associated with higher LVEF
(MD: 3.82, 95% CI: 1.18-6.46; P = 0.005; I² = 98%), lower peak
CK-MB release (MD: -6.08, 95% CI: -8.01, -4.15; P < 0.001; I² =
97%), lower rate of major arrhythmias (OR: 0.42; 95% CI: 0.27-0.66; P <
0.001; I² = 0%), lower incidence of inotropic support (OR:
0.39, 95% CI: 0.25-0.61; P < 0.001; I² = 56%) and a higher
level of spontaneous recovery of the heart performance after
cardiopulmonary bypass (OR: 3.49, 95% CI: 2.28-5.35; P < 0.001;
I² = 49%) when compared with the control group. In a mixed
population of patients with coronary artery disease, chronic heart failure
or in those undergoing cardiac surgery, PCr may reduce all-cause
short-term mortality. In addition, PCr administration was associated with
improved cardiac outcomes. Owing to the pharmacological plausibility of
this effect and to the concordance of the beneficial effects of PCr on
several secondary but important outcomes and survival, there is urgent
need for a large multicentre randomized trial to confirm these findings.
Copyright &#xa9; 2016 The Author 2016. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<14>
Accession Number
612728932
Author
Ammirati E.; Cipriani M.G.; Varrenti M.; Colombo T.; Garascia A.; Cannata
A.; Pedrazzini G.; Benazzi E.; Milazzo F.; Oliva F.; Gagliardone M.P.;
Russo C.F.; Frigerio M.
Institution
(Ammirati, Cipriani, Varrenti, Colombo, Garascia, Cannata, Pedrazzini,
Milazzo, Oliva, Gagliardone, Russo, Frigerio) 'De Gasperis' Cardio Center,
Niguarda Ca' Granda Hospital, Transplant Center, Piazza Ospedale Maggiore
3, Milan 20162, Italy
(Benazzi) Coordinamento Trapianti North Italy Transplantation Program
(NITp), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan,
Italy
Title
A prospective comparison of mid-term outcomes in patients treated with
heart transplantation with advanced age donors versus left ventricular
assist device implantation.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (4) (pp 584-592),
2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES In Europe, the age of heart donors is constantly increasing.
Ageing of heart donors limits the probability of success of heart
transplantation (HTx). The aim of this study is to compare the outcome of
patients with advanced heart failure (HF) treated with a continuous-flow
left ventricular assist device (CF-LVAD) with indication as bridge to
transplantation (BTT) or bridge to candidacy (BTC) versus recipients of
HTx with the donor's age above 55 years (HTx with donors >55 years).
METHODS we prospectively evaluated 301 consecutive patients with advanced
HF treated with a CF-LVAD (n = 83) or HTx without prior bridging (n = 218)
in our hospital from January 2006 to January 2015. We compared the outcome
of CF-LVAD-BTT (n = 37) versus HTx with donors >55 years (n = 45) and the
outcome of CF-LVAD-BTT plus BTC (n = 62) versus HTx with donors >55 years
at the 1- and 2-year follow-up. Survival was evaluated according to the
first operation. RESULTS The perioperative (30-day) mortality rate was 0%
in the LVAD-BTT group vs 20% (n = 9) in the HTx group with donors >55
years (P = 0.003). Perioperative mortality occurred in 5% of the
LVAD-BTT/BTC patients (n = 3) and in 20% of the HTx with donors >55 year
group (P = 0.026). Kaplan-Meier curves estimated a 2-year survival rate of
94.6% in CF-LVAD-BTT vs 68.9% in HTx with donors >55 years [age- and
sex-adjusted hazard ratio (HR) 0.25; 95% confidence interval (CI)
0.08-0.81; P = 0.02 in favour of CF-LVAD]. Considering the post-HTx
outcome, a trend in favour of CF-LVAD-BTT was also observed (age- and
sex-adjusted HR 0.45; 95% CI 0.17-1.16; P = 0.09 in favour of CF-LVAD),
whereas CF-LVAD-BTT/BTC showed a similar survival at 2 years compared with
HTx with donors >55 years, both censoring the follow-up at the time of HTx
and considering the post-HTx outcome. CONCLUSIONS Early and mid-term
outcomes of patients treated with a CF-LVAD with BTT indication seem
better than HTx with old donors. It must be emphasized that up to 19% of
patients in the CF-LVAD/BTT group underwent transplantation in an urgent
condition due to complications related to the LVAD. At the 2-year
follow-up, CF-LVAD with BTT and BTC indications have similar outcome than
HTx using old heart donors. These results must be confirmed in a larger
and multicentre population and extending the follow-up. Copyright &#xa9;
2016 The Author 2016. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<15>
Accession Number
611290417
Author
Duell P.B.; Santos R.D.; Kirwan B.-A.; Witztum J.L.; Tsimikas S.;
Kastelein J.J.P.
Institution
(Duell) Knight Cardiovascular Institute, Oregon Health and Sciences
University, Portland, OR, United States
(Santos) Lipid Clinic Heart Institute (InCor), University of Sao Paulo
Medical School Hospital, Sao Paulo, Brazil
(Kirwan) SOCAR Research SA, Nyon, Switzerland
(Kastelein) London School of Hygiene & Tropical Medicine, London, United
Kingdom
(Kirwan) Division of Endocrinology and Metabolism, University of
California San Diego, La Jolla, CA, United States
(Witztum) Division of Cardiovascular Medicine, Sulpizio Cardiovascular
Center, University of California San Diego, La Jolla, CA, United States
(Tsimikas) Ionis Pharmaceuticals, Carlsbad, CA, United States
(Tsimikas) Department of Vascular Medicine, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
Title
Long-term mipomersen treatment is associated with a reduction in
cardiovascular events in patients with familial hypercholesterolemia.
Source
Journal of Clinical Lipidology. 10 (4) (pp 1011-1021), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier Ltd
Abstract
Background Familial hypercholesterolemia (FH) is characterized by severely
elevated LDL-cholesterol and up to a 20-fold increase in premature
cardiovascular disease (CVD). Objective Mipomersen has been shown to lower
the levels of these atherogenic lipoproteins, but whether it lowers major
adverse cardiac events (MACEs) has not been addressed. Methods This post
hoc analysis of prospectively collected data of three randomized trials
and an open-label extension phase included patients that were exposed to
>12 months of mipomersen. MACE rates that occurred during 24 months before
randomization in the mipomersen group were compared to MACE rates after
initiation of mipomersen. Data from the trials included in this report are
registered in Clinicaltrials.gov (NCT00607373, NCT00706849, NCT00794664,
NCT00694109). The occurrence of MACE events, defined as cardiovascular
death, nonfatal acute myocardial infarction, hospitalization for unstable
angina, coronary revascularization and nonfatal ischemic stroke, was
obtained from medical history data pre-treatment and adjudicated by an
independent adjudication committee for events occurring post-treatment
with mipomersen. Results MACEs were identified in 61.5% of patients (64
patients with 146 events [39 myocardial infarctions, 99 coronary
revascularizations, 5 unstable angina episodes, 3 ischemic strokes])
during 24 months before mipomersen treatment, and in 9.6% of patients (10
patients with 13 events [1 cardiovascular death, 2 myocardial infarctions,
6 coronary interventions, 4 unstable angina episodes]) during a mean of
24.4 months after initiation of mipomersen (MACE rate 25.7 of 1000
patient-months vs 3.9 of 1000 patient-months, OR = 0.053 [95% CI,
0.016-0.168], P < .0001 by the exact McNemar test). The reduction in MACE
coincided with a mean absolute reduction in LDL-C of 70 mg/dL (-28%) and
of non-HDL cholesterol of 74 mg/dL (-26%) as well as reduction in Lp(a) of
11 mg/dL (-17%). Conclusion Long-term mipomersen treatment not only lowers
levels of atherogenic lipoproteins but may also lead to a reduction in
cardiovascular events in FH patients. Copyright &#xa9; 2016 National Lipid
Association

<16>
Accession Number
612667847
Author
Abdul-Jawad Altisent O.; Durand E.; Munoz-Garcia A.J.; Nombela-Franco L.;
Cheema A.; Kefer J.; Gutierrez E.; Benitez L.M.; Amat-Santos I.J.; Serra
V.; Eltchaninoff H.; Alnasser S.M.; Elizaga J.; Dager A.; Garcia del
Blanco B.; Ortas-Nadal M.D.R.; Marsal J.R.; Campelo-Parada F.; Regueiro
A.; del Trigo M.; Dumont E.; Puri R.; Rodes-Cabau J.
Institution
(Abdul-Jawad Altisent, Ortas-Nadal, Campelo-Parada, Regueiro, del Trigo,
Dumont, Puri, Rodes-Cabau) Cardiology Department, Quebec Heart and Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Durand, Eltchaninoff) Cardiology Department, University Hospital of
Rouen, Hospital Charles Nicolle, Rouen, France
(Munoz-Garcia) Cardiology Department, Hospital Universitario Virgen de la
Victoria, Universidad de Malaga, Malaga, Spain
(Nombela-Franco) Cardiology Department, Hospital Universitario Clinico San
Carlos, Madrid, Spain
(Cheema, Alnasser) Cardiology Department, St. Michael's Hospital, Toronto
University, Toronto, Ontario, Canada
(Kefer) Cardiology Department, Saint Luc University Hospital, Brussels,
Belgium
(Gutierrez, Elizaga) Cardiology Department, Instituto de Investigacion
Sanitaria Gregorio Maranon, Madrid, Spain
(Benitez, Dager) Cardiology Department, Clinica de Occidente de Cali,
Valle del Cauca, Colombia
(Amat-Santos) Cardiology Department, Hospital Clinico Universitario de
Valladolid, Valladolid, Spain
(Serra, Garcia del Blanco, Marsal) Cardiology Department, Hospital
Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona,
Spain
(Marsal) CIBER of Epidemiology and Public Health (CIBERESP), Barcelona,
Spain
Title
Warfarin and Antiplatelet Therapy Versus Warfarin Alone for Treating
Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve
Replacement.
Source
JACC: Cardiovascular Interventions. 9 (16) (pp 1706-1717), 2016. Date of
Publication: 22 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to examine the risk of ischemic events and
bleeding episodes associated with differing antithrombotic strategies in
patients undergoing transcatheter aortic valve replacement (TAVR) with
concomitant atrial fibrillation (AF). Background Guidelines recommend
antiplatelet therapy (APT) post-TAVR to reduce the risk of stroke.
However, data on the efficacy and safety of this recommendation in the
setting of a concomitant indication for oral anticoagulation (due to
atrial fibrillation [AF]) with a vitamin K antagonist (VKA) are scarce.
Methods A multicenter evaluation comprising 621 patients with AF
undergoing TAVR was undertaken. Post-TAVR prescriptions were used to
determine the antithrombotic regimen used according to the following 2
groups: monotherapy (MT) with VKA (n = 101) or multiple antithrombotic
therapy (MAT) with VKA plus 1 or 2 antiplatelet agents (aspirin or
clopidogrel; n = 520). Endpoint definitions were in accordance with Valve
Academic Research Consortium-2 criteria. The rate of stroke, major adverse
cardiovascular events (stroke, myocardial infarction, or cardiovascular
death), major or life-threatening bleeding events, and death were assessed
by a Cox multivariate model regression survival analysis according to the
antithrombotic regime used. Results During a median follow-up of 13 months
(interquartile range: 3 to 31 months) there were no differences between
groups in the rate of stroke (MT: 5%, MAT: 5.2%; adjusted hazard ratio
[HR]: 1.25; 95% confidence interval [CI]: 0.45 to 3.48; p = 0.67), major
adverse cardiovascular events (MT: 13.9%, MAT: 16.3%; adjusted HR: 1.33;
95% CI: 0.75 to 2.36; p = 0.33), and death (MT 22.8%, MAT: 19.2%; adjusted
HR: 0.93; 95% CI: 0.58 to 1.50; p = 0.76). A higher risk of major or
life-threatening bleeding was found in the MAT group (MT: 14.9%, MAT:
24.4%; adjusted HR: 1.85; 95% CI: 1.05 to 3.28; p = 0.04). These results
remained similar when patients receiving VKA plus only 1 antiplatelet
agent (n = 463) were evaluated. Conclusions In TAVR recipients prescribed
VKA therapy for AF, concomitant antiplatelet therapy use appears not to
reduce the incidence of stroke, major adverse cardiovascular events, or
death, while increasing the risk of major or life-threatening bleeding.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<17>
Accession Number
612908791
Author
Hoexum F.; Coveliers H.M.E.; Lu J.J.; Jongkind V.; Yeung K.K.; Wisselink
W.
Institution
(Hoexum, Coveliers, Jongkind, Yeung, Wisselink) Department of Vascular
Surgery, Vrije Universiteit Medical Center, De Boelelaan 1117, Amsterdam
1081 HV, Netherlands
(Lu) Grand Rapids Medical Education Partners, Grand Rapids, MI, United
States
Title
Thoracic sympathectomy for upper extremity Ischemia.
Source
Minerva Cardioangiologica. 64 (6) (pp 676-685), 2016. Date of Publication:
December 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Thoracic sympathectomy is performed in the management of a
variety of disorders of the upper extremity. To evaluate the contemporary
results of thoracic sympathectomy for upper extremity ischemia a
systematic review of the literature was conducted. EVIDENCEAQUISITION: We
performed a Pub Med, EMBASE and Cochrane search of the literature written
in the English language from January 1975 to December 2015. All articles
presenting original patient data regarding the effect of treatment on
symptoms or on the healing of ulcers were eligible for inclusion.
Individual analyses for Primary Raynaud's Disease (PRD) and Secondary
Raynaud's Phenomenon (SRP) were performed. EVIDENCESYNTHESIS: We included
6 prospective and 23 retrospective series with a total of 753 patients and
1026 affected limbs. Early beneficial effects of thoracic sympathectomy
were noticed in 63-100% (median 94%) of all patients, in 73-100% (median
98%) of PRD patients and in 63-100% (median 94%) of SRP patients. The
beneficial effect was noted to lessen over time. Long-term beneficial
effects were reported in 13-100% (median 75%) of all patients, in 22-100%
(median 58%) of PRD patients, and in 13-100% (median 79%) of SRD patients.
Complete or improved ulcer healing was achieved in 33-100% and 25-67%
respectively, of all patients. CONCLUSIONS: Thoracic sympathectomy can be
beneficial in the treatment of upper extremity ischemia in select
patients. Although the effect in patients with PRD will lessen over time,
it may still reduce the severity of symptoms. In SRD, effects are more
often long-lasting. In addition, thoracic sympathectomy may maximize
tissue preservation or prevent amputation in cases of digital ulceration.
Copyright &#xa9; 2016 EDIZIONI MINERVA MEDICA.

<18>
Accession Number
612775364
Author
Guo C.; Mei J.; Liu C.; Deng S.; Pu Q.; Lin F.; Liu L.
Institution
(Guo, Mei, Liu, Deng, Pu, Lin, Liu) Department of Thoracic Surgery, West
China Hospital, Sichuan University, Chengdu 610041, China
(Guo, Mei, Liu, Deng, Pu, Lin, Liu) Western China Collab Innovation Center
for Early Diagnosis, Multidisciplinary Therapy of Lung Cancer, Sichuan
University, Chengdu 610041, China
Title
Video-assisted thoracic surgery compared with posterolateral thoracotomy
for mediastinal bronchogenic cysts in adult patients.
Source
Journal of Thoracic Disease. 8 (9) (pp 2504-2511), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Mediastinal bronchogenic cyst (MBC) is the most common primary
cystic lesion of the mediastinum. This study aimed to investigate the
efficacy and safety of video-assisted thoracic surgery (VATS) compared
with posterolateral thoracotomy (PLT) for the treatment of MBCs in a large
series. Methods: Patients with MBCs who underwent surgical resection
between August 2005 and December 2015 were identified from the electronic
database of the Department of Thoracic Surgery, West China Hospital. The
patient demographic characteristics, intraoperative findings,
postoperative outcomes and follow-up information were reviewed and
analyzed. Results: A total of 99 patients underwent cystectomy were
enrolled for the present study. Of those patients, 65 underwent VATS
cystectomy (VATS group) and 34 underwent PLT cystectomy (PLT group) during
the same period. The VATS group had shorter operative time than the PLT
group (108.77+/-47.81 vs. 144.62+/-55.16, P=0.001), less intraoperative
blood loss (median 20 vs. 100 mL, P<0.001), and less pleural drainage of
the first three days after surgery (median 240 vs. 400 mL, P=0.002). In
addition, the length of postoperative hospital stay and duration of chest
drainage for the VATS group was also shorter than those of the PLT group
(4.94+/-2.01 vs. 8.64+/-5.52 days, P=0.001; 2.52+/-1.29 vs. 3.71+/-1.55
days, P < 0.001, respectively). No statistical significance was revealed
among the two groups with regard to the maximum diameter of the cysts,
pleural atresia, incomplete resection, surgery-related complications,
duration of intensive care unit stay, and postoperative complications.
Conclusions: Both VATS and PLT are reliable approaches for the surgical
resection of MBCs. The VATS approach is superior to PLT with shorter
operative time, shorter duration of chest drainage, shorter postoperative
hospital stay, less intraoperative blood loss, and less pleural drainage
of the first three days after surgery. We conclude that VATS should be the
preferred approach for the treatment of MBCs. Copyright &#xa9; Journal of
Thoracic Disease.

<19>
Accession Number
612775291
Author
Anonymous
Title
Erratum: Transcatheter valve-in-valve implantation versus reoperative
conventional aortic valve replacement: A systematic review [J Thorac Dis,
8, (2016), (E83-E93)] doi: 10.3978/j.issn.2072-1439.2016.01.44.
Source
Journal of Thoracic Disease. 8 (9) (pp E1111), 2016. Date of Publication:
2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
In the article that appeared on Page E83-E93, Vol 8, No 1 (January 2016)
Issue of the Journal of Thoracic Disease (1), there is an error of Kevin
Phan's degree as "BS, MD". The degree should have been shown as
"BSc(Adv)". The publisher regrets the error. Copyright &#xa9; Journal of
Thoracic Disease.

<20>
[Use Link to view the full text]
Accession Number
612775283
Author
Claessen B.E.; Hoebers L.P.; Elias J.E.; Van Dongen I.M.; Henriques J.P.S.
Institution
(Claessen, Hoebers, Elias, Van Dongen, Henriques) Department of
Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
Title
Meta-analyses and randomized trials investigating percutaneous coronary
intervention of chronic total occlusions: What is left to explore?.
Source
Journal of Thoracic Disease. 8 (9) (pp E1100-E1102), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)

<21>
Accession Number
610884092
Author
Ait Ali L.; Trocchio G.L.; Crepaz R.; Stuefer J.; Stagnaro N.; Siciliano
V.; Molinaro S.; Sicari R.; Festa P.
Institution
(Ait Ali, Siciliano, Molinaro, Sicari) Institute of Clinical Physiology,
The National Research Council (CNR), Via Aurelia Sud, Massa-Pisa 54100,
Italy
(Trocchio) Pediatric Cardiology Department, Giannina Gaslini Institute,
Genova, Italy
(Crepaz) Pediatric Cardiology, Department of Cardiology, Regional Hospital
S.Maurizio, Bolzano, Italy
(Stuefer) Magnetic Resonance, Department of Radiology, Regional Hospital
S.Maurizio, Bolzano, Italy
(Stagnaro) Radiology Department, Giannina Gaslini Institute, Genova, Italy
(Festa) O.U. Pediatric Cardiology, Ospedale del cuore, Fondazione G.
Monasterio-CNR, Regione Toscana, Italy
(Festa) MR Laboratory, Fondazione G. Monasterio-CNR, Regione Toscana,
Italy
Title
Left ventricular dysfunction in repaired tetralogy of Fallot: incidence
and impact on atrial arrhythmias at long term-follow up.
Source
International Journal of Cardiovascular Imaging. 32 (9) (pp 1441-1449),
2016. Date of Publication: 01 Sep 2016.
Publisher
Springer Netherlands
Abstract
Left ventricle (LV) systolic dysfunction in repaired tetralogy of Fallot
(TOF) has been identified as a risk factor for functional status and
adverse outcome. The aims of this cross-sectional followed by a
prospective study were: (1) to evaluate the prevalence of LV systolic
dysfunction in a large cohort of adults with repaired tetralogy of Fallot,
(2) to test the relationship between LV systolic dysfunction and other
known risk factors and (3) to evaluate the impact of LV systolic
dysfunction on adverse cardiac events. In a multicenter study, 237 adults
repaired TOF (58 % males, age 30 +/- 10 years) were evaluated by cardiac
magnetic resonance (CMR). Demographics, surgical history, ECG, Echo-Color
Doppler and follow-up data were recorded. LV was dilated (Z value >2) in
16 patients (6 %), however 56 patients (23.6 %) had a reduced LV systolic
function left ventricle ejection fraction (LVEF) (Z value <-2). Patients
with LV systolic dysfunction were mainly males (82 %), had reduced right
ventricle ejection fraction (RVEF), and higher right and left Late
Gadolinium Enhanced scores. In a multivariate regression analysis male
gender and RVEF resulted to be independent factors associated to LV
systolic dysfunction. Atrial arrhythmias were the main adverse cardiac
event at the follow-up and were associated to higher biventricular volumes
and lower biventricular ejection fraction (EF); however multivariable
analysis identified age, right ventricle end-diastolic volume (RVEDVi) and
tricuspid regurgitation as independents factors associated to atrial
arrhythmias. At long term follow-up at least 1/4 of repaired TOF has LV
dysfunction. Lower LVEF is associated to male gender and lower RVEF.
Copyright &#xa9; 2016, Springer Science+Business Media Dordrecht.

<22>
Accession Number
611216219
Author
Ungar L.; Rodriguez F.; Mahaffey K.W.
Institution
(Ungar, Mahaffey) Department of Medicine, Stanford Center for Clinical
Research, Stanford University, 300 Pasteur Drive, Stanford, CA 94305,
United States
(Rodriguez, Mahaffey) Division of Cardiovascular Medicine, Stanford Center
for Clinical Research, Stanford University, Stanford, CA, United States
Title
Vorapaxar: Emerging evidence and clinical questions in a new era of PAR-1
inhibition.
Source
Coronary Artery Disease. 27 (7) (pp 604-615), 2016. Date of Publication:
01 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Despite the use of therapies recommended in practice guidelines for
secondary prevention in patients with atherosclerotic coronary artery
disease, the residual risk for cardiovascular events remains high. Some of
the residual risk is believed to result from incomplete platelet
inhibition with current therapy. Vorapaxar is a first-in-class, novel
antiplatelet agent that acts by antagonizing the PAR-1 receptor,
inhibiting thrombin-mediated platelet activation. Vorapaxar was recently
approved by the Food and Drug Administration for secondary prevention of
cardiovascular events in patients with a history of myocardial infarction
or peripheral artery disease who do not have a history of transient
ischemic attack or stroke. We review the data from two key phase III
cardiovascular outcome trials with vorapaxar: TRACER and TRA 2P-TIMI 50.
We will focus on identifying the key patient populations that should be
identified for treatment, highlight practical clinical issues when
prescribing vorapaxar, and review unanswered questions. Vorapaxar should
be considered in patients at high risk for recurrent ischemic events and
low risk of bleeding. Copyright &#xa9; 2016 Wolters Kluwer Health, Inc.

<23>
Accession Number
611361021
Author
Wang C.; Tang Y.-F.; Zhang J.-J.; Bai Y.-F.; Yu Y.-C.; Zhang G.-X.; Han L.
Institution
(Wang, Tang, Zhang, Bai, Yu, Zhang, Han) Department of Cardiothoracic
Surgery, Changhai Hospital, Second Military Medical University, Shanghai
200433, China
Title
Comparison of four risk scores for in-hospital mortality in patients
undergoing heart valve surgery: A multicenter study in a Chinese
population.
Source
Heart and Lung: Journal of Acute and Critical Care. 45 (5) (pp 423-428),
2016. Date of Publication: 01 Sep 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background and aim of the study To compare four risk scores with regard to
their validity to predict in-hospital mortality after heart valve surgery
in a multicenter patient population of China. Materials and methods From
January 2009 to December 2012, data from 12,412 consecutive patients older
than 16 years who underwent heart valve surgery at four cardiac surgical
centers were collected and scored according to the EuroSCORE II, Ambler
risk score, NYC risk score, and STS risk score. The patients were divided
into two subgroups according to the types of valve procedures, and the
performance of the four risk scores for each group was assessed.
Calibration was assessed by the Hosmer-Lemeshow (H-L) test. Discrimination
was tested by calculating the area under the receiver operating
characteristic (ROC) curve. Results Observed mortality was 2.09% overall.
The EuroSCORE II, Ambler score, and NYC score overpredicted observed
mortality (Hosmer-Lemeshow: P = 0.002, P < 0.0001, and P < 0.0001,
respectively) and the STS score underpredicted observed mortality
(Hosmer-Lemeshow: P = 0.001). The discriminative power in the entire
cohort for in-hospital mortality was highest for the STS score (0.735),
followed by the EuroSCORE II score (0.704), NYC score (0.693), and Ambler
score (0.674). Meanwhile, the STS score and EuroSCORE II give an accurate
prediction in patients undergoing single valve surgery compared with the
Ambler score and NYC score. However, all four risk scores give an
imprecise prediction in patients undergoing multiple valve surgery.
Conclusions Both the STS score and Euroscore II, especially the STS score,
were suitable for individual operative risk in Chinese patients undergoing
single valve surgery compared with the Ambler score and NYC score,
however, all four risk scores were not suitable for prediction in Chinese
patients undergoing multiple valve surgery. Therefore, the creation of a
new model which accurately predicts outcomes in patients undergoing
multiple valve surgery is possibly required in China. Copyright &#xa9;
2016 The Author(s)

<24>
Accession Number
610439711
Author
Curi-Curi P.J.; Springall del Villar M.R.; Gomez-Garcia L.; Gonzalez
Vergara B.; Calderon-Colmenero J.; Ramirez-Marroquin S.; Cervantes-Salazar
J.L.
Institution
(Curi-Curi, Ramirez-Marroquin, Cervantes-Salazar) Departamento de Cirugia
Cardiaca Pediatrica y de Cardiopatias Congenitas, Instituto Nacional de
Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
(Springall del Villar, Gomez-Garcia) Departamento de Inmunologia,
Instituto Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
(Gonzalez Vergara) Departamento de Perfusion, Instituto Nacional de
Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
(Calderon-Colmenero) Departamento de Cardiologia Pediatrica, Instituto
Nacional de Cardiologia Ignacio Chavez, Ciudad de Mexico, Mexico
Title
Operatory impact of modified ultrafiltration in pediatric congenital heart
disease patients operated with cardiopulmonary bypass.
Source
Cirugia Cardiovascular. 23 (4) (pp 179-186), 2016. Date of Publication: 01
Jul 2016.
Publisher
Elsevier Doyma (E-mail: editorial@elsevier.com)
Abstract
Introduction and objectives The use of modified ultrafiltration procedure
in paediatric cardiac surgery with cardiopulmonary bypass in order to
reduce the systemic inflammatory response is controversial. The aim of
this study is to demonstrate the usefulness of this procedure for removing
pro-inflammatory substances in non-neonatal paediatric patients with
non-complex congenital heart disease. Additionally, we aimed to determine
its effects on haemoconcentration and in lactate and fluid removal.
Methods A clinical trial was designed that included non-neonatal
paediatric patients weighing >5 kg with non-complex congenital heart
disease and underwent surgery with cardiopulmonary bypass over a period of
one year. They were randomised into a problem group (with modified
ultrafiltration) and a control group (without it), and blood samples were
taken in order to measure concentrations of interleukins (6 and 10), C3d
and C4d complement fractions at the following times: baseline, before
cardiopulmonary bypass, after it, after modified ultrafiltration, from the
ultrafiltration concentrate, and on discharge from the operating room.
Endpoints were defined in terms of morbidity and mortality,
pro-inflammatory substances, lactate removal, fluid balance, and
haemoconcentration. Results A total of 13 patients were included in the
problem group and 15 in the control group. A significantly lower serum
IL-6, IL-10, and lactate at the end of cardiopulmonary bypass, were
observed in the problem group, as well as a greater fluid removal,
lactate, and C4d concentration in the ultrafiltration product. Conclusions
Modified ultrafiltration may benefit non-neonatal paediatric patients with
congenital heart disease operated on with cardiopulmonary bypass, as it is
able to decrease serum concentration of IL-6, IL-10, and lactate.
Additionally, it can help to filter C4d and remove excess fluid, thus a
greater haemoconcentration. Therefore, its routine use is recommended when
the haemodynamic conditions are favourable. Copyright &#xa9; 2016 Sociedad
Espanola de Cirugia Toracica-Cardiovascular

<25>
Accession Number
612646029
Author
Soon J.; Sulaiman N.; Park J.K.; Kueh S.-H.A.; Naoum C.; Murphy D.; Ellis
J.; Hague C.J.; Blanke P.; Leipsic J.
Institution
(Soon, Sulaiman, Kueh, Murphy, Ellis, Hague, Blanke, Leipsic) Dept of
Radiology and Centre for Heart Valve Innovation, St Paul's Hospital,
Vancouver, Canada
(Naoum) Cardiology Department, Concord Hospital, The University of Sydney,
Australia
(Park) Division of Cardiology, National Health Insurance Service Ilsan
Hospital, Goyang, South Korea
Title
The effect of a whole heart motion-correction algorithm on CT image
quality and measurement reproducibility in Pre-TAVR aortic annulus
evaluation.
Source
Journal of Cardiovascular Computed Tomography. 10 (5) (pp 386-390), 2016.
Date of Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Motion correction (MC) algorithms have been shown to improve
image quality, interpretability and diagnostic accuracy in coronary CT
angiography. We sought to determine whether MC extended to the whole heart
would demonstrate improved image quality and reproducibility of aortic
annular measurements in pre-TAVR CT. Materials and methods Twenty-two
consecutive contrast enhanced CT data sets acquired for pre TAVR
evaluation using retrospective ECG synchronization during a single heart
beat were retrospectively identified. Image data sets were obtained from
raw data acquired at 35% and 75% of the R-R interval using both standard
(STD) and motion corrected (MC) reconstruction algorithms. Four data sets
(2 STD, 2 MC) per patient were analyzed by 2 independent, blinded readers
for aortic annular area, short and long axis, perimeter and average
diameter. Image quality was graded using a 5 point Likert score (1 and 2
non diagnostic, 5 excellent). Statistical analysis was performed using
Wilcoxon matched paired tests, Bland-Altman (B-A) plots and Lin's
concordance coefficient comparing 35% STD to 35% MC, and 75% STD to 75%
MC. Results Eighty-eight datasets were analyzed (44 STD, 44 MC). At 35%,
there was a significant improvement in image quality for MC (Likert score
3.3 +/- 0.9 STD vs. 3.9 +/- 0.7 MC, p < 0.007). While B-A analysis
demonstrated narrower interobserver agreement for aortic annular area
(bias 0.03 vs 0.02 cm², range -0.32 to 0.39 cm² vs
-0.50 to 0.55 cm²), and perimeter (bias 0.3 vs 0.3 mm, range
-3.1 to 3.8 mm vs -4.6 to 5.3 mm), this was not statistically significant
by concordance correlation coefficient. At 75%, there was no significant
difference in image quality (Likert score 3.3 +/- 0.9 vs. 3.5 +/- 0.76, p
= 0.454) or annular measurement agreement intervals. Conclusion Motion
correction algorithms may yield significant improvements of image quality
in systolic CT data sets of the heart. Further validation studies are
required to determine the effect on annular measurements and translation
into clinical practice. Copyright &#xa9; 2016 Society of Cardiovascular
Computed Tomography

<26>
Accession Number
612826331
Author
Brener S.J.; Mehran R.; Lansky A.J.; Ayele G.M.; Stone G.W.
Institution
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York Methodist Hospital, United States
(Brener, Mehran, Ayele, Stone) Department of Medicine, Cardiovascular
Research Foundation, United States
(Mehran) Mount Sinai Medical Center, United States
(Lansky) Yale University Medical Center, United States
(Stone) Columbia University Medical Center, United States
Title
Pretreatment with aspirin in acute coronary syndromes: Lessons from the
ACUITY and HORIZONS-AMI trials.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (5) (pp 449-454),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Aspirin is promptly administered to patients presenting with
acute coronary syndromes. It is not known whether aspirin pretreatment in
acute coronary syndrome patients is beneficial, particularly because some,
but not all, prior studies identified aspirin pretreatment as an
independent risk factor for adverse ischemic events. Objective: To study
the effect of aspirin pretreatment in patients with acute coronary
syndromes enrolled in two large randomized clinical trials. Methods:
Patients enrolled in the ACUITY and HORIZONS-AMI trials were analyzed
according to aspirin pretreatment within 5-7 days before acute coronary
syndromes. We evaluated the incidence of death, myocardial infarction,
target vessel revascularization, stent thrombosis and bleeding at 30 days
and 1 year. Multivariable regression analysis was performed for all-cause
and cardiac death. Results: Among 17,387 patients, 10,587 (60.9%) were
pretreated with aspirin. Pretreated patients were significantly older and
more likely to have diabetes mellitus, hypertension and prior
revascularization, and receive only medical therapy without
revascularization. Aspirin pretreatment was associated with reduced
48-hour cardiac death (adjusted hazard ratio 0.50, 95% confidence interval
0.26-0.97; P=0.04) and 30-day death (adjusted hazard ratio 0.68, 95%
confidence interval 0.49-0.94; P=0.04). Myocardial infarction was more
frequent in the aspirin pretreatment group at 30 days (P<0.0001), while
stent thrombosis was less frequent (P=0.01). A strong interaction was
present such that aspirin pretreatment was associated with reduced 30-day
death in patients with non-ST-segment elevation acute coronary syndrome
(NSTEACS), but not in those with ST-segment elevation myocardial
infarction (P=0.001). Conclusions: Among patients with acute coronary
syndromes in these two large prospective studies, aspirin pretreatment
identified a higher risk cohort and was an independent predictor of
reduced mortality at 30 days, especially in patients with NSTEACS.
Copyright &#xa9; The European Society of Cardiology 2016.

<27>
Accession Number
612341959
Author
Anonymous
Title
Erratum: Sodium bicarbonate infusion to reduce cardiac surgery-associated
acute kidney injury: A phase II multicenter double-blind randomized
controlled trial (Critical Care Medicine (2013) 41 (1599-1607)).
Source
Critical Care Medicine. 42 (10) (pp e691), 2014. Date of Publication:
October 2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
In the article beginning on page 1599 in the July 2013 issue, there were
several errors, which are outlined below. On page 1602, in the first
paragraph of "Other Outcomes", in lines 6-7, the text should read "....and
90-day mortality (4 [2%] vs 5 [2%]); p = 0.06)." On page 1605, in Table 4,
in the 'Died in ICU, n (%)' row, the 'Sodium Bicarbonate' column should
read "3 (1.4)" and the 'Sodium Chloride' column should read "4 (1.9)".
Additionally, the p value column should read "0.69". On page 1605, in
Table 4, in the 'Died by day 90, n (%)' row, the 'Sodium Bicarbonate'
column should read "4 (1.9)" and the 'Sodium Chloride' column should read
"5 (2.4)". Additionally, the p value column should read "0.72".

<28>
Accession Number
604795763
Author
Nunes A.J.; MacArthur R.G.G.; Kim D.; Singh G.; Buchholz H.; Chatterley
P.; Klarenbach S.W.
Institution
(Nunes, MacArthur, Singh, Buchholz) Division of Cardiac Surgery,
Department of Surgery, Faculty of Medicine and Dentistry, Edmonton, AB,
Canada
(Kim) Division of Cardiology, Department of Medicine, Faculty of Medicine
and Dentistry, Edmonton, AB, Canada
(Chatterley) University of Alberta Libraries, Edmonton, AB, Canada
(Klarenbach) Division of Nephrology, Department of Medicine, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
Title
A Systematic Review of the Cost-Effectiveness of Long-Term Mechanical
Circulatory Support.
Source
Value in Health. 19 (4) (pp 494-504), 2016. Date of Publication: 01 Jun
2016.
Publisher
Elsevier Ltd
Abstract
Background Mechanical circulatory support (MCS) is an option for the
treatment of medically intractable end-stage heart failure. MCS therapy,
however, is resource intensive. Objective The purpose of this report was
to systematically review the MCS cost-effectiveness literature as it
pertains to the treatment of adult patients in end-stage heart failure.
Methods We conducted a systematic search and narrative review of available
cost- effectiveness and cost-utility analyses of MCS in adult patients
with end-stage heart failure. Results Eleven studies analyzing the
cost-effectiveness or cost-utility of MCS were identified. Seven studies
focused on bridge to transplantation, three studies focused on destination
therapy, and one study presented analyses of both strategies. Two articles
evaluated the cost-effectiveness of the HeartMate II (Thoratec Corp.,
Pleasanton, CA). Incremental cost-effectiveness ratios between MCS and
medical management ranged between 85,025 and 200,166 for bridge to
transplantation and between 87,622 and 1,257,946 for destination therapy
(2012 Canadian dollars per quality-adjusted life-year). Sensitivity
analyses indicated that improvements in survival and quality of life and
reductions in device and initial hospital-stay costs may improve the
cost-effectiveness of MCS. Conclusions Current studies suggest that MCS is
likely not cost-effective with reference to generally accepted or
explicitly stated thresholds. Refined patient selection, complication
rates, achieved quality of life, and device/surgical costs, however, could
modify the cost-effectiveness of MCS. Copyright &#xa9; 2016 International
Society for Pharmacoeconomics and Outcomes Research (ISPOR)

<29>
Accession Number
612646542
Author
Guerrero M.; Dvir D.; Himbert D.; Urena M.; Eleid M.; Wang D.D.; Greenbaum
A.; Mahadevan V.S.; Holzhey D.; O'Hair D.; Dumonteil N.; Rodes-Cabau J.;
Piazza N.; Palma J.H.; DeLago A.; Ferrari E.; Witkowski A.; Wendler O.;
Kornowski R.; Martinez-Clark P.; Ciaburri D.; Shemin R.; Alnasser S.;
McAllister D.; Bena M.; Kerendi F.; Pavlides G.; Sobrinho J.J.; Attizzani
G.F.; George I.; Nickenig G.; Fassa A.-A.; Cribier A.; Bapat V.; Feldman
T.; Rihal C.; Vahanian A.; Webb J.; O'Neill W.
Institution
(Guerrero, Feldman) Department of Medicine, Division of Cardiology,
Evanston Hospital, Evanston, Illinois, United States
(Dvir, Webb) Center for Heart Valve Innovation, St. Paul's Hospital,
Vancouver, British Columbia, Canada
(Himbert, Urena, Vahanian) Cardiology Department, Bichat-Claude Bernard
Hospital, Paris, France
(Eleid, Rihal) Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minnesota, United States
(Wang, Greenbaum, O'Neill) Department of Medicine, Division of Cardiology,
Henry Ford Hospital, Detroit, Michigan, United States
(Mahadevan) Department of Medicine, Division of Cardiology, University of
California San Francisco, San Francisco, California, United States
(Holzhey) Department of Cardiac Surgery, Leipzig Heart Center, Leipzig,
Germany
(O'Hair) Department of Surgery, Aurora St. Luke's Medical Center,
Milwaukee, Wisconsin, United States
(Dumonteil) Department of Cardiology, Rangueil University Hospital,
Toulouse, France
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec
City, Quebec, Canada
(Piazza) Department of Interventional Cardiology, McGill University Health
Centre, Montreal, Quebec, Canada
(Palma) Department of Cardiovascular Surgery, Escola Paulista de Medicina,
Sao Paolo, Brazil
(DeLago) Department of Medicine, Division of Cardiology, Albany Medical
Center Hospital, Albany, New York, United States
(Ferrari) Cardiac Surgery Unit, Cardiocentro Ticino Foundation, Lugano,
Switzerland
(Witkowski) Department of Interventional Cardiology & Angiology, Institute
of Cardiology, Warsaw, Poland
(Wendler) Department of Surgery, King's College Hospital, London, United
Kingdom
(Kornowski) Department of Medicine, Division of Cardiology, Rabin Medical
Center, Petah Tikva, Israel
(Martinez-Clark) Department of Medicine, Division of Cardiology,
Angiografia de Occidente, Cali, Colombia
(Ciaburri) Department of Surgery, Saint Francis Medical Center, Peoria,
Illinois, United States
(Shemin) Department of Surgery, UCLA Medical Center, Los Angeles,
California, United States
(Alnasser) Department of Medicine, Division of Cardiology, St. Michael's
Hospital, Toronto, Canada
(McAllister) Department of Medicine, Division of Cardiology, The Iowa
Heart Center, Des Moines, Iowa, United States
(Bena) Department of Cardiac Surgery, National Institute of Cardiovascular
Diseases, Bratislava, Slovakia
(Kerendi) Department of Surgery, Heart Hospital of Austin, Austin, Texas,
United States
(Pavlides) Department of Medicine, Division of Cardiology, The Nebraska
Medical Center, Omaha, Nebraska, United States
(Sobrinho) Department of Surgery, Complexo Hospitalar de Niteroi, Niteroi,
Brazil
(Attizzani) The Valve and Structural Heart Interventional Center,
University Hospitals Case Medical Center, Cleveland, Ohio, United States
(George) Columbia Heart Valve Center, New York Presbyterian
Hospital-Columbia University Medical Center, New York, New York, United
States
(Nickenig) Heart Center, University of Bonn, Bonn, Germany
(Fassa) Department of Medicine, Division of Cardiology, Hopital de La
Tour, Geneva, Switzerland
(Cribier) Department of Cardiology, University of Rouen's Charles Nicolle
Hospital, Rouen, France
(Bapat) Department of Cardiology and Cardiac Surgery, St. Thomas'
Hospital, London, United Kingdom
Title
Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With
Severe Mitral Annular Calcification: Results From the First Multicenter
Global Registry.
Source
JACC: Cardiovascular Interventions. 9 (13) (pp 1361-1371), 2016. Date of
Publication: 11 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate the outcomes of the early
experience of transcatheter mitral valve replacement (TMVR) with
balloon-expandable valves in patients with severe mitral annular
calcification (MAC) and reports the first large series from a multicenter
global registry. Background The risk of surgical mitral valve replacement
in patients with severe MAC is high. There are isolated reports of
successful TMVR with balloon-expandable valves in this patient population.
Methods We performed a multicenter retrospective review of clinical
outcomes of patients with severe MAC undergoing TMVR. Results From
September 2012 to July of 2015, 64 patients in 32 centers underwent TMVR
with compassionate use of balloon-expandable valves. Mean age was 73 +/-
13 years, 66% were female, and mean Society of Thoracic Surgeons score was
14.4 +/- 9.5%. The mean mitral gradient was 11.45 +/- 4.4 mm Hg and the
mean mitral area was 1.18 +/- 0.5 cm². SAPIEN valves (Edwards
Lifesciences, Irvine, California) were used in 7.8%, SAPIEN XT in 59.4%,
SAPIEN 3 in 28.1%, and Inovare (Braile Biomedica, Brazil) in 4.7%. Access
was transatrial in 15.6%, transapical in 43.8%, and transseptal in 40.6%.
Technical success according to Mitral Valve Academic Research Consortium
criteria was achieved in 46 (72%) patients, primarily limited by the need
for a second valve in 11 (17.2%). Six (9.3%) had left ventricular tract
obstruction with hemodynamic compromise. Mean mitral gradient
post-procedure was 4 +/- 2.2 mm Hg, paravalvular regurgitation was mild or
absent in all. Thirty-day all-cause mortality was 29.7% (cardiovascular =
12.5% and noncardiac = 17.2%); 84% of the survivors with follow-up data
available were in New York Heart Association functional class I or II at
30 days (n = 25). Conclusions TMVR with balloon-expandable valves in
patients with severe MAC is feasible but may be associated with
significant adverse events. This strategy might be an alternative for
selected high-risk patients with limited treatment options. Copyright
&#xa9; 2016 American College of Cardiology Foundation

<30>
Accession Number
612646533
Author
Koskinas K.C.; Shakir S.; Fankhauser M.; Nietlispach F.; Attinger-Toller
A.; Moschovitis A.; Wenaweser P.; Pilgrim T.; Stortecky S.; Praz F.; Raber
L.; Windecker S.; Meier B.; Gloekler S.
Institution
(Koskinas, Shakir, Fankhauser, Moschovitis, Wenaweser, Pilgrim, Stortecky,
Praz, Raber, Windecker, Meier, Gloekler) Cardiology, Cardiovascular
Department, University Hospital of Bern, Bern, Switzerland
(Nietlispach, Attinger-Toller) Cardiology, University Hospital of Zurich,
Zurich, Switzerland
Title
Predictors of Early (1-Week) Outcomes Following Left Atrial Appendage
Closure With Amplatzer Devices.
Source
JACC: Cardiovascular Interventions. 9 (13) (pp 1374-1383), 2016. Date of
Publication: 11 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to assess predictors of adverse
1-week outcomes and determine the effect of left atrial appendage (LAA)
morphology following LAA closure (LAAC) with Amplatzer devices. Background
Percutaneous LAAC is a valuable treatment option for stroke prevention in
patients with atrial fibrillation. Determinants of procedural safety
events with Amplatzer occluders are not well established, and the possibly
interrelating effect of LAA anatomy is unknown. Methods Between 2009 and
2014, 500 consecutive patients with atrial fibrillation ineligible or at
high risk for oral anticoagulation underwent LAAC using Amplatzer devices.
Procedure- and device-related major adverse events (MAEs) were defined as
the composite of death, stroke, major or life-threatening bleeding,
serious pericardial effusion, device embolization, major access-site
vascular complication, or need for cardiovascular surgery within 7 days
following the intervention. Results Patients (mean age 73.9 +/- 10.1
years) were treated with Amplatzer Cardiac Plug (n = 408 [82%]) or Amulet
(n = 92 [18%]) devices. Early procedural success was 97.8%, and MAEs
occurred in 29 patients (5.8%). Independent predictors of MAEs included
device repositioning (odds ratio: 9.13; 95% confidence interval: 2.85 to
33.54; p < 0.001) and left ventricular ejection fraction <30% (odds ratio:
4.08; 95% confidence interval: 1.49 to 11.20; p = 0.006), with no effect
of device type or size. Angiographic LAA morphology, characterized as
cauliflower (33%), cactus (32%), windsock (20%), or chicken wing (15%),
was not associated with procedural success (p = 0.51) or the occurrence of
MAEs (p = 0.78). Conclusions In this nonrandomized study, procedural
success of LAAC using Amplatzer devices was high. MAEs within 7 days were
predicted by patient- and procedure-related factors. Although LAA
morphology displayed substantial heterogeneity, outcomes were comparable
across the spectrum of LAA anatomies. Copyright &#xa9; 2016 American
College of Cardiology Foundation

<31>
Accession Number
612721145
Author
Ali-Hassan-Sayegh S.; Mirhosseini S.J.; Tahernejad M.; Mahdavi P.;
Karimi-Bondarabadi A.A.; Dehghan A.-M.; Rahimizadeh E.; Haddad F.;
Ghodratipour Z.; Sarrafan-Chaharsoughi Z.; Shahidzadeh A.; Ghanei A.;
Lotfaliani M.; Zeriouh M.; Weymann A.; Popov A.-F.; Sabashnikov A.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Tahernejad, Mahdavi, Shahidzadeh,
Karimi-Bondarabadi, Dehghan, Rahimizadeh, Ghodratipour,
Sarrafan-Chaharsoughi, Shahidzadeh, Ghanei, Lotfaliani) Cardiovascular
Research Center, Shahid Sadoughi University of Medical Sciences, Yazd,
Iran, Islamic Republic of
(Haddad) Department of Physiology, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
(Zeriouh, Weymann, Popov, Sabashnikov) Department of Cardiothoracic
Transplantation and Mechanical Circulatory Support, Royal Brompton &
Harefield NHS Foundation Trust, London, United Kingdom
(Weymann) Department of Thoracic and Cardiovascular Surgery, University
Hospital Heidelberg, Heidelberg, Germany
Title
Impact of antioxidant supplementations on cardio-renal protection in
cardiac surgery: an updated and comprehensive meta-analysis and systematic
review.
Source
Cardiovascular Therapeutics. 34 (5) (pp 360-370), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
This systematic review with meta-analysis sought to determine the strength
of evidence in terms of the impact of common antioxidant supplementations,
such as N-acetylcysteine (NAC), vitamin C, and polyunsaturated fatty acids
(PUFA) on perioperative outcomes after cardiac surgery with particular
focus on the incidence of atrial fibrillation (AF) and acute kidney injury
(AKI) with associated mortality. A total of 29 trials were identified that
reported incidence of AF and 17 trials that reported incidence of AKI.
Pooled analysis reported that NAC (OR=0.5; P=.001), vitamin C (OR=0.4;
P=.001), and PUFA (OR=0.8; P=.01) administration were associated with
significantly reduced incidence of AF. In terms of postoperative AKI, only
NAC was shown to be a beneficial supplement that was able to significantly
reduce the incidence of AKI (OR=0.7; P=.01), and NAC could also
significantly decrease overall mortality (OR=0.3; P=.03) following cardiac
surgery. The use of NAC in patients undergoing cardiac surgery should be
strongly recommended due to its combined cardio-renal protective effects
and reduced mortality. Also, PUFA and vitamin C might be able to
significantly decrease the incidence of arrhythmia; however,
reno-protective effects and impact on overall mortality of these
supplements seem to be less impressive. Copyright &#xa9; 2016 John Wiley &
Sons Ltd

<32>
Accession Number
605598790
Author
Molnar A.O.; Fergusson D.; Tsampalieros A.K.; Bennett A.; Fergusson N.;
Ramsay T.; Knoll G.A.
Institution
(Molnar, Fergusson, Tsampalieros, Bennett, Fergusson, Ramsay, Knoll)
Division of Nephrology, Kidney Research Centre, Department of Medicine,
University of Ottawa, 501 Smyth Road, Ottawa K1H 8L6, Canada
(Molnar, Tsampalieros, Bennett, Fergusson) Clinical Epidemiology Program,
Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa K1H 8L6, Canada
(Fergusson) Division of Nephrology, Children's Hospital of Eastern
Ontario, 401 Smyth Road, Ottawa K1H 8L1, Canada
Title
Generic immunosuppression in solid organ transplantation: Systematic
review and meta-analysis.
Source
BMJ (Online). 350 (no pagination), 2015. Article Number: h3163. Date of
Publication: 22 Jun 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
OBJECTIVE: To compare the clinical efficacy and bioequivalence of generic
immunosuppressive drugs in patients with solid organ transplants. DESIGN:
Systematic review and meta-analysis of all studies comparing generic with
innovator immunosuppressive drugs. DATA SOURCES: Medline and Embase from
1980 to September 2014. REVIEW METHODS: A literature search was performed
for all studies comparing a generic to an innovator immunosuppressive drug
in solid organ transplantation. Two reviewers independently extracted data
and assessed quality of studies. Meta-analyses of prespecified outcomes
were performed when deemed appropriate. Outcomes included patient
survival, allograft survival, acute rejection, adverse events and
bioequivalence. RESULTS: 1679 citations were screened, of which 50 studies
met eligibility criteria (17 randomized trials, 15 non-randomized
interventional studies, and 18 observational studies). Generics were
compared with Neoral (cyclosporine) (32 studies), Prograf (tacrolimus) (12
studies), and Cellcept (mycophenolate mofetil) (six studies). Pooled
analysis of randomized controlled trials in patients with kidney
transplants that reported bioequivalence criteria showed that Neoral (two
studies) and Prograf (three studies) were not bioequivalent with generic
preparations according to criteria of the European Medicines Agency. The
single Cellcept trial also did not meet bioequivalence. Acute rejection
was rare but did not differ between groups. For Neoral, the pooled Peto
odds ratio was 1.23 (95% confidence interval 0.64 to 2.36) for kidney
randomized controlled trials and 0.66 (0.40 to 1.08) for observational
studies. For kidney observational studies, the pooled Peto odds ratios
were 0.98 (0.37 to 2.60) for Prograf and 0.49 (0.09 to 2.56) for Cellcept.
Meta-analyses for non-renal solid organ transplants were not performed
because of a lack of data. There were insufficient data reported on
patient or graft survival. Pooling of results was limited by inconsistent
study methods and reporting of outcomes. Many studies did not report
standard criteria used to determine bioequivalence. While rates of acute
rejection seemed similar and were relatively rare, few studies were
designed to properly compare clinical outcomes. Most studies had short
follow-up times and included stable patients without a history of
rejection. CONCLUSIONS: High quality data showing bioequivalence and
clinical efficacy of generic immunosuppressive drugs in patients with
transplants are lacking. Given the serious consequences of rejection and
allograft failure, well designed studies on bioequivalence and safety of
generic immunosuppression in transplant recipients are needed. Copyright
&#xa9; BMJ Publishing Group Ltd 2015.

<33>
Accession Number
612894960
Author
Dimarakis I.
Institution
(Dimarakis) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Manchester, United Kingdom
Title
Miniaturized cardiopulmonary bypass in adult cardiac surgery: a clinical
update.
Source
Expert Review of Cardiovascular Therapy. 14 (11) (pp 1245-1250), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Cardiopulmonary bypass has undoubtedly been the cornerstone
in the rapid development of cardiac surgery, allowing even the performance
of procedures beyond the scope of cardiothoracic surgery. Its use however,
is associated with significant complications that arise from the
mechanical effects of the circuit on circulating blood components as well
as the contact of blood with non-endothelial surfaces. Miniature
cardiopulmonary bypass systems have been developed in an attempt to
minimize these complications. Areas covered: Herein clinical outcomes from
the most recent studies in adult cardiac surgery are discussed. The main
benefits of miniaturisation as well as potential areas of further
application are described. Expert commentary: Data is critically appraised
in the context of current guidelines. Finally the need for further basic
science in addition to large multi-centre randomized controlled trial data
is highlighted. Copyright &#xa9; 2016 Informa UK Limited, trading as
Taylor & Francis Group.

<34>
Accession Number
612488217
Author
Becattini C.; Sembolini A.; Paciaroni M.
Institution
(Becattini, Sembolini, Paciaroni) Internal and Cardiovascular Medicine -
Stroke Unit, University of Perugia, Italy
Title
Resuming anticoagulant therapy after intracerebral bleeding.
Source
Vascular Pharmacology. 84 (pp 15-24), 2016. Date of Publication: 01 Sep
2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The clinical benefit of resuming anticoagulant treatment after an
anticoagulants-associated intracranial hemorrhage (ICH) is debated. No
randomized trial has been conducted on this particular clinical issue. The
risk of ICH recurrence from resuming anticoagulant therapy is expected to
be higher after index lobar than deep ICH and in patients with not
amendable risk factors for ICH. Retrospective studies have recently shown
improved survival with resumption of treatment after index
anticoagulants-associated ICH. Based on these evidences and on the risk
for thromboembolic events without anticoagulant treatment, resumption of
anticoagulation should be considered in all patients with mechanical heart
valve prosthesis and in those with amendable risk factors for
anticoagulants-associated ICH. Resumption with direct oral anticoagulants
appears a reasonable option for non-valvular atrial fibrillation (NVAF)
patients at moderate to high thromboembolic risk after deep ICH and for
selected NVAF patients at high thromboembolic risk after lobar ICH. For
VTE patients at high risk for recurrence, resumption of anticoagulation or
insertion of vena cava filter should be tailored on the estimated risk for
ICH recurrence. Copyright &#xa9; 2016 Elsevier Inc.

<35>
Accession Number
612700970
Author
Wallen M.P.; Skinner T.L.; Pavey T.G.; Hall A.; Macdonald G.A.; Coombes
J.S.
Institution
(Wallen, Skinner, Coombes) Centre for Research on Exercise, Physical
Activity and Health (CRExPAH), School of Human Movement and Nutrition
Sciences, The University of Queensland, Brisbane, Queensland, Australia
(Macdonald) School of Medicine, The University of Queensland, Brisbane,
Queensland, Australia
(Macdonald) Department of Gastroenterology and Hepatology, Princess
Alexandra Hospital, Brisbane, Queensland, Australia
(Hall) Department of Anaesthesia, Princess Alexandra Hospital, Brisbane,
Queensland, Australia
(Pavey) School of Exercise and Nutrition Sciences, Queensland University
of Technology, Brisbane, Queensland, Australia
Title
Safety, adherence and efficacy of exercise training in solid-organ
transplant candidates: A systematic review.
Source
Transplantation Reviews. 30 (4) (pp 218-226), 2016. Date of Publication:
01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Background Patients awaiting solid-organ transplantation may be encouraged
to undertake exercise training to improve pre- and post-transplant
outcomes. However, the safety, adherence and efficacy of exercise training
in this population remain unclear. Methods All randomized, non-randomized
and non-controlled trials of exercise training interventions in
solid-organ transplant candidates were included. The Cochrane risk of bias
tool and a modified Newcastle-Ottawa scale were used to assess procedural
quality. Safety was defined as the number of reported adverse events
during exercise training. Adherence was evaluated from session attendance,
and efficacy as changes in cardiorespiratory fitness (CRF), exercise
capacity, muscular strength, health-related quality of life (HR-QoL) and
lung function. Results Eleven studies involving 874 patients were
included: four randomized controlled, one non-randomized controlled and
six non-controlled trials. Six studies included heart transplant
candidates and five involved patients awaiting lung transplantation. Three
trials included aerobic-only training, one incorporated resistance-only
exercise and seven combined modalities. Twelve adverse events were
reported with four due to exercise, although methods to collect these data
were often omitted. Exercise adherence ranged from 82.5% to 100%, but was
poorly described. No significant between-group changes attributable to
exercise training were demonstrated. However, significant within-group
improvements in CRF, exercise capacity, muscular strength, lung function
and HR-QoL were observed. Conclusions Patients awaiting heart or lung
transplant appear to tolerate exercise training despite the larger number
of adverse events compared to other high-risk populations. Exercise
training demonstrated within-group benefits for several outcomes, with no
significant between-group differences. Randomized controlled trials with
sufficient statistical power are required for all solid-organ transplant
candidates. Copyright &#xa9; 2016 Elsevier Inc.

<36>
Accession Number
602182189
Author
de Moraes A.G.; Racedo Africano C.J.; Hoskote S.S.; Reddy D.R.S.; Tedja
R.; Thakur L.; Pannu J.K.; Hassebroek E.C.; Smischney N.J.
Institution
(de Moraes, Racedo Africano, Hoskote, Reddy, Tedja, Thakur, Pannu,
Hassebroek) Department of Medicine, Division of Pulmonary and Critical
Care Medicine, Mayo Clinic, Rochester, MN, United States
(Smischney) Department of Anesthesiology, Division of Critical Care
Medicine and Multidisciplinary Epidemiology and Translational Research in
Intensive Care (METRIC), Mayo Clinic, Rochester, MN, United States
Title
Ketamine and propofol combination ("Ketofol") for endotracheal intubations
in critically ill patients: A case series.
Source
American Journal of Case Reports. 16 (pp 81-86), 2015. Date of
Publication: 13 Feb 2015.
Publisher
Medical Science International (E-mail: office@isl-science.com)
Abstract
Objective: Educational Purpose (only if useful for a systematic review or
synthesis)
Case Series: We describe 6 cases in which the combination of ketamine and
propofol ("ketofol") was used as an induction agent for endotracheal
intubation in critically ill patients with a focus on hemodynamic
outcomes. All patients received a neuromuscular blocker and fentanyl,
while 5 patients received midazolam. We recorded mean arterial pressure
(MAP) 1 minute before induction and 15 minutes after intubation with the
combination. Of the 6 patients, 5 maintained a MAP 365 mmHg 15 minutes
after intubation. One patient was on norepinephrine infusion with a MAP of
64 mmHg, and did not require an increase in the dose of the vasopressor 15
minutes after intubation. No hemodynamic complications were reported after
any of the intubations.
Conclusions: This case series describes the use of the "ketofol"
combination as an induction agent for intubation in critically ill
patients when hemodynamic stability is desired. Further research is needed
to establish the safety of this combination and how it compares to other
induction medications.
Background: Endotracheal intubation is a common procedure performed for
critically ill patients that can have immediate life-threatening
complications. Induction medications are routinely given to facilitate the
procedure, but most of these medications are associated with hypotension.
While etomidate is known for its neutral hemodynamic profile, it has been
linked with increased mortality in septic patients and increased morbidity
in trauma patients. Ketamine and propofol are effective anesthetics with
counteracting cardiovascular profiles. No data are available about the use
of this combination in critically ill patients undergoing endotracheal
intubation. Copyright &#xa9; Am J Case Rep, 2015.

<37>
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).

<38>
Accession Number
612703952
Author
Sotomi Y.; Cavalcante R.; van Klaveren D.; Ahn J.-M.; Lee C.W.; de Winter
R.J.; Wykrzykowska J.J.; Onuma Y.; Steyerberg E.W.; Park S.-J.; Serruys
P.W.
Institution
(Sotomi, de Winter, Wykrzykowska) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Cavalcante, Onuma) ThoraxCenter, Erasmus Medical Center, Rotterdam,
Netherlands
(van Klaveren, Steyerberg) Department of Public Health, Erasmus Medical
Center, Rotterdam, Netherlands
(Ahn, Lee, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
Title
Individual Long-Term Mortality Prediction Following Either Coronary
Stenting or Bypass Surgery in Patients With Multivessel and/or Unprotected
Left Main Disease: An External Validation of the SYNTAX Score II Model in
the 1,480 Patients of the BEST and PRECOMBAT Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. 9 (15) (pp 1564-1572), 2016. Date of
Publication: 08 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to validate the SYNTAX (Synergy Between
Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score
II mortality prediction model after percutaneous coronary intervention
(PCI) or coronary artery bypass grafting in a large pooled population of
patients with multivessel coronary disease (MVD) and/or unprotected left
main disease (UPLMD) enrolled in the PRECOMBAT (Bypass Surgery Versus
Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main
Coronary Artery Disease) and BEST (Artery Bypass Surgery and
Everolimus-Eluting Stent Implantation in the Treatment of Patients with
Multivessel Coronary Artery Disease) randomized controlled trials.
Background For patients with MVD and/or UPLMD, the choice of the best
revascularization strategy remains challenging. Methods Pooled individual
patient-level data from PRECOMBAT and BEST were used to assess calibration
and discrimination of the SYNTAX score II prediction model for all-cause
mortality after PCI and coronary artery bypass grafting at 4-year
follow-up. The study population comprised 1,480 patients (600 with UPLMD,
880 with MVD). Results The overall incidence of all-cause mortality was
6.1% after a median follow-up period of 4.9 years. Validation plots showed
good model calibration overall and across treatment groups but tended to
overestimate all-cause mortality in the highest risk quintiles of patients
in the whole population and the PCI arm. The SYNTAX score II showed
moderate discrimination ability for the whole population (C index = 0.685)
but better for patients receiving PCI than CABG (C index = 0.718 vs. 0.662
in patients with UPLMD, C index = 0.700 vs. 0.661 in those with MVD).
Observed all-cause mortality was higher when the treatment received was at
variance with that recommended by the model and similar when it was
concordant. Conclusions The SYNTAX score II has good calibration but only
moderate discrimination ability for long-term mortality prediction in this
randomized population. This score provides an important tool to help guide
the heart team's decision-making process regarding the selection of the
best revascularization strategy for patients with MVD and/or UPLMD.
(Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in
Patients With Left Main Coronary Artery Disease, NCT00422968; Bypass
Surgery Versus Everolimus-Eluting Stent Implantation for Multivessel
Coronary Artery Disease, NCT00997828) Copyright &#xa9; 2016 American
College of Cardiology Foundation

<39>
Accession Number
612949033
Author
Chaudhri M.S.; Shah M.U.A.; Asghar M.I.; Siddiqi R.; Janjua A.M.; Iqbal A.
Institution
(Chaudhri, Shah, Asghar, Janjua, Iqbal) Department of Cardiac Surgery,
Armed Forces Institute of Cardiology and National Institute of Heart
Diseases (AFIC-NIHD), Rawalpindi, Pakistan
(Siddiqi) Department of Cardio-Thoracic Anesthesia, Armed Forces Institute
of Cardiology and National Institute of Heart Diseases (AFIC-NIHD),
Rawalpindi, Pakistan
Title
Skeletonization of left internal mammary artery in coronary artery bypass
grafting.
Source
Journal of the College of Physicians and Surgeons Pakistan. 26 (9) (pp
736-739), 2016. Date of Publication: 2016.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To compare mean per-operative flow capacity between
skeletonized and pedicled left internal mammary artery (LIMA) in patients
undergoing coronary artery bypass grafting (CABG) surgery. Study Design:
Randomized control trial. Place and Duration of Study: Department of
Cardiac Surgery, Armed Forces Institute of Cardiology and National
Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan from
February to August, 2013. Methodology: Patients undergoing CABG for
coronary artery disease, under 80 years, excluded by the exclusion
criteria; and fulfilling the inclusion criteria were randomly assigned to
two groups of 70 each. One group underwent skeletonized and the other
underwent pedicled technique of LIMA harvesting. Free flow was checked
just before anastamosis of each LIMA to the LAD, manually in blood flow in
ml per minute during cardiopulmonary bypass by allowing it to bleed into a
100 ml container over 20 seconds. A specialized proforma was used to
record the age, gender, weight, disease, type of IMA used, and free flow
of the IMA. Data was analyzed using SPSS 18. Results: The mean age of the
patients was 57.16 years in 40 patients, ranging from 36 to 75 years.
Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and
triple vessel coronary artery disease, respectively. There was
significantly higher free flow in the skeletonized group than the pedicled
group (p=0.04). Conclusion: Skeletonized IMA had superior flow to pedicled
IMA in addition to its traditional proven advantages, which justifies its
further use as a conduit for myocardial revascularization.

<40>
Accession Number
612943862
Author
Mrkobrada M.; Hill M.D.; Chan M.T.V.; Sigamani A.; Cowan D.; Kurz A.;
Sessler D.I.; Jacka M.; Graham M.; Dasgupta M.; Dunlop V.; Emery D.J.;
Gulka I.; Guyatt G.; Heels-Ansdell D.; Murkin J.; Pettit S.; Sahlas D.J.;
Sharma M.; Srinathan S.; St John P.; Tsai S.; Gelb A.W.; O'Donnell M.; Siu
D.; Chiu P.W.Y.; Sharath V.; George A.; Devereaux P.J.
Institution
(Mrkobrada, Dasgupta, Murkin, Sharma) University of Western Ontario, 339
Windermere Road B9-100, London, ON N6A 5A5, Canada
(Hill) University of Calgary, Calgary, AB, Canada
(Chan, Siu, Chiu) Chinese University of Hong Kong, Hong Kong
(Sigamani, Sharath, George) St John's Medical College, St John's Research
Institute, Bangalore, India
(Cowan, Guyatt, Heels-Ansdell, Sahlas, Sharma, O'Donnell, Devereaux)
McMaster University, Hamilton, ON, Canada
(Kurz, Sessler) Cleveland Clinic, Cleveland, OH, United States
(Jacka, Graham, Emery) University of Alberta Hospital, Edmonton, AB,
Canada
(Dunlop, Pettit) Population Health Research Institute, Hamilton, ON,
Canada
(Gulka) London Health Sciences, London, ON, Canada
(Srinathan, St John) University of Manitoba, Winnipeg, MB, Canada
(Tsai) Hamilton Health Sciences, Hamilton, ON, Canada
(Gelb) University of California, San Francisco, CA, United States
Title
Covert stroke after non-cardiac surgery: A prospective cohort study.
Source
British Journal of Anaesthesia. 117 (2) (pp 191-197), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Overt stroke after non-cardiac surgery has a substantial impact
on the duration and quality of life. Covert stroke in the non-surgical
setting is much more common than overt stroke and is associated with an
increased risk of cognitive decline and dementia. Little is known about
covert stroke after non-cardiac, non-carotid artery surgery. Methods We
undertook a prospective, international cohort study to determine the
incidence of covert stroke after non-cardiac, non-carotid artery surgery.
Eligible patients were >65 yr of age and were admitted to hospital for at
least three nights after non-cardiac, non-carotid artery surgery. Patients
underwent a brain magnetic resonance study between postoperative days 3
and 10. The main outcome was the incidence of perioperative covert stroke.
Results We enrolled a total of 100 patients from six centres in four
countries. The incidence of perioperative covert stroke was 10.0% (10/100
patients, 95% confidence interval 5.5-17.4%). Five of the six centres that
enrolled patients reported an incident covert stroke, and covert stroke
was found in patients undergoing major general (3/27), major orthopaedic
(3/41), major urological or gynaecological (3/22), and low-risk surgery
(1/12). Conclusions This international multicentre study suggests that 1
in 10 patients >65 yr of age experiences a perioperative covert stroke. A
larger study is required to determine the impact of perioperative covert
stroke on patient-important outcomes. Clinical trial registration
NCT01369537. Copyright &#xa9; 2016 The Author 2016.

<41>
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.

<42>
Accession Number
612922714
Author
Santucci A.; Gargiulo G.; Ariotti S.; Marino M.; Magnani G.; Baldo A.;
Piccolo R.; Franzone A.; Valgimigli M.
Institution
(Santucci, Gargiulo, Ariotti, Marino, Magnani, Baldo, Piccolo, Franzone,
Valgimigli) Department of Cardiology, Bern University Hospital, Bern 3010,
Switzerland
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy
(Ariotti, Valgimigli) Department of Cardiology, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
Title
Radial versus femoral approach in STEMI: What do we know so far?.
Source
Minerva Cardioangiologica. 64 (3) (pp 219-237), 2016. Date of Publication:
June 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Radial approach has been used since 1989 to perform coronary angiography
as an alternative to femoral access. During past decades, the development
of dedicated equipment has led to high efficacy also in complex
procedures. ST elevation myocardial infarction (STEMI) is known to be a
high bleeding risk setting and in turn bleeding events can negatively
impact on outcomes. Observational studies have demonstrated feasibility,
efficacy and safety of radial approach when compared to femoral access in
STEMI patients, with benefit in bleeding rates. These advantages have also
been described in specific populations such as in the elderly and in
patients with cardiogenic shock. Some large randomized trials have been
conducted to assess outcomes of transradial access versus transfemoral
access, with RIVAL and MATRIX representing the largest two studies. The
RIVAL documented a significant reduction in access site-related
complications in the global population of acute coronary syndrome (ACS)
patients, with also lower mortality and net clinical adverse events
(NACE), mainly driven by significant reduction of bleeding and all-cause
mortality, in the STEMI sub-group. Overall, the MATRIX trial confirmed
that radial access decreased bleeding and all-cause death thus reducing
the rate of NACE and supporting the transradial access as the one to be
preferred in ACS patients. Clinical advantages of radial access have been
also tested in smaller randomized trials corroborating the evidence of
radial access as a highly recommendable alternative to femoral access in
the setting of primary percutaneous coronary intervention (p-PCI). The
current evidence suggests that radial access should become the default
access for patients with ACS undergoing invasive management. Copyright
&#xa9; 2016 Edizioni Minerva Medica.

<43>
Accession Number
612922155
Author
Sharma D.; Ramsewak A.; Manoharan G.; Spence M.S.
Institution
(Sharma, Manoharan, Spence) Royal Victoria Hospital, Belfast Health and
Social Care Trust, Belfast, Northern Ireland BT12 6BA, United Kingdom
(Ramsewak) Altnagelvin Hospital, Londonderry, Northern Ireland, United
Kingdom
Title
Efficacy of RADPAD protection drape in reducing radiation exposure to the
primary operator during Transcatheter Aortic Valve Implantation (TAVI).
Source
Minerva Cardioangiologica. 64 (1) (pp 41-46), 2016. Date of Publication:
February 2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: The efficacy of RADPAD (a sterile, lead-free drape) has been
demonstrated to reduce the scatter radiation to the primary operator
during fluoroscopic procedures. However, the use of the RADPAD during TAVI
procedures has not been studied. Transcatheter aortic valve implantation
(TAVI) is now an established treatment for patients with symptomatic
severe aortic stenosis who are deemed inoperable or at high risk for
conventional surgical aortic valve replacement (AVR). Consequently the
radiation exposure to the patient and the interventional team from this
procedure has become a matter of interest and importance. Methods to
reduce radiation exposure to the interventional team during this procedure
should be actively investigated. In this single center prospective study,
we determined the radiation dose during this procedure and the efficacy of
RADPAD in reducing the radiation dose to the primary operator. METHODS:
Fifty consecutive patients due to undergo elective TAVI procedures were
identified. Patients were randomly assigned to undergo the procedure with
or without the use of a RADPAD drape. There were 25 patients in each group
and dosimetry was performed at the left eye level of the primary operator.
The dosimeter was commenced at the start of the procedure, and the dose
was recorded immediately after the end of the procedure. Fluoroscopy times
and DAP were also recorded prospectively. RESULTS: Twenty-five patients
underwent transfemoral TAVI using a RADPAD and 25 with no-RADPAD. The mean
primary operator radiation dose was significantly lower in the RADPAD
group at 14.8 mSv vs. 24.3 mSv in the no-RADPAD group (P=0.008). There was
no significant difference in fluoroscopy times or dose-area products
between the two patient groups. The dose to the primary operator relative
to fluoroscopy time (RADPAD: slope=0.325; no RADPAD: slope=1.148; analysis
of covariance F=7.47, P=0.009) and dose area product (RADPAD:
slope=0.0007; no RADPAD: slope=0.002; analysis of covariance F=7.38;
P=0.009) was smaller in the RADPAD group compared to no-RADPAD group.
CONCLUSIONS: Use of a RADPAD significantly reduces radiation exposure to
the primary operator during TAVI procedures. Copyright &#xa9; 2016
EDIZIONI MINERVA MEDICA.

<44>
Accession Number
612923171
Author
Calcagno S.; Lucisano L.; Mancone M.; Cavallo E.; Pennacchi M.; Stio R.E.;
Sardella G.
Institution
(Calcagno, Lucisano, Mancone, Cavallo, Pennacchi, Stio, Sardella)
Department of Cardiovascular Respiratory, Nephrologic, Anesthesiologic and
Geriatric Sciences, Umberto i Hospital, Sapienza University of Rome,
Policlinico Umberto i, Viale del Policlinico 155, Rome 00186, Italy
Title
Bleeding versus thrombosis: Role of short DAPT in complex lesions.
Source
Minerva Cardioangiologica. 63 (6) (pp 533-546), 2015. Date of Publication:
December 2015.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Therapy with dual antiplatelet agents, defined as the combination of a
platelet P2Y12 inhibitor and aspirin, is required to prevent thrombotic
complications, after percutaneous coronary intervention (PCI) with stent
implantation. Usually current guidelines recommend administration of dual
antiplatelet therapy (DAPT) following percutaneous revascularization with
drug-eluting stent (DES) for a period of at least 12 months or for 6 to 12
months in patients not at high risk. Nevertheless, the treatment of
stable/unstable coronary artery disease with DES implantation increasing
largely, the optimal duration of DAPT is still unclear. The duration of
DAPT after coronary stenting has been evaluated in recent randomized
studies with conflicting results. The administration of long period of
DAPT is a strategy to reduce thrombosis events but largely increase the
hemorrhagic ones. Otherwise, shorter DAPT period is protective about
bleeds with consequently increased ischemic events. In addition, as new
DES carry a lower risk of stent thrombosis (ST) compared with the
first-generation DES and possibly even bare-metal stents, a shift toward
better protection from ST may have an effect on the duration and the
intensity of DAPT. Whether the duration of DAPT should be shorter or
longer than the currently recommended 6 to 12 months is analyzed in this
review, drawing on results from the most recent studies and meta-analysis.

<45>
[Use Link to view the full text]
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.

<46>
Accession Number
612908478
Author
Ribeiro H.B.; Orwat S.; Hayek S.S.; Larose E.; Babaliaros V.; Dahou A.; Le
Ven F.; Pasian S.; Puri R.; Abdul-Jawad Altisent O.; Campelo-Parada F.;
Clavel M.-A.; Pibarot P.; Lerakis S.; Baumgartner H.; Rodes-Cabau J.
Institution
(Ribeiro, Larose, Dahou, Le Ven, Pasian, Puri, Abdul-Jawad Altisent,
Campelo-Parada, Clavel, Pibarot, Rodes-Cabau) Quebec Heart & Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Orwat, Baumgartner) Division of Adult Congenital and Valvular Heart
Disease, Department of Cardiovascular Medicine, University Hospital
Muenster, Muenster, Germany
(Hayek, Babaliaros, Lerakis) Emory University School of Medicine, Atlanta,
Georgia, United States
Title
Cardiovascular Magnetic Resonance to Evaluate Aortic Regurgitation After
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 68 (6) (pp 577-585), 2016.
Date of Publication: 09 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Residual aortic regurgitation (AR) following transcatheter
aortic valve replacement (TAVR) is associated with greater mortality; yet,
determining AR severity post-TAVR using Doppler echocardiography remains
challenging. Cardiovascular magnetic resonance (CMR) is purported as a
more accurate means of quantifying AR; however, no data exist regarding
the prognostic value of AR as assessed by CMR post-TAVR. Objectives This
study sought to evaluate the effect of AR assessed with CMR on clinical
outcomes post-TAVR. Methods We included 135 patients from 3 centers. AR
was quantified using regurgitant fraction (RF) measured by phase-contrast
velocity mapping CMR at a median of 40 days post-TAVR, and using Doppler
echocardiography at a median of 6 days post-TAVR. Median follow-up was 26
months. Clinical outcomes included mortality and rehospitalization for
heart failure. Results Moderate-severe AR occurred in 17.1% and 12.8% of
patients as measured by echocardiography and CMR, respectively. Higher RF
post-TAVR was associated with increased mortality (hazard ratio: 1.18 for
each 5% increase in RF [95% confidence interval: 1.08 to 1.30]; p < 0.001)
and the combined endpoint of mortality and rehospitalization for heart
failure (hazard ratio: 1.19 for each 5% increase in RF; 95% confidence
interval: 1.15 to 1.23; p < 0.001). Prediction models yielded significant
incremental predictive value; CMR performed a median of 40 days post-TAVR
had a greater association with post-TAVR clinical events compared with
early echocardiography (p < 0.01). RF >30% best predicted poorer clinical
outcomes (p < 0.001 for either mortality or the combined endpoint of
mortality and heart failure rehospitalization). Conclusions Worse
CMR-quantified AR was associated with increased mortality and poorer
clinical outcomes following TAVR. Quantifying AR with CMR may identify
patients with AR who could benefit from additional treatment measures.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<47>
[Use Link to view the full text]
Accession Number
612908445
Author
Van Belle E.; Hengstenberg C.; Lefevre T.; Kupatt C.; Debry N.; Husser O.;
Pontana F.; Kuchcinski G.; Deliargyris E.N.; Mehran R.; Bernstein D.;
Anthopoulos P.; Dangas G.D.
Institution
(Van Belle, Debry) Department of Cardiology, Centre Hospitalier Regional
Universitaire (CHRU) Lille and Unite Mixte de Recherche (UMR1011), Lille,
France
(Hengstenberg, Husser) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Hengstenberg) Deutsches Zentrum fur Herz-Kreislauf-Forschung E.V. (DZHK),
partner site Munich Heart Alliance, Munich, Germany
(Lefevre) Institut Cardio Vasculaire Paris Sud, Paris, France
(Kupatt) Ludwig Maximilian University of Munich (LMU) Munich, Munich,
Germany
(Pontana, Kuchcinski) Department of Radiology, CHRU Lille, Lille, France
(Deliargyris, Bernstein) The Medicines Company, Parsippany, New Jersey,
United States
(Mehran, Dangas) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, New York, United States
(Anthopoulos) The Medicines Company, Zurich, Switzerland
Title
Cerebral Embolism During Transcatheter Aortic Valve Replacement: The
BRAVO-3 MRI Study.
Source
Journal of the American College of Cardiology. 68 (6) (pp 589-599), 2016.
Date of Publication: 09 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Cerebral embolization is a frequent complication after
transcatheter aortic valve replacement (TAVR). We hypothesized that
cerebral embolization may be reduced by anticoagulation with bivalirudin
during TAVR. Objectives This study sought to determine the proportion of
patients with new cerebral embolus after TAVR and to investigate whether
parenteral procedural anticoagulation strategies affect cerebral
embolization. Methods The BRAVO (Effect of Bivalirudin on Aortic Valve
Intervention Outcomes)-3 randomized trial compared bivalirudin with
unfractionated heparin in patients undergoing transfemoral TAVR. A
prospective cerebral magnetic resonance imaging (MRI) substudy was
conducted in 4 sites; 60 patients were imaged with brain MRI after TAVR.
Primary endpoint was proportion of patients with new cerebral emboli on
MRI. Secondary endpoints included quantitative MRI analyses of cerebral
lesions and neurological outcomes at 48 h and 30 days. Results Patients
were randomized to bivalirudin (n = 29) versus heparin (n = 31). The
proportion of patients with new cerebral emboli on MRI did not differ
between bivalirudin and heparin groups (65.5% vs. 58.1%; p = 0.55). Groups
were similar for median number of emboli per patient (1 [interquartile
range (IQR): 0 to 3] vs. 1 [IQR: 0 to 1]; p = 0.08), total volume of
emboli (45 [IQR: 0 to 175] mm³ vs. 33 [IQR: 0 to 133]
mm³; p = 0.86), or proportion of patients with a clinical
neurological deficit at 48 h or 30 days. All patients who presented
clinically with stroke had evidence of new emboli on MRI. Conclusions This
study documented cerebral embolization in nearly two-thirds of patients
during contemporary TAVR. There were no significant differences in
cerebral embolization for bivalirudin versus heparin anticoagulation
during TAVR. (Open-Label, Randomized Trial in Patients Undergoing TAVR to
Determine Safety and Efficacy of Bivalrudin vs. UFH [BRAVO-2/3];
NCT01651780) Copyright &#xa9; 2016 American College of Cardiology
Foundation

<48>
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.

<49>
Accession Number
612907562
Author
Jones T.K.; Rome J.J.; Armstrong A.K.; Berger F.; Hellenbrand W.E.;
Cabalka A.K.; Benson L.N.; Balzer D.T.; Cheatham J.P.; Eicken A.;
McElhinney D.B.
Institution
(Jones) Seattle Children's Hospital, Seattle, Washington, United States
(Rome) The Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania, United States
(Armstrong, Cheatham) Nationwide Children's Hospital, Columbus, Ohio,
United States
(Berger) Deutsches Herzzentrum Berlin and Charite-Universitaetsmedizin
Berlin, Berlin, Germany
(Hellenbrand) Yale University School of Medicine, New Haven, Connecticut,
United States
(Cabalka) Mayo Clinic College of Medicine, Rochester, Minnesota, United
States
(Benson) The Hospital for Sick Children, Toronto, Canada
(Balzer) St. Louis Children's Hospital, St. Louis, Missouri, United States
(Eicken) German Heart Center Munich, Munich, Germany
(McElhinney) Lucille Packard Children's Hospital Stanford, Palo Alto,
California, United States
Title
Transcatheter Pulmonary Valve Replacement Reduces Tricuspid Regurgitation
in Patients With Right Ventricular Volume/Pressure Overload.
Source
Journal of the American College of Cardiology. 68 (14) (pp 1525-1535),
2016. Date of Publication: 04 Oct 2016.
Publisher
Elsevier USA
Abstract
Background Tricuspid regurgitation (TR) is a common and important
comorbidity in patients with postoperative right ventricular outflow tract
(RVOT) obstruction or pulmonary regurgitation (PR). Transcatheter
pulmonary valve replacement (TPVR) has become a useful tool in the
management of postoperative RVOT obstruction and PR, but it is unknown
whether relief of the right ventricular volume and/or pressure overload by
TPVR will have a beneficial effect on TR, as is often seen with surgical
pulmonary valve replacement. Objectives This study sought to assess the
prevalence of and factors associated with significant TR in patients
undergoing TPVR for RVOT obstruction or PR. Methods Data were combined
from 3 prospective multicenter trials of patients referred for TPVR.
Follow-up data through 5 years post-implantation were analyzed. Results Of
300 patients studied, 77 (25.6%) had moderate or severe TR at baseline.
After TPVR, TR severity was improved in 65% of those patients, and more
than one-half had mild TR or less TR at discharge. Of 13 patients with
severe TR pre-implantation, only 1 had severe TR at 1-year follow-up and
beyond. Moderate or severe baseline TR was associated with shorter freedom
from RVOT reintervention after TPVR. Conclusions In this prospective
multicenter study of post-operative patients with RVOT obstruction and/or
PR, TR was common. In patients with significant baseline TR, TPVR resulted
in clinically relevant acute reductions in TR that persisted over at least
5 years of follow-up. These observations support the application of TPVR
therapy in patients with RVOT obstruction or PR who are anatomically
suitable, even in the setting of significant concomitant TR. Copyright
&#xa9; 2016 American College of Cardiology Foundation

<50>
Accession Number
612843323
Author
Kato T.S.; Nakamura H.; Murata M.; Kuroda K.; Suzuki H.; Yokoyama Y.;
Shimada A.; Matsushita S.; Yamamoto T.; Amano A.
Institution
(Kato, Nakamura, Murata, Kuroda, Yokoyama, Shimada, Matsushita, Yamamoto,
Amano) Heart Center, Juntendo University, Department of Cardiovascular
Surgery, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Suzuki) Juntendo University School of Medicine, Division of Nephrology,
Department of Internal Medicine, Bunkyo-ku, Tokyo, Japan
Title
The effect of tolvaptan on renal excretion of electrolytes and urea
nitrogen in patients undergoing coronary artery bypass surgery.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 181. Date of Publication: 13 Sep 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Adequate fluid management is an important component of patient
care following cardiac surgery. Our aim in this study was to determine the
benefits of tolvaptan, an oral selective vasopressin-2 receptor antagonist
that causes electrolyte-free water diuresis, in postoperative fluid
management. We prospectively examined the effect of tolvaptan on renal
excretion of electrolytes and urea nitrogen in cardiac surgery patients.
Methods: Patients undergoing coronary artery bypass surgery were
randomized to receive conventional loop diuretics (Group C, n = 30) or
conventional loop diuretic therapy plus tolvaptan (Group T, n = 27).
Fractional excretions of sodium (FENA), potassium (FEK) and urea nitrogen
(FEUN) were measured in both groups during post-surgical hospitalization.
Results: Urine output was greater with tolvaptan (Group T) than without it
(Group C), and some patients in Group C required intravenous as well as
oral loop diuretics. Serum sodium concentrations decreased after surgery
in Group C, but were unchanged in Group T (postoperative day [POD] 3,
139.8 +/- 3.5 vs. 142.3 +/- 2.6 mEq/L, p = 0.006). However, postoperative
FENA values in Group C did not decrease, and the values were similar in
both groups. Serum potassium levels remained lower and FEK values remained
higher than the preoperative values, but only in Group C (all p < 0.05).
BUN increased postoperatively in both groups, but it remained higher than
its preoperative value only in Group C (all p < 0.01). Group T showed an
initial increase in BUN, which peaked and then returned to its
preoperative value within a week. The FEUN increased postoperatively in
both groups, but the change was more pronounced in Group T (POD7, 52.7 +/-
9.3 vs. 58.2 +/- 6.5 %, p = 0.025). Conclusions: Renal excretion of sodium
and potassium reflects the changes in serum concentration in patients
treated with tolvaptan. Patients treated only with loop diuretics showed a
continuous excretion of sodium and potassium that led to electrolyte
imbalance, whereas the combination of loop diuretics and tolvaptan
increased renal urea nitrogen elimination. Tolvaptan therefore appears to
be an effective diuretic that minimally affects serum electrolytes while
adequately promoting the elimination of urea nitrogen from the kidneys in
patients undergoing coronary artery bypass surgery. Trial registration:
The present study is registered with the UMIN Clinical Trials Registry
(ID: UMIN000011039) Copyright &#xa9; 2016 The Author(s).

<51>
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

<52>
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.

<53>
Accession Number
612834036
Author
Smit K.F.; Brevoord D.; Hert S.; Mol B.A.; Kerindongo R.P.; Dieren S.;
Schlack W.S.; Hollmann M.W.; Weber N.C.; Preckel B.
Institution
(Smit, Brevoord, Kerindongo, Dieren, Schlack, Hollmann, Weber, Preckel)
Academic Medical Centre (AMC), Laboratory of Experimental Intensive Care
and Anesthesiology (L.E.I.C.A.), Department of Anesthesiology,
Meibergdreef 9, Amsterdam 1100 DD, Netherlands
(Mol) Academic Medical Centre (AMC), Department of Cardiothoracic Surgery,
Amsterdam, Netherlands
(Hert) Ghent University, Department of Anesthesiology, Ghent, Belgium
Title
Effect of helium pre- or postconditioning on signal transduction kinases
in patients undergoing coronary artery bypass graft surgery.
Source
Journal of Translational Medicine. 14 (1) (no pagination), 2016. Article
Number: 294. Date of Publication: 14 Oct 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The noble gas helium induces pre- and postconditioning in
animals and humans. Volatile anesthetics induce cardioprotection in humans
undergoing coronary artery bypass graft (CABG) surgery. We hypothesized
that helium induces pre- and postconditioning in CABG-patients, affecting
signaling molecules protein kinase C-epsilon (PKC-epsilon), p38 mitogen
activated protein kinase (p38 MAPK), extracellular signal-regulated kinase
1/2 (ERK-1/2) and heat shock protein 27 (HSP-27) within cardiac tissue,
and reducing postoperative troponin levels. Methods: After ethical
approval and informed consent, 125 elective patients undergoing CABG
surgery were randomised into this prospective, placebo controlled,
investigator blinded, parallel arm single-centre study. Helium
preconditioning (3 x 5 min of 70 % helium and 30 % oxygen) was applied
before aortic cross clamping; postconditioning (15 min of helium) was
applied before release of the aortic cross clamp. Signaling molecules were
measured in right atrial appendix specimens. Troponin-T was measured at 4,
12, 24 and 48 h postoperatively. Results: Baseline characteristics of all
groups were similar. Helium preconditioning did not significantly alter
the primary outcome (molecular levels of kinases PKC-epsilon and HSP-27,
ratio of activated p38 MAPK or ERK 1/2). Postoperative troponin T was 11
arbitrary units [5, 31; area-under-the-curve (interquartile range)] for
controls, and no statistically significant changes were observed after
helium preconditioning [He-pre: 11 (6, 18)], helium postconditioning
[He-post: 11 (8, 15)], helium pre- and postconditioning [He-PP: 14 (6,
20)] and after sevoflurane preconditioning [APC: 12 (8, 24), p = 0.13]. No
adverse effects related to study treatment were observed in this study.
Conclusions: No effect was observed of helium preconditioning,
postconditioning or the combination thereof on activation of p38 MAPK, ERK
1/2 or levels of HSP27 and PKC-epsilon in the human heart. Helium pre- and
postconditioning did not affect postoperative troponin release in patients
undergoing CABG surgery. Clinical trial number Dutch trial register (
http://www.trialregister.nl/ ) number NTR1226 Copyright &#xa9; 2016 The
Author(s).

<54>
Accession Number
612776573
Author
Giraud K.; Pontin M.; Sharples L.D.; Fletcher P.; Dalgleish T.; Eden A.;
Jenkins D.P.; Vuylsteke A.
Institution
(Giraud) Cognitive Research Unit, Research and Development Department,
Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
(Pontin) Critical Care Unit, Papworth Hospital NHS Foundation Trust,
Cambridge, United Kingdom
(Sharples) Leeds Institute of Clinical Trials Research, Faculty of
Medicine and Health, University of Leeds, Leeds, United Kingdom
(Fletcher) Department of Psychiatry, School of Clinical Medicine,
University of Cambridge, Cambridge, United Kingdom
(Dalgleish) Cognition, Emotion, and Mental Health Programme, Medical
Research Council Cognition and Brain Sciences Unit, Cambridge, United
Kingdom
(Eden) Physiotherapy Department, Papworth Hospital NHS Foundation Trust,
Cambridge, United Kingdom
(Jenkins) Cardiac Services, Papworth Hospital NHS Foundation Trust,
Cambridge, United Kingdom
(Vuylsteke) Department of Cardiothoracic Anaesthesia and Intensive Care,
Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
Title
Use of a structured mirrors intervention does not reduce delirium
incidence but may improve factual memory encoding in cardiac surgical ICU
patients aged over 70 years: A pilot time-cluster randomized controlled
trial.
Source
Frontiers in Aging Neuroscience. 8 (SEP) (no pagination), 2016. Article
Number: 228. Date of Publication: 28 Sep 2016.
Publisher
Frontiers Research Foundation (E-mail: info@frontiersin.org)
Abstract
Introduction: Post-operative delirium remains a significant problem,
particularly in the older surgical patient. Previous evidence suggests
that the provision of supplementary visual feedback about ones environment
via the use of a mirror may positively impact on mental status and
attention (core delirium diagnostic domains). We aimed to explore whether
use of an evidence-based mirrors intervention could be effective in
reducing delirium and improving post-operative outcomes such as factual
memory encoding of the Intensive Care Unit (ICU) environment in older
cardiac surgical patients. Methods: This was a pilot time-cluster
randomized controlled trial at a 32-bed ICU, enrolling 223 patients aged
70 years and over, admitted to ICU after elective or urgent cardiac
surgery from October 29, 2012 to June 23, 2013. The Mirrors Group received
a structured mirrors intervention at set times (e.g., following change in
mental status). The Usual Care Group received the standard care without
mirrors. Primary outcome was ICU delirium incidence; secondary outcomes
were ICU delirium days, ICU days with altered mental status or
inattention, total length of ICU stay, physical mobilization (balance
confidence) at ICU discharge, recall of factual and delusional ICU
memories at 12 weeks, Health-Related Quality of Life at 12 weeks, and
acceptability of the intervention. Results: The intervention was not
associated with a significant reduction in ICU delirium incidence
[Mirrors: 20/115 (17%); Usual Care: 17/108 (16%)] or duration [Mirrors: 1
(1-3); Usual Care: 2 (1-8)]. Use of the intervention on ICU was predictive
of significantly higher recall of factual (but not delusional) items at 12
weeks after surgery (p = 0.003) and acceptability was high, with
clinicians using mirrors at 86% of all recorded hourly observations. The
intervention did not significantly impact on other secondary outcomes.
Conclusion: Use of a structured mirrors intervention on the post-operative
ICU does not reduce delirium, but may result in improved factual memory
encoding in older cardiac surgical patients. This effect may occur via
mechanisms unrelated to delirium, altered mental status, or inattention.
The intervention may provide a new means of improving outcomes in patients
at risk of post-ICU anxiety and/or Post-Traumatic Stress Disorder.
Copyright &#xa9; 2016 Giraud, Pontin, Sharples, Fletcher, Dalgleish, Eden,
Jenkins and Vuylsteke.

<55>
Accession Number
612953391
Author
Howard-Quijano K.; Salem A.; Barkulis C.; Mazor E.; Scovotti J.C.; Ho
J.K.; Shemin R.J.; Grogan T.; Elashoff D.; Mahajan A.
Institution
(Howard-Quijano) From the Departments of *Anesthesiology and Perioperative
Medicine, +Cardiothoracic Surgery, ++Medicine Statistics Core, and
Biomathematics and Medicine, University of California, Los Angeles, Los
Angeles, California.
Title
Preoperative Three-Dimensional Strain Imaging Identifies Reduction in Left
Ventricular Function and Predicts Outcomes After Cardiac Surgery.
Source
Anesthesia and Analgesia. (no pagination), 2016. Date of Publication: 24
Oct 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: Echocardiography-based speckle-tracking strain imaging is an
emerging modality to assess left ventricular function. The aim of this
study was to investigate the change in left ventricular systolic function
after cardiac surgery with 3-dimensional (3D) speckle-tracking strain
imaging and to determine whether preoperative 3D strain is an independent
predictor of acute and long-term clinical outcomes after aortic valve,
mitral valve, and coronary artery bypass grafting operations. METHODS:: In
total, 163 adult patients undergoing aortic valve, mitral valve, and
coronary artery bypass surgeries were enrolled prospectively and had
complete data sets. Demographic, operative, and outcome data were
collected. 3D transthoracic echocardiograms were preformed preoperatively
and on second to fourth postoperative day. Blinded off-line analysis was
performed for left ventricular 2-dimensional (2D) ejection fraction (EF2D)
and 3D ejection fraction (EF3D) and global peak systolic area,
longitudinal, circumferential, and radial strain. RESULTS:: 3D global
strain correlated well with EF3D. Ventricular function as measured by
strain imaging decreased significantly after all types of cardiac surgery.
When preoperative EF3D was used, receiver operating characteristic curves
identified reference values for 3D global strain corresponding to normal,
mildly reduced, and severely reduced ventricular function. Normal
ventricular function (EF3D > 50%) corresponded to 3D global area strain
-25%, with area under curve = 0.86 (0.81-0.89). Patients with reduced
preoperative 3D global area strain had worse postoperative outcomes,
including length of intensive care unit stay (4 vs 3 days, P = .001),
major adverse events (27% vs 11%, P = .03), and decreased 1-year
event-free survival (69% vs 88%, P = .005). After we controlled for
baseline preoperative risk models including European System for Cardiac
Operative Risk Evaluation score and surgery type, preoperative strain was
an independent predictor of both short- and long-term outcomes, including
length of intensive care unit stay, postoperative inotrope score, and
1-year event-free survival. CONCLUSIONS:: This study shows that cardiac
surgery was associated with an acute reduction in postoperative left
ventricular function, when evaluated with 3D strain imaging. In addition,
preoperative 3D strain was demonstrated to be an independent predictor of
acute and long-term clinical outcomes after cardiac surgery. The use of
noninvasive 3D transthoracic echocardiogram strain imaging before cardiac
surgery may provide added information to aid in perioperative risk
stratification and management for these high-risk patients. Copyright
&#xa9; 2016 International Anesthesia Research Society

<56>
Accession Number
612947787
Author
Likosky D.S.; Paugh T.A.; Harrington S.D.; Wu X.; Rogers M.A.M.; Dickinson
T.A.; DeLucia A.; Benedetti B.R.; Prager R.L.; Zhang M.; Paone G.
Institution
(Likosky, Paugh, Wu, Benedetti, Prager) Department of Cardiac Surgery,
University of Michigan, Ann Arbor, Michigan
(Rogers) Department of Internal Medicine, University of Michigan, Ann
Arbor, Michigan
(Zhang) Department of Biostatistics, University of Michigan, Ann Arbor,
Michigan
(Harrington) Heart and Vascular Institute, Henry Ford Macomb Hospitals,
Clinton Township, Michigan
(Dickinson) Department of Surgery, Mayo Clinic, Rochester, Minnesota
(DeLucia) Department of Cardiac Surgery, Bronson Methodist Hospital,
Kalamazoo, Michigan
(Paone) Division of Cardiac Surgery, Department of Surgery, Henry Ford
Hospital, Detroit, Michigan
Title
Prediction of Transfusions After Isolated Coronary Artery Bypass Grafting
Surgical Procedures.
Source
Annals of Thoracic Surgery. (no pagination), 2016. Date of Publication:
2016.
Publisher
Elsevier USA
Abstract
Background: Although blood transfusions are common and have been
associated with adverse sequelae after cardiac surgical procedures, few
contemporaneous models exist to support clinical decision making. This
study developed a preoperative clinical decision support tool to predict
perioperative red blood cell transfusions in the setting of isolated
coronary artery bypass grafting. Methods: We performed a multicenter,
observational study of 20,377 patients undergoing isolated coronary artery
bypass grafting among patients at 39 hospitals participating in the
Michigan Society of Thoracic and Cardiovascular Surgeons Quality
Collaborative's PERFusion measures and outcomes (PERForm) registry between
2011 and 2015. Candidates' preoperative risk factors were identified based
on previous work and clinical input. The study population was randomly
divided into a 70% development sample and a 30% validation sample. A
generalized linear mixed-effect model was developed to predict
perioperative red blood cell transfusion. The model's performance was
assessed for calibration and discrimination. Sensitivity analysis was
performed to assess the robustness of the model in different clinical
subgroups. Results: Transfusions occurred in 36.8% of patients. The final
regression model included 16 preoperative variables. The correlation
between the observed and expected transfusions was 1.0. The risk
prediction model discriminated well (receiver operator characteristic
[ROC]<inf>development</inf>, 0.81; ROC<inf>validation</inf>, 0.82) and had
satisfactory calibration (correlation between observed and expected rates
was r = 0.999). The model performance was confirmed across medical centers
and clinical subgroups. Conclusions: Our risk prediction model uses 16
readily obtainable preoperative variables. This model, which provides a
patient-specific estimate of the need for transfusion, offers clinicians a
guide for decision making and evaluating the effectiveness of blood
management strategies. Copyright &#xa9; 2016 The Society of Thoracic
Surgeons.

<57>
Accession Number
612946616
Author
Codner P.; Levi A.; Gargiulo G.; Praz F.; Hayashida K.; Watanabe Y.;
Mylotte D.; Debry N.; Barbanti M.; Lefevre T.; Modine T.; Bosmans J.;
Windecker S.; Barbash I.; Sinning J.-M.; Nickenig G.; Barsheshet A.;
Kornowski R.
Institution
(Codner, Levi, Barsheshet, Kornowski) Cardiology Department, Rabin Medical
Center, Petah Tikva, Israel
(Codner, Levi, Barsheshet, Kornowski) Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(Gargiulo, Praz, Windecker) Cardiology Department, Inselspital University
Hospital, Bern, Switzerland
(Hayashida) Keio University School of Medicine, Tokyo, Japan
(Watanabe, Lefevre) Hospital Prive Jacques Cartier, Institut
Cardiovasculaire Paris Sud, Massy, France
(Mylotte) Cardiology Department, Galway University Hospital, Galway,
Ireland
(Debry, Modine) Institut Cardio-Pneumologique, CHRU, Lille, France
(Barbanti) Cardiology Department, Ferrarotto Hospital, Catania, Italy
(Bosmans) Interventional Cardiology, University Hospital, Antwerp, Belgium
(Barbash) Interventional Cardiology, Sheba Medical Center, Ramat Gan,
Israel
(Sinning, Nickenig) Cardiology Department, Bonn University Hospital, Bonn,
Germany
Title
Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve
Replacement Outcomes in a Large Multicenter Cohort.
Source
American Journal of Cardiology. (no pagination), 2016. Date of
Publication: May 28, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with advanced chronic renal dysfunction were excluded from
randomized trials of transcatheter aortic valve replacement (TAVR). The
potential impact of chronic renal disease on TAVR prognosis is not fully
understood. We aim to evaluate outcomes within a large cohort of patients
who underwent TAVR distinguished by renal function. Baseline
characteristics, procedural data, and clinical follow-up findings were
collected from 10 high-volume TAVR centers in Europe, Israel, and Japan.
Data were analyzed according to renal function. Patients (n = 1,204) were
divided into 4 groups according to pre-TAVR-estimated glomerular
filtration rate (eGFR): group I (eGFR >60), n = 288 (female 45%), group II
(eGFR 31 to 60), n = 452 (female 61%), group III (eGFR <30), n = 398
(female 61%), and group IV (dialysis), n = 66 (female 31%). Mean Society
of Thoracic Surgeons score was higher in patients with lower preprocedural
eGFR. All-cause mortality at 1 year was higher in patients with lower eGFR
(9.0%, 12.1%, 24.3%, and 24.2% for group I, II, III, and IV, respectively,
p <0.001). Multivariate analysis demonstrated that eGFR <30, but not eGFR
31 to 60, was associated with increased risk of death (odds ratio 3),
bleeding (odds ratio 5.2), and device implantation failure (hazard ratio
2.28). For each 10 ml/min decrease in eGFR, there was an associated
relative increase in the risk of death (35%; p <0.001), cardiovascular
death (14%; p = 0.018), major bleeding 35% (p <0.001), and transcatheter
valve failure (16%; p = 0.007). Renal dysfunction was not associated with
stroke or need for pacemaker implantation. In conclusion, among patients
who underwent TAVR, baseline renal dysfunction is an important independent
predictor of morbidity and mortality. Copyright &#xa9; 2016 Elsevier Inc.

<58>
Accession Number
612933994
Author
Royse C.F.; Saager L.; Whitlock R.; Ou-Young J.; Royse A.; Vincent J.;
Devereaux P.J.; Kurz A.; Awais A.; Panjasawatwong K.; Sessler D.I.
Institution
(Royse) From the Department of Surgery, University of Melbourne,
Melbourne, Victoria, Australia (C.F.R., J.O.-Y., A.R.); Department of
Anaesthesia and Pain Management (C.F.R.) and Department of Cardiothoracic
Surgery (A.R.), The Royal Melbourne Hospital, Melbourne, Victoria,
Australia; Department of Outcomes Research, Anesthesiology Institute,
Cleveland Clinic, Cleveland, Ohio (L.S., A.K., A.A., K.P.D.I.S.);
Department of Surgery (R.W., P.J.D.), Population Health Research Institute
(R.W., J.V., P.J.D.), Hamilton Health Sciences and McMaster University,
Hamilton, Ontario, Canada; and Department of Anesthesiology, Faculty of
Medicine, Chiang Mai University, Thailand (K.P.).
Title
Impact of Methylprednisolone on Postoperative Quality of Recovery and
Delirium in the Steroids in Cardiac Surgery Trial: A Randomized,
Double-blind, Placebo-controlled Substudy.
Source
Anesthesiology. (no pagination), 2016. Date of Publication: 24 Oct 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: Inflammation after cardiopulmonary bypass may contribute to
postoperative delirium and cognitive dysfunction. The authors evaluated
the effect of high-dose methylprednisolone to suppress inflammation on the
incidence of delirium and postoperative quality of recovery after cardiac
surgery. METHODS:: Five hundred fifty-five adults from three hospitals
enrolled in the randomized, double-blind Steroids in Cardiac Surgery trial
were randomly allocated to placebo or 250 mg methylprednisolone at
induction and 250 mg methylprednisolone before cardiopulmonary bypass.
Each completed the Postoperative Quality of Recovery Scale before surgery
and on days 1, 2, and 3 and 1 and 6 months after surgery and the Confusion
Assessment Method scale for delirium on days 1, 2, and 3. Recovery was
defined as returning to preoperative values or improvement at each time
point. RESULTS:: Four hundred eighty-two participants for recovery and 498
participants for delirium were available for analysis. The quality of
recovery improved over time but without differences between groups in the
primary endpoint of overall recovery (odds ratio range over individual
time points for methylprednisolone, 0.39 to 1.45; 95% CI, 0.08-2.04 to
0.40-5.27; P = 0.943) or individual recovery domains (all P > 0.05). The
incidence of delirium was 10% (control) versus 8% (methylprednisolone; P =
0.357), with no differences in delirium subdomains (all P > 0.05). In
participants with normal (51%) and low baseline cognition (49%), there
were no significant differences favoring methylprednisolone in any domain
(all P > 0.05). Recovery was worse in patients with postoperative delirium
in the cognitive (P = 0.004) and physiologic (P < 0.001) domains.
CONCLUSIONS:: High-dose intraoperative methylprednisolone neither reduces
delirium nor improves the quality of recovery in high-risk cardiac
surgical patients. Copyright &#xa9; by 2016, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<59>
Accession Number
612933208
Author
Abe S.; Ishida K.; Masuda M.; Ueda H.; Kohno H.; Matsuura K.; Tamura Y.;
Watanabe M.; Matsumiya G.
Institution
(Abe, Ishida, Ueda, Kohno, Matsuura, Tamura, Watanabe, Matsumiya)
Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba
University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
(Masuda) Department of Cardiovascular Surgery, Chiba Medical Center, 4-1-2
Tsubakimori, Chuo-ku, Chiba 260-0042, Japan
Title
A prospective, randomized study of inhaled prostacyclin versus nitric
oxide in patients with residual pulmonary hypertension after pulmonary
endarterectomy.
Source
General Thoracic and Cardiovascular Surgery. (pp 1-7), 2016. Date of
Publication: 25 Oct 2016.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
Objectives: Pulmonary endarterectomy (PEA) is an effective treatment for
chronic thromboembolic pulmonary hypertension (CTEPH), but postoperative
residual hypertension leads to in-hospital mortality. Inhaled epoprostenol
sodium (PGI<inf>2</inf>) and NO are administered for pulmonary
hypertension after cardiothoracic surgery. This prospective study provides
the first comparative evaluation of the effects of inhaled PGI<inf>2</inf>
and NO on pulmonary hemodynamics, systemic hemodynamics, and gas exchange
in patients developing residual pulmonary hypertension after PEA. Methods:
Thirteen patients were randomized to receive either NO (n = 6) or PGI2 (n
= 7) inhalation when pulmonary hypertension persisted after weaning from
cardiopulmonary bypass. Hemodynamic and respiratory variables were
measured before inhalation of the agent (T0); 30 min (T1), 3 h (T2), and 6
h after inhalation (T3); and the next morning (T4). The NO dose was
started at 20 ppm and gradually tapered until extubation, and
PGI<inf>2</inf> was administered at a dose of 10 ng kg^-1
min^-1. Results: In both groups, mean pulmonary artery pressure
(PAP) and pulmonary vascular resistance (PVR) significantly decreased over
time until T4 (mean PAP: p < 0.0001; PVR: p = 0.003), while mean systemic
arterial blood pressure significantly increased (p = 0.028). There were no
significant between-group differences in patient characteristics, cardiac
index, left atrial pressure, or ratio of arterial oxygen tension to
fraction of inspired oxygen. There were no in-hospital deaths.
Conclusions: Both inhaled PGI<inf>2</inf> and NO significantly reduced PAP
and PVR without adverse effects on systemic hemodynamics in patients who
developed residual pulmonary hypertension after PEA. Inhaled
PGI<inf>2</inf> can be offered as alternative treatment option for
residual pulmonary hypertension. Copyright &#xa9; 2016 The Author(s)

<60>
Accession Number
612920724
Author
Nuhoglu F.; Gumus F.; Sinikoglu S.N.; Yektas A.; Erkalp K.; Alagol A.
Institution
(Nuhoglu) Department of Ophthalmology, Bezmialem Private University,
Istanbul, Turkey
(Gumus, Sinikoglu, Yektas, Erkalp, Alagol) Department of Anesthesiology
and Reanimation, Bagcilar Training and Research Hospital, Istanbul, Turkey
Title
Changes in intraocular pressure during cardiopulmonary bypass.
Source
International Ophthalmology. (pp 1-6), 2016. Date of Publication: 24 Oct
2016.
Publisher
Springer Netherlands
Abstract
Purpose: The aim of the present study was to investigate the changes in
intraocular pressures (IOP) in patients who underwent pulsatile and
non-pulsatile cardiopulmonary bypass (CPB). Methods: A total of 42
patients operated for elective coronary bypass surgery (CABG) on CPB were
randomly allocated to pulsatile (Group P) and non-pulsatile (Group N)
groups. Pulsatile flow was applied to Group P patients during crops-clamp
period. The IOP measurements were made before and after the induction of
anesthesia, before the onset of CPB, on the 5th, 15th, 30th, 45th, and
60th min of CPB, after CPB and at the end of the operation. The results of
repetitive measurements were analyzed at different intervals and in two
groups. Results: The second IOP measurements of right and left eyes
displayed statistically significant decreases from the baseline level
[11.9 +/- 2.9 (p = 0.0001) and 12.5 +/- 3.2 (p = 0.0001), respectively].
The significant decrease in the IOP values persisted in the repeated
measurements except for the 5th min of CPB values [17.0 +/- 3.5 (p =
0.346) and 16.7 +/- 3.6 (p = 0.399)]. Comparison of two groups
demonstrated significant differences at pre-CPB (right 12.8 +/- 2.3 vs.
10.8 +/- 2.4; p = 0.013 and left 13.3 +/- 2.4 vs. 11.5 +/- 2.5; p =
0.023), and 5th min of CPB measurements (right 18.5 +/- 3.1 vs. 15.9 +/-
3.4; p = 0.015; left 18.2 +/- 3.0 vs. 15.7 +/- 3.6; p = 0.019).
Conclusion: We noted a steady decrease in repeated IOP measurements except
for the transient increase in CPB values on 5th min. The IOP values were
higher in pulsatile CPB group in pre-CPB and 5th min of CPB measurements;
however, the difference was not significant in the repeated measurements.
Copyright &#xa9; 2016 Springer Science+Business Media Dordrecht

<61>
Accession Number
612920673
Author
Wang P.-L.; Zhang L.; Wang S.-L.; Yang Q.-N.; Gao Z.-Y.; du J.-P.; Zhang
D.-W.; Fu C.-G.; Gu F.; Xu H.; Li L.-Z.; Wang C.-L.; Shi D.-Z.
Institution
(Wang, Zhang, Yang, Gao, du, Zhang, Fu, Gu, Xu, Li, Wang, Shi) Institute
of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese
Medical Sciences, Beijing 100091, China
(Wang) Department of Gastroenterology, Guang'anmen Hospital, China Academy
of Chinese Medical Sciences, Beijing 100053, China
Title
Long-term follow-up of Chinese herbal medicines combined with conventional
treatment in patients with acute coronary syndrome after percutaneous
coronary intervention: A multicenter randomized controlled trial.
Source
Chinese Journal of Integrative Medicine. (pp 1-7), 2016. Date of
Publication: 24 Oct 2016.
Publisher
Chinese Journal of Integrated Traditional and Western Medicine Press
(E-mail: cjim@jia.net)
Abstract
Objective: To evaluate the prognosis effect of Chinese herbal medicines
(CHMs) for benefifiting qi and activating blood circulation adjunctive to
conventional treatment in patients with acute coronary syndrome (ACS)
after percutaneous coronary intervention (PCI). Methods: A total of 702
patients with ACS who underwent PCI were enrolled and randomly assigned to
receive conventional treatment plus CHMs for benefifiting qi and
activating blood circulation (treatment group, 351 cases) or conventional
treatment alone (control group, 351 cases) for 6 months. Six months later,
all patients received conventional treatment alone. Follow-ups were
scheduled at 6th, 12th, 18th, 24th month after enrollment in April 2008,
and the fifinal follow-up visit was during September 2011 and November
2011. The primary endpoint was the composite of cardiac death, nonfatal
myocardial infarction or revascularization (PCI or coronary artery bypass
grafting); and the secondary endpoint was the composite of re-admission
for ACS, congestive heart failure, nonfatal stroke or other thrombus
events. Results: A total of 621 (88.59%) patients completed 35.4+/-3.8
months follow-up, while 80 (11.41%) patients withdrew from the trial (41
in the treatment group and 39 in the control group). The incidence of
primary endpoint was 5.7% (20 patients) in the treatment group versus
10.86% (38 patients) in the control group [relative risk (RR): 0.53; 95%
confifidence interval (CI): 0.30, 0.88; P=0.013; absolute risk reduction
(ARR):-0.052, 95% CI:-0.06, 0.01]. The incidence of secondary endpoint was
5.98% (21 patients) in the treatment group versus 10.28% (36 patients) in
control group (RR: 0.58, 95% CI: 0.33, 0.97, P=0.037; ARR:-0.043, 95% CI:
0.06, 0.01). Most of the primary and secondary endpoints were occurred in
18 months (84.50% in the treatment group versus 78.10% in the control
group). Conclusions: CHMs for benefifiting qi and activating blood
circulation adjunctive to conventional treatment improved clinical
outcomes for patients with ACS after PCI in long-term follow-up. Copyright
&#xa9; 2016 Chinese Association of the Integration of Traditional and
Western Medicine and Springer-Verlag Berlin Heidelberg

<62>
Accession Number
612910494
Author
Dell'Aquila A.M.; Pollari F.; Fattouch K.; Santarpino G.; Hillebrand J.;
Schneider S.; Landwerht J.; Nasso G.; Gregorini R.; Del Giglio M.; Mikus
E.; Albertini A.; Deschka H.; Fischlein T.; Martens S.; Gallo A.;
Concistre G.; Speziale G.; Regesta T.
Institution
(Dell'Aquila, Hillebrand, Schneider, Landwerht, Deschka, Martens) Division
of Cardiac Surgery, Department of Cardiothoracic Surgery, University
Hospital of the Westfaelische Wilhelms-University Muenster,
Albert-Schweitzer-Campus 1, Muenster 48159, Germany
(Pollari, Santarpino, Fischlein) Department of Cardiac Surgery,
Cardiovascular Center, Klinikum Nuernberg, Paracelsus Medical University,
Nuremberg, Germany
(Fattouch) Department of Cardiovascular Surgery, Maria Eleonora Hospital
GVM Care and Research, Palermo, Italy
(Nasso, Speziale) Department of Cardiovascular Surgery, Anthea Hospital
GVM Care and Research, Bari, Italy
(Gregorini) Department of Cardiovascular Surgery, Cardiac Surgery Unit,
Citta di Lecce Hospital GVM Care and Research, Lecce, Italy
(Del Giglio, Mikus, Albertini) Department of Cardiovascular Surgery, Maria
Cecilia Hospital GVM Care and Research, Cotignola, Italy
(Gallo, Regesta) Department of Cardiac Surgery, San Martino University
Hospital, University of Genova, Genoa, Italy
(Concistre) Fondazione CNR Ospedale del cuore "G. Pasquinucci", Massa,
Italy
Title
Early outcomes in re-do operation after acute type A aortic dissection:
results from the multicenter REAAD database.
Source
Heart and Vessels. (pp 1-8), 2016. Date of Publication: 21 Oct 2016.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
This study provides early results of re-operations after the prior
surgical treatment of acute type A aortic dissection (AAD) and identifies
risk factors for mortality. Between May 2003 and January 2014, 117 aortic
re-operations after an initial operation for AAD (a mean time from the
first procedure was 3.98 years, with a range of 0.1-20.87 years) were
performed in 110 patients (a mean age of 59.8 +/- 12.6 years) in seven
European institutions. The re-operation was indicated due to a proximal
aortic pathology in ninety cases: twenty aortic root aneurysms, seventeen
root re-dissections, twenty-seven aortic valve insufficiencies and
twenty-six proximal anastomotic pseudoaneurysms. In fifty-eight cases,
repetitive surgical treatment was subscripted because of distal aortic
pathology: eighteen arch re-dissections, fifteen arch dilation and
twenty-five anastomotic pseudoaneurysms. Surgical procedures comprised a
total of seventy-one isolated proximals, thirty-one isolated distals and
fifteen combined interventions. In-hospital mortality was 19.6 %
(twenty-three patients); 11.1 % in patients with elective/urgent
indication and 66.6 % in emergency cases. Mortality rates for isolated
proximal, distal and combined operations regardless of the emergency
setting were 14.1 % (10 pts.), 25.8 % (8 pts.) and 33.3 % (5 pts.),
respectively. The causes of death were cardiac in eight, neurological in
three, MOF in five, sepsis in two, bleeding in three and lung failure in
two patients. A multivariate logistic regression analysis revealed that
risk factors for mortality included previous distal procedure (p = 0.04),
new distal procedure (p = 0.018) and emergency operation (p < 0.001). New
proximal procedures were not found to be risk factors for early mortality
(p = 0.15). This multicenter experience shows that the outcome of REAAD is
highly dependent on the localization and extension of aortic pathology and
the need for emergency treatment. Surgery in an emergency setting and
distal re-do operations after previous AAD remain a surgical challenge,
while proximal aortic re-operations show a lower mortality rate.
Foresighted decision-making is needed in cases of AAD repair, as the
results are essential preconditions for further surgical interventions.
Copyright &#xa9; 2016 Springer Japan

<63>
Accession Number
612901782
Author
Narula J.; Kiran U.; Malhotra Kapoor P.; Choudhury M.; Rajashekar P.;
Kumar Chowdhary U.
Institution
(Narula, Kiran, Malhotra Kapoor, Choudhury) Cardiac Anesthesiology
(Rajashekar, Kumar Chowdhary) Cardio-Thoracic and Vascular Surgery, Cardio
and Neurosciences Centre, All India Institute of Medical Sciences, New
Delhi, India
Title
Assessment of Changes in Hemodynamics and Intrathoracic Fluid Using
Electrical Cardiometry During Autologous Blood Harvest.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the effect of autologous blood harvest
(ABH)-induced volume shifts using electrical cardiometry (EC) in patients
with pulmonary artery hypertension secondary to left heart disease.
Design: Prospective, randomized, controlled trial. Setting: A tertiary
care hospital. Participants: The study comprised 50 patients scheduled to
undergo heart valve replacement. Interventions: Patients were divided
randomly into 2 experimental groups that were distinguished by whether ABH
was performed. Blood volume extracted in the test group was replaced
simultaneously with 1:1 colloid (Tetraspan; B Braun Melsungen, Melsungen,
Germany). Hemodynamic, respiratory, and EC-derived parameters were
recorded at predefined set points (T1 [post-induction/pre-ABH] and T2 [20
minutes post-ABH]). Measurements and Main Results: Withdrawal of 15% of
blood volume in the ABH group caused significant reductions in thoracic
fluid content (TFC) (-10.1% [-15.0% to -6.1%]); right atrial pressure
(-23% [-26.6% to -17.6%]); mean arterial pressure (-12.6% [-22.2% to
-3.8%]); airway pressures: (peak -6.2% [-11.7% to -2.8%] and mean -15.4%
[-25.0% to -8.3%]); and oxygenation index (-10.34% [-16.4% to -4.8%]).
Linear regression analysis showed good correlation between the percentage
change in TFC after ABH and the percentage of change in right atrial
pressure, stroke volume variation, autologous blood extracted, peak and
mean airway pressures, and oxygen index. Conclusions: In addition to its
proven role in blood conservation, therapeutic benefits derived from ABH
include decongestion of volume-loaded patients, decrease in TFC, and
improved gas exchange. EC tracks beat-to-beat fluid and hemodynamic
fluctuations during ABH and helps in the execution of an early
patient-specific, goal-directed therapy, allowing for its safe
implementation in patients with pulmonary hypertension secondary to left
heart disease. Copyright &#xa9; 2016 Elsevier Inc.

<64>
Accession Number
612895883
Author
Panosian J.; Ding S.-A.; Wewalka M.; Simonson D.C.; Goebel-Fabbri A.;
Foster K.; Halperin F.; Vernon A.; Goldfine A.B.
Institution
(Panosian, Ding, Wewalka, Goebel-Fabbri, Foster, Halperin, Goldfine)
Research Division, Section of Clinical Behavioral and Outcomes Research,
Joslin Diabetes Center, Boston, Mass
(Ding, Wewalka, Simonson, Goebel-Fabbri, Halperin, Vernon, Goldfine)
Harvard Medical School, Boston, Mass
(Simonson, Halperin, Vernon, Goldfine) Division of Endocrinology, Brigham
and Women's Hospital, Boston, Mass
(Vernon) Division of General and Gastrointestinal Surgery, Department of
Surgery, Brigham and Women's Hospital, Boston, Mass
Title
Physical Activity in Obese Type 2 Diabetes After Gastric Bypass or Medical
Management.
Source
American Journal of Medicine. (no pagination), 2016. Date of Publication:
2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The purpose of this study was to compare effects of Roux-en-Y
gastric bypass versus a multidisciplinary, group-based medical diabetes
and weight management program on physical fitness and behaviors. Methods:
Physical behavior and fitness were assessed in participants of the study
Surgery or Lifestyle With Intensive Medical Management in the Treatment of
Type 2 Diabetes (SLIMM-T2D) (NCT01073020), a randomized, parallel-group
trial conducted at a US academic hospital and diabetes clinic with 18- to
24-month follow-up. Thirty-eight type 2 diabetes patients with hemoglobin
A<inf>1c</inf> >6.5% and body mass index 30-42 kg/m² were
randomized to Roux-en-Y gastric bypass or the medical program. A 6-minute
walk test to evaluate fitness, self-reported physical activity,
standardized physical surveys, and cardiometabolic risk assessment were
performed at baseline and after intervention. Results: Both groups
similarly improved 6-minute walk test distance, with greater improvements
in oxygen saturation and reduced heart rate after surgery. Self-reported
physical activity improved similarly at 18-24 months after interventions,
although exercise increased gradually after surgery, whereas early
substantial increases in the medical group were not fully sustained.
Self-reported total and physical health were similar by Short Form-36 but
improved more in the Impact of Weight on Quality of Life survey after
surgery. Improvement in cardiovascular risk scores, HbA<inf>1c</inf>, and
body mass index were greater after surgery. Conclusion: In this small,
randomized study, both interventions led to therapeutic lifestyle changes
and improved objective and self-reported physical fitness. Greater
improvements in heart rate, oxygen saturation, and perceived impact of
weight on health were seen after surgery, which could be attributable to
greater weight loss. The clinical importance of these improvements with
greater weight loss warrants further investigation. Copyright &#xa9; 2016
Elsevier Inc.

<65>
Accession Number
612895264
Author
Konda P.; Ai D.; Guerra C.E.; Rodriguez-Restrepo A.; Mehran R.J.; Rice D.;
Hofstetter W.; Heir J.; Kwater P.; Gottumukkala V.; Hernandez M.; Cata
J.P.
Institution
(Konda, Rodriguez-Restrepo, Heir, Kwater, Gottumukkala) Departments of
Anesthesiology and Perioperative Medicine, University of Texas MD Anderson
Cancer Center, Houston, TX
(Ai) Department of Pathology, Baylor Scott and White Health, Temple, TX
(Guerra) Department of Anesthesiology, Henry Ford Hospital, Wayne State
University, Detroit, MI
(Mehran, Rice, Hofstetter) Thoracic and Cardiovascular Surgery, and
(Hernandez) Biostatistics, University of Texas MD Anderson Cancer Center,
Houston, TX
(Cata) Anesthesiology and Surgical Oncology Research Group, Houston, TX
Title
Identification of Risk Factors Associated With Postoperative Acute Kidney
Injury After Esophagectomy for Esophageal Cancer.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objective: To identify risks factors associated with acute kidney injury
(AKI) after esophageal cancer surgery. Design: This was a retrospective
study. Setting: Single academic center. Participants: Subjects with
non-metastatic esophageal cancer. Patients were excluded if they were
younger than 18 years and had missing data. Measurements and Main Results:
Primary outcome of the study was AKI according to AKI Network criteria.
Demographic and perioperative variables were compared in patients with and
without AKI. A multivariate Cox proportional model was used to assess the
association between perioperative variables and AKI; p<0.05 was considered
statistically significant. AKI was found in 107 (11.9%) of the 898
patients included in the study. The multivariate analysis also showed that
BMI (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.11), number
of comorbidities (OR 1.52, 95% CI 1.20-1.93, p = 0.001), and preoperative
creatinine concentrations (OR 2.37, 95% CI 1.14-4.92, p = 0.02) were
independent predictors for AKI. The use of dexamethasone was associated
with a reduced risk for AKI. Conclusions: In support of previous reports
in the literature, the authors found that AKI was not an uncommon
complication after esophageal surgery. Obesity, cardiovascular
comorbidities, and high preoperative concentrations were predictors of
AKI. Dexamethasone administration during surgery appeared to have a
protective effect. This finding opens an opportunity to further study in a
randomized controlled trial the efficacy of dexamethasone in the
prevention of AKI. Copyright &#xa9; 2016 Elsevier Inc.

<66>
Accession Number
612885313
Author
Hill Q.A.; Harrison L.C.; Padmakumar A.D.; Owen R.G.; Prasad K.R.; Lucas
G.F.; Tachtatzis P.
Institution
(Hill) Department of Haematology, St James's University Hospital, Leeds,
UK
(Harrison, Tachtatzis) Department of Hepatology, St James's University
Hospital, Leeds, UK
(Padmakumar) Department of Anaesthesia & Intensive Care Medicine, St
James's University Hospital, Leeds, UK
(Owen) HMDS Laboratory and Department of Haematology, St James's
University Hospital, Leeds, UK
(Prasad) Department of Transplant and Hepatobiliary Surgery, St James's
University Hospital, Leeds, UK
(Lucas) Histocompatibility & Immunogenetics Laboratory, NHS Blood and
Transplant, North Bristol Park, Bristol, UK
Title
A fatal case of transplantation-mediated alloimmune thrombocytopenia
following liver transplantation.
Source
Hematology. (pp 1-6), 2016. Date of Publication: 19 Oct 2016.
Publisher
Taylor and Francis Ltd. (E-mail: maney@maney.co.uk)
Abstract
Objective and importance: Transplantation-mediated alloimmune
thrombocytopenia (TMAT) occurs when leukocytes transferred in a donor
organ from a patient with immune thrombocytopenia (ITP), mount a response
against recipient platelets. We present the first fatal case of TMAT
following liver transplantation and review its aetiology and treatment.
Clinical presentation: The liver donor had ITP and died from an
intracranial haemorrhage. The recipient platelet count fell to
2x10⁹/l on post-operative day 2. Treatment refractory
thrombocytopenia resulted in pulmonary haemorrhage and death. TMAT did not
occur in a kidney recipient from the same ITP donor. Intervention:
Extramedullary haematopoiesis was identified in the donor liver biopsy.
Antibodies against platelet GPIb/IX were demonstrated in both donor and
recipient. The thrombocytopenia was refractory to platelet transfusions,
intravenous immunoglobulin, methylprednisolone, rituximab, romiplostim,
plasmapheresis, vincristine and splenic artery embolization. On review of
the literature, severe thrombocytopenia (<10x10⁹/l) has started
within 3 days of transplantation in all reported TMAT cases. Serious
non-fatal bleeding was observed in 3/5 previously reported cases. The
optimal treatment is unclear. TMAT should resolve as donor lymphocytes are
eliminated but re-transplantation may be required in severe refractory
cases. TMAT has been reported in recipients of a liver but not kidney or
heart transplant from ITP donors, probably because of the greater burden
of co-transplanted lymphoid tissue. Conclusion: Before using the liver of
an ITP donor, the recipient's fully informed consent is required. However,
the risk of TMAT from an ITP donor is currently unknown and systematic
review of donor registries is needed. Copyright &#xa9; 2016 Informa UK
Limited, trading as Taylor & Francis Group