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<1>
Accession Number
612853533
Author
He F.; Jiang Y.; Li L.
Institution
(He) Department of Anesthesiology and Pain Management, Sir Run Run Shaw
Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang,
China
(Jiang) Department of Anesthesiology, Children's Hospital, Zhejiang
University School of Medicine, Hangzhou, Zhejiang, China
(Li) Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang
University School of Medicine, No. 3, East Qingchun Road, Hangzhou,
Zhejiang 310016, China
Title
The effect of naloxone treatment on opioidinduced side effects A
meta-analysis of randomized and controlled trails.
Source
Medicine (United States). 95 (37) (no pagination), 2016. Article Number:
e4729. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: To evaluate the effects of naloxone on opioid-induced side
effects, the present meta-analysis was constructed. Methods: Electronic
databases including PubMed, EMBASE, and CNKI (China National Knowledge
Internet) were used for literature search. Studies on comparison of
opioid-side effects between naloxone-treated group and placebo or normal
saline-related group were included in the meta-analysis. Heterogeneity
analysis was performed with Chi-square and I2 test. Pooled analysis was
based on fixed-effects model, if heterogeneity between the eligible
studies was negligible (I2>50%, P>0.05), otherwise, randomeffects model
was used. Sensitivity analysis was applied to assess the robustness of the
results and publication bias was evaluated by Begg and Egger test.
Results: Thirteen studies including 1138 patients were included in the
meta-analysis. Pooled analysis indicated that naloxone could significantly
reduce the occurrence of pruritus (RR [risk ratio]=0.252, 95% CI
[confidence interval]=0.137-0.464), nausea (RR= 0.323, 95%
CI=0.245-0.428), and vomiting (RR=0.338, 95% CI=0.192-0.593) which were
induced by opioids. However, naloxone did not relieve pain (standardized
mean difference [SMD]=-0.052, 95% CI=-0.453 to 0.348) and somnolence (RR=
0.561, 95% CI=0.287 to 1.097) in patients received opioid treatment.
Additionally, there were no significant publication bias between the
included studies (Begg test, P=0.602; Egger test, P=0.388). Conclusion:
Addition of naloxone might act as an effective treatment for prophylaxis
of opioid-induced pruritus, nausea, and vomiting in clinical practice.
Copyright &#xa9; 2016 the Author(s). Published by Wolters Kluwer Health,
Inc. All rights reserved.

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

<3>
Accession Number
604815360
Author
Ismail N.A.; Gordon J.; Dunning J.
Institution
(Ismail, Gordon, Dunning) Department of Cardiothoracic Surgery, James Cook
University Hospital, Middlesbrough, United Kingdom
Title
The use of octreotide in the treatment of chylothorax following
cardiothoracic surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (6) (pp 848-854),
2015. Date of Publication: 01 Jun 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was 'Is octreotide (a
long-acting somatostatin analogue) effective in patients with
post-operative or traumatic chylothorax as a part of conservative
management to reduce lymphorrhagia?' Altogether 180 papers were found
using the reported search, of which 20 represented the best evidence to
answer the clinical question. One case was reported twice and therefore
was excluded, leaving us with 19 papers. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Although rare,
iatrogenic and traumatic chylothorax have been well described in the
literature. At present, there have been no randomized controlled clinical
trials on the use of octreotide in chylothorax. Sixteen of 19 papers found
octreotide to be effective in the treatment of chylothorax. Octreotide was
found to have no complementary effect in three reports. Two of the papers
were retrospective studies: one a randomized controlled trial in canines,
and the remainder were case reports and case series. The two retrospective
studies showed a success rate of 87-90% in the use of octreotide as an
adjunct to conservative management for the treatment of chylothorax and
hence preventing the need for further surgery. Experimental study in
canines has shown significant drain reduction and earlier fistula closure,
although transferability of this result to human is difficult to
interpret. Twelve case reports found octreotide effective in reduction of
the volume and arrest of chylothorax. Most reported benefit in 2-3 days of
administration of octreotide. The general consensus is for conservative
management with octreotide to be instituted for 1 week before
consideration of surgery, although some authors have advocated for a large
volume chylothorax, especially after oesophageal surgery with no response
to conservative management with octreotide, to be operated on sooner. We
concluded that octreotide is effective in the management of moderate to
large volume chylothorax. Copyright &#xa9; The Author 2015. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<4>
Accession Number
604815125
Author
Ali-Hassan-Sayegh S.; Mirhosseini S.J.; Haddad F.; Karimi-Bondarabadi
A.A.; Shahidzadeh A.; Weymann A.; Popov A.-F.; Sabashnikov A.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Haddad, Karimi-Bondarabadi, Shahidzadeh)
Cardiovascular Research Center, Shahid Sadoughi University of Medical
Sciences, Arsalan Street, Yazd 8916936637, Iran, Islamic Republic of
(Mirhosseini) Department of Cardiovascular Surgery, Shahid Sadoughi
University of Medical Sciences, , Yazd, Iran, Islamic Republic of
(Weymann, Popov, Sabashnikov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
Title
Protective effects of corticosteroids in coronary artery bypass graft
surgery alone or combined with valvular surgery: An updated and
comprehensive meta-analysis and systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (6) (pp 825-836),
2015. Date of Publication: 01 Jun 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
This systematic review with meta-analysis sought to determine the
protective effects of corticosteroids on clinical outcomes following
coronary artery bypass grafting (CABG). Medline, Embase, Elsevier and
Sciences online database as well as Google scholar literature were used
for selecting appropriate studies with randomized controlled design. The
effect sizes measured were odds ratio (OR) for categorical variables and
weighted mean difference with 95% confidence interval (CI) for calculating
differences between mean values of duration of hospitalization in
intervention and control groups. Values of P < 0.1 for Q-test or
I² > 50% indicated significant heterogeneity between the
studies. The literature search of all major databases retrieved 3735
studies. After screening, a total of 45 trials were identified that
reported outcomes. Pooled analysis was performed on incidence of atrial
fibrillation (OR of 0.71; 95% CI: 0.59-0.86; P = 0.000), stroke (OR of
1.61; 95% CI: 0.63-4.1; P = 0.3), infection (OR of 1.03; 95% CI: 0.68-1.5;
P = 0.8), re-infarction (OR of 0.88; 95% CI: 0.47-1.63; P = 0.6), length
of ventilation time [weighted mean difference (WMD) of 0.257; 95% CI:
0.10-0.41; P = 0.00], length of hospital stay (WMD of -0.48; 95% CI: -0.66
to -0.3; P = 0.000), amount of blood loss (WMD of -124.05; 95% CI: -147.72
to -100.38; P = 0.00), re-exploration (OR of 1.25; 95% CI: 0.66-2.35; P =
0.4) and mortality (OR of 0.87; 95% CI: 0.46-1.64; P = 0.6). Overall,
steroid prophylaxis in patients undergoing CABG could significantly reduce
complications such as atrial fibrillation and length of hospital stay, but
slightly increased the length of ventilation time. On the other hand, no
significant impact on the incidence of infection was observed compared
with the placebo. Copyright &#xa9; The Author 2015. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<5>
Accession Number
601699409
Author
Masson S.; Wu J.H.Y.; Simon C.; Barlera S.; Marchioli R.; Mariani J.;
Macchia A.; Lombardi F.; Vago T.; Aleksova A.; Dreas L.; Favaloro R.R.;
Hershson A.R.; Puskas J.D.; Dozza L.; Silletta M.G.; Tognoni G.;
Mozaffarian D.; Latini R.
Institution
(Masson, Barlera, Latini) Department of Cardiovascular Research,
IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
(Wu) The George Institute for Global Health, Sydney Medical School, The
University of Sydney, Sydney, NSW, Australia
(Simon) Cardiovascular Department, Cardiac Surgery, Ospedali Riuniti di
Bergamo, Bergamo, Italy
(Marchioli) Hematology-Oncology Therapeutic Delivery Unit, Quintiles,
Milan, Italy
(Mariani, Macchia) GESICA Foundation, Buenos Aires, Argentina
(Lombardi) U.O.C. Malattie Cardiovascolari, Fondazione IRCCS Ospedale
Maggiore Policlinico, Department of Clinical and Community Sciences,
University of Milan, Milan, Italy
(Vago) Laboratory of Endocrinology, Ospedale Luigi Sacco, Milan, Italy
(Aleksova, Dreas) Cardiovascular Department, 'Ospedali Riuniti' and
University of Trieste, Trieste, Italy
(Favaloro, Hershson) AR Fundacion Favaloro, Buenos Aires, Argentina
(Puskas) Emory Health Care, Atlanta, GA, United States
(Dozza) E.S. Research Foundation, GVM Care and Research, Maria Cecilia
Hospital, Cotignola, Italy
(Silletta, Tognoni) Laboratory of Clinical Epidemiology of Cardiovascular
Disease, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
(Mozaffarian) Departments of Epidemiology and Nutrition, Harvard School of
Public Health, Boston, MA, United States
(Mozaffarian) Division of Cardiovascular Medicine and Channing Division of
Network Medicine, Department of Medicine, Brigham and Women's Hospital and
Harvard Medical School, Boston, MA, United States
Title
Circulating cardiac biomarkers and postoperative atrial fibrillation in
the OPERA trial.
Source
European Journal of Clinical Investigation. 45 (2) (pp 170-178), 2015.
Date of Publication: 01 Feb 2015.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common
complication after cardiac surgery and predicts increased morbidity and
mortality. Identification of patients at high risk of POAF with the help
of circulating biomarkers may enable early preventive treatment but data
are limited, especially in contemporary surgical patients. Methods: Plasma
concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP)
and high-sensitivity cardiac troponin T (hs-cTnT) were measured at
enrolment, on the morning of cardiac surgery, at end surgery, and 2 days
postsurgery in 562 patients undergoing cardiac surgery, randomized to
perioperative supplementation with oral fish oil or placebo in the Omega-3
Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial
(OPERA). The primary endpoint was incident POAF lasting > 30 s, centrally
adjudicated and confirmed electrocardiographically. Results: Higher levels
of NT-proBNP and hs-cTnT before surgery were associated with older age,
renal or cardiac dysfunction and EuroSCORE. NT-proBNP peaked on
postoperative day 2 (2172 [1238-3758] ng/L, median [Q1-Q3]), while hs-cTnT
peaked at the end of surgery (373 [188-660] ng/L). Fish oil
supplementation did not alter the time course of the cardiac biomarkers (P
> 0.05). Concentrations of NT-proBNP or hs-cTnT, on the morning of
surgery, or changes in their level between morning of surgery and
postsurgery, were not significantly associated with POAF after adjustment
for clinical and surgical characteristics. Conclusion: Among patients
undergoing cardiac surgery, NT-proBNP and hs-cTnT are related to clinical
and surgical characteristics, have different perioperative time courses
but are not independently associated with risk of POAF. Copyright &#xa9;
2014 Stichting European Society for Clinical Investigation Journal
Foundation.

<6>
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Accession Number
605251816
Author
Ben-Gal Y.; Mohr R.; Feit F.; Ohman E.M.; Kirtane A.; Xu K.; Mehran R.;
Stone G.W.
Institution
(Ben-Gal, Mohr) Department of Cardiothoracic Surgery, Tel Aviv Sourasky
Medical Center, Tel Aviv University, 6 Weizman St, Tel Aviv 64239, Israel
(Feit) Department of Cardiology, New York University, School of Medicine,
United States
(Ohman) Department of Cardiology, Duke University, Medical Center, Durham,
NC, United States
(Kirtane, Xu, Stone) Department of Cardiology, Columbia University, New
York-Presbyterian Hospital, United States
(Mehran) Department of Cardiology, Mount Sinai Medical Center, New York,
NY, United States
(Kirtane, Xu, Mehran, Stone) Cardiovascular Research Foundation, New York,
NY, United States
Title
Surgical versus percutaneous coronary revascularization for multivessel
disease in diabetic patients with non-ST-segment-elevation acute coronary
syndrome: Analysis from the acute catheterization and early intervention
triage strategy trial.
Source
Circulation: Cardiovascular Interventions. 8 (6) (no pagination), 2015.
Article Number: e002032. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The preferred revascularization strategy for diabetic patients with acute
coronary syndromes and multivessel coronary artery disease is uncertain.
We evaluated the outcomes of diabetic patients with moderate and high-risk
acute coronary syndrome and multivessel disease managed with percutaneous
coronary intervention (PCI) versus coronary artery bypass grafting (CABG).
Methods and Results-Among 13 819 moderate and high-risk acute coronary
syndrome patients enrolled in the Acute Catheterization and Early
Intervention Triage Strategy (ACUITY) trial, 1772 diabetic patients had
multivessel disease with left anterior descending artery involvement and
were managed by PCI (n=1349) or CABG (n=423). Propensity scoring was
applied to adjust for differences in baseline clinical and angiographic
characteristics, yielding a total of 326 matched patients (163 managed by
PCI and 163 managed by CABG). At 30 days, treatment with PCI compared with
CABG was associated with lower rates of major bleeding (15.3% versus
55.6%; P<0.0001), blood transfusions (9.2% versus 43.2%; P<0.0001), and
acute kidney injury (13.4% versus 33.6%; P<0.0001), but more unplanned
revascularization procedures (6.9% versus 1.9%; P=0.03). At 1 year PCI was
associated with higher rates of repeat revascularization procedures (19.5%
versus 5.2%; P=0.0001), with nonsignificantly different rates of
myocardial infarction, stroke, and death at either 30 days or 1 year.
Conclusions-In the large-scale ACUITY trial, diabetic patients with acute
coronary syndrome and multivessel disease treated with PCI rather than
CABG had less bleeding and acute kidney injury, greater need for repeat
revascularization procedures, and comparable rates of myocardial
infarction, stroke, and death through 1-year follow-up. Copyright &#xa9;
2015 American Heart Association, Inc.

<7>
Accession Number
372661100
Author
Verma S.; Lovren F.; Pan Y.; Yanagawa B.; Deb S.; Karkhanis R.; Quan A.;
Teoh H.; Feder-elituv R.; Moussa F.; Souza D.S.R.; Fremes S.E.
Institution
(Verma, Lovren, Pan, Yanagawa, Quan, Teoh, Feder-elituv) Division of
Cardiac Surgery, Keenan Research Centre in the Li Ka Shing Knowledge
Institute at St. Michael's Hospital, Toronto, ON, Canada
(Verma, Yanagawa, Deb, Moussa, Fremes) Department of Surgery, University
of Toronto, Toronto, ON, Canada
(Deb, Karkhanis, Moussa, Fremes) Division of Cardiac Surgery, Schulich
Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, Keenan Research Centre in
the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto,
ON, Canada
(Souza) Department of Cardiovascular and Thoracic Surgery,, Orebro
University Hospital, Orebro, Sweden
Title
Pedicled no-touch saphenous vein graft harvest limits vascular smooth
muscle cell activation: The PATENT saphenous vein graft study.
Source
European Journal of Cardio-thoracic Surgery. 45 (4) (pp 717-725), 2014.
Article Number: ezt560. Date of Publication: April 2014.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVE: Neointimal hyperplasia secondary to vascular smooth muscle cell
(VSMC) activation limits the long-term patency of saphenous vein grafts
(SVGs). We compared markers of vascular injury and VSMC activation in SVGs
harvested using the pedicled 'no-touch' (NT) vs the conventional (CON)
technique. METHODS: Patients undergoing coronary artery bypass surgery
were enrolled in the PATENT SVG trial (clinicaltrials.gov NCT01488084).
Patients were randomly allocated to have SVGs harvested with the NT
technique from one leg and the CON method from the other. SVG segments
underwent morphometry, histological and electron microscopy assessments
and transcript measurements of VSMC activation and differentiation
markers. Leg wound functional recovery and harvest site complications were
assessed using a quality-of-life questionnaire. RESULTS: A total of 17
patients (65.3 +/- 7.3 years) were enrolled. SVGs harvested using the NT
vs CON technique exhibited preserved intimal, medial and adventitial
architecture. CON harvest was associated with greater medial Kruppel-like
factor 4 transcript levels (0.26 +/- 0.05 vs 0.11 +/- 0.02, P < 0.05). CON
samples had significantly lower medial serum response factor (0.53 +/-
0.11 vs 1.44 +/- 0.50, P < 0.05) and myocardin (0.59 +/- 0.08 vs 1.33 +/-
0.33, P < 0.05) transcript levels. MicroRNA-145, an inhibitor of VSMC
activation and differentiation, was higher in the NT vs CON samples (1.84
+/- 1.03 vs 0.50 +/- 0.19, P < 0.05). Leg assessment scores were worse in
the NT legs at 3 months, but similar to CON scores at 12 months.
CONCLUSIONS: SVGs harvested using the 'NT' technique exhibit an early
molecular and morphological pattern consistent with decreased VSMC
activation compared with CON harvesting. Functional leg recovery was
similar in both groups at 12 months. Larger studies are required to
corroborate these findings. &#xa9; The Author 2013. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<8>
Accession Number
612825441
Author
Attizzani G.F.; Ohno Y.; Latib A.; Petronio A.S.; Giannini C.; Ettori F.;
Fiorina C.; Bedogni F.; Brambilla N.; Bruschi G.; Colombo P.; Presbitero
P.; Fiorilli R.; Poli A.; Barbanti M.; Colombo A.; Tamburino C.
Institution
(Attizzani, Ohno, Barbanti) Department of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Tamburino) Department of Cardiology, University of Catania, Catania,
Italy
(Latib, Colombo) Department of Cardiology, Scientific Institute S.
Raffaele, Milan, Italy
(Petronio) Department of Cardiology, Azienda Ospedaliera Pisana, Pisa,
Italy
(Giannini) Department of Cardiology, Ospedali Civili, Brescia, Italy
(Ettori, Fiorina) Department of Cardiology, Policlinico San Donato, San
Donato, Italy
(Bedogni, Brambilla) Department of Cardiology, Niguarda Ca'Granda
Hospital, Milan, Italy
(Bruschi, Colombo) Department of Cardiology, Clinical Institute Humanitas,
Milan, Italy
(Presbitero) Department of Cardiology, Azienda Ospedaliera San Camillo
Forlanini Hospital, Rome, Italy
(Fiorilli, Poli) Department of Cardiology, Ospedale Civile, Legnano, Italy
Title
Age-Related Differences in 1- and 12-Month Outcomes in Patients Undergoing
Transcatheter Aortic Valve Implantation (from a Large Multicenter Data
Repository).
Source
American Journal of Cardiology. 118 (7) (pp 1024-1030), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Scarce data are available on the impact of age on transcatheter aortic
valve implantation (TAVI) outcomes. We therefore, analyzed 1,845
consecutive patients from 9 Italian centers who underwent TAVI with the
Corevalve Revalving System from September 2007 to March 2014; patients
were dichotomized according to their age in the date of the procedure, as
follows: 75 to 85 years old and >85 years old. End points were defined
according to Valve Academic Research Consortium definitions. In-hospital,
30-day, and 1-year clinical and echocardiographic data were available for
100% of the patients included. Propensity matching was performed.
Procedural success rates were high (>94%) and comparable between groups.
Although worse baseline renal function was observed in the older group,
the incidence of acute kidney injury after procedure was comparable (17.1%
and 17.4%, respectively for the 75- to 85- and >85-year-old group, p =
0.877); importantly, >99% of acute kidney injury episodes in both groups
were grades 1 and 2. Procedural complications rates were low without
between-group differences. In-hospital death (3.7% and 4.6%, p = 0.379)
and stroke/transient ischemic attack (1.9% and 1.9%, respectively, p =
0.960) were comparable. The 1-year death rates were 14.9% and 17.2% (p =
0.197) in the 75- to 85- and >85-year-old group, respectively.
Cardiovascular death was observed in 7.8% and 7% (p = 0.542), while
stroke/transient ischemic attack was demonstrated in 5.2% and 4.4% (p =
0.496), respectively. Results were sustained after propensity matching. In
conclusion, advanced age did not negatively impact the outcomes of TAVI
through 1-year after procedure. Copyright &#xa9; 2016 Elsevier Inc.

<9>
Accession Number
612825379
Author
Muralidharan A.; Thiagarajan K.; Van Ham R.; Gleason T.G.; Mulukutla S.;
Schindler J.T.; Jeevanantham V.; Thirumala P.D.
Institution
(Muralidharan) College of Literature, Science, and the Arts, University of
Michigan, Ann Arbor, Michigan, United States
(Thiagarajan, Thirumala) Department of Neurological Surgery, University of
Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, United States
(Van Ham, Thirumala) Department of Neurological Surgery, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
(Mulukutla, Schindler) Heart and Vascular Institute, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
(Jeevanantham) Saint Anthony Hospital, Oklahoma City, Oklahoma, United
States
Title
Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter
Aortic Valve Implantation.
Source
American Journal of Cardiology. 118 (7) (pp 1031-1045), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) is a rapidly evolving safe
method with decreasing incidence of perioperative stroke. There is a void
in literature concerning the impact of stroke after TAVI in predicting
30-day stroke-related mortality. The primary aim of this meta-analysis was
to determine whether perioperative stroke increases risk of stroke-related
mortality after TAVI. Online databases, using relevant keywords, and
additional related records were searched to retrieve articles involving
TAVI and stroke after TAVI. Data were extracted from the finalized studies
and analyzed to generate a summary odds ratio (OR) of stroke-related
mortality after TAVI. The stroke rate and stroke-related mortality rate in
the total patient population were 3.07% (893 of 29,043) and 12.27% (252 of
2,053), respectively. The all-cause mortality rate was 7.07% (2,053 of
29,043). Summary OR of stroke-related mortality after TAVI was estimated
to be 6.45 (95% confidence interval 3.90 to 10.66, p <0.0001). Subgroup
analyses were performed among age, approach, and valve type. Only 1
subgroup, transapical TAVI, was not significantly associated with
stroke-related mortality (OR 1.97, 95% confidence interval, 0.43 to 7.43,
p = 0.42). A metaregression was conducted among females, New York Heart
Association class III/IV status, previous stroke, valve type, and
implantation route. All failed to exhibit any significant associations
with the OR. In conclusion, perioperative strokes after TAVI are
associated with >6 times greater risk of 30-day stroke-related mortality.
Transapical TAVI is not associated with increased stroke-related mortality
in patients who suffer from perioperative stroke. Preventative measures
need to be taken to alleviate the elevated rates of stroke after TAVI and
subsequent direct mortality. Copyright &#xa9; 2016 Elsevier Inc.

<10>
Accession Number
610173231
Author
Solberg O.G.; Stavem K.; Ragnarsson A.; Ioanes D.; Arora S.; Endresen K.;
Benth J.S.; Gullestad L.; Gude E.; Andreassen A.K.; Aaberge L.
Institution
(Solberg, Ragnarsson, Arora, Endresen, Gullestad, Gude, Andreassen,
Aaberge) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Solberg, Stavem, Benth) Faculty of Medicine, University of Oslo, Oslo,
Norway
(Stavem) Department of Pulmonary Medicine, Akershus University Hospital,
Lorenskog, Norway
(Stavem, Benth) HOKH, Research Centre, Akershus University Hospital,
Lorenskog, Norway
(Ioanes) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) K.G. Jebsen Cardiac Research Centre and Centre for Heart
Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
Title
Index of microvascular resistance after early conversion from calcineurin
inhibitor to everolimus in heart transplantation: A sub-study to a 1-year
randomized trial.
Source
Journal of Heart and Lung Transplantation. 35 (8) (pp 1010-1017), 2016.
Date of Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Microvascular function in transplanted hearts can be evaluated
by methods used in routine left heart catheterization follow-up after
heart transplantation (HTx). This sub-study of a randomized study compared
the effects of everolimus (EVR) and calcineurin inhibitor (CNI) treatment
on microvascular function as expressed by the index of microvascular
resistance (IMR) at 1 year after HTx. A secondary objective was to compare
the change in IMR from 7-11 weeks to 1 year after HTx between randomized
groups. Methods There were 70 HTx recipients included and randomly
assigned to combination therapy (EVR and CNI with early CNI withdrawal) vs
conventional CNI treatment. Coronary physiologic assessment was performed
7-11 weeks and 1 year after HTx. A linear mixed model was used to assess
the group difference at 1 year and the difference in IMR change between
7-11 weeks and 1 year after HTx. Results At 1 year, there was no
significant difference in IMR between the EVR group (17.5 mm Hg.sec +/-
8.9) (mean +/- SD) and the CNI group (14.9 mm Hg.sec +/- 6.6, p = 0.17).
The difference in IMR change between the 2 treatment arms was 1.6 mm
Hg.sec (95% confidence interval, -2.8 to 5.9; p = 0.49). Spearman's rank
correlation coefficient at 1 year after HTx between IMR and maximal
intimal thickness as assessed with intravascular ultrasound in the left
anterior descending artery was -0.13 (p = 0.28). Conclusions In this
prospective, open, randomized study comparing early CNI withdrawal with
mammalian target of rapamycin inhibitors immunosuppression during the
first year after HTx, early transition from CNI-based immunosuppression to
EVR-based treatment did not result in differences in microvascular
function as assessed by the IMR. Copyright &#xa9; 2016 International
Society for Heart and Lung Transplantation

<11>
Accession Number
609745889
Author
Morris A.A.; Kransdorf E.P.; Coleman B.L.; Colvin M.
Institution
(Morris) Division of Cardiology, Emory University, Atlanta, Georgia,
United States
(Kransdorf) Division of Cardiovascular Diseases, Cedars-Sinai Heart
Institute, Beverly Hills, California, United States
(Coleman) Nursing Research and Development, Cedars Sinai Medical Center,
Los Angeles, California, United States
(Colvin) Division of Cardiology, University of Michigan, Ann Arbor,
Michigan, United States
Title
Racial and ethnic disparities in outcomes after heart transplantation: A
systematic review of contributing factors and future directions to close
the outcomes gap.
Source
Journal of Heart and Lung Transplantation. 35 (8) (pp 953-961), 2016. Date
of Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
The demographics of patients undergoing heart transplantation in the
United States have shifted over the last 10 years, with an increasing
number of racial and ethnic minorities undergoing heart transplant.
Multiple studies have shown that survival of African American patients
after heart transplantation is lower compared with other ethnic groups. We
review the data supporting the presence of this outcome disparity and
examine the multiple mechanisms that contribute. With an increasingly
diverse population in the United States, knowledge of these disparities,
their mechanisms, and ways to improve outcomes is essential. Copyright
&#xa9; 2016 International Society for Heart and Lung Transplantation

<12>
[Use Link to view the full text]
Accession Number
612824667
Author
Zhu G.; Huang Y.; Wei D.; Shi Y.
Institution
(Zhu, Huang, Wei, Shi) Department of Respiratory and Critical Care
Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing
Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Title
Efficacy and safety of noninvasive ventilation in patients after
cardiothoracic surgery A PRISMA-compliant systematic review and
meta-analysis.
Source
Medicine (United States). 95 (38) (no pagination), 2016. Article Number:
e4734. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Noninvasive ventilation (NIV) is a promising therapeutic
strategy after cardiothoracic surgery. This study aimed to meta-analyze
the efficacy and safety of NIV as compared to conventional management
after cardiothoracic surgery. Methods: PubMed, EMBASE, and Cochrane
Library databases were searched for randomized controlled trials (RCTs)
comparing NIV with conventional management after cardiothoracic surgery.
Relative risk (RR), standard mean difference (SMD), and 95% confidence
intervals (CIs) were used to measure the efficacy and safety of NIV using
random-effects model. Heterogeneity was evaluated using the Q statistic.
Results: This study included 14 RCTs (1740 patients) for the evaluation of
efficacy and safety of NIV as compared to conventional management after
cardiothoracic surgery. Overall, NIV had minimal effect on the risk of
mortality (RR: 0.64; 95% CI: 0.36-1.14; P= 0.127), endotracheal intubation
(RR: 0.52; 95% CI: 0.24-1.11; P=0.090), respiratory (RR: 0.70; 95% CI:
0.47-1.30; P=0.340), cardiovascular (RR: 0.81; 95% CI: 0.54-1.22;
P=0.306), renal (RR: 0.70; 95% CI: 0.26-1.92; P=0.491), and other
complications (RR: 0.72; 95% CI: 0.38-1.36; P=0.305), respiratory rate
(SMD:-0.10; 95% CI:-1.21-1.01; P=0.862), heart rate (SMD:-0.27; 95%
CI:-0.76-0.22; P=0.288), PaO2/FiO2 ratio (SMD: 0.34; 95% CI:-0.17-0.85;
P=0.194), PaCO2 (SMD: 0.83; 95% CI:-0.12-1.77; P=0.087), systolic pressure
(SMD:-0.04; 95% CI:-0.25-0.17; P=0.700), pH (SMD:-0.01; 95% CI:-0.44-0.43;
P=0.974), length of ICU stay (SMD:-0.19; 95% CI:-0.47-0.08; P=0.171), and
hospital stay (SMD:-0.31; 95% CI:-1.00-0.38; P=0.373). Sensitivity
analysis showed that NIV was associated with higher levels of
PaO<inf>2</inf>/FiO<inf>2</inf> ratio (SMD: 0.52; 95% CI: 0.00-1.05;
P=0.048) and lower risk of endotracheal intubation (RR: 0.38; 95% CI:
0.22-0.66; P=0.001). Conclusion: As compared to conventional management,
the use of NIV after cardiothoracic surgery improved patient's oxygenation
and decreased the need for endotracheal intubation, without significant
complications. Copyright &#xa9; 2016 the Author(s). Published by Wolters
Kluwer Health, Inc. All rights reserved.

<13>
Accession Number
610947098
Author
Zhang Q.; Zhao X.-H.; Gu H.-F.; Xu Z.-R.; Yang Y.-M.
Institution
(Zhang, Zhao, Gu, Xu, Yang) Department of Geriatrics, First Affiliated
Hospital, School of Medicine, Zhejiang University, Hangzhou, China
Title
Clinical Outcomes of Coronary Artery Bypass Grafting vs Percutaneous
Coronary Intervention in Octogenarians With Coronary Artery Disease.
Source
Canadian Journal of Cardiology. 32 (9) (pp 1166.e21-1166.e28), 2016. Date
of Publication: 01 Sep 2016.
Publisher
Pulsus Group Inc.
Abstract
Background The number of elderly people receiving treatment for coronary
artery disease (CAD) is increasing, and there are few studies that
compared the outcomes of coronary artery bypass grafting (CABG) and
percutaneous coronary intervention (PCI) in the elderly. The objective of
this study was to compare outcomes of CABG and PCI in octogenarians with
CAD. Methods We conducted a search to identify articles that reported the
results of 2-arm studies that compared CABG with PCI in octogenarians. The
primary outcomes were short-term mortality and overall survival, and
secondary outcomes included length of hospital stay and cerebrovascular
accident (CVA) and myocardial infarction (MI) rates. Results Seven studies
that enrolled 1879 patients who received CABG and 1432 treated with PCI
were included. Short-term mortality was significantly less for patients in
the PCI arms (odds ratio [OR], 1.47; 95% confidence interval [CI],
1.05-2.06; P = 0.02), as was duration of hospital stay (difference in
means, 6.07; 95% CI, 2.81-9.34; P < 0.001). Patients in the CABG arms had
longer overall survival (hazard ratio, 0.81; 95% CI, 0.73-0.89; P <
0.001). CVA and MI rates were similar (CVA: OR, 1.06; 95% CI, 0.57-1.95; P
= 0.86; MI: OR, 0.70; 95% CI, 0.42-1.17; P = 0.17). Conclusions The
results suggest that physicians should consider not only the clinical
features of CAD, but also the elderly patients future health outlook when
choosing a revascularization procedure. Copyright &#xa9; 2016 Canadian
Cardiovascular Society

<14>
Accession Number
602450792
Author
Lindholm E.E.; Aune E.; Seljeflot I.; Otterstad J.E.; KirkebOen K.A.
Institution
(Lindholm) Department of Anaesthesiology, Vestfold Hospital Trust, P.O.
Box 2168, Tonsberg, Norway
(Aune, Otterstad) Department of Cardiology, Vestfold Hospital Trust,
Tonsberg, Norway
(Seljeflot) Center for Clinical Heart Research, Department of Cardiology,
Oslo University Hospital, Oslo, Norway
(KirkebOen) Department of Anaesthesiology, Oslo University Hospital, Oslo,
Norway
(Seljeflot, KirkebOen) Faculty of Medicine, University of Oslo, Oslo,
Norway
Title
Biomarkers of inflammation in major vascular surgery: A prospective
randomised trial.
Source
Acta Anaesthesiologica Scandinavica. 59 (6) (pp 773-787), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background Surgery induces inflammation and pro-inflammatory cytokines are
associated with post-operative complications. In cardiac surgery, it has
been shown that volatile anaesthetics have cardioprotective properties. We
explored whether sevoflurane affects the pro-inflammatory response
favourably compared with total intravenous anaesthesia (TIVA) after
surgery. Methods We measured monocyte chemotactic protein 1 (MCP-1),
matrix metalloproteinase 9 (MMP-9), C-reactive protein (CRP), vascular
cell adhesion molecule 1 (VCAM-1), interleukin (IL)-6 and IL-8
perioperatively and evaluated if the anaesthetic regimen affected these
mediators. Our hypothesis was that sevoflurane-based anaesthesia is
associated with a reduced release of biomarkers of inflammation compared
with TIVA with propofol/remifentanil. Results In the total population,
MCP-1, MMP-9, IL-6 and IL-8 increased 30min after arrival intensive care
unit, compared with before surgery (P<0.001), whereas CRP and VCAM-1
transiently declined (P<0.001). From 30min after arrival intensive care
unit to 1st post-operative day, MCP-1 and IL-6 levels declined (P<0.001),
CRP and VCAM-1 increased (P<0.001), whereas MMP-9 and IL-8 were not
significantly altered. Pre-operatively there were no significant
differences in any variables between the two anaesthetic groups. Lower
levels of MCP-1 and IL-8 (P<0.001) and higher levels of IL-6 and MMP-9
(P=0.003) were found in the sevoflurane group, compared with the TIVA
group 30min post-operatively. CRP and VCAM-1 levels did not differ. There
were no significant differences between the two anaesthetic groups before
surgery or at 1st post-operative day. Conclusion We found an inflammatory
response during the observation period, which was modified by the
anaesthetic regimen in the early phase. This short-lasting difference is
probably too short to support a cardioprotective effect of sevoflurane
compared with TIVA in open abdominal aortic surgery. Copyright &#xa9; 2015
The Acta Anaesthesiologica Scandinavica Foundation. Published by John
Wiley and Sons Ltd.

<15>
Accession Number
608854628
Author
Khan A.R.; Khan S.; Riaz H.; Luni F.K.; Simo H.; Bin Abdulhak A.; Bavishi
C.; Flaherty M.
Institution
(Khan, Flaherty) Division of Cardiovascular Medicine, Department of
Internal Medicine, University of Louisville, Louisville, KY, United States
(Khan, Simo) Department of Internal Medicine, University of Toledo Medical
Center, Toledo, OH, United States
(Riaz) Department of Internal Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Luni) Division of Cardiovascular Medicine, Department of Internal
Medicine, Saint Vincent Mercy Hospital, Toledo, OH, United States
(Bin Abdulhak) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of Iowa, Iowa City, IA, United States
(Bavishi) Division of Cardiovascular Medicine, Department of Internal
Medicine, St Lukes Roosevelt Hospital, New York, United States
Title
Efficacy and safety of transcatheter aortic valve replacement in
intermediate surgical risk patients: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 88 (6) (pp 934-944),
2016. Date of Publication: 15 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The efficacy of transcatheter aortic valve replacement (TAVR)
in aortic stenosis patients at high surgical risk has been established.
The data on patients with intermediate risk is not conclusive. We
performed a meta-analysis of studies which compared TAVR with surgical
aortic valve replacement (SAVR) in patients at intermediate surgical risk.
Methods: Several databases searched from inception to February 2015
yielded 7 eligible studies with 2,173 participants. The measured outcome
of efficacy was all-cause mortality. Data on safety included stroke,
permanent pacemaker implantation (PPI), aortic regurgitation (AR),
vascular access complications, and major bleeding. Outcomes were pooled
and relative risk (RR) was calculated with the Mantel-Haenszel method.
Results: There was no difference in either short-term (RR, 1.02; 95% CI:
0.63-1.63; P = 0.94; I² = 0%) or medium to long-term all-cause
mortality (RR, 0.99; 95% CI: 0.81-1.21; P = 0.91; I² = 0%).
There was increased incidence of stroke (RR, 2.96; 95% CI: 0.87-10.09; P =
0.08; I² = 0%), AR (RR, 3.59; 95% CI: 2.13-7.19; P < 0.00001;
I² = 2%), PPI (RR, 6.53; 95% CI: 1.91-22.32; P < 0.003;
I² = 0%) and vascular access complications (RR, 3.84; 95% CI:
0.65-22.76; P < 0.14; I² = 48%) in patients with TAVR. There
was a small, albeit increased risk of major or life threatening bleeding
with SAVR as compared to TAVR (RR, 1.36; 95% CI: 1.04-1.80; P < 0.03;
I² = 0%). Conclusions: In this meta-analysis we found that TAVR
may be an acceptable alternative to SAVR in patients with intermediate
risk for surgery. However, we must await evidence from the current large
randomized trials before widespread adoption of this procedure is
undertaken. &#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016
Wiley Periodicals, Inc.

<16>
Accession Number
613204495
Author
Noiseux N.; Mansour S.; Weisel R.; Stevens L.-M.; Der Sarkissian S.; Tsang
K.; Crean A.M.; Larose E.; Li S.-H.; Wintersperger B.; Vu M.Q.; Prieto I.;
Li R.-K.; Roy D.C.; Yau T.M.
Institution
(Noiseux, Stevens, Prieto) Division of Cardiac Surgery, Centre Hospitalier
de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
(Mansour) Division of Cardiology, Centre Hospitalier de l'Universite de
Montreal (CHUM), Montreal, Quebec, Canada
(Noiseux, Mansour, Stevens, Der Sarkissian, Vu) Centre Hospitalier de
l'Universite de Montreal Research Center (CRCHUM), Montreal, Quebec,
Canada
(Noiseux, Stevens, Der Sarkissian, Prieto, Roy) Department of Surgery,
Universite de Montreal, Montreal, Quebec, Canada
(Mansour) Department of Medicine, Universite de Montreal, Montreal,
Quebec, Canada
(Larose) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec City, Quebec, Canada
(Weisel, Tsang, Crean, Li, Wintersperger, Li, Yau) Peter Munk Cardiac
Centre, University Health Network, Toronto, Ontario, Canada
(Weisel, Tsang, Li, Li, Yau) Division of Cardiovascular Surgery,
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
(Crean, Wintersperger) Division of Medical Imaging, University of Toronto,
Toronto, Ontario, Canada
(Roy) Department of Hematology, Hopital Maisonneuve-Rosemont (HMR),
Montreal, Quebec, Canada
Title
The IMPACT-CABG trial: A multicenter, randomized clinical trial of
CD133⁺ stem cell therapy during coronary artery bypass grafting
for ischemic cardiomyopathy.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (6) (pp 1582-1588.e2),
2016. Date of Publication: 01 Dec 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives The IMPACT-CABG trial is the first North American multicenter
phase II randomized study of intramyocardial delivery of autologous
CD133⁺ stem cells in patients with chronic ischemic
cardiomyopathy undergoing coronary artery bypass grafting. The primary
objective was to demonstrate safety, including freedom from major adverse
cardiac events. The secondary objective was to evaluate feasibility of
same-day autologous cell preparation. Although the trial was not powered
to evaluate LV function, exploratory data were collected. Methods After 7
open-label patients who received cells, patients randomly received stem
cells or placebo (N = 40 total, 20 per center). After completion of
coronary anastomoses, up to 10 million CD133⁺,
CD34⁺, CD45⁺ triple-positive cells or placebo were
injected into the infarct and border zones. Patients were followed up
clinically and underwent magnetic resonance imaging preoperatively and
after 6 months. Results There were no procedural complications from bone
marrow isolation and cell injection, no in-hospital mortality, and no
protocol-related complications. Four patients had transient renal
insufficiency, with 1 death during 6-month follow-up. Magnetic resonance
imaging revealed that left ventricular volumes and ejection fractions
improved in all patients (no difference between groups). Conclusions The
trial successfully met both primary and secondary objectives,
demonstrating that same-day isolation and autologous CD133⁺
cell delivery with coronary artery bypass grafting is safe and feasible.
The positive findings support a larger randomized, multicenter trial, with
higher numbers of transplanted cells to demonstrate beneficial effects.
The upcoming IMPACT-CABG II trial will evaluate higher cell doses and
pharmacologic enhancement to determine whether these cells improve
perfusion and myocardial function. Copyright &#xa9; 2016 The American
Association for Thoracic Surgery

<17>
[Use Link to view the full text]
Accession Number
609717367
Author
Lee A.C.H.; Feger M.A.; Singla A.; Abel M.F.
Institution
(Lee) University of Virginia, School of Medicine, PO Box 800739,
Charlottesville, VA 22908, United States
(Feger, Singla, Abel) Department of Orthopedic Surgery, University of
Virginia, Charlottesville, VA, United States
Title
Effect of surgical approach on pulmonary function in adolescent idiopathic
scoliosis patients a systemic review and meta-analysis.
Source
Spine. 41 (22) (pp E1343-E1355), 2016. Date of Publication: 15 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Study Design. Systemic review and meta-analysis. Objective. To analyze the
effect of spinal fusion and instrumentation for adolescent idiopathic
scoliosis (AIS) on absolute pulmonary function test (PFTs). Summary of
Background Data. Pulmonary function is correlated with severity of
deformity in AIS patients and studies that have analyzed the effect of
spinal fusion and instrumentation on PFTs for AIS have reported
inconsistent results. There is a need to analyze the effect of spinal
fusion on PFTs with stratification by surgical approach. Methods. Our
analysis included 22 studies. Cohen?s d effect sizes were calculated for
absolute PFT outcome measures with 95% confidence intervals (CI).
Meta-analyses were performed at each postoperative time frame for six
homogeneous surgical approaches: (i) combined anterior release and
posterior fusion with instrumentation; (ii) combined video assisted
anterior release and posterior fusion with instrumentation without
thoracoplasty; (iii) posterior fusion with instrumentation without
thoracoplasty; (iv) anterior fusion with instrumentation and without
thoracoplasty; (v) video assisted anterior fusion with instrumentation
without thoracoplasty; and (vi) any scoliosis surgery with additional
thoracoplasty. Results. Anterior spinal fusion with instrumentation, any
scoliosis surgery with concomitant thoracoplasty, or videoassisted
anterior fusion with instrumentation for AIS had similar absolute PFTs at
their 2 year postoperative follow up compared with their preoperative PFTs
(effect sizes ranging from -0.2-0.2 with all CI crossing 0). Posterior
spinal fusion with instrumentation (with or without an anterior release)
demonstrated small to moderate increases in PFTs 2 years postoperatively
(effect sizes ranging from 0.35-0.65 with all CI not crossing 0).
Conclusion. Anterior fusion with instrumentation, regardless of the
approach, and any scoliosis surgery with concomitant thoracoplasty do not
lead to significant change in pulmonary functions 2 year after surgery.
Posterior spinal fusion with instrumentation (with or without an anterior
release) resulted in small to moderate increases in PFTs. Copyright &#xa9;
2016 Wolters Kluwer Health, Inc. All rights reserved.

<18>
Accession Number
613254036
Author
Collins R.; Reith C.; Emberson J.; Armitage J.; Baigent C.; Blackwell L.;
Blumenthal R.; Danesh J.; Smith G.D.; DeMets D.; Evans S.; Law M.;
MacMahon S.; Martin S.; Neal B.; Poulter N.; Preiss D.; Ridker P.; Roberts
I.; Rodgers A.; Sandercock P.; Schulz K.; Sever P.; Simes J.; Smeeth L.;
Wald N.; Yusuf S.; Peto R.
Institution
(Collins, Reith, Emberson, Armitage, Baigent, Blackwell, Preiss, Peto)
Clinical Trial Service Unit & Epidemiological Studies Unit and MRC
Population Health Research Unit, Nuffield Department of Population Health,
University of Oxford, Oxford, United Kingdom
(Blumenthal, Martin) Ciccarone Center for the Prevention of Heart Disease,
Division of Cardiology, Johns Hopkins University School of Medicine,
Baltimore, MD, United States
(Danesh) MRC/BHF Cardiovascular Epidemiology Unit, Department of Public
Health and Primary Care, University of Cambridge, Cambridge, United
Kingdom
(Smith) MRC Integrative Epidemiology Unit, University of Bristol, Bristol,
United Kingdom
(DeMets) Department of Biostatistics and Medical Informatics, University
of Wisconsin, Madison, WI, United States
(Evans) Department of Medical Statistics, London School of Hygiene &
Tropical Medicine, University of London, London, United Kingdom
(Roberts) Clinical Trials Unit, London School of Hygiene & Tropical
Medicine, University of London, London, United Kingdom
(Smeeth) Department of Non-Communicable Disease Epidemiology, London
School of Hygiene & Tropical Medicine, University of London, London,
United Kingdom
(Law, Wald) Wolfson Institute of Preventive Medicine, Barts and The London
School of Medicine and Dentistry, Queen Mary University of London, London,
United Kingdom
(MacMahon, Neal, Rodgers) The George Institute for Global Health,
University of Sydney, Sydney, Australia
(Simes) National Health and Medical Research Council Clinical Trial
Centre, University of Sydney, Sydney, Australia
(Poulter) International Centre for Circulatory Health & Imperial Clinical
Trials Unit, Imperial College London, London, United Kingdom
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Ridker) Center for Cardiovascular Disease Prevention, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Sandercock) Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, United Kingdom
(Schulz) FHI 360, University of North Carolina School of Medicine,
University of North Carolina, Chapel Hill, NC, United States
(Yusuf) Population Health Research Institute, Hamilton Health Sciences and
McMaster University, Hamilton, ON, Canada
Title
Interpretation of the evidence for the efficacy and safety of statin
therapy.
Source
The Lancet. 388 (10059) (pp 2532-2561), 2016. Date of Publication: 19 Nov
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
This Review is intended to help clinicians, patients, and the public make
informed decisions about statin therapy for the prevention of heart
attacks and strokes. It explains how the evidence that is available from
randomised controlled trials yields reliable information about both the
efficacy and safety of statin therapy. In addition, it discusses how
claims that statins commonly cause adverse effects reflect a failure to
recognise the limitations of other sources of evidence about the effects
of treatment. Large-scale evidence from randomised trials shows that
statin therapy reduces the risk of major vascular events (ie, coronary
deaths or myocardial infarctions, strokes, and coronary revascularisation
procedures) by about one-quarter for each mmol/L reduction in LDL
cholesterol during each year (after the first) that it continues to be
taken. The absolute benefits of statin therapy depend on an individual's
absolute risk of occlusive vascular events and the absolute reduction in
LDL cholesterol that is achieved. For example, lowering LDL cholesterol by
2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (eg,
atorvastatin 40 mg daily, costing about 2 per month) for 5 years in 10 000
patients would typically prevent major vascular events from occurring in
about 1000 patients (ie, 10% absolute benefit) with pre-existing occlusive
vascular disease (secondary prevention) and in 500 patients (ie, 5%
absolute benefit) who are at increased risk but have not yet had a
vascular event (primary prevention). Statin therapy has been shown to
reduce vascular disease risk during each year it continues to be taken, so
larger absolute benefits would accrue with more prolonged therapy, and
these benefits persist long term. The only serious adverse events that
have been shown to be caused by long-term statin therapy-ie, adverse
effects of the statin-are myopathy (defined as muscle pain or weakness
combined with large increases in blood concentrations of creatine kinase),
new-onset diabetes mellitus, and, probably, haemorrhagic stroke.
Typically, treatment of 10 000 patients for 5 years with an effective
regimen (eg, atorvastatin 40 mg daily) would cause about 5 cases of
myopathy (one of which might progress, if the statin therapy is not
stopped, to the more severe condition of rhabdomyolysis), 50-100 new cases
of diabetes, and 5-10 haemorrhagic strokes. However, any adverse impact of
these side-effects on major vascular events has already been taken into
account in the estimates of the absolute benefits. Statin therapy may
cause symptomatic adverse events (eg, muscle pain or weakness) in up to
about 50-100 patients (ie, 0.5-1.0% absolute harm) per 10 000 treated for
5 years. However, placebo-controlled randomised trials have shown
definitively that almost all of the symptomatic adverse events that are
attributed to statin therapy in routine practice are not actually caused
by it (ie, they represent misattribution). The large-scale evidence
available from randomised trials also indicates that it is unlikely that
large absolute excesses in other serious adverse events still await
discovery. Consequently, any further findings that emerge about the
effects of statin therapy would not be expected to alter materially the
balance of benefits and harms. It is, therefore, of concern that
exaggerated claims about side-effect rates with statin therapy may be
responsible for its under-use among individuals at increased risk of
cardiovascular events. For, whereas the rare cases of myopathy and any
muscle-related symptoms that are attributed to statin therapy generally
resolve rapidly when treatment is stopped, the heart attacks or strokes
that may occur if statin therapy is stopped unnecessarily can be
devastating. Copyright &#xa9; 2016 Elsevier Ltd

<19>
[Use Link to view the full text]
Accession Number
52689443
Author
Imazio M.; Belli R.; Beqaraj F.; Giammaria M.; Lestuzzi C.; Hoit B.; Le
Winter M.; Spodick D.H.; Adler Y.
Institution
(Imazio, Belli, Beqaraj, Giammaria) Cardiology Department, Maria Vittoria
Hospital, Via Luigi Cibrario 72, Torino 10141, Italy
(Lestuzzi) Cardiology CRO, National Cancer Institute, Aviano, Italy
(Hoit) Harrington Heart and Vascular Institute, University Hospitals Case
Medical Center, Cleveland, OH, United States
(Le Winter) Cardiology Unit, Fletcher Allen Healthcare, Burlington, MA,
United States
(Spodick) Internal Medicine Department, St. Vincent Hospital, Worcester,
MA, United States
(Adler) Chaim Sheba Medical Center, Tel Hashomer and Sacker Faculty of
Medicine, Tel Aviv, Israel
Title
DRainage or Pericardiocentesis alone for recurrent nonmalignant,
nonbacterial pericardial effusions requiring intervention: Rationale and
design of the DROP trial, a randomized, open-label, multicenter study.
Source
Journal of Cardiovascular Medicine. 15 (6) (pp 510-514), 2014. Date of
Publication: 2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives Evidence to support the use of pericardial drainage instead of
simple pericardiocentesis for nonmalignant pericardial effusions
refractory to medical therapy is based on observational studies and
experts' opinions, rather than randomized trials. The aim of the present
trial is to fill this knowledge gap and to provide a stronger base of
evidence to support a specific interventional treatment in this setting.
Methods DRainage Or Pericardiocentesis (DROP) alone for recurrent
nonmalignant, nonbacterial pericardial effusions requiring intervention is
a randomized, open-label and multicenter study. The primary efficacy
endpoints are the incidence of recurrent pericardial effusion, and the
need for additional pericardiocentesis or cardiac surgery at 12 months.
Secondary endpoints are hospital length stay, disease-related admission
and overall mortality. Safety and complications rates of each intervention
will be also assessed. Implications and conclusion The DROP trial will be
the first multicenter randomized trial to evaluate the efficacy and safety
of pericardiocentesis versus pericardiocentesis and extended pericardial
drainage for recurrent nonmalignant, nonbacterial pericardial effusions
refractory to medical therapy and requiring interventional treatments3.
Copyright &#xa9; 2014 Italian Federation of Cardiology.

<20>
[Use Link to view the full text]
Accession Number
612245929
Author
Mavrakanas T.A.; Charytan D.M.
Institution
(Mavrakanas) General Internal Medicine Division, Geneva University
Hospitals, Geneva, Switzerland
(Mavrakanas, Charytan) Renal Division, Brigham and Women's Hospital,
Harvard Medical School, 1620 Tremont Street, Boston, MA 02115, United
States
Title
Cardiovascular complications in chronic dialysis patients.
Source
Current Opinion in Nephrology and Hypertension. 25 (6) (pp 536-544), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Purpose of review This review article focuses on the most significant
cardiovascular complications in dialysis patients [sudden cardiac death
(SCD), acute coronary syndromes, heart failure, and atrial fibrillation].
Recent findings Current and ongoing research aims to quantify the rate and
pattern of significant arrhythmia in dialysis patients and to determine
the predominant mechanism of SCD. Preliminary findings from these studies
suggest a high rate of atrial fibrillation and that bradycardia and
asystole may be more frequent than ventricular arrhythmia as a cause of
sudden death. A recently published matched cohort study in dialysis
patients who received a defibrillator for primary prevention showed that
there was no significant difference in mortality rates between
defibrillator-treated patients and propensity-matched controls. Two
randomized controlled trials are currently recruiting participants and
will hopefully answer the question of whether implantable or wearable
cardioverter defibrillators can prevent SCD. An observational study using
United States Renal Data System data demonstrated how difficult it is to
keep hemodialysis patients on warfarin, as more than two-thirds
discontinued the drug during the first year. The ISCHEMIA-CKD trial may
provide answers about the optimal strategy for the treatment of
atherosclerotic coronary disease in patients with advanced chronic kidney
disease. Summary The article reviews the diagnosis of acute coronary
syndromes in dialysis patients, current literature on myocardial
revascularization, and data on fatal and nonfatal cardiac arrhythmia. The
new classification of heart failure in end-stage renal disease is
reviewed. Finally, available cohort studies on warfarin for stroke
prevention in dialysis patients with atrial fibrillation are reviewed.
Copyright &#xa9; 2016 Wolters Kluwer Health, Inc.

<21>
Accession Number
611157091
Author
Gupta P.; Rettiganti M.; Jeffries H.E.; Brundage N.; Markovitz B.P.;
Scanlon M.C.; Simsic J.M.
Institution
(Gupta) Division of Pediatric Cardiology, Department of Pediatrics,
University of Arkansas for Medical Sciences, Little Rock, Arkansas, United
States
(Rettiganti) Section of Biostatistics, Department of Pediatrics,
University of Arkansas for Medical Sciences, Little Rock, Arkansas, United
States
(Jeffries) Department of Pediatrics, Seattle Children's Hospital,
University of Washington School of Medicine, Seattle, Washington, United
States
(Brundage, Markovitz, Scanlon) Virtual PICU Systems, LLC, Los Angeles,
California, United States
(Markovitz) Division of Critical Care Medicine, Department of Pediatrics
and Anesthesiology, Children's Hospital Los Angeles, University of
Southern California Keck School of Medicine, Los Angeles, California,
United States
(Scanlon) Division of Critical Care, Department of Pediatrics, Medical
College of Wisconsin, Milwaukee, Wisconsin, United States
(Simsic) Division of Cardiology, Department of Pediatrics, Nationwide
Children's Hospital, Columbus, Ohio, United States
Title
Association of 24/7 In-House Intensive Care Unit Attending Physician
Coverage With Outcomes in Children Undergoing Heart Operations.
Source
Annals of Thoracic Surgery. 102 (6) (pp 2052-2061), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier USA
Abstract
Background Multicenter data regarding the around-the-clock (24/7) presence
of an in-house critical care attending physician with outcomes in children
undergoing cardiac operations are limited. Methods Patients younger than
18 years of age who underwent operations (with or without cardiopulmonary
bypass [CPB]) for congenital heart disease at 1 of the participating
intensive care units (ICUs) in the Virtual PICU Systems (VPS, LLC)
database were included (2009-2014). The study population was divided into
2 groups: the 24/7 group (14,737 patients; 32 hospitals), and the No 24/7
group (10,422 patients; 22 hospitals). Propensity-score matching was
performed to match patients 1:1 in the 24/7 group and in the No 24/7
group. Results Overall, 25,159 patients from 54 hospitals qualified for
inclusion. By propensity matching, 9,072 patients (4,536 patient pairs)
from 51 hospitals were matched 1:1 in the 2 groups. After matching,
mortality at ICU discharge was lower among the patients treated in
hospitals with 24/7 coverage (24/7 versus No 24/7, 2.8% versus 4.0%; p =
0.002). The use of extracorporeal membrane oxygenation (ECMO), the
incidence of cardiac arrest, extubation within 48 hours after operation,
the rate of reintubation, and the duration of arterial line and central
venous line use after operation were significantly improved in the 24/7
group. When stratified by surgical complexity, survival benefits of 24/7
coverage persisted among patients undergoing both high-complexity and
low-complexity operations. Conclusions The presence of 24-hour in-ICU
attending physician coverage in children undergoing cardiac operations is
associated with improved outcomes, including ICU mortality. It is possible
that 24-hour in-ICU attending physician coverage may be a surrogate for
other factors that may bias the results. Further study is warranted.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<22>
[Use Link to view the full text]
Accession Number
611973953
Author
Bradley D.; Moreira S.; Subramoney V.; Chin C.; Ives J.; Wang K.
Institution
(Bradley, Ives) Roche Products Ltd, Welwyn Garden City, United Kingdom
(Moreira) Pfizer, Inc, Madison, NJ, United States
(Subramoney) Certara USA, Inc, Princeton, NJ, United States
(Chin) Cincinnati Children's Hospital Medical Center, Cincinnati, OH,
United States
(Wang) Pharma Research and Early Development, Roche Translational and
Clinical Research Center, 430 E. 29th St., New York, NY 10016, United
States
Title
Pharmacokinetics and safety of valganciclovir in pediatric heart
transplant recipients 4 months of age and younger.
Source
Pediatric Infectious Disease Journal. 35 (12) (pp 1324-1328), 2016. Date
of Publication: 28 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Valganciclovir (VGCV) effectively prevents cytomegalovirus
disease in adult and pediatric solid organ transplant recipients. A dosing
algorithm for VGCV for pediatric patients, based on body surface area and
renal function, provides a personalized dose using age-Appropriate
formulations. The suitability of this dosing algorithm has not been
assessed specifically in infants and neonates 4 months of age and younger
receiving a solid organ transplant. Methods: This multicenter prospective
study evaluated the pharmacokinetics (PK) and safety of VGCV oral solution
in 17 heart transplant recipients 4 months of age and younger who received
2 doses of VGCV on consecutive days using the pediatric dosing algorithm.
Plasma concentrations of ganciclovir (GCV) were analyzed at specified
times up to 24 hours post VGCV administration. Results: GCV concentration
data were available from 16 patients. The combined data from this study
and historic study datasets were used to establish a 2-compartment
population PK model with first-order formation to describe the PK of GCV
after oral VGCV administration in patients across all pediatric age
ranges, including those younger than 4 months of age. Estimated mean area
under the curve during the 0-24 hours dosing interval for these patients
was 68.1 mug.h/mL. Conclusions: The pediatric dosing algorithm for VGCV
(utilizing individuals' body surface area and renal function) provides
systemic GCV exposures in patients younger than 4 months that are similar
to those observed in older pediatric populations. The data indicate that
this dosing algorithm is appropriate across the entire pediatric age
range, including this youngest age group. Copyright &#xa9; 2016 Wolters
Kluwer Health, Inc. All rights reserved.

<23>
Accession Number
612327511
Author
Fernandes G.A.; Lima A.C.G.; Gonzaga I.C.A.; de Barros Araujo R.; de
Oliveira R.A.; Nicolau R.A.
Institution
(Fernandes, Lima, Gonzaga, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IP&D, Universidade do Vale do Paraiba,
UNIVAP, Sao Paulo, Brazil
(Fernandes, Gonzaga) Uninovafapi College, Teresina, Piaui, Brazil
(Lima) University of Piaui State (UESPI), Teresina, Piaui, Brazil
(de Barros Araujo) Cardiac Surgery Department, Santa Maria Hospital,
Teresina, Piaui, Brazil
(de Oliveira) Uninovafapi College and University of Piaui State (UESPI),
Teresina, Piaui, Brazil
(Fernandes) Vitorino Orthigues Fernandes Street, 6123, Teresina, Piaui
64073-505, Brazil
Title
Low-intensity laser (660 nm) on sternotomy healing in patients who
underwent coronary artery bypass graft: a randomized, double-blind study.
Source
Lasers in Medical Science. 31 (9) (pp 1907-1913), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Springer London
Abstract
The aim of this study was to analyze the healing effects of low-level
laser therapy (LLLT) on the longitudinal sternotomy incisions of patients
who underwent coronary artery bypass graft (CABG). The volunteers were
randomized into three groups of equal size (n = 30): control, placebo, and
laser (lambda = 660 nm and spatial average energy fluency [SAEF] = 1.06
J/cm²). The patients in the laser group underwent irradiation
on postoperative days 2, 4, 6, and 8, and their sternotomy incisions were
photographed immediately after the surgery and 8 days later for analysis.
Three researchers who were blinded to the patient treatment groups
analyzed the incision photographs to assess hyperemia and wound closure on
the day of hospital discharge (eighth postoperative day). The sternotomy
incisions in the LLLT group demonstrated less hyperemia, incisional
bleeding, and dehiscence (p < 0.005). Copyright &#xa9; 2016,
Springer-Verlag London.

<24>
Accession Number
610218331
Author
Ando T.; Holmes A.A.; Taub C.C.; Slovut D.P.; DeRose J.J.
Institution
(Ando) Department of Internal Medicine Mount Sinai Beth Israel, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Holmes, Taub, Slovut) Division of Cardiology, Montefiore Medical Center,
Albert Einstein College of Medicine, Bronx, NY, United States
(Slovut, DeRose) Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY,
United States
Title
Iatrogenic Ventricular Septal Defect Following Transcatheter Aortic Valve
Replacement: A Systematic Review.
Source
Heart Lung and Circulation. 25 (10) (pp 968-974), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ltd
Abstract
Background Ventricular septal defects (VSD) are rarely reported as a
complication following transcatheter aortic valve replacement (TAVR). We
sought to characterise the patients, clinical management, and outcomes
regarding this rare phenomenon. Methods Relevant articles were identified
by a systematic search of MEDLINE and EMBASE databases from January, 2002
to September, 2015. Results A total of 18 case reports, including 20
patients, were identified. The median age was 83 years and six were male.
Twelve were performed by trans-femoral approach. Pre-dilation was
performed in 12 patients and post-dilation in four. Balloon expandable
valves were used in the majority (85%) of cases. The clinical presentation
varied from asymptomatic to progressive heart failure. The timing of the
diagnosis also varied significantly from immediately post valve
implantation to one year afterwards. There were two cases of Gerbode-type
defect while the rest were inter-ventricular defects. The location was
mostly membranous or perimembranous (79%) and adjacent to the valve
landing zone. A total of seven interventions (one open surgery and six
percutaneous closure) were performed. Four patients died during the same
hospital admission. Sixteen survived past discharge (range 12 days to two
years). Conclusions Ventricular septal defects post-TAVR were seen more
with balloon expandable valves and with pre-dilation or post-dilation.
Percutaneous treatment of the VSD was preferred over open cardiac surgery
given the high surgical risk in this patient population. Some, but not
all, patients survived TAVR and VSD and had a good prognosis for both
patient groups with or without VSD closure. Copyright &#xa9; 2016
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<25>
[Use Link to view the full text]
Accession Number
611201860
Author
Van Aelbrouck C.; Jorquera-Vasquez S.; Beukinga I.; Pradier O.; Ickx B.;
Barvais L.; Van Obbergh L.; Faraoni D.
Institution
(Van Aelbrouck, Jorquera-Vasquez, Ickx, Barvais, Van Obbergh) Department
of Anaesthesiology, Erasme University Hospital, Route de Lennik 808,
Brussels 1070, Belgium
(Beukinga, Pradier) Department of Haematology and Haemostasis, Erasme
University Hospital, Free University of Brussels, Brussels, Belgium
(Faraoni) Department of Anesthesiology, Peri-operative and Pain Medicine,
Boston Children's Hospital, Harvard Medical School, Boston, MA, United
States
Title
Tranexamic acid decreases the magnitude of platelet dysfunction in
aspirin-free patients undergoing cardiac surgery with cardiopulmonary
bypass: A pilot study.
Source
Blood Coagulation and Fibrinolysis. 27 (8) (pp 855-861), 2016. Date of
Publication: 13 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
This study sought to compare the effect of tranexamic acid (TXA)
administration on cardiopulmonary bypass-induced platelet dysfunction in
patients who received preoperative aspirin or not. We performed a
prospective, randomized, double-blind pilot study, including patients
undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).
Patients without aspirin interruption were enrolled in the 'group ASPIRIN'
(n U 18) and those who had never been treated with aspirin were included
in the 'group NO ASPIRIN' (n U 10). Patients were then randomized to
receive either TXA or the same infusion of normal saline. Multiple
electrode aggregometry was used to assess platelet function at the
different time points throughout the surgery: baseline, post-TXA loading
dose, aortic unclamping (End CPB), and 5 min after protamine (Protamine).
Compared to those included in the group NO ASPIRIN, patients included in
the group ASPIRIN presented a decreased baseline platelet function
measured by ASP test (P < 0.01) and collagen test (P < 0.01). In the group
NO ASPIRIN, treatment group (TXA vs. placebo) significantly influenced the
results for ADP test (P < 0.01), thrombin receptor-activating peptide test
(P U 0.01), and ASP test (P U 0.01). We observed that TXA improved
platelet function, as measured using multiple electrode aggregometry on
ADP test, thrombin receptoractivating peptide test, and ASP test, at the
end of CPB (P < 0.05). TXA might decrease the magnitude of platelet
dysfunction in aspirin-free patients undergoing cardiac surgery. Further
studies are needed to confirm these results and assess a potential
relationship with clinical endpoints. Copyright &#xa9; 2016 Wolters Kluwer
Health, Inc. All rights reserved.

<26>
Accession Number
612097776
Author
Vroomen M.; Pison L.
Institution
(Vroomen, Pison) Department of Cardiology, Maastricht University Medical
Center, PO Box 5800, Maastricht, Netherlands
(Vroomen, Pison) Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
Title
Hybrid ablation for atrial fibrillation: a systematic review.
Source
Journal of Interventional Cardiac Electrophysiology. 47 (3) (pp 265-274),
2016. Date of Publication: 01 Dec 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Hybrid ablation for AF is performed in a growing number of
centers. Due to absence of guidelines, operative approaches and
perioperative care differ per center. In this review, an overview of
findings from published studies on hybrid ablations is given, and related
topics are discussed (e.g., one- and two-stage approaches, lesion sets,
and patient management). Methods: A systematic literature search was
performed in the PubMed and Embase databases. All identified articles were
screened and checked for eligibility by the two authors. Results: Twelve
studies describing a total of 563 patients were selected. Due to
substantial differences in approaches (one-stage, two-stage, sequential),
surgical techniques (bilateral or monolateral thoracoscopy, subxiphoideal,
transabdominal), energy sources (unipolar, bipolar), lesion sets (applying
left or right atrial lesions), periprocedural care and endpoints
(monitoring, definition of recurrence), and success rates (sinus rhythm
after a mean of 26 months) are difficult to compare and varied from 27 %
(without antiarrhythmic drugs, AADs) to 94 % (with AADs). For studies
using bipolar devices, success rates with the use of antiarrhythmic drugs
were at least 71 %. Major complications such as bleeding, sternotomy, and
death occurred in 7 % of the total population (of which ten complications,
16 %, occurred in the concomitant cardiac surgery hybrid group).
Conclusion: The field of AF ablation has dramatically changed over the
past years, with one of the most recent developments the hybrid AF
ablation. Lack of matching data hinders drawing conclusions and creating
guidelines. Early results however are encouraging. More data are awaiting
and needed. Copyright &#xa9; 2016, The Author(s).

<27>
Accession Number
611632756
Author
Cevallos P.C.; Rose M.J.; Armsby L.B.; Armstrong A.K.; El-Said H.;
Foerster S.R.; Glatz A.C.; Goldstein B.H.; Hainstock M.R.; Kreutzer J.;
Latson L.A.; Leahy R.A.; Petit C.J.; Torres A.; Shahanavaz S.; Zampi J.D.;
Bergersen L.
Institution
(Cevallos, Rose, Bergersen) Department of Cardiology, Boston Children's
Hospital, Bader 607, 300 Longwood Avenue, Boston, MA 02115, United States
(Armsby) Pediatric Cardiology Department, Doernbecher Children's Hospital,
Portland, OR, United States
(Armstrong) Department of Cardiology, Nationwide Children's Hospital,
Columbus, OH, United States
(El-Said) Department of Cardiology, Rady Children's Hospital, San Diego,
CA, United States
(Foerster) Division of Cardiology, Children's Hospital of Wisconsin,
Milwaukee, WI, United States
(Glatz) Cardiac Center, The Children's Hospital of Philadelphia,
Philadelphia, PA, United States
(Goldstein) Department of Cardiology, Cincinnati Children's Hospital,
Cincinnati, OH, United States
(Hainstock) Division of Pediatric Cardiology, University of Virginia
Medical Center, Charlottesville, VA, United States
(Kreutzer) Division of Pediatric Cardiology, Children's Hospital of
Pittsburgh, Pittsburgh, PA, United States
(Latson) Department of Cardiology, Joe DiMaggio Children's Hospital,
Hollywood, FL, United States
(Leahy) Department of Cardiology, Kosair Children's Hospital, Louisville,
KY, United States
(Petit) Department of Cardiology, Children's Healthcare of Atlanta Sibley
Heart Center, Atlanta, GA, United States
(Torres) Division of Pediatric Cardiology, Morgan Stanley Children's
Hospital, New York, NY, United States
(Shahanavaz) Division of Pediatric Cardiology, St. Louis Children's
Hospital, St. Louis, MO, United States
(Zampi) Department of Pediatric Cardiology, University of Michigan, Ann
Arbor, MI, United States
Title
Implementation of Methodology for Quality Improvement in Pediatric Cardiac
Catheterization: A Multi-center Initiative by the Congenital Cardiac
Catheterization Project on Outcomes-Quality Improvement (C3PO-QI).
Source
Pediatric Cardiology. 37 (8) (pp 1436-1445), 2016. Date of Publication: 01
Dec 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The Congenital Cardiac Catheterization Project on Outcomes (C3PO) launched
in 2007 as a multi-center collaborative to establish standardized and
comparable metrics for pediatric cardiac catheterization procedures. The
limitations of larger registries at the time led to the development of the
next phase in 2013, C3PO-Quality Improvement (C3PO-QI), focusing on
instituting QI initiatives within the field. The objective of this
manuscript is to provide a detailed overview of C3PO-QI and report data on
case characteristics and outcome metrics being explored. C3PO-QI was
designed to cultivate institutional collaboration during implementation of
its initiatives. A database and website were developed to support data
entry and on-demand reporting. The registry prospectively captures
pediatric cardiac catheterization data among 15 hospitals. The present
study includes case demographic data (n) and quality metric reporting by
case type, age, and radiation dose variables. This dataset includes 13,135
cases entered into the database between 1/1/2014 and 12/31/2015.
Interventional cases make up the highest percentage by case mix
distribution (48 %), and patients <1 years make up the highest percentage
by age distribution (26 %). The ratio of diagnostic and interventional
procedures performed changes by age group. Application of QI metric shows
all procedure types surpassing metric goals. Large volume data collection,
such as in C3PO-QI, allows for meaningful interpretation of data. C3PO-QI
is uniquely poised to deliver fast-paced changes in the field. Although
the project initiatives are specific to pediatric cardiac catheterization,
the implementation of the project and utilization of real-time reporting
is generalizable to other specialties and multi-center collaboratives.
Copyright &#xa9; 2016, Springer Science+Business Media New York.

<28>
Accession Number
611840479
Author
Hill G.D.; Rudd N.A.; Ghanayem N.S.; Hehir D.A.; Bartz P.J.
Institution
(Hill, Rudd, Bartz) Divison of Cardiology, Department of Pediatrics,
Medical College of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI 53226,
United States
(Ghanayem) Division of Critical Care, Department of Pediatrics, Medical
College of Wisconsin, Milwaukee, WI, United States
(Hehir) Division of Cardiac Critical Care, Department of Pediatrics,
Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, United
States
(Bartz) Division of Adult Cardiovascular Medicine, Department of Internal
Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
Title
Center Variability in Timing of Stage 2 Palliation and Association with
Interstage Mortality: A Report from the National Pediatric Cardiology
Quality Improvement Collaborative.
Source
Pediatric Cardiology. 37 (8) (pp 1516-1524), 2016. Date of Publication: 01
Dec 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
For infants with single-ventricle lesions with aortic arch hypoplasia, the
interstage period from discharge following stage 1 palliation (S1P) until
stage 2 palliation (S2P) remains high risk. Significant variability among
institutions exists around the timing of S2P. We sought to describe
institutional variation in timing of S2P, determine the association
between timing of S2P and interstage mortality, and determine the impact
of earlier S2P on hospital morbidity and mortality. The National Pediatric
Cardiology Quality Improvement Collaborative registry was queried. Centers
were divided based on median age at S2P into early (n = 15) and late (n =
16) centers using a cutoff of 153 days. Groups were compared using
Chi-squared or Wilcoxon rank-sum test. Multivariable logistic regression
was used to determine risk factors for interstage mortality. The final
cohort included 789 patients from 31 centers. There was intra- and
inter-center variability in timing of S2P, with the median age by center
ranging from 109 to 214 days. Late centers had a higher mortality (9.9 vs.
5.7 %, p = 0.03) than early centers. However, the event rate (late: 8.2
vs. early: 5.8 deaths per 10,000 interstage days) was not different by
group (p = 0.26). Survival to hospital discharge and hospital length of
stay following S2P were similar between groups. In conclusion, in a large
multi-institution collaborative, the median age at S2P varies among
centers. Although optimal timing of S2P remains unclear, centers
performing early S2P did not experience worse S2P outcomes and experienced
less interstage mortality. Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<29>
Accession Number
613436127
Author
Chen Y.S.
Institution
(Chen) Department of Cardiovascular Surgery, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
Title
E-CPR ECPR: Extracorporeal cardiopulmonary resuscitation-new evolution in
resuscitation, what is the past and what is the further trend.
Source
Respirology. Conference: 21st Congress of the Asian Pacific Society of
Respirology, APSR 2016. Thailand. Conference Start: 20161112. Conference
End: 20161115. 21 (pp 8), 2016. Date of Publication: November 2016.
Publisher
Blackwell Publishing
Abstract
Extracorporeal membrane oxygenation (ECMO) derived from cardiopulmonary
bypass (CPB) in open-heart surgery was developed for more than 40 years.
The initial application was designed for the failed open heart procedure
with extension of the CPB to the intensive care unit. This was partly due
the high cost the operation theater and the anesthiologist service. The
initial result was poor and it might achieve more than 90% mortality.
Since ECMO could support the heart and lung function, the first general
application was for the neonatal respiratory disease. A randomized trial
in United States in early 80 failed to prove its efficacy in treating
neonatal respiratory disease, In spite of the failed result, ECMO still
was considered as the final or the last choice for the neonatal
respiratory disease after trail of several new-advanced therapies. After
extension of the respiratory disease, the purpose of cardiac support was
re-considered. The result in cardiac support was not unique because of the
different condition and pathologies. However, it was considered as the
first and cheapest device for mechanical support in the cardiogenic shock.
It could work as the selection tool or transitional device for longterm
ventricular device. The timing of conversion of ECMO to VAD was sill
controversial and it was clinically oriented without standard guideline.
The application of ECMO was extended to more critical patients, not only
in shock but in the status under resuscitation. ECMO application in CPR
condition was once considered as relative contraindication due to the very
poor outcome in the early 90s. The organization of the team and the
advancement of resuscitation makes the possibility of applying ECMO in
CPR. It changes the result of prolonged CPR, from less than 10% to around
30% survival. Furthermore, ECMO associated with hypothermia therapy become
a hot investigational topic although the final conclusion still was
unknown. The future of ECMO may change the present medical practice and
proceed to the resuscitation fluid and protocol for better outcome. We
believe the more new innovation in the equipment and the more application
of ECMO will develop.

<30>
Accession Number
613436086
Author
Lakomkin N.; Vasquez-Castellanos R.A.; Davis B.J.; Ladner T.R.; Cheng J.S.
Institution
(Lakomkin, Vasquez-Castellanos, Davis, Ladner, Cheng) Vanderbilt
University Medical Center, Department of Neurosurgery, Nashville, TN,
United States
Title
The efficacy of intraoperative monitoring in spine surgery.
Source
Spine Journal. Conference: 30th Annual Meeting of the North American Spine
Society, NASS 2015. United States. Conference Start: 20151014. Conference
End: 20151017. 15 (10 Supplement 1) (pp 181S), 2015. Date of Publication:
October 2015.
Publisher
Elsevier Inc.
Abstract
BACKGROUND CONTEXT: Multimodal intraoperative monitoring (IOM) is a common
tool used in spine surgery for detecting neurological injury during
surgery. The use of transcranial electric motor-evoked potentials (TCeMEP)
and/or somatosensory-evoked potentials (SSEPs) has been studied numerous
times in scoliosis corrective surgery and remains the gold standard of
care. However, the use of IOM during routine spine surgery remains
controversial. PURPOSE: The aim of this study is to determine the
sensitivity and specificity of IOM in routine cervical, thoracic and
lumbar spine surgery as well as its ability to predict neurological
deficits. STUDY DESIGN/SETTING: Retrospective analysis of medical records
and neuromonitoring data of patients who underwent spine surgery at a
single institution between January 2010 and February 2013. PATIENT SAMPLE:
This is a retrospective analysis of 122 patients with an average age of 49
years who underwent spine surgery with the use of intraoperative
monitoring at a single institution between January 2010 and February 2013.
OUTCOME MEASURES: Medical records and neuromonitoring data were analyzed
consecutively from a randomized database. Clinical outcomes were assessed
immediately postop and at the moment of discharge. Patients who showed
significant bilateral or unilateral loss of amplitude during SSEP/TCeMEP
monitoring as well as those with clinically relevant EMG changes were
identified. A neurological deficit was defined as a decrease in motor
and/or sensory exam at the moment of discharge. METHODS: Preoperative
history and physical exams, operative reports, and postoperative inpatient
progress notes were examined for each patient. Pre- and postoperative
motor and sensory exam results were extracted (on the date of surgery and
at discharge) and any intraoperative monitoring changes were noted. The
procedures were initially separated into 3 categories based on the
location of the spine at which the surgery occurred: cervical, thoracic,
and lumbar. The ability of each type of monitoring to predict neurological
deficits at discharge was then assessed by calculating the sensitivity,
specificity, positive predictive value (PPV), and negative predictive
value (NPV) for each region. A 2-sided Fischer exact test was used to
determine whether neurological deficits were associated with changes in
intraoperative monitoring. RESULTS: Of the 122 cases analyzed, 46 were
associated with a significant neuromonitoring change. Twenty patients
developed new postoperative deficits referable to neuromonitoring change.
In anterior cervical procedures, there was no significant relationship
between SSEPs or TCe- MEPs alone and a postoperative deficit. However, the
combination of SSEP and TCeMEP monitoring improved the sensitivity and was
significantly associated with a new deficit (p=0.015; sensitivity: 100%,
specificity: 76.9%). In posterior cervical procedures, however, the
combined use of modalities did not improve detection. The only significant
relationship was found using SSEPs alone (p=0.024; sensitivity: 60%,
specificity: 91.7%). For thoracic procedures, SSEPs alone had a high
sensitivity (P=0.101; sensitivity: 100%, specificity: 72.7%). Lumbar
procedures also did not appear to demonstrate a statistically significant
relationship between new deficits, and any of these modalities in addition
to EMGs. When all levels/approaches were considered in combination, only
the use of SSEPs had a statistically significant relationship with
postoperative deficits (p=0.001; sensitivity: 52.6%, specificity: 84.3%).
CONCLUSIONS: The sensitivity and specificity of SSEP, TCeMEP, and EMG
intraoperative monitoring varies by spinal region and surgical approach.
The modality with the highest sensitivity and specificity is SSEP for
posterior cervical surgeries, combined SSEP and TCeMEP for anterior
cervical surgeries, and SSEP for thoracic surgeries. All modalities had
low sensitivity during lumbar surgeries. This study may help guide better
cost and operative time utilization of neuromonitoring in spine surgery.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any
applicable devices or drugs.

<31>
Accession Number
613413855
Author
Faure E.; Canaud L.; Desgranges P.; Becquemin J.-P.; Alric P.
Institution
(Desgranges, Becquemin, Alric) Services De Chirurgie Vasculaire, CHU
Arnaud De Villeneuve, Montpellier, France
(Faure, Canaud) Et CHU Henri Mondor, Creteil, France
Title
Evaluation of the endovascular treatment of ruptured acute type B aortic
dissections.
Source
Annals of Vascular Surgery. Conference: 30th Annual Meeting, French
Society for Vascular Surgery, SCV 2015. France. Conference Start:
20150627. Conference End: 20150629. 29 (6) (pp 1053), 2015. Date of
Publication: August 2015.
Publisher
Elsevier Inc.
Abstract
Objectives: The studies concerning the endovascular treatment of the
complicated type B aortic dissections at the acute stage (AcBAD) include a
wide range of clinical presentations. Rupture, with a death rate reaching
50% at 30 days after conventional surgery, is the most severe
complication, and the optimal characteristics (length of the aortic
covering, oversizing, choice of the stentgraft in emergency) of the
endovascular treatment of this specific sub-group of AcBAD is not clearly
established. The aim of our study was to evaluate the results of the
endovascular treatment of ruptured type B aortic dissections (ArBAD).
Materials and Methods: We retrospectively analyzed all the thoracic
patients treated with stentgrafts for ArBAD in two reference centers for
the thoracic aorta. The operative, clinical and pre- and postoperative CT
data were analyzed. Results: Between 2000 and 2014, 24 patients (mean age
71 years; 14 men) had a thoracic endovascular treatment for ArBAD. Sixteen
of them were in shock (systolic blood pressure <80 mmHg) in preoperative.
Seven patients had a covering of the left subclavian artery, including
four patients hemodynamically stable at the time of the procedure that had
a concomitant revascularization of this artery by cervicotomy. The median
length of aortic covering was of 150 mm, the median proximal oversizing
was 13.3% (from 6.2 to 33.3%). The technical success rate was 100%.
Intra-hospital mortality was 16% (n=4). Two patients (8%) had a
postoperative paraplegia; there were no retrograde cerebral vascular
accident or dissection. During a 28 months average follow-up, eight
patients (40%) required reintervention, and there was a death in relation
to the aortic pathology. All the reinterventions were carried out by
endovascular route. On the last control, eight patients (40%) had a
complete remodeling of the aortic wall. Conclusion: With an intra-hospital
death rate of 16% and a rate of major morbidity of 8% this study confirms
the superiority of the endovascular treatment compared to conventional
surgery for ARBAD. A limited aortic covering over the main entrance of the
dissection seems to be enough to exclude the rupture. Considering the high
rate of reintervention, a long-term follow-up is recommended.

<32>
Accession Number
613352542
Author
Zhe X.; Fan J.; Jiang M.; Tan M.-N.; Ma S.-H.; Ou J.-S.; Zhang X.; Wang
Z.P.
Institution
(Zhe, Tan, Ma, Ou, Zhang, Wang) First Affiliated Hospital of Sun-Yat-sen
University, China
(Fan) First Affiliated Hospital of Jinan University, China
(Jiang) First Affiliated Hospital of Guangzhou Medical University, China
Title
Perioperative Statin in Cardiac Surgery: A systematic review and
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C162), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES Although statins have been shown to have rapid antiinflammatory
and antioxidant effects, the advantage of perioperative statin therapy in
patients undergoing cardiac surgery requires further support. Our aim was
to evaluate the effectiveness and safety of statin in these patients.
METHODS Relevant randomized controlled trials (RCTs) published before
April 2016 were collected in several databases and analyzed with Revman
5.3. RESULTS Fifteen RCTs with 3161 patients undergoing on- or off-pump
cardiac surgical procedures were included. Pooled analysis of the included
studies showed that statin therapy significantly reduced postoperative
atrial fibrillation (AF) [relative risk (RR) 0.78; 95% confidence
intervals (CI), 0.68-0.91; P=0.001] and hospital length of stay (LOS)
[mean difference (MD) in days -0.38, 95% CI -0.52 to -0.24, P<0.00001].
More decrease in postoperative AF was found in patients undergoing
coronary artery bypass grafting when compared to isolated valvular
surgery. Other endpoints, such as short-term mortality, post-operative
stroke, myocardial infarction, renal failure and the intensive care unit
(ICU) length of stay, were all similar in both groups. CONCLUSIONS Based
on the pooled results of the current relevant literature, Preoperative
statin therapy reduces the incidence of postoperative AF and shortens the
hospital LOS. These beneficial effects seem to be more marked in patients
undergoing myocardial revascularizations.

<33>
Accession Number
613352540
Author
Zhe X.; Fan J.; Jiang M.; Tan M.-N.; Ma S.-H.; Wang Z.-P.; Zhang X.; Ou
J.-S.
Institution
(Zhe, Tan, Ma, Wang, Zhang, Ou) First Affiliated Hospital of Sun-Yat-sen
University, China
(Fan) First Affiliated Hospital of Jinan University, China
(Jiang) First Affiliated Hospital of Guangzhou Medical University, China
Title
Minimally invasive versus conventional median sternotomy in mitral valve
repair patients: A systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C162), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES Minimally invasive approaches to mitral valve repair are more
and more popular, but the optimal surgical approach is still
controversial. Our aim was to evaluate the effectiveness and safety of
minimally invasive (MIVS) approaches versus median sternotomy in mitral
valve repair patients. METHODS Relevant studies published before April
2016 were collected in several databases and analyzed with Revman 5.3.
RESULTS Twenty one studies (3 randomized controlled trials, 18
observational studies) with 4525 patients were included. All-cause
mortality up to 30 days and stroke rate were similar in both groups. The
duration of respirator dependence ([mean difference (MD) -16.71 hours; 95%
confidence intervals (CI), -24.01~-9.41; P<0.00001]) and hospital stay
(MD, -1.31 days; 95% CI, -2.26~-0.36; P=0.007) were significantly shorter
in the MIVS group. However, cardiopulmonary bypass time (MD, 49.92
minutes; 95% CI, 27.08- 72.77; P<0.0001) and crossclamp time (MD, 35.53
minutes; 95% CI, 19.15-51.91; P<0.0001) were significantly longer in the
MIVS group. No significant differences were found in both groups in other
endpoints, such as late mortality, the rates of rethoracotomy and blood
transfusions. CONCLUSIONS MIVS approaches and conventional median
sternotomy have a similar perioperative outcome. Mitral valve repair via
MIVS approaches seems to be favorable with regard to respiratory
complications and their hospital stay.

<34>
Accession Number
613352535
Author
Zhe X.; Fan J.; Jiang M.; Tan M.-N.; Ma S.-H.; Wang Z.-P.; Zhang X.; Ou
J.-S.
Institution
(Zhe, Tan, Ma, Wang, Zhang, Ou) First Affiliated Hospital of Sun-Yat-sen
University, China
(Fan) First Affiliated Hospital of Jinan University, China
(Jiang) First Affiliated Hospital of Guangzhou Medical University, China
Title
Early postoperative anticoagulation after mechanical heart valve
replacement: A systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C161), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES The optimal early postoperative anticoagulation regimen after
mechanical valve replacement remains debatable. Our aim was to evaluate
the effectiveness and safety of 3 regimens in these patients. METHODS
Relevant studies published before Feb. 2016 were collected in several
databases and analyzed with Comprehensive Meta-Analysis software version
2.0. Three regimens were defined as follows: a regimen of a vitamin K
antagonist (VKA) throughout early postoperative period; a unfractionated
heparin (UFH)+VKA regimen using bridging anticoagulation therapy with UFH
during early postoperative period; a low molecular weight heparin (LMWH)
+VKA regimen using bridging anticoagulation therapy with LMWH during early
postoperative period. RESULTS Forty-four studies including 23171 patients
were included. The anticoagulation related mortality rates were similar
among the three groups. The major thromboembolic event rate was 2.08% (95%
CI 1.71%-2.52%) in the group receiving VKA regimen, which was
significantly higher than the rate of bridging therapy groups in the
UFH+VKA regimen group(0.90%, 95% CI 0.70%-1.16%, P<0.0001), and the
LMWH+VKA regimen group (0.90%, 95% CI 0.55%-1.45%, P<0.0001). The major
haemorrhage rate in the UFH+VKA regimen group (2.03%, 95% CI 1.60-2.57)
was similar with the group receiving VKA regimen (2.00%, 95% CI 1.64-2.43,
P=0.937), while significantly lower than the rate of LMWH+VKA regimen
group (5.35%, 95% CI 4.42-6.46, P<0.0001). CONCLUSIONS In the absence of
randomized controlled trials, this meta-analysis including 23171 patients
showed that UFH+VKA regimen may be the best early postoperative
anticoagulation regimen after mechanical heart valve replacement.

<35>
Accession Number
613352437
Author
Yundai C.; Pham V.N.; Huang S.; Kim D.; Ma T.; Yang X.; Chen Y.
Institution
(Yundai, Chen) Chinese PLA General Hospital, China
(Pham) Tam Duc Hospital, Vietnam
(Huang) Affiliated Hospital of Guangdong Medical College, China
(Kim) Inje University Busan Paik Hospital, South Korea
(Ma) Merck China Ltd, China
(Yang) Beijing Chao-Yang Hospital Capital Medical University, China
Title
Lowering of mean resting heart rate is associated with less cardiovascular
events in bisoprolol-treated Asian patients with coronary artery disease:
Results from a multinational, observational study.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C130-C131), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES This study was to evaluate the association between mean resting
heart rate (RHR) and prognosis of coronary artery disease (CAD) in Asian
patients treated with bisoprolol. METHODS Between October 2011 and April
2014, this observational, phase 4 study enrolled 889 patients with CAD
from 40 hospitals in China, South Korea and Vietnam. The primary endpoint
was occurrence of composite cardiovascular (CV) events (CV death,
non-fatal acute myocardial infarction and hospitalisation for unstable
angina or revascularisation) during 18-month bisoprolol treatment.
Exploratory analyses of the primary endpoint compared the occurrence of
composite CV events in different RHR groups (<70 vs. >70 bpm), and
evaluated the association between the change in RHR (high-low, i.e. from
>70 to <70bpm; and high-high, i.e. from >70 to >70bpm) and CV events.
Relationship between HR and CV events was analysed using Poisson
regression. Secondary endpoints were changes in RHR, heart function,
intima media thickness (IMT), mortality; hospitalisation due to acute
coronary syndrome (ACS) and coronary revascularisation and occurrence of
cerebral events. Relationship between HR and secondary endpoints was
analysed with a mixed model repeated measures or cox proportional hazard
model. RESULTS Intent-to-treat (ITT) set included 866 patients with CAD
(mean age: 63.85+/-10.35 years, mean BMI 25.45+/-3.19 kg/m2) and per
protocol (PP) set included 688 patients. Totally 178 patients were
excluded from PP set due to violation of eligibility criteria (3) and
early termination but without CV events (175). Mean dose of bisoprolol was
3.63+/-1.90 mg for a mean duration of 522.8+/-133.6 days. In all, 45% and
38.7% of patients were treated with doses of 2.5 and 5 mg, respectively.
In PP set, lower mean RHR was significantly associated with less
occurrence of composite CV events (estimate: 0.03 [95%CI: 0.00-0.07],
p=0.0412). ITT set did not report any significant association between RHR
and CV events (estimate: 0.02 [95%CI: 0.02-0.05], p=0.3114). Exploratory
analyses showed significantly low occurrence of CV events in subjects with
a mean HR <70 bpm than those with a mean HR >70 bpm (p=0.0328) in PP set.
Patients with a change of RHR categorised in high-low group had less
occurrence of composite CV events than those categorised in high-high
group (p<0.0001) in PP set. For secondary endpoints, higher level of RHR
was significantly associated with all-cause mortality in ITT (HR: 1.077,
p=0.0024) and PP (HR: 1.077, p=0.013). Subgroup analyses showed lower RHR
was significantly associated with less CV events in patients aged >70
years in both ITT (estimate: 0.07 [95%CI: 0.01-0.13], p=0.0195) and PP
(estimate: 0.11 [95%CI: 0.04-0.17], p=0.0008). CONCLUSIONS Reduction in
RHR after bisoprolol treatment lowered the incidence of composite CV
events in Asian patients with CAD, which was of significance for patients
aged >70 years. Controlling RHR <70 bpm helped improve prognosis in
patients with CAD and dose of bisoprolol needed to be further optimised.

<36>
Accession Number
613352394
Author
Wang W.; Yuan X.H.
Institution
(Wang) Scripps Memorial Hospital, China
(Wang, Yuan) Peace Hospital of Changzhi Medical College, China
Title
Clinical efficacy of epicardial application with an optimal dosage of
amiodarone-releasing hydrogels to prevent postoperative atrial
fibrillation.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C117-C118), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES Postoperative atrial fibrillation is the most frequent
complication arising after cardiac surgery, occurring in 40% of cases. The
treatment of postoperative atrial fibrillation with epicardial amiodarone
hydrogel delivery can increase efficacy and reduce side effects. The
effective dose of amiodarone and toxicity to local myocytes must be
determined. To further evaluate the optimal dose of amiodarone mixture
with hydrogel to provide pharmacologic therapy with elevated target tissue
levels and minimal local side effects, we performed a randomized
prospective study in 150 patients with coronary artery bypass grafting to
compare the effectiveness of different doses of amiodarone on
postoperative atrial fibrillation. METHODS After institutional review
board approval, 150 patients, from January 2012 to July 2015, who had
undergone cardiac surgery were randomized to 3 equal groups. Group I
received poly-based hydrogel with 1.5mg/kg of amiodarone, and group II
received polybased hydrogel with 2.0mg/kg of amiodarone. Both hydrogels
were sprayed diffusely over the biatrial epicardium. The control group
underwent the procedure with only hydrogel spray. Continuous telemetry
monitored for postoperative atrial fibrillation, and amiodarone levels in
the atria, plasma, and tissue were measured postoperatively. Daily
electrocardiographic parameters, cardiac biomarker tests and CRP were
measured until postoperative day 10. RESULTS The incidence of
postoperative atrial fibrillation was significantly less in group II, with
2 of 50 patients (4%) incurring atrial fibrillation compared with 9 of 50
patients (18%) in group I and 13 of 50 patients (26%) in the control group
(P<.01). The mean amiodarone concentrations in the atria coronary sinus
(40.06 +/- 5.1) in group II and (20.5 +/- 0.9) in Group I respectively.
Both groups reached therapeutic level > 20 mug/mL and were significantly
greater than those in the extracardiac tissues (1.32 +/- 0.9/0.2 +/- 0.4;
P < .01). The plasma amiodarone levels remained below the detection limit
(<8 mug/mL) during the 14 days of follow-up. Troponin I and Troponin T
were negative within first postoperative week. Bradycardia was observed
less in the control group (93 +/- 18) than in study group I (76 +/- 29; P
< .01). CONCLUSIONS Epicardial application of amiodarone-releasing
adhesive hydrogel is a less-invasive, well-tolerated, quick, and effective
therapeutic option for preventing postoperative atrial fibrillation with
minimal risk of adverse cardiac effects. A dose of 2mg/kg amiodarone in
drug releasinghydrogel is optimal in preventing postoperative atrial
fibrillation.

<37>
Accession Number
613352332
Author
Zhe X.; Fan J.; Jiang M.; Tan M.-N.; Ma S.-H.; Ou J.-S.; Wang Z.-P.; Zhang
X.
Institution
(Zhe, Tan, Ma, Ou, Wang, Zhang) First Affiliated Hospital of Sun-Yat-sen
University, China
(Fan) First Affiliated Hospital of Jinan University, China
(Jiang) First Affiliated Hospital of Guangzhou Medical University, China
Title
Mitral valve repair versus replacement for ischemic mitral regurgitation:
A systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C85), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES The optimal surgical strategy for the management of ischemic
mitral regurgitation (IMR) remains a matter of debate. Our aim was to
evaluate the effectiveness and safety of mitral valve repair (MVr) and
mitral valve replacement (MVR) in these patients. METHODS Relevant studies
published before April 2016 were collected in several databases and
analyzed with Revman 5.3. RESULTS Twenty seven studies (1randomized
controlled trial, 26 observational studies) with 4837 patients were
included. Pooled analysis of the observational studies showed
significantly reduced peri-operative mortality [relative risk (RR) 0.50;
95% confidence intervals (CI), 0.38-0.67; I2=34%; P<0.00001] following
MVr, while the randomized controlled trial showed no difference between
groups (RR, 0.40; 95% CI, 0.08-2.01; P=0.26). At long-term follow-up, late
mortality rates were similar between the MVr and MVR group (RR, 0.85; 95%
CI, 0.66-1.09; I2=38%; P=0.20). Pooled analysis showed the recurrence of
at least moderate mitral regurgitation (MR) was higher following MVr (RR,
5.26; 95% CI, 2.88-10.97; I2=44%; P<0.0001). CONCLUSIONS Based on the
meta-analysis of the current relevant literature, MVr for IMR may reach a
better outcome than MVR in IMR patients without basal aneurysm/dyskinesis,
significant leaflet tethering and severe LV remodeling. MVR is indicated
for patients identified as high risk for postoperative MR recurrence.
Larger prospective randomized trials are needed to further compare
long-term survival and freedom from re-intervention.

<38>
Accession Number
613352221
Author
Zhe X.; Fan J.; Jiang M.; Ma S.-H.; Fan Y.; Ou J.-S.; Wang Z.-P.; Zhang X.
Institution
(Zhe, Ma, Ou, Wang, Zhang) Division of Cardiac Surgery, Department of
Cardiovascular Diseases, First Affiliated Hospital of Sun-Yat-sen
University, China
(Fan) Division of Obstetrics and Gynecology, First Affiliated Hospital of
Jinan University, China
(Jiang) Division of Laboratory of Respiratory, Department of Respiratory
Diseases, First Affiliated Hospital of Guangzhou Medical University, China
(Fan) Division of Obstetrics and Gynecology, Guangzhou Women and
Children's Medical Center, China
Title
Meta-analysis of studies on stem cell therapy for patients undergoing
coronary artery bypass grafting.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C83), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES Stem cell therapy combined with coronary artery bypass grafting
(CABG) as an option for regenerative therapy in ischemic heart disease
(IHD) was evaluated in a few studies. No consistent conclusions were
reached regarding salubrious effects in enhancing heart function,
remodeling and improving outcomes. Our aim was to provide a pooled
analysis on the safety and potential benefit of stem cell therapy during
CABG. METHODS Relevant studies published before April 2016 were collected
in a number of databases and analyzed with RevMan 5.3 and SPSS 19.0.
Primary outcomes were all-cause mortality and left ventricular ejection
fraction (LVEF). Secondary outcomes included stroke, ventricular
tachycardia (VT)/ventricular fibrillation (VF), left ventricular
end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV)
and wall motion index score (WMIS). RESULTS Eighteen studies (11
randomized controlled trials, 7 observational studies) with 741 patients
were included. Pooled analysis showed the bone marrow-derived stem cells
(BMDSC) transplantation significantly, but moderately, improved LVEF in
the short-term (4.74%, 95% CI: 2.98%-6.50%, P<0.00001) and long-term
follow-up (4.69%, 95% CI: 2.13%-7.25%, P=0.0003). Patients using bone
marrow mononuclear cell may have greater LVEF improvement than those using
CD133+ cell (WMD 5.01%, 95% CI: 3.27%-6.76%, P<0.00001; WMD 2.72%, 95% CI:
-1.13%-6.57%, P=0.17). Moreover, the pooled results showed a significant
difference in the mean LVESV (-10.03 ml, 95% CI: -16.46 ml to -3.60 ml,
P=0.002), LVEDV (-10.92 ml, 95% CI: -19.96 ml to -1.88 ml, P=0.02) and
WMIS (-0.21, 95% CI: -0.32 to -0.09, P=0.003) in favour of BMDSC therapy.
BMDSC-based therapies were generally safe as treatment for IHD patients
undergoing CABG, however the use of smooth muscle cell in these patients
increased the risk of VT/VF (RR 5.583, 95% CI: 1.157-26.932, P=0.025) and
all-cause mortality (RR 5.333, 95% CI: 1.575-18.065, P=0.005). CONCLUSIONS
Bone marrow derived stem cell therapies are generally safe and have a
clinical benefit on IHD patients undergoing CABG in the short-term and
long-term follow-up.

<39>
Accession Number
613352205
Author
Ye Z.; Xu J.; Zhang C.; Shi K.J.; Sun F.; Mu X.W.
Institution
(Ye) Department of Surgical Intensive Care Unit, 1st Affiliated Hospital
of SUN Yat-sen University, China
(Xu) Department of Emergency, 1st Affiliated Hospital of SUN Yat-sen
University, China
(Zhang, Shi, Sun, Mu) Department of Intensive Care Unit, Nanjing Hospital
of Nanjing Medical University, China
Title
The efficacy of IntelliVent-ASV mode in post-cardiac surgery patients.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C171), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES Ventilation management is crucial in the treatment of Post
cardiac surgery patients. Although ventilation therapy is appropriate and
improves survival, prolong use and irrationality set parameters are
increase the risk of respiratory dysfunction and mortality. Anesthesia
recovery and after cardiac surgery, increased of basal metabolic rate and
produce of carbon dioxide, patients needed dynamically ventilation
support. We aimed to evaluate the safety and efficacy of IntelliVent-ASV
mode in ICU patients with post cardiac surgery. To estimate underlying
reduce incidence of respiratory dysfunction. METHODS Consecutive patients
undergoing cardiac surgery from April to October in 2014 were randomly
divided into adaptive support ventilation (ASV) group and IntelliVent-ASV
group. Demographic and clinical data were collected on all adult patients
with cardiac surgery in ICU. In the ASV group, minute volume (MV), FiO2
and positive end-expiratory pressure (PEEP) were set according to the
local hospital protocol based on currently available guidelines. In the
IntelliVent-ASV group, clinician set targets for SpO2 and PetCO2
individually, at the same time patient height, sex, ideal body weight,
initial FiO2, PEEP, MV were input. According to the physiologic inputs
from the patients, IntelliVent-ASV automatically sets ventilator controls
to reach targets. FiO2, PEEP, MV, SpO2, PetCO2, Tidal volume (Vt),
respiratory rate (RR) and static lung compliance inspiratory pressure were
continuously monitored and recorded in time of arrive at ICU(T0),1 hour
(T1),2 hour (T2) and before Spontaneous Breathing Trial(TSBT). Vital
parameters of signs hemodynamics and blood gas analysis (ABG) were
recorded in simultaneously. RESULTS Intellivent-ASV group required
significantly less FiO2 in T1 (34.00+/-7.34 Vs. 41.28+/-5.22,p<0.01), T2
(31.93+/-4.44 Vs.41.28+/-4.09,p<0.01), TSBT (31.44+/-3.13 Vs.39.49+/-2.24,
p<0.01) respectively. VT/PBW were significantly higher in Intellivent-ASV
patients, T1 (8.05+/-1.00 ml/kg Vs. 7.55+/-1.05 ml/kg, p<0.05), T2
(8.17+/-1.01 ml/kg to 7.67+/-0.97 ml/kg, p<0.05), TSBT (9.35+/-1.40 ml/kg
Vs. 7.92+/-1.31 ml/kg,p<0.01). Matched-pair analysis of PaCO2 in two
groups was performed significant differences in T1 (37.67+/-3.88mmHg to
34.9 0+/-5.72mmHg, p<0.05). No significant differences in PaO2, pH,
lactic, PaO2/FiO2 were monitored. The linear regression shows the positive
correlation between PetCO2 and PaCO2(R2=0.607,n=172)in Intellivent-ASV
group. CONCLUSIONS IntelliVent-ASV mode and ASV mode were safe in
hemodynamically stable patients following cardiac surgery. PetCO2 as one
of the available parameter to set Ventilatior.IntelliVent-ASV can
continuously and timely auto adjust parameters to improves an effective
support for post cardiac surgery patients.

<40>
Accession Number
613352118
Author
Neuner B.; Weiss B.; Wulfekammer T.; Radtke F.; Franck M.; Spies C.
Institution
(Neuner, Weiss, Wulfekammer, Radtke, Franck, Spies) Department of
Anesthesiology and Intensive Care Medicine, Charite - Universitaetsmedizin
Berlin, Berlin, Germany
(Radtke) Dept of Anaesthesia, Anaestesiologisk Afdeling, Naestved, Denmark
Title
Absolute values of blood pressure fluctuation as an independent risk
factor for postoperative delirium: Secondary, exploratory analysis of the
randomized controlled "surgery Depth of anaesthesia and Cognitive
Outcome"-(SuDoCO) trial.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C185), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES Postoperative delirium (POD) is an acute onset of disturbance
in attention/consciousness combined with cognitive deficits. It is unclear
if intraoperative fluctuations in intraoperative blood pressure are
independent risk factors for POD. Secondary analysis of a randomized
controlled trial, primarily aimed to test the efficiency of BIS guided
anaesthesia for the prevention of POD. METHODS The "Surgery Depth of
anaesthesia and Cognitive Outcome"- (SuDoCO) trial, carried out 03-2009
untill 04-2010, included > 60-year-old patients scheduled for elective
non-cardiac surgery of > 60 minutes under general anaesthesia 1.
Intra-operative hand written blood pressure record sheets were digitalized
and analyzed using univariate and multivariate analyses. Endpoint was the
cumulative POD incidence (defined according to DSM-IV) within seven
post-operative days. RESULTS Overall 917 complete data on all independent
variables as well as outcomes were available. The mean age was 70.0+/-6.5
years and n=489 (53.3%) were males. The median surgical time was 2.3
(range: 0.1 up 10.1) hours and 197 patients (21.5%) developed POD. In
univariate analysis, patients with POD showed higher mean systolic blood
pressure (117.1+/-10.5 vs. 114.9+/-11.0 mmHg, p= 0.014) while there were
no differences in diastolic blood pressure and mean arterial pressure
(MAP). The absolute values of blood pressure fluctuation in systolic and
diastolic blood pressure as well as MAP were significantly higher in
patients with POD compared to patients without POD (all p< 0.05). After
adjustments for randomization status, age, gender, ASA physical status,
Mini Mental State Examination (MMSE) pre-operatively, as well as site of
operation, length of hospital stay and length of procedure, systolic blood
pressure fluctuations (p=0.048), diastolic blood pressure fluctuations (p=
0.09) as well as fluctuations in MAP (p= 0.027) were associated with POD,
independently from their interactions with length of operation (p=0.038,
p= 0.71, and p= 0.14, respectively). CONCLUSIONS Fluctuations in systolic
blood pressure, despite significant interaction with operation time, as
well as fluctuations in MAP seem to be independent predictors for POD.
Future studies should evaluate whether a strict blood pressure regimen,
avoiding intraoperative blood pressure fluctuations, prevents POD.

<41>
Accession Number
613352040
Author
Jieyu L.; Cai R.; Hong Z.
Institution
(Jieyu, Cai, Hong) First Affiliated Hospital of Sun Yat-sen University,
China
Title
The efficacy analysis between levosimendan and dobutamine on post-cardiac
surgery patients.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C168), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES Dobutamine as a traditional cardiac tonic used in postcardiac
surgery patients are commonly. Levosimendan is a new cardiac tonic, which
in many studies had showed that it has a good efficacy on improving
cardiac function, but less used in post-cardiac surgery patients. This
study will compare the efficacy of levosimendan and dobutamine on
post-cardiac surgery patients. METHODS We include 45 post-cardiac surgery
patients, which were randomly divided into dobutamine injection group and
levosimendan injection group. Each group test cardiac output and
echocardiography at baseline and 1 week. RESULTS The cardiac output (CO)
increased overtime in the levosimendan group compared with the dobutamine
group (P = 0.012). In levosimendan group, the improvement in the ejection
fraction from 34.6 to 43.2% (P = 0.014) compared with the dobutamine
group. CONCLUSIONS The study determines that levosimendan treatment on
post-cardiac surgery patient provides a better clinical outcome compared
with dobutamine treatment.

<42>
Accession Number
613352000
Author
Xing L.; Yuan H.
Institution
(Xing, Yuan) Department of Cardiology, Third Xiangya Hospital, Central
South University, Changsha 410013, China
Title
Model for Assessing postoperative AKI in hypertension patients.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C137), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES A model for predicting surgery related AKI in hypertension
patients is limited. This study was conducted to develop and validate a
risk model of surgery related AKI using preoperative risk factors in a
large cohort. METHODS In total, 24357 hypertension patients aged >18 years
who underwent general surgery were enrolled. Subjects were randomly
classified into the train (n=17020) and validation (n=7337) cohorts. The
AKI events were defined based on the KDIGO (Kidney Disease: Improving
Global Outcomes) AKI classification system. Models were developed by
stepwise multivariate logistic regression. To compare the performance of
the models to other published models, the models were built using the
published equations. A comprehensive search of Medline Database was
performed. Studies were included if a model was developed to predict adult
(>18 years old) AKI based on KDIGO AKI classification system after any
kinds of surgery and reported in the form of a scoring system or
algorithm. RESULTS During hospitalization, surgery related AKI developed
in 1982 patients (8.1%). In the train cohort, our model, named Xiang-ya
Model, consisted of blood urea nitrogen (BUN), eGFR, NLR, pulmonary
infection, age, prothrombin time, uric acid, and serum albumin. The
C-index for the validation set (0.88, 95% CI 0.86-0.89) was almost equal
to the performance achieved in the training set (C-index =0.88, 95% CI
0.86-0.89). When this model was tested in other published model, only one
model by Kate et al 2014 fulfilled the inclusion criteria. Our model
outperformed the model by Kate et al with an NRI of 82.60% (95%CI
69.1%-94.1%) and an IDI of 13% (95%CI 10.46%- 15.70%) in those underwent
cardiac surgery patients (n=1726), respectively. CONCLUSIONS An AKI risk
model based on preoperative risk factors and biomarkers was developed and
showed a feasible model performance for predicting events in a large
cohort of hypertensive patients underwent general surgery.

<43>
Accession Number
613351999
Author
Lufeng M.; Ding R.; Hu D.
Institution
(Lufeng) School of Public Health and Family Medicine, Capital Medical
University, China
(Ding, Hu) Heart Center, Peking University People's Hospital, China
Title
The prognosis of stable angina pectoris patients with PCI, CABG and
medical therapy.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C109), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES The purpose of this study was to evaluate the outcome of
percutaneous coronary intervention (PCI), coronary artery bypass graft
surgery (CABG) and medical therapy in stable angina pectoris patients.
METHODS This is a multicenter, retrospective trial to assess the outcome
of the PCI, CABG and medical therapy in patients who had stable angina
pectoris between January 2003 and December 2011. Among 8,770 CAD patients,
469 had stable angina pectoris and were managed by PCI (n=225), CABG (n
=80) and medical therapy (n =164). The primary outcome measure is major
adverse cardiac and cerebrovascular events (MACCE: all-cause mortality,
myocardial infarction, stroke or re-revascularization). RESULTS The rate
of all-cause mortality of PCI, CABG and medical therapy were 2.67%, 5.00%
and 1.22% respectively, P=0.2263; The rates of MACCE were 11.6%, 7.5% and
8.5% respectively, P=0.4559. Multivariable logistic regression analysis
showed that compared with medical therapy, the hazard rates of MACCE of
PCI and CABG were 0.879(PCI?FOR.0.879, 95% CI 0.376-2.055, P=0.7898) and
o.596 (OR=0.596, 95% CI, 0.143-2.484 P=0.5186), respectively. However,
there was no statistical significance of the hazard rates of MACCE.
CONCLUSIONS There was no difference in MACCE of stable angina pectoris
patients by PCI, CABG and medical therapy.

<44>
Accession Number
613351977
Author
Lufeng M.; Ding R.; Hu D.
Institution
(Lufeng) School of Public Health and Family Medicine, Capital Medical
University, China
(Ding, Hu) Heart Center, Peking University People's Hospital, China
Title
The prognosis of multi-vessel coronary revascularization in patients with
or without diabetes mellitus.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C108-C109), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES The purpose of this study was to evaluate the outcome of
coronary artery bypass graft surgery (CABG) and percutaneous coronary
intervention (PCI) in patients who had multi-vessel coronary artery
disease with or without diabetes mellitus. METHODS This is a multicenter,
retrospective trial to assess the outcome of the CABG and PCI in patients
who had multi-vessel coronary artery disease with or without diabetes
mellitus between January 2003 and December 2011. The primary outcome is
major adverse cardiac and cerebrovascular events (MACCE.all-cause
mortality, myocardial infarction, stroke or re-revascularization). RESULTS
Patients with multi-vessel disease were divided in diabetic group (n=662,
29.9%) and non-diabetic group (n=1549, 70.1%). The rates of all-cause
mortality of diabetic group and non-diabetic group were 6.0%(in=40), 4.3%
(n=67), P=0.0911; The rates of MACCE were 13.3% (n=88), 9.06%(n=139)
P=0.0027.The incidence of MACCE was significantly higher in diabetic
patients than those of non-diabetic patients (OR 1.555, 95%CI 1.114-2.169,
P=0.0094), the incidence of all-cause mortality in diabetic group was
similar to that of non-diabetic group (OR 1.176, 95%CI 0.665-2.082,
P=0.5769). Among diabetic patients, the rates of all-cause mortality of
PCI, CABG were 6.9% (n=35), 3.3% (n=5), P=0.0800; The rates of MACCE were
14.1% (n=72), 10.5%(n=16), P=0.22787. The incidence of all-cause mortality
was significantly lower in CABG than in PCI (OR=0.069, 95% CI, 0.008-0.559
P=0.0123). The incidence of MACCE in CABG was similar to that of
PCI(OR=1.641, 95% CI, 0.32-1.284 P=0.2093). CONCLUSIONS Coronary
revascularization with CABG surgery is the treatment of choice in diabetic
patients with multi-vessel coronary artery disease. Diabetes was the
independent risk factor of MACCE in patients, who had multi-vessel
coronary artery disease.

<45>
Accession Number
613351926
Author
Zhe X.; Zhang S.-Y.; Hu R.; Wang Z.-P.; Ou J.-S.; Yin S.-L.; Li J.-L.;
Huang M.; Zhang X.
Institution
(Zhe, Wang, Ou, Yin, Zhang) Division of Cardiac Surgery, Department of
Cardiovascular Diseases, First Affiliated Hospital of Sun-Yat-sen
University, Guangzhou, China
(Zhang, Hu, Li, Huang) Institute of Clinical Pharmacology, School of
Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
Title
A double-blind, randomized controlled trial of genotype-based warfarin
initiation in patients with mechanical heart valves.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C46), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES To compare genotype-guided initiation dosing(CYP2C9, VKORC1 and
CYP4F2) of warfarin with clinical dosing protocol in patients with
mechanical heart valves. METHODS A double-blind, randomized, controlled
trial involving patients with mechanical heart valves (NCT01633957) was
conducted. For patients assigned to the genotype-guided group and the
control group, warfarin doses were prescribed according to
pharmacogenetic-based algorithms or the clinical dosing protocol for the
first 3 days. From the 4th day the management of all patients was
performed according to routine clinical practice. All the included
patients were followed up to the 90th day after the operation. The primary
outcomes were themean time to reach a stable therapeutic international
normalized ratio (INR) and the percentage of time in the therapeutic range
(TTR) of 1.8 to 2.5 for the INR from day 4 through day 90 of therapy.
RESULTS A total of 180 patients were recruited, with 90 randomly assigned
to the genotype guided group and 90 assigned to the control group. The
follow-up rate was 100%. No patient died in our trial. The mean time to
reach a stable therapeutic INR was 27.14days in the genotype-guided group
and 36.84 days in the control group respectively (P=0.011).The survival
analysis showed that grouping was the most important factor influencing
the time to reach a stable therapeutic INR(P=0.010). The TTR was 59.25% in
the genotype-guided group as compared with 56.96% in the control
group(P=0.946). There were no significant differences between the two
groups for all the secondary outcomes. There were no significant
differences with respect to the incidence of the adverse outcomes (all
cause mortality, major haemorrhage and major thromboembolic events).
CONCLUSIONS Compared with clinical dosing, pharmacogeneticbased dosing was
associated with a shorter mean time to reach a stable therapeutic INR
during the initiation of warfarin therapy in patients with mechanical
heart valves. Pharmacogenetic-based dosing could improve the quality of
anticoagulation in the initiation period after the operation of mechanical
valve replacement.

<46>
Accession Number
613351861
Author
Kim M.H.; Guo L.Z.; Shim C.H.; Choi S.Y.; Serebruany V.L.
Institution
(Kim, Guo) Department of Cardiology, Dong-A University Hospital, Busan,
South Korea
(Kim, Guo, Shim, Choi) Clinical Trial Center, Dong-A University Hospital,
Busan, South Korea
(Kim, Guo) Department of Cardiology, Fourth Affiliated Hospital of Harbin
Medical University, Harbin, China
(Serebruany) HeartDrug Research Laboratories, Johns Hopkins University,
Baltimore, MD, United States
Title
Impact of renal impairment on platelet reactivity and clinical outcomes
during chronic dual antiplatelet therapy following coronary stenting.
Source
Journal of the American College of Cardiology. Conference: 27th Great Wall
International Congress of Cardiology, 21st Annual Scientific Meeting of
the International Society of Cardiovascular Pharmacotherapy International
Congress of Cardiovascular Prevention and Rehabilitation 2016. China.
Conference Start: 20161013. Conference End: 20161016. 68 (16 Supplement)
(pp C106), 2016. Date of Publication: 18 Oct 2016.
Publisher
Elsevier USA
Abstract
OBJECTIVES Clinical utilization of dual antiplatelet therapy (DAPT) in
patients with renal impairment (RI) following percutaneous coronary
interventions (PCI) represents an urgent, unmet need choosing optimal
agents, duration of treatment, and potential dose/regimen adjustment. Lack
of any large randomized trials specifically in RI patients, and absence of
the uniformed clinical data reporting policy clouds the reality. Moreover,
triaging RI patients is problematic due to ongoing kidney deterioration,
and the fact that RI patients are prone to both vascular occlusions and
bleeding. METHODS 701 Korean patients receiving DAPT with aspirin 100 mg/
daily and clopidogrel 75 mg/daily after PCI were prospectively enrolled in
the study. Patients were dichotomized into 5 groups according to RI:
estimated glomerular filtration rate (eGFR)> 90 mL/ min/1.73m²
(RI1), 60 - 89 mL/min/1.73m² (RI2), 30 - 59 mL/min/1.73m2
(RI3), < 30 mL/min/1.73m² (RI4), and undergoing dialysis (RI5).
Major adverse clinical event (MACE) (cardiovascular death, myocardial
infarction, stent thrombosis and stroke) were collected for 1 year.
Platelet reactivity by VerifyNow? assay and eGFR were simultaneously
assessed at 1 month after maintenance DAPT. RESULTS Patients with RI
exhibited gradual significant increase of residual platelet reactivity
during DAPT, dependent on eGFR deterioration [191+/- 72PRU (RI1) vs.
216+/- 78PRU (RI2) vs. 248+/- 80PRU (RI3) vs. 264+/-70PRU (RI4) vs. 317+/-
96PRU (RI5), p<0.001] being the highest in the dialyses group. Declined
eGFR has been gradually associated with advancing age (OR=1.03, 95%
CI=1.00-1.05; p=0.032), female gender (OR=1.7, 95% CI=1.1-2.5; p=0.01),
diminished smoking rates (OR=0.6, 95% CI=0.37-1.00; p=0.05), hypertension
(OR=1.8, 95% CI=1.3-2.5; p<0.001); diabetes (OR=1.5, 95% CI=1.1-2.1;
p=0.007), and MACE (HR=13.9; CI=1.6-124.3;p=0.02 for RI4; and (HR=31.9;
CI=2.9- 351.9;p=0.005 for dialysis), but not for bleeding (p=0.143). MACE
risks still remained significant for RI4 (p=0.027), and RI5 (0.002) by
multivariate Cox hazard regression estimates. CONCLUSIONS RI is strongly
associated with gradual elevation of residual platelet reactivity while on
DAPT, enhanced MACE risks, but not bleeding events. These data should be
confirmed in a large randomized outcome-driven trial, and may justify
future maintenance phase DAPT regimen/dose adjustment in RI patients.

<47>
Accession Number
613313545
Author
Basaran O.; Dogan V.; Biteker M.; Beton O.; Tekinalp M.; Bolat I.; Tasar
O.; Kalcik M.; Kalaycioglu E.; Aykan A.C.; Safak O.; Yaman M.; Inci S.;
Altintas B.; Kalkan S.; Karadeniz F.; Altun I.; Soylu M.O.
Institution
(Basaran) Mugla Sitki Kocman University, Cardiology, Mugla, Turkey
(Dogan, Biteker, Altun, Soylu) Mugla Sitki Kocman University, Mugla,
Turkey
(Beton) Cumhuriyet University, Sivas, Turkey
(Tekinalp) Kahramanmaras Necip Fazil State Hospital, Kahramanmaras, Turkey
(Bolat) Fethiye State Hospital, Mugla, Turkey
(Tasar) Elazig Education and Research Hospital, Elazig, Turkey
(Kalcik) Iskilip Atif Hoca State Hospital, Corum, Turkey
(Kalaycioglu, Aykan) Trabzon Ahi Evren Education and Research Hospital,
Trabzon, Turkey
(Safak) Burdur State Hospital, Burdur, Turkey
(Yaman) Samsun Education and Research Hospital, Samsun, Turkey
(Inci) Aksaray State Hospital, Aksaray, Turkey
(Altintas) Diyarbakir Gazi Yasargil Education and Research Hospital,
Diyarbakir, Turkey
(Kalkan) Gonen State Hospital, Balikesir, Turkey
(Karadeniz) Sanliurfa Balikligol State Hospital, Sanliurfa, Turkey
Title
Guideline adherence of non-vitamin K antagonist oral anticoagulant
therapy: Results from RAMSES study.
Source
Thrombosis Research. Conference: 24th Biennial International Congress on
Thrombosis - EMLTD Congress 2016. Turkey. Conference Start: 20160504.
Conference End: 20160507. 141 (pp S7-S8), 2016. Date of Publication: May
2016.
Publisher
Elsevier Ltd
Abstract
Background: Ischemic stroke is one of the feared complication of atrial
fibrillation (AF). Oral anticoagulant therapy is indicated for stroke
prevention in patients with AF if the risk of stroke is moderate or high
assessed by CHA<inf>2</inf>DS<inf>2</inf>VASc score. The availability of
high and low dose of non-vitamin K antagonist oral anticoagulants (NOACs)
have led to a probable misuse of these drugs. In this study we aimed to
investigate guideline adherent use of NOAC doses in patients with
non-valvular AF (NVAF). Methods: Real-life Multicenter Survey Evaluating
Stroke prevention strategies (RAMSES study) was across-sectional,
observational study. Patients were excluded if they had valve replacement
or mitral stenosis. A total number of 6273 NVAF patients were enrolled in
RAMSES study and 2086 patients who were on NOACs (dabigatran, rivaroxaban,
apixaban) were included to the current analysis. Patients were divided
into two groups according to 2012 European Society of Cardiology AF
guideline recommendation as "high" and "low" dose of NOAC recommended.
Than study patients were divided to undertreatment, overtreatment and
appropriate treatment groups. Results: High dose of the drug was
recommended to 1557 (74.6%) and low dose was recommended to 529 (25.3%)
patients according to ESC guideline. Of the high dose recommended patients
634 (40.7%) were on undertreatment and of the low dose recommended
patients 205 (38.75%) were on overtreatment. Low dose of NOACs were chosen
for elder patient with low creatinine clearance. There was no association
among comorbid diseases and guideline adherence. However
CHA<inf>2</inf>DS<inf>2</inf>VASc score was higher in the undertreatment
group (3.4+/-1.3 vs. 3.1+/-1.3 p<0.001) and HAS-BLED was higher in the
overtreatment group (2.5+/-1.02 vs. 2.3+/-1.1 p=0.041). Undertreatment was
most prevalent for dabigatran, (57.5%) followed by rivaroxaban, (29.1%)
and apixaban, (17.6%) whereas overtreatment was most common for
rivaroxaban, (52.4%) followed by apixaban, (40.0%) and dabigatran (27.8%).
Conclusions: We evaluated guideline adherence of NOACs in a multicenter
epidemiological study and found that nearly 40% of patients were on
undertreatment or overtreatment. Undertreatment was more common in high
stroke patients and overtreatment was more common in high bleeding risk
patients. Guideline adherent management of NOACs has been associated with
better outcomes thus there is a need for greater adherence to the
guidelines. (Table Presented).

<48>
Accession Number
613313140
Author
Kim M.H.; Guo L.Z.; Shim C.H.; Choi S.Y.; Serebruany V.L.
Institution
(Kim) Cardiology, Global Clinical Trial Center, Dong-A University
Hospital, Busan, South Korea
(Guo, Shim, Choi) Dong-A University Hospital, Busan, South Korea
(Serebruany) HeartDrug Research Laboratories, Johns Hopkins University,
Baltimore, United States
Title
Impact of renal impairment on platelet reactivity and clinical outcomes
during chronic dual antiplatelet therapy following coronary stenting.
Source
Thrombosis Research. Conference: 24th Biennial International Congress on
Thrombosis - EMLTD Congress 2016. Turkey. Conference Start: 20160504.
Conference End: 20160507. 141 (pp S3), 2016. Date of Publication: May
2016.
Publisher
Elsevier Ltd
Abstract
Background: Clinical utilization of dual antiplatelet therapy (DAPT) in
patients with renal impairment (RI) following percutaneous coronary
interventions (PCI) represents an urgent, unmet need choosing optimal
agents, duration of treatment, and potential dose/regimen adjustment. Lack
of any large randomized trials specifically in RI patients, and absence of
the uniformed clinical data reporting policy clouds the reality. Moreover,
triaging RI patients is problematic due to ongoing kidney deterioration,
and the fact that RI patients are prone to both vascular occlusions and
bleeding. Methods: 701 Korean patients receiving DAPT with aspirin 100
mg/daily and clopidogrel 75 mg/daily after PCI were prospectively enrolled
in the study. Patients were dichotomized into 5 groups according to RI:
estimated glomerular filtration rate (eGFR)> 90 mL/min/1.73m2 (RI1), 60 -
89 mL/ min/1.73m2 (RI2), 30 - 59 mL/min/1.73m2 (RI3), < 30 mL/min/1.73m2
(RI4), and undergoing dialysis (RI5). Major adverse clinical event (MACE)
(cardiovascular death, myocardial infarction, stent thrombosis and stroke)
were collected for 1 year. Platelet reactivity by VerifyNowTM assay and
eGFR were simultaneously assessed at 1 month after maintenance DAPT.
Results: Patients with RI exhibited gradual significant increase of
residual platelet reactivity during DAPT, dependent on eGFR deterioration
[191+/- 72PRU (RI1) vs. 216+/- 78PRU (RI2) vs. 248+/- 80PRU (RI3) vs.
264+/-70PRU (RI4) vs. 317+/- 96PRU (RI5), p<0.001] being the highest in
the dialyses group. Declined eGFR has been gradually associated with
advancing age (OR=1.03, 95% CI=1.00-1.05; p=0.032), female gender (OR=1.7,
95% CI=1.1- 2.5; p=0.01), diminished smoking rates (OR=0.6, 95%
CI=0.37-1.00; p=0.05), hypertension (OR=1.8, 95% CI=1.3-2.5; p<0.001);
diabetes (OR=1.5, 95% CI=1.1-2.1; p=0.007), and MACE (HR=13.9;
CI=1.6-124.3;p=0.02 for RI4; and (HR=31.9; CI=2.9-351.9;p=0.005 for
dialysis), but not for bleeding (p=0.143). MACE risks still remained
significant for RI4 (p=0.027), and RI5 (0.002) by multivariate Cox hazard
regression estimates. Conclusions: RI is strongly associated with gradual
elevation of residual platelet reactivity while on DAPT, enhanced MACE
risks, but not bleeding events. These data should be confirmed in a large
randomized outcomedriven trial, and may justify future maintenance phase
DAPT regimen/dose adjustment in RI patients.

<49>
Accession Number
613244125
Author
Murphy M.E.; Hakim J.S.; Kerezoudis P.; Alvi M.A.; Ubl D.S.; Habermann
E.B.; Bydon M.
Institution
(Murphy, Kerezoudis, Alvi, Bydon) Department of Neurologic Surgery, Mayo
Clinic, Rochester, Minnesota, 200 1st St. SW, Rochester, MN 55905, United
States
(Murphy, Hakim, Kerezoudis, Alvi, Bydon) Mayo Clinic Neuro-Informatics
Laboratory, Mayo Clinic, Rochester, Minnesota, 200 1st St. SW, Rochester,
MN 55905, United States
(Hakim) Mayo Medical School, Mayo Clinic, Rochester, Minnesota, 200 1st
St. SW, Rochester, MN 55905, United States
(Ubl, Habermann) Department of Health Sciences Research Mayo Clinic, 200
1st St. SW, MN, Rochester, MN 55905, United States
Title
Micro vs. macrodiscectomy: Does use of the microscope reduce complication
rates?.
Source
Clinical Neurology and Neurosurgery. 152 (pp 28-33), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier B.V.
Abstract
Objective A single level discectomy is one of the most common procedures
performed by spine surgeons. While some practitioners utilize the
microscope, others do not. We postulate improved visualization with an
intraoperative microscope decreases complications and inferior outcomes.
Methods A multicenter surgical registry was utilized for this
retrospective cohort analysis. Patients with degenerative spinal diagnoses
undergoing elective single level discectomies from 2010 to 2014 were
included. Univariate analysis was performed comparing demographics,
patient characteristics, operative data, and outcomes for discectomies
performed with and without a microscope. Multivariable logistic regression
analysis was then applied to compare outcomes of micro- and
macrodiscectomies. Results Query of the registry yielded 23,583 patients
meeting inclusion criteria. On univariate analysis the microscope was used
in a greater proportion of the oldest age group as well as Hispanic white
patients. Patients with any functional dependency, history of congestive
heart failure, chronic corticosteroid use, or anemia (hematocrit < 35%)
also had greater proportions of microdiscectomies. Thoracic region
discectomies more frequently involved use of the microscope than cervical
or lumbar discectomies (25.0% vs. 16.4% and 13.0%, respectively, p <
0.001). Median operative time (IQR) was increased in microscope cases [80
min (60, 108) vs. 74 min (54, 102), p < 0.001]. Of the patients that
required reoperation within 30 days, 2.5% of them had undergone a
microdiscectomy compared to 1.9% who had undergone a macrodiscectomy, p =
0.044. On multivariable analysis, microdiscectomies were more likely to
have an operative time in the top quartile of discectomy operative times,
>103 min (OR 1.256, 95% CI 1.151-1.371, p < 0.001). In regards to other
multivariable outcome models for any complication, surgical site
infection, dural tears, reoperation, and readmission, no significant
association with microdiscectomy was found. Conclusions The use of the
microscope was found to significantly increase the odds of longer
operative time, but not influence rates of postoperative complications.
Thus, without evidence from this study that the microscope decreases
complications, the use of the microscope should be at the surgeon's
discretion, validating the use of both macro and micro approaches to
discectomy as acceptable standards of care. Copyright &#xa9; 2016 Elsevier
B.V.

<50>
Accession Number
613243000
Author
Shah R.; Yow E.; Jones W.S.; Kohl L.P.; Kosinski A.S.; Hoffmann U.; Lee
K.L.; Fordyce C.B.; Mark D.B.; Lowe A.; Douglas P.S.; Patel M.R.
Institution
(Shah, Yow, Jones, Kosinski, Lee, Fordyce, Mark, Lowe, Douglas, Patel)
Duke Clinical Research Institute, Duke University School of Medicine,
Durham, NC, United States
(Jones, Mark, Douglas, Patel) Division of Cardiology, Department of
Medicine, Duke University School of Medicine, Durham, NC, United States
(Kohl) Hennepin County Medical Center, Minneapolis, MN, United States
(Hoffmann) Massachusetts General Hospital and Harvard Medical School,
Boston, MA, United States
Title
Comparison of visual assessment of coronary stenosis with independent
quantitative coronary angiography: Findings from the Prospective
Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial.
Source
American Heart Journal. 184 (pp 1-9), 2017. Date of Publication: 01 Feb
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
The outcomes in patients by visual assessment and quantitative coronary
angiography (QCA) for obstructive coronary artery disease (CAD) are not
known. Our objectives were to compare visual and QCA estimates of
obstructive CAD and to assess their relationship to outcomes in stable
patients with symptoms of CAD. Methods The PROMISE trial randomized 10,003
patients with CAD symptoms to anatomical or functional testing. Site
reports of invasive angiography detailing visual stenosis and independent,
blinded QCA were performed for obstructive CAD (>50% stenosis).
Disagreement between methods was determined and compared with outcomes
(death, myocardial infarction, unstable angina hospitalization, or major
procedural complications). Results Of 929 patients (9.3% of PROMISE
cohort) with angiograms assessed by sites and QCA, 593 (64%) had
obstructive CAD per site reports, whereas 428 (46%) had stenosis >50% per
QCA. Results differed in 177 patients (disagreement rate 19.1%, kappa =
0.63), of whom 171 had CAD per sites but not per QCA. One-year unadjusted
Kaplan-Meier event rates were highest (5.1%) when QCA and visual
assessment agreed for CAD, lowest (0.9%) when the 2 agreed for no
obstructive CAD, and intermediate (3.1%) for patients who had CAD per
visual assessment but not per QCA. Conclusions Visual estimation of
angiograms results in more frequent diagnosis of obstructive CAD as
compared with QCA. Concordance of results for presence or absence of
obstructive CAD was associated with high and low event rates,
respectively. Disagreement was associated with intermediate event rates,
suggesting that cardiologists integrated clinical information into routine
visual assessment of angiograms. Copyright &#xa9; 2016

<51>
Accession Number
613271791
Author
Su X.; Meng Z.-T.; Wu X.-H.; Cui F.; Li H.-L.; Wang D.-X.; Zhu X.; Zhu
S.-N.; Maze M.; Ma D.
Institution
(Su, Meng, Wu, Cui, Wang) Department of Anaesthesiology and Critical Care
Medicine, Peking University First Hospital, Beijing, China
(Zhu) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Li, Zhu) Department of Critical Care Medicine, Peking University Third
Hospital, Beijing, China
(Maze) Department of Anesthesia and Perioperative Care, University of
California, San Francisco, CA, United States
(Ma) Section of Anaesthetics, Pain Management and Intensive Care,
Department of Surgery and Cancer, Imperial College London, Chelsea and
Westminster Hospital, London, United Kingdom
Title
Dexmedetomidine for prevention of delirium in elderly patients after
non-cardiac surgery: a randomised, double-blind, placebo-controlled trial.
Source
The Lancet. 388 (10054) (pp 1893-1902), 2016. Date of Publication: 15 Oct
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Delirium is a postoperative complication that occurs frequently
in patients older than 65 years, and presages adverse outcomes. We
investigated whether prophylactic low-dose dexmedetomidine, a highly
selective alpha<inf>2</inf> adrenoceptor agonist, could safely decrease
the incidence of delirium in elderly patients after non-cardiac surgery.
Methods We did this randomised, double-blind, placebo-controlled trial in
two tertiary-care hospitals in Beijing, China. We enrolled patients aged
65 years or older, who were admitted to intensive care units after
non-cardiac surgery, with informed consent. We used a computer-generated
randomisation sequence (in a 1:1 ratio) to randomly assign patients to
receive either intravenous dexmedetomidine (0.1 mug/kg per h, from
intensive care unit admission on the day of surgery until 0800 h on
postoperative day 1), or placebo (intravenous normal saline).
Participants, care providers, and investigators were all masked to group
assignment. The primary endpoint was the incidence of delirium, assessed
twice daily with the Confusion Assessment Method for intensive care units
during the first 7 postoperative days. Analyses were done by
intention-to-treat and safety populations. This study is registered with
Chinese Clinical Trial Registry, www.chictr.org.cn, number
ChiCTR-TRC-10000802. Findings Between Aug 17, 2011, and Nov 20, 2013, of
2016 patients assessed, 700 were randomly assigned to receive either
placebo (n=350) or dexmedetomidine (n=350). The incidence of postoperative
delirium was significantly lower in the dexmedetomidine group (32 [9%] of
350 patients) than in the placebo group (79 [23%] of 350 patients; odds
ratio [OR] 0.35, 95% CI 0.22-0.54; p<0.0001). Regarding safety, the
incidence of hypertension was higher with placebo (62 [18%] of 350
patients) than with dexmedetomidine (34 [10%] of 350 patients; 0.50,
0.32-0.78; p=0.002). Tachycardia was also higher in patients given placebo
(48 [14%] of 350 patients) than in patients given dexmedetomidine (23 [7%]
of 350 patients; 0.44, 0.26-0.75; p=0.002). Occurrence of hypotension and
bradycardia did not differ between groups. Interpretation For patients
aged over 65 years who are admitted to the intensive care unit after
non-cardiac surgery, prophylactic low-dose dexmedetomidine significantly
decreases the occurrence of delirium during the first 7 days after
surgery. The therapy is safe. Funding Braun Anaesthesia Scientific
Research Fund and Wu Jieping Medical Foundation, Beijing, China. Study
drugs were manufactured and supplied by Jiangsu Hengrui Medicine Co, Ltd,
Jiangsu, China. Copyright &#xa9; 2016 Elsevier Ltd

<52>
Accession Number
613198627
Author
Bavishi C.; Balasundaram K.; Argulian E.
Institution
(Bavishi, Balasundaram, Argulian) Mount Sinai St. Luke's and Mount Sinai
West Hospitals, New York, New York, United States
Title
Integration of Flow-Gradient Patterns Into Clinical Decision Making for
Patients With Suspected Severe Aortic Stenosis and Preserved LVEF: A
Systematic Review of Evidence and Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 9 (11) (pp 1255-1263), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study was designed to evaluate the evidence base for the
2014 American Heart Association/American College of Cardiology (AHA/ACC)
guidelines for severe aortic stenosis (SAS) and preserved left ventricular
ejection fraction by comparing the natural history of the disease in
subgroups of low-gradient (LG) aortic stenosis patients with high-gradient
(HG) patients. Background The 2014 AHA/ACC valvular disease guidelines
recommend estimation of stroke volume index by echocardiography in
patients with suspected LG SAS and preserved left ventricular ejection
fraction. Methods PubMed, Embase, and Scopus databases were searched for
all studies that have compared the natural history of SAS with preserved
ejection fraction in flow-gradient patterns. We studied the following 3
subgroups: HG, low-flow low-gradient (LFLG), and normal-flow low-gradient
(NFLG). The random effects model was used to pool individual study
results. The end-point was long-term all-cause mortality. Results A total
of 9 studies with 3,065 patients fulfilled the criteria. Compared to HG
SAS, both LFLG and NFLG patients had a higher burden of comorbidities such
as coronary artery disease and hypertension. Atrial fibrillation was more
prevalent in LFLG patients. Moreover, end-diastolic volume index was
smaller for LFLG patients and indexed aortic valve area was larger for
NFLG patients. All-cause mortality was similar between HG and LFLG
subgroups (relative risk: 1.07; 95% confidence interval: 0.83 to 1.38; p =
0.60), whereas patients with NFLG had a significantly lower all-cause
mortality compared to the HG subgroup (relative risk: 0.64; 95% confidence
interval: 0.47 to 0.86; p = 0.004). Conclusions Patients with LFLG SAS
have similar outcomes compared to HG SAS but worse compared to NFLG SAS.
These findings support estimating stroke volume index in patients with
suspected LG SAS. All analyses revealed high heterogeneity and further
high-quality studies are necessary. Copyright &#xa9; 2016 American College
of Cardiology Foundation

<53>
Accession Number
613203996
Author
Adeeb N.; Griessenauer C.J.; Patel A.S.; Moore J.; Dolati-Ardejani P.;
Gupta R.; Motiei-Langroudi R.; Ogilvy C.S.; Thomas A.J.
Institution
(Adeeb, Griessenauer, Patel, Moore, Dolati-Ardejani, Gupta,
Motiei-Langroudi, Ogilvy, Thomas) Neurosurgical Service, Beth Israel
Deaconess Medical Center, Harvard Medical School, 110 Francis Street,
Boston, MA 02215-5501, United States
Title
Reliability of dual- vs single-volume reconstruction of three-dimensional
digital subtraction angiography for follow-up evaluation of endovascularly
treated intracranial aneurysms.
Source
Interventional Neuroradiology. 22 (6) (pp 687-692), 2016. Date of
Publication: 01 Dec 2016.
Publisher
SAGE Publications Inc. (E-mail: nicola.leonardi@centuro.it)
Abstract
Introduction Single-volume reconstruction of three-dimensional (3D)
digital subtraction angiography (DSA) can be effectively used for aneurysm
assessment and planning of endovascular embolization. Unfortunately,
post-embolization follow-up angiographic images can be obscured by
artifact. The dual-volume reconstruction technique was developed in order
to reduce artifact and enhance the visualization of the aneurysm, the
parent vessel and side branches, and endovascular devices. The purpose of
this study was to compare the reliability of dual- vs single-volume
reconstruction of 3D DSA in evaluation of follow-up images after
endovascular embolization of intracranial aneurysms. Method Four
cerebrovascular neurosurgeons independently and blindly reviewed 20
randomly selected dual-and single-volume reconstructions of 3D DSAs
demonstrating cerebral aneurysms treated with primary coil embolization,
stent-assisted coil embolization, or Pipeline embolization. Five images
were repeated for each modality (single and dual volume) in order to
assess intra-rater reliability. The intraclass correlation coefficient was
calculated as a measure of the overall inter-rater agreement. Cohen's
kappa value was used to assess repeat measurement consistency for each
rater. Results Overall inter-rater agreement using dual- and single-volume
reconstruction was 0.81 and 0.75, respectively. Dual-volume reconstruction
resulted in superior agreement in assessing location, occlusion status,
position of aneurysm recanalization or residual, status of nearby
branches, presence of coil migration and presence of intravascular devices
(stent or Pipeline). Conclusion Three-dimensional reconstruction is an
important complementary imaging technique in evaluating the
angioarchitecture of aneurysms and recanalization after endovascular
embolization. Dual-volume reconstruction imaging was associated with
superior inter- and intra-rater reliability. Copyright &#xa9; SAGE
Publications.

<54>
Accession Number
613203890
Author
Rauch B.; Davos C.H.; Doherty P.; Saure D.; Metzendorf M.-I.; Salzwedel
A.; Voller H.; Jensen K.; Schmid J.-P.
Institution
(Rauch) Institut fur Herzinfarktforschung Ludwigshafen, Bremserstr. 79,
Haus M, Ludwigshafen am Rhein D-67063, Germany
(Davos) Cardiovascular Research Laboratory, Biomedical Research
Foundation, Academy of Athens, Greece
(Doherty) Department of Health Sciences, University of York, United
Kingdom
(Saure, Jensen) Institute of Medical Biometry and Informatics (IMBI),
University of Heidelberg, Germany
(Metzendorf) Cochrane Metabolic and Endocrine Disorders Group, Institute
of General Practice, University of Dusseldorf, Germany
(Salzwedel, Voller) Centre of Rehabilitation Research, University of
Potsdam, Germany
(Schmid) Department of Cardiology Spital Tiefenau, Switzerland
Title
The prognostic effect of cardiac rehabilitation in the era of acute
revascularisation and statin therapy: A systematic review and
meta-analysis of randomized and non-randomized studies - The Cardiac
Rehabilitation Outcome Study (CROS).
Source
European Journal of Preventive Cardiology. 23 (18) (pp 1914-1939), 2016.
Date of Publication: 01 Dec 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background The prognostic effect of multi-component cardiac rehabilitation
(CR) in the modern era of statins and acute revascularisation remains
controversial. Focusing on actual clinical practice, the aim was to
evaluate the effect of CR on total mortality and other clinical endpoints
after an acute coronary event. Design Structured review and meta-analysis.
Methods Randomised controlled trials (RCTs), retrospective controlled
cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs)
evaluating patients after acute coronary syndrome (ACS), coronary artery
bypass grafting (CABG) or mixed populations with coronary artery disease
(CAD) were included, provided the index event was in 1995 or later.
Results Out of n = 18,534 abstracts, 25 studies were identified for final
evaluation (RCT: n = 1; pCCS: n = 7; rCCS: n = 17), including n = 219,702
patients (after ACS: n = 46,338; after CABG: n = 14,583; mixed
populations: n = 158,781; mean follow-up: 40 months). Heterogeneity in
design, biometrical assessment of results and potential confounders was
evident. CCSs evaluating ACS patients showed a significantly reduced
mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95%
confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds
ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac
Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral
results. CR participation was also associated with reduced mortality after
CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations.
Conclusions CR participation after ACS and CABG is associated with reduced
mortality even in the modern era of CAD treatment. However, the
heterogeneity of study designs and CR programmes highlights the need for
defining internationally accepted standards in CR delivery and scientific
evaluation. Copyright &#xa9; European Society of Cardiology.

<55>
Accession Number
613198250
Author
Shin D.-H.; Hong S.-J.; Mintz G.S.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi
D.; Jang Y.; Hong M.-K.
Institution
(Shin, Kim, Kim, Ko, Choi, Jang, Hong) Department of Internal Medicine,
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul,
South Korea
(Hong) Department of Internal Medicine, Sanggye Paik Hospital, Inje
University, Seoul, South Korea
(Mintz) Cardiovascular Research Foundation, New York, New York, United
States
(Kim, Kim, Ko, Choi, Jang, Hong) Cardiovascular Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Jang, Hong) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seoul, South Korea
Title
Effects of Intravascular Ultrasound-Guided Versus Angiography-Guided
New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With
Individual Patient-Level Data From 2,345 Randomized Patients.
Source
JACC: Cardiovascular Interventions. 9 (21) (pp 2232-2239), 2016. Date of
Publication: 14 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to evaluate the clinical usefulness
of intravascular ultrasound (IVUS)-guided new-generation drug-eluting
stent (DES) implantation using a meta-analysis of individual patient-level
data from randomized trials. Background Published randomized trials that
compare IVUS-guided versus angiography-guided new-generation DES
implantation are scarce. Methods Searches of the MEDLINE, Embase, and
Cochrane databases were performed to find randomized trials that compared
IVUS-guided versus angiography-guided new-generation DES implantation. A
total of 2,345 patients from 3 randomized trials were identified, and all
patients were treated for long lesions or chronic total occlusions.
Individual patient-level data were obtained. The primary endpoint was a
major adverse cardiac event, a composite of cardiac death, myocardial
infarction, or stent thrombosis. An intention-to-treat analysis and per
protocol analysis were performed. Results By 1 year post-procedure, major
adverse cardiac events had occurred in 0.4% of the patients who underwent
IVUS-guided DES implantation versus 1.2% of those who underwent
angiography-guided DES implantation (hazard ratio [HR]: 0.36; 95%
confidence interval [CI]: 0.13 to 0.99; p = 0.040). For the IVUS-guided
group, favorable clinical outcomes were observed for myocardial infarction
(0% vs. 0.4%; HR: 0.09; p = 0.026). In addition, the clinical benefit of
IVUS guidance was stronger in the per protocol analysis (HR: 0.32; 95% CI:
0.12 to 0.89; p = 0.021). Conclusions Compared with angiographic guidance,
IVUS-guided new-generation DES implantation was associated with favorable
outcomes in terms of major adverse cardiac events, the composite of
cardiac death, myocardial infarction, or stent thrombosis. These findings
must be interpreted only for complex lesions, because all identified
patients had long lesions or chronic total occlusions. Copyright &#xa9;
2016 American College of Cardiology Foundation

<56>
Accession Number
613196284
Author
Lotfi A.S.; Eftekhari H.; Atreya A.R.; Kashikar A.; Sivalingam S.K.;
Giannoni M.; Visintainer P.; Engelman D.
Institution
(Lotfi, Eftekhari, Atreya, Sivalingam, Giannoni) Department of Cardiology,
Baystate Medical Center, Tufts University School of Medicine, Springfield,
MA 01199, United States
(Kashikar) Department of Anesthesiology, Baystate Medical Center, Tufts
University School of Medicine, Springfield, MA 01199, United States
(Visintainer) Department of Epidemiology and Biostatistics, Baystate
Medical Center, Tufts University School of Medicine, Springfield, MA
01199, United States
(Engelman) Department of Cardiac Surgery, Baystate Medical Center, Tufts
University School of Medicine, Springfield, MA 01199, United States
Title
Randomized controlled trial of remote ischemic preconditioning and atrial
fibrillation in patients undergoing cardiac surgery.
Source
World Journal of Cardiology. 8 (10) (pp 615-622), 2016. Date of
Publication: 2016.
Publisher
Baishideng Publishing Group Co (E-mail: bpg@baishideng.com)
Abstract
AIM To study whether remote ischemic preconditioning (RIPC) has an impact
on clinical outcomes, such as post-operative atrial fibrillation (POAF).
METHODS This was a prospective, single-center, single-blinded,randomized
controlled study. One hundred and two patients were randomized to receive
RIPC (3 cycles of 5 min ischemia and 5 min reperfusion in the upper arm
after induction of anesthesia) or no RIPC (control). Primary outcome was
POAF lasting for five minutes or longer during the first seven days after
surgery. Secondary outcomes included length of hospital stay, incidence of
inpatient mortality, myocardial infarction, and stroke. RESULTS POAF
occurred at a rate of 54% in the RIPC group and 41.2% in the control group
(P = 0.23). No statistically significant differences were noted in
secondary outcomes between the two groups. CONCLUSION This is the first
study in the United States to suggest that RIPC does not reduce POAF in
patients with elective or urgent cardiac surgery. There were no
differences in adverse effects in either group. Further studies are
required to assess the relationship between RIPC and POAF. Copyright
&#xa9; 2016 Baishideng Publishing Group Inc. All rights reserved.

<57>
Accession Number
613091822
Author
Anonymous
Title
Association of the magnitude of weight loss and changes in physical
fitness with long-term cardiovascular disease outcomes in overweight or
obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD
randomised clinical trial.
Source
The Lancet Diabetes and Endocrinology. 4 (11) (pp 913-921), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Findings from the Look AHEAD trial showed no significant
reductions in the primary outcome of cardiovascular disease incidence in
adults with type 2 diabetes randomly assigned to an intensive lifestyle
intervention for weight loss compared with those randomly assigned to
diabetes support and education (control). We examined whether the
incidence of cardiovascular disease in Look AHEAD varied by changes in
weight or fitness. Methods Look AHEAD was a randomised clinical trial done
at 16 clinical sites in the USA, recruiting patients from Aug 22, 2001, to
April 30, 2004. In the trial, 5145 overweight or obese adults aged 45-76
years with type 2 diabetes were assigned (1:1) to an intensive lifestyle
intervention or diabetes support and education. In this observational,
post-hoc analysis, we examined the association of magnitude of weight loss
and fitness change over the first year with incidence of cardiovascular
disease. The primary outcome of the trial and of this analysis was a
composite of death from cardiovascular causes, non-fatal acute myocardial
infarction, non-fatal stroke, or admission to hospital for angina. The
secondary outcome included the same indices plus coronary artery bypass
grafting, carotid endartectomy, percutaneous coronary intervention,
hospitalisation for congestive heart failure, peripheral vascular disease,
or total mortality. We adjusted analyses for baseline differences in
weight or fitness, demographic characteristics, and risk factors for
cardiovascular disease. The Look AHEAD trial is registered with
ClinicalTrials.gov, number NCT00017953. Findings For the analyses related
to weight change, we excluded 311 ineligible participants, leaving a
population of 4834; for the analyses related to fitness change, we
excluded 739 participants, leaving a population of 4406. In analyses of
the full cohort (ie, combining both study groups), over a median 10.2
years of follow-up (IQR 9.5-10.7), individuals who lost at least 10% of
their bodyweight in the first year of the study had a 21% lower risk of
the primary outcome (adjusted hazard ratio [HR] 0.79, 95% CI 0.64-0.98;
p=0.034) and a 24% reduced risk of the secondary outcome (adjusted HR
0.76, 95% CI 0.63-0.91; p=0.003) compared with individuals with stable
weight or weight gain. Achieving an increase of at least 2 metabolic
equivalents in fitness change was associated with a significant reduction
in the secondary outcome (adjusted HR 0.77, 95% CI 0.61-0.96; p=0.023) but
not the primary outcome (adjusted HR 0.78, 0.60-1.03; p=0.079). In
analyses treating the control group as the reference group, participants
in the intensive lifestyle intervention group who lost at least 10% of
their bodyweight had a 20% lower risk of the primary outcome (adjusted HR
0.80, 95% CI 0.65-0.99; p=0.039), and a 21% lower risk of the secondary
outcome (adjusted HR 0.79, 95% CI 0.66-0.95; p=0.011); however, change in
fitness was not significantly associated with a change in the primary
outcome. Interpretation The results of this post-hoc analysis of Look
AHEAD suggest an association between the magnitude of weight loss and
incidence of cardiovascular disease in people with type 2 diabetes. These
findings suggest a need to continue to refine approaches to identify
individuals who are most likely to benefit from lifestyle interventions
and to develop strategies to improve the magnitude of sustained weight
loss with lifestyle interventions. Funding US National Institute of
Diabetes and Digestive and Kidney Diseases. Copyright &#xa9; 2016 Elsevier
Ltd

<58>
Accession Number
613261923
Author
Costanzo M.R.; Ponikowski P.; Javaheri S.; Augostini R.; Goldberg L.;
Holcomb R.; Kao A.; Khayat R.N.; Oldenburg O.; Stellbrink C.; Abraham W.T.
Institution
(Costanzo) Advocate Heart Institute, Naperville, IL, United States
(Ponikowski) Department of Heart Diseases, Medical University, Military
Hospital, Wroclaw, Poland
(Javaheri) Bethesda North Hospital, Cincinnati, OH, United States
(Augostini, Khayat, Abraham) Ohio State University, Columbus, OH, United
States
(Goldberg) University of Pennsylvania, Philadelphia, PA, United States
(Holcomb) Independent Biostatistician, Minneapolis, MN, United States
(Kao) Mid America Heart Institute, Kansas City, MO, United States
(Oldenburg) Bad Oeynhausen Heart and Diabetes Centre, Bad Oeynhausen,
Germany
(Stellbrink) Bielefeld Medical Centre, Bielefeld, Germany
Title
Transvenous neurostimulation for central sleep apnoea: a randomised
controlled trial.
Source
The Lancet. 388 (10048) (pp 974-982), 2016. Date of Publication: 03 Sep
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Central sleep apnoea is a serious breathing disorder associated
with poor outcomes. The remede system (Respicardia Inc, Minnetonka, MN,
USA) is an implantable device which transvenously stimulates a nerve
causing diaphragmatic contraction similar to normal breathing. We
evaluated the safety and effectiveness of unilateral neurostimulation in
patients with central sleep apnoea. Methods We recruited patients from 31
hospital-based centres in Germany, Poland, and the USA in this
prospective, multicentre, randomised trial. Participants had to have been
medically stable for at least 30 days and have received appropriate
guideline recommended therapy, be aged at least 18 years, be expected to
tolerate study procedures, and willing and able to comply with study
requirements. Eligible patients with an apnoea-hypopnoea index (AHI) of at
least 20 events per h, tested by a polysomnography, underwent device
implantation and were randomly assigned (1:1) by a computer-generated
method stratified by site to either stimulation (treatment) or no
stimulation (control) for 6 months. The primary effectiveness endpoint in
the intention-to-treat population was the comparison of the proportions of
patients in the treatment versus control groups achieving a 50% or greater
AHI reduction from baseline to 6 months, measured by a full-night
polysomnography assessed by masked investigators in a core laboratory. The
primary safety endpoint of 12-month freedom from serious adverse events
related to the procedure, system, or therapy was evaluated in all
patients. This trial is active, but not recruiting, and is registered with
ClinicalTrials.gov (NCT01816776). Findings Between April 17, 2013, and May
28, 2015, we randomly assigned 151 eligible patients to the treatment
(n=73) or control (n=78) groups. In the analysis of the intention-to-treat
population, significantly more patients in the treatment group (35 [51%]
of 68) had an AHI reduction from baseline of 50% or greater at 6 months
than had those in the control group (eight [11%] of 73; difference between
groups 41%, 95% CI 25-54, p<0.0001). 138 (91%) of 151 patients had no
serious-related adverse events at 12 months. Seven (9%) cases of
related-serious adverse events occurred in the control group and six (8%)
cases were reported in the treatment group. Seven patients died (unrelated
to implant, system, or therapy), four deaths (two in treatment group and
two in control group) during the 6-month randomisation period when
neurostimulation was delivered to only the treatment group and was off in
the control group, and three deaths between 6 months and 12 months of
follow-up when all patients received neurostimulation. 27 (37%) of 73
patients in the treatment group reported non-serious therapy-related
discomfort that was resolved with simple system reprogramming in 26 (36%)
patients, but was unresolved in one (1%) patient. Interpretation
Transvenous neurostimulation significantly reduced the severity of central
sleep apnoea, including improvements in sleep metrics, and was well
tolerated. The clinically meaningful effects of the therapy are supported
by the concordant improvements in oxygenation and quality of life, making
transvenous neurostimulation a promising therapeutic approach for central
sleep apnoea. Funding Respicardia Inc. Copyright &#xa9; 2016 Elsevier Ltd

<59>
Accession Number
613173107
Author
Biedrzycka A.; Kowalik M.; Pawlaczyk R.; Jagielak D.; Swietlik D.;
Szymanowicz W.; Lango R.
Institution
(Biedrzycka) Department of Anaesthesiology and Intensive Care, Medical
University of Gdansk, Gdansk, Poland
(Kowalik, Szymanowicz, Lango) Department of Cardiac Anaesthesia, Medical
University of Gdansk, Debinki Street 7, Gdansk 80-211, Poland
(Pawlaczyk, Jagielak) Department of Cardiac and Vascular Surgery, Medical
University of Gdansk, Gdansk, Poland
(Swietlik) Intrafaculty College of Medical Informatics and Biostatistics,
Medical University of Gdansk, Gdansk, Poland
Title
Aortic cross-clamping phase of cardiopulmonary bypass is related to
decreased microvascular reactivity after short-term ischaemia of the
thenar muscle both under intravenous and volatile anaesthesia: A
randomized trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 770-778),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES The purpose of the present study was to assess, by
near-infrared spectroscopy with an INVOS oximeter during the vascular
occlusion test (VOT), the influence of cardiopulmonary bypass (CPB) on
tissue saturation in the thenar muscle. The secondary aim was to compare
the effects of propofol and sevoflurane anaesthesia on tissue saturation.
METHODS This was a prospective, randomized, open-label study. Sixty
cardiac surgery patients received either propofol or sevoflurane
anaesthesia. Three-minute VOT was performed at the following time points:
30 min after anaesthesia induction, directly after sternotomy, 20 and 40
min after aortic cross-clamping, 20 min after aortic cross-clamp removal
and 45 min after weaning of cardiopulmonary bypass. Group and time effects
on tissue saturation were analysed with RM-ANOVA and the post hoc Tukey
test. RESULTS In both groups at baseline, the lowest and the highest
tissue saturation and the rate of saturation recovery during the
reperfusion phase of the vascular occlusion test were lower during aortic
cross-clamping in comparison to the values before CPB. Lower nadir tissue
saturation during ischaemia was observed under propofol in comparison to
sevoflurane anaesthesia (P = 0.018). CONCLUSIONS This study demonstrated
that the aortic cross-clamping phase of CPB cardiac surgery is associated
with lower values of tissue saturation and a decreased rate of saturation
recovery under both propofol and sevoflurane anaesthesia. Aortic
cross-clamp release is followed by accelerated tissue desaturation during
VOT. Propofol anaesthesia for CPB cardiac surgery results in greater
reduction of nadir tissue saturation during the ischaemic phase of VOT in
comparison to that of sevoflurane. TRIAL REGISTRATION NUMBER NCT02593448
Copyright &#xa9; 2016 The Author 2016. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<60>
Accession Number
613172839
Author
Gabriel J.; Gobolos L.; Miskolczi S.; Barlow C.
Institution
(Gabriel) Royal Bournemouth Hospital, Castle Lane East, Bournemouth,
Dorset BH7 7DW, United Kingdom
(Gobolos, Miskolczi, Barlow) Wessex Cardiothoracic Centre, Southampton
University Hospital, NHS Trust, Southampton, United Kingdom
Title
How safe is it to train residents to perform mitral valve surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 810-813),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic was constructed according to a structured protocol.
The enquiry: In [patients undergoing mitral valve surgery] are
[postoperative morbidity and mortality outcomes] acceptable when patients
are operated on by [residents]? Four hundred and twenty-three were
identified from the search strategy. Six articles selected as best
evidence were tabulated. All current published evidence, encompassing open
and minimally invasive mitral valve repair in addition to mitral valve
replacement, supports the involvement of trainees in mitral procedures.
Although trainees may experience longer aortic cross-clamp and
cardiopulmonary bypass times than specialist surgeons, they are not
associated with significantly worse perioperative or postoperative
outcomes in comparable mitral procedures. Important factors in the
viability of mitral valve training and its quality include the volume of
cases per institution and the expertise of the supervising surgeon, and
these remain largely unexplored. Overall, mitral valve surgery remains a
valuable potential training opportunity, one which is perhaps
underexploited. Copyright &#xa9; 2016 The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<61>
Accession Number
613172482
Author
Anastasiadis K.; Antonitsis P.; Vranis K.; Kleontas A.; Asteriou C.;
Grosomanidis V.; Tossios P.; Argiriadou H.
Institution
(Anastasiadis, Antonitsis, Vranis, Kleontas, Asteriou, Grosomanidis,
Tossios, Argiriadou) Cardiothoracic Department, AHEPA University Hospital,
S. Kyriakidi 1, Thessaloniki 546 36, Greece
Title
Effectiveness of prophylactic levosimendan in patients with impaired left
ventricular function undergoing coronary artery bypass grafting: A
randomized pilot study.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 740-747),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES Perioperative low cardiac output syndrome occurs in 3-14% of
patients undergoing isolated coronary artery bypass grafting (CABG),
leading to significant increase in major morbidity and mortality.
Considering the unique pharmacological and pharmacokinetic properties of
levosimendan, we conducted a prospective, double-blind, randomized pilot
study to evaluate the effectiveness of prophylactic levosimendan in
patients with impaired left ventricular function undergoing CABG. METHODS
Thirty-two patients undergoing CABG with low left ventricular ejection
fraction (LVEF < 40%) were randomized to receive either a continuous
infusion of levosimendan at a dose of 0.1 mug/kg/min for 24 h without a
loading dose or a placebo. The primary outcome of the study was the change
in the LVEF assessed with transthoracic echocardiography on the seventh
postoperative day. Secondary outcomes included the physiological and
clinical effects of levosimendan. RESULTS All patients tolerated
preoperative infusion of levosimendan well. The LVEF improved in both
groups; this increase was statistically significant in the levosimendan
group (from 35.8 +/- 5% preoperatively to 42.8 +/- 7.8%, P = 0.001)
compared with the control group (from 37.5 +/- 3.4% preoperatively to 41.2
+/- 8.3%, P = 0.1). The cardiac index, SvO<inf>2</inf>, pulmonary
capillary wedge pressure and right ventricular stroke work index showed a
similar trend, which was optimized in patients treated with levosimendan.
Moreover, an increase in extravascular lung water was noticed in this
group during the first 24 h after surgery. CONCLUSIONS This pilot study
shows that prophylactic levosimendan infusion is safe and effective in
increasing the LVEF postoperatively in patients with impaired cardiac
function undergoing coronary surgery. This finding may be translated to
'optimizing' patients' status before surgery. Copyright &#xa9; 2016 The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<62>
Accession Number
613172447
Author
Kowalowka A.R.; Onyszczuk M.; Wanha W.; Deja M.A.
Institution
(Kowalowka, Onyszczuk, Deja) Department of Cardiac Surgery, Medical
University of Silesia, School of Medicine in Katowice, Katowice, Poland
(Wanha) Third Department of Cardiology, Medical University of Silesia,
School of Medicine in Katowice, Katowice, Poland
Title
Do we have to operate on moderate functional mitral regurgitation during
aortic valve replacement for aortic stenosis?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 806-809),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Do we have to operate on
moderate functional mitral regurgitation (FMR) during aortic valve
replacement (AVR) for aortic stenosis (AS)?' Altogether 325 papers were
found using the reported search, of which 9 represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. The current evidence obtained from
these papers revealed that the significant predictors of improvement
outcome include lower preoperative mitral regurgitation and lower
preoperative left ventricle fractional area change. We also know that
persistent atrial fibrillation, enlarged left atrium, increased indexed
left ventricular mass, pulmonary hypertension and preoperative peak aortic
valve gradient <60 mmHg are predictors of deterioration. Generally, we
observed a trend towards improvement or non-progression of FMR following
AVR for AS. In the six papers that suggest conservative treatment of FMR,
the degree of mitral regurgitation (MR) improved in 45-95%, remained
unchanged in 19-38% and deteriorated in 1-14%. In the three papers
favoring surgical treatment of MR, the degree of MR improved in 46-69%,
stay unchanged in 34-53% and deteriorated in 10%. The current evidence
suggests that moderate or less grade of FMR without predictors of
deterioration should be treated conservatively and moderate-severe and
severe FMR warrants additional surgical procedure. A clearly randomized
study, especially in patients with moderate and moderate-severe FMR for
AS, seems appropriate to further elucidate surgical strategy. Copyright
&#xa9; 2016 The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<63>
Accession Number
613171983
Author
Lex J.R.; Naidu B.
Institution
(Lex, Naidu) University of Birmingham, Medical School, Birmingham, United
Kingdom
(Naidu) Department of Thoracic Surgery, Heart of England NHS Foundation
Trust, Birmingham, United Kingdom
Title
In patients with resectable non-small-cell lung cancer, is video-assisted
thoracoscopic segmentectomy an appropriate alternative to video-assisted
thoracoscopic lobectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 826-831),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'In patients with
resectable non-small-cell lung cancer, is video-assisted thoracoscopic
segmentectomy an appropriate alternative to video-assisted thoracoscopic
lobectomy?' Two hundred papers were found using the reported search, of
which 8 represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
In one meta-analysis identified, there was no significant difference
observed between groups in overall survival (HR = 0.808, 95% CI
0.556-1.174). All other studies identified also found no significant
difference in overall survival. As well, local and distant recurrence
rates and disease-free survival were similar in all studies. Two studies
identified a significantly greater number of lymph nodes dissected with
the video-assisted thoracosopic surgery (VATS) lobectomy procedure;
however, all other studies noted no significant difference. There was
evidence from two studies that VATS segmentectomy is associated with a
shorter length of hospital stay than lobectomy. Between both groups, there
was an overall low number of postoperative complications and 30-day
mortality (highest n = 2), highlighting the safety of both procedures.
Three studies compared patient groups with similar tumour sizes; the
average tumour size was 17 +/- 1 mm. However, in the four other
observational studies, the tumour size in the VATS lobectomy group was
significantly larger. From the limited evidence currently available, VATS
segmentectomy appears to be a valid alternative to VATS lobectomy. The
included studies were mainly retrospective observational studies, with one
meta-analysis; however, there are currently two large randomized trials
ongoing with results expected to be reported in 2021. Copyright &#xa9;
2016 The Author 2016. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<64>
Accession Number
613171903
Author
Gao H.; Zhang N.; Lu F.; Yu X.; Zhu L.; Mo X.; Wang W.
Institution
(Gao, Zhang, Lu, Yu, Zhu, Wang) Department of Cardiothoracic Surgery,
Shanghai Children's Medical Center, Shanghai Jiaotong University, School
of Medicine, 1678 Dongfang Road, Pudong, Shanghai 200127, China
(Mo) Institute for Pediatric Translational Medicine, Shanghai Children's
Medical Center, Shanghai Jiaotong University, School of Medicine,
Shanghai, China
Title
Circulating histones for predicting prognosis after cardiac surgery: A
prospective study.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 681-687),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES The objective of this study was to assess the perioperative
changes in circulating histones and their relationships with other
biomarkers and clinical outcomes after cardiac surgery with
cardiopulmonary bypass (CPB) in patients. METHODS Forty-eight patients
with congenital cardiac diseases undergoing corrective procedure with CPB
were prospectively enrolled in this study. Circulating histones,
N-terminal pro-brain natriuretic peptide (NT-proBNP), procalcitonin (PCT)
and C-reactive protein (CRP) were measured preoperatively (T0) and at 0
(T1), 24 (T2), 48 (T3) and 72 (T4) h postoperatively. The relationships
between biomarkers and clinical outcomes were analysed. RESULTS
Circulating histones, NT-proBNP, PCT and CRP increased significantly
postoperatively, with histones reaching the peak value earliest at T1.
Circulating histone levels were higher in patients with adverse events.
Receiver operating characteristic curve analysis showed that peak histone
levels had a better predictive value for adverse events postoperatively.
Peak histone levels correlated with the peak level of NT-proBNP (r =
0.563, P < 0.01), PCT (r = 0.551, P < 0.01), CRP (r = 0.606, P < 0.01) and
clinical parameters such as ventilation time (r = 0.601, P < 0.01) and
intensive care unit time (r = 0.623, P < 0.01). CONCLUSIONS Circulating
histones reached peak levels faster than NT-proBNP, PCT and CRP.
Furthermore, peak histone levels correlated with biomarkers and
postoperative clinical outcomes. Circulating histones may be used as a
prognostic indicator for patients after cardiac surgery with CPB. CLINICAL
TRIALS ClinicalTrials.gov (ID: NCT02325765). Copyright &#xa9; 2016 The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<65>
Accession Number
613171898
Author
Spitzer E.; Hadorn S.; Zanchin T.; Yamaji K.; Moschovitis A.; Pilgrim T.;
Stortecky S.; Juni P.; Heg D.; Windecker S.; Raber L.
Institution
(Spitzer, Hadorn, Zanchin, Yamaji, Moschovitis, Pilgrim, Stortecky,
Windecker, Raber) Department of Cardiology, Bern University Hospital, Bern
3010, Switzerland
(Juni) Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Department of Medicine, Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, Canada
(Heg) Institute of Social and Preventive Medecine, Clinical Trials Unit,
University of Bern, Bern, Switzerland
Title
External validity of a contemporaneous primary percutaneous coronary
intervention trial in patients with acute ST-elevation myocardial
infarction: Insights from a single-centre investigation.
Source
EuroIntervention. 12 (9) (pp 1135-1143), 2016. Date of Publication:
October 2016.
Publisher
EuroPCR
Abstract
Aims: Randomised controlled trials (RCTs) represent the most robust source
of evidence-based medicine. However, the generalisability of RCTs is
limited by the inclusion of selected populations. We sought to assess the
external validity of a contemporary trial including patients with
ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous
coronary intervention (PPCI). Methods and results: Patients presenting to
Bern University Hospital during the inclusion period of the COMFORTABLE
AMI trial were divided into three groups: RCT participants (41%), eligible
not included (17.5%), and excluded patients (41.5%). Major adverse cardiac
events (MACE) were defined as one-year death and myocardial infarction.
RCT participants compared with RCT-eligible patients had comparable
baseline characteristics and outcomes; however, excluded patients differed
in risk and had higher rates of MACE (HR 3.63, 95% CI: 2.03-6.48,
p<0.001), death (HR 6.23, 95% CI: 2.93-13.24, p<0,001) and
definite/probable stent thrombosis (HR 3.63, 95% CI: 1.79-7.36, p<0.001).
Inability to provide consent was the most frequent exclusion criterion and
was independently associated with an increased risk for MACE (HR 6.85, 95%
CI: 3.97-11.81, p<0.001). Conclusions: In this single-centre
investigation, results from the COMFORTABLE AMI trial appeared applicable
to a broad representation of RCT-eligible patients. However, patients
excluded from the trial represented a higher-risk population with impaired
clinical outcomes and a lower adherence to cardiovascular medication.
Copyright &#xa9; 2016 Europa Digital & Publishing. All rights reserved.

<66>
Accession Number
613171590
Author
Chevalier B.; Onuma Y.; Van Boven A.J.; Piek J.J.; Sabate M.; Helqvist S.;
Baumbach A.; Smits P.C.; Kumar R.; Wasungu L.; Serruys P.W.
Institution
(Chevalier) Ramsay Generale de Sante, Institut Cardiovasculaire Paris Sud,
Massy, France
(Onuma) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Van Boven) Medical Center Leeuwarden, Leeuwarden, Netherlands
(Piek) AMC Heart Center, Academic Medical Center, Amsterdam, Netherlands
(Sabate) Thorax Institute, Hospital Clinic, University of Barcelona,
Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS),
Barcelona, Spain
(Helqvist) Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Baumbach) Bristol Heart Institute, Bristol, United Kingdom
(Smits) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Kumar, Wasungu) Abbott Vascular, Diegem, Belgium
(Serruys) International Centre for Cardiovascular Health, Imperial
College, South Kensington Campus, London SW7 2AZ, United Kingdom
Title
Randomised comparison of a bioresorbable everolimuseluting scaffold with a
metallic everolimus-eluting stent for ischaemic heart disease caused by de
novo native coronary artery lesions: The 2-year clinical outcomes of the
ABSORB II trial.
Source
EuroIntervention. 12 (9) (pp 1102-1107), 2016. Date of Publication:
October 2016.
Publisher
EuroPCR
Abstract
Aims: The one-year randomised data of the ABSORB II trial showed that the
everolimus-eluting bioresorbable scaffold and the everolimus-eluting
metallic stent were comparable for the composite secondary clinical
outcomes of patient-oriented composite endpoint (PoCE) and device-oriented
composite endpoint (DoCE)/target lesion failure (TLF), MACE and TVF. This
report describes the two-year clinical outcomes of the ABSORB II trial.
Methods and results: Patients were randomly assigned in a 2:1 ratio to
receive treatment with an everolimus-eluting bioresorbable scaffold
(Absorb; Abbott Vascular, Santa Clara, CA, USA) or treatment with an
everolimus-eluting metallic stent (XIENCE; Abbott Vascular). The trial
enrolled 501 patients. Clinical follow-up at two years was available in
320 patients in the Absorb BVS arm and 160 patients in the XIENCE arm. At
two years, the PoCE for the Absorb and XIENCE arms was 11.6% and 12.8%
(p=0.70) and the DoCE/TLF was 7.0% and 3.0% (p=0.07), respectively. The
hierarchical ID-MACE rate was 7.6% vs. 4.3% (p=0.16) and the rate of TVF
was 8.5% vs. 6.7% (p=0.48). The definite/probable thrombosis rate was 1.5%
in the Absorb arm vs. 0% in the XIENCE arm (p=0.17). Thirty-six percent
and 34% of patients remained on DAPT at two years, respectively.
Ninety-two percent of patients in both arms remained on aspirin.
Conclusions: Two-year clinical results demonstrate sustained low rates of
PoCE, MACE, DoCE and TVF with the Absorb BVS as compared to the XIENCE
stent. Copyright &#xa9; 2016 Europa Digital & Publishing. All rights
reserved.

<67>
Accession Number
607488205
Author
Kubo T.; Shinke T.; Okamura T.; Hibi K.; Nakazawa G.; Morino Y.; Shite J.;
Fusazaki T.; Otake H.; Kozuma K.; Akasaka T.
Institution
(Kubo, Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University, Wakayama, Japan
(Shinke, Otake) Department of Internal Medicine, Division of
Cardiovascular and Respiratory Medicine, Kobe University Graduate School
of Medicine, Kobe, Japan
(Okamura) Division of Cardiology, Department of Medicine and Clinical
Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
(Hibi) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Nakazawa) Division of Cardiology, Tokai University School of Medicine,
Isehara, Japan
(Morino, Fusazaki) Division of Cardiology, Iwate Medical University,
Morioka, Japan
(Shite) Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka,
Japan
(Kozuma) Division of Cardiology, Teikyo University School of Medicine,
Tokyo, Japan
Title
Optical frequency domain imaging vs. intravascular ultrasound in
percutaneous coronary intervention (OPINION trial): Study protocol for a
randomized controlled trial.
Source
Journal of Cardiology. 68 (5) (pp 455-460), 2016. Date of Publication: 01
Nov 2016.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Optical coherence tomography is becoming increasingly
widespread as an adjunctive intravascular diagnostic technique in
percutaneous coronary intervention (PCI), because of its ability to
visualize coronary structures at high resolution. Several studies have
reported that intravascular ultrasound (IVUS) guidance in PCI might be
helpful to reduce subsequent stent thrombosis, restenosis, repeat
revascularization, myocardial infarction, and cardiac death. The OPtical
frequency domain imaging vs. INtravascular ultrasound in percutaneous
coronary InterventiON (OPINION) trial is aimed at evaluating the impact of
optical frequency domain imaging (OFDI) guidance in PCI on clinical
outcomes compared with IVUS guidance. Methods and design The OPINION trial
is a multicenter, prospective, randomized, controlled, open-label,
parallel group, non-inferiority trial in Japan. The eligible patients are
randomly assigned to receive either OFDI-guided PCI or IVUS-guided PCI.
PCI is performed using the biolimus-eluting stent in accordance with a
certain criteria of OFDI and IVUS for optimal stent deployment. All
patients will undergo a follow-up angiography at 8 months. The primary
endpoint is target vessel failure composed of cardiac death, myocardial
infarction attributed to the target vessel, and clinically-driven target
vessel revascularization at 12 months. Conclusion When completed, the
OPINION trial will contribute to define the clinical value of the OFDI
guidance in PCI. Copyright &#xa9; 2015 Japanese College of Cardiology

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

<69>
Accession Number
613105017
Author
Forni Ogna V.; Menetrey I.; Muller O.; Tousset E.; Guihard L.; Fontana P.;
Eeckhout E.; Eap C.B.; Vrijens B.; Burnier M.; Wuerzner G.
Institution
(Forni Ogna, Menetrey, Guihard, Burnier, Wuerzner) Service of Nephrology
and Hypertension, Department of Medicine, Lausanne University Hospital,
Lausanne, Switzerland
(Muller, Eeckhout) Department of Cardiology, Lausanne University Hospital,
Lausanne, Switzerland
(Tousset, Vrijens) Aardex Group, Vise, Belgium
(Fontana) Division of Angiology and Hemostasis, Geneva University Hospital
and Faculty of Medicine, Geneva, Switzerland
(Eap) Unit of Biochemistry and Clinical Psychopharmacology, Center for
Psychiatric Neuroscience, Department of Psychiatry, Lausanne University
Hospital, Lausanne, Switzerland
Title
Effect of long-term adherence to clopidogrel on the VASP-PRI after
elective coronary stent implantation: a randomized controlled study.
Source
British Journal of Clinical Pharmacology. 82 (6) (pp 1486-1497), 2016.
Date of Publication: 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims: The biological response to clopidogrel is highly variable and a poor
responsiveness is associated with major adverse cardiac events. Adherence
to therapy is a major cause of poor responsiveness but its impact on
long-term platelet inhibition is unknown. The objective of the present
study was to evaluate the effect of different programmes monitoring
adherence to clopidogrel on platelet reactivity. Methods: The study took
the form of a monocentric, parallel group, randomized controlled trial.
Adults treated with clopidogrel 75 mg after elective coronary stenting
were randomized into one of three groups: (i) a standard of care group;
(ii) a standard of care + adherence electronic monitoring group, in which
drug intake was recorded but kept blinded until the study end; or (iii) an
integrated care group, with regular feedback on recorded adherence.
Clopidogrel response was assessed with the vasodilator-stimulated
phosphoprotein-platelet reactivity index (VASP-PRI) at randomization, 3
months and 6 months. Results: A total of 123 adults were enrolled and
randomized. Baseline VASP-PRI was highly variable, with a mean of 48 +/-
18.8%. No difference between groups in VASP-PRI was found at 6 months (P =
0.761), despite better adherence to clopidogrel in the integrated care
group. However, adherence (P = 0.035) and baseline VASP-PRI (P = 0.015)
were associated with VASP-PRI at 3 months and 6 months. The association
between adherence and VASP-PRI was lost in patients with baseline VASP-PRI
> 50%. Diabetes, CYP2C19*2 carrier status and body mass index were
significant predictors of VASP-PRI. Conclusions: The platelet response to
clopidogrel during chronic therapy remained highly variable, despite high
adherence. Different adherence monitoring programmes did not affect
VASP-PRI at 6 months. Poor adherence is associated with lower VASP-PRI
only in initial good responders to clopidogrel. Copyright &#xa9; 2016 The
British Pharmacological Society

<70>
Accession Number
601163408
Author
Clive A.O.; Wilson P.; Taylor H.; Morley A.J.; De Winton E.; Panakis N.;
Rahman N.; Pepperell J.; Howell T.; Batchelor T.J.P.; Jordan N.; Lee
Y.C.G.; Dobson L.; Maskell N.A.
Institution
(Clive, Morley, Jordan, Maskell) Respiratory Research Unit, North Bristol
NHS Trust, Southmead Hospital, Bristol, United Kingdom
(Clive, Maskell) Academic Respiratory Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Wilson) University Hospitals Bristol NHS Trust, Bristol, United Kingdom
(Taylor) Research Design Service South West, Bristol, United Kingdom
(De Winton) Royal United Hospital, Bath, United Kingdom
(Panakis, Rahman) Oxford University Hospitals NHS Trust, Oxford, United
Kingdom
(Pepperell) Musgrove Park Hospital, Taunton, United Kingdom
(Howell) Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
(Batchelor) University Hospitals Bristol NHS Foundation Trust, Bristol,
United Kingdom
(Lee) Allergy and Respiratory Research, School of Medicine and
Pharmacology, University of Western Australia, Perth, Australia
(Dobson) South Devon Healthcare NHS Foundation Trust, Torbay, United
Kingdom
Title
Protocol for the surgical and large bore procedures in malignant pleural
mesothelioma and radiotherapy trial (Smart Trial): An RCT evaluating
whether prophylactic radiotherapy reduces the incidence of procedure tract
metastases.
Source
BMJ Open. 5 (1) (no pagination), 2015. Article Number: e006673. Date of
Publication: 01 Jan 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Patients with malignant pleural mesothelioma (MPM) may develop painful
'procedure tract metastasis' (PTM) at the site of previous pleural
interventions. Prophylactic radiotherapy has been used to minimise this
complication; however, three small randomised trials have shown
conflicting results regarding its effectiveness. The surgical and large
bore procedures in malignant pleural mesothelioma and radiotherapy trial
(SMART Trial) is a suitably powered, multicentre, randomised controlled
trial, designed to evaluate the efficacy of prophylactic radiotherapy
within 2 days of pleural instrumentation in preventing the development of
PTM in MPM. Methods and analysis: 203 patients with a histocytologically
proven diagnosis of MPM, who have undergone a large bore pleural
intervention (thoracic surgery, large bore chest drain, indwelling pleural
catheter or local anaesthetic thoracoscopy) in the previous 35 days, will
be recruited from UK hospitals. Patients will be randomised (1:1) to
receive immediate radiotherapy (21 Gy in 3 fractions over 3 working days
within 42 days of the pleural intervention) or deferred radiotherapy (21
Gy in 3 fractions over 3 working days given if a PTM develops). Patients
will be followed up for 12 months. The primary outcome measure is the rate
of PTM until death or 12 months (whichever is sooner), as defined by the
presence of a clinically palpable nodule of at least 1 cm diameter felt
within cm of the margins of the procedure site as confirmed by two
assessors. Secondary outcome measures include chest pain, quality of life,
analgaesic requirements, healthcare utilisation and safety (including
radiotherapy toxicity). Ethics and dissemination: The trial has received
ethical approval from the Southampton B Research Ethics Committee
(11/SC/0408). There is a Trial Steering Committee, including independent
members and a patient and public representative. The trial results will be
published in a peer-reviewed journal and presented at international
conferences. Trial registration number: ISRCTN72767336.

<71>
[Use Link to view the full text]
Accession Number
605252052
Author
Bagai A.; Huang Z.; Lokhnygina Y.; Harrington R.A.; Armstrong P.W.; Strony
J.; White H.D.; Leonardi S.; Held C.; Van De Werf F.; Wallentin L.;
Tricoci P.; Mahaffey K.W.
Institution
(Bagai) Terrence Donnelly Heart Center, St. Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Bagai, Huang, Lokhnygina, Leonardi, Tricoci) Department of Medicine, Duke
Clinical Research Center, Duke University, Durham, NC, United States
(Harrington, Mahaffey) Department of Medicine, Stanford University, CA,
United States
(Armstrong) Department of Medicine, University of Alberta, Edmonton,
Canada
(Strony) Merck and Co, Whitehouse Station, NJ, United States
(White) Department of Medicine, Green Lane Cardiovascular Service,
Auckland, New Zealand
(Leonardi) Department of Medicine, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
(Held, Wallentin) Department of Medicine, Uppsala Clinical Research
Center, Uppsala University, Sweden
(Van De Werf) Department of Medicine, University Hospitals Leuven, Leuven,
Belgium
Title
Magnitude of troponin elevation and long-term clinical outcomes in acute
coronary syndrome patients treated with and without revascularization.
Source
Circulation: Cardiovascular Interventions. 8 (6) (no pagination), 2015.
Article Number: e002314. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
In patients with non-ST-segment-elevation acute coronary syndrome (NSTE
ACS), elevated troponin levels identify patients at high risk for adverse
outcomes; however, it is unknown whether the magnitude of troponin
elevation during hospitalization remains predictive of subsequent events
in patients undergoing coronary revascularization. Methods and Results-We
studied 12 635 patients with NSTE ACS in the Thrombin Receptor Antagonist
for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) study
with at least 1 troponin measurement during index hospitalization. Cox
proportional hazards regression was used to examine the relationship
between peak troponin level (standardized as the ratio of peak troponin
value measured during hospitalization and local laboratory upper reference
limit [URL]) and revascularization on all-cause mortality at 2 years.
Revascularization (percutaneous coronary intervention or coronary artery
bypass graft) was performed during index hospitalization in 8586 patients
(68.0%); revascularized patients had higher peak troponin ratios (median,
23 versus 9.5x URL). Among patients that did not undergo
revascularization, the mortality rate at 2 years increased in a
curvilinear fashion with increasing levels of peak troponin. In contrast,
the mortality rate at 2 years remained constant irrespective of peak
troponin levels among revascularized patients (P for interaction=0.004).
This relationship was unchanged after multivariable adjustment.
Conclusions-There is a differential relationship between the magnitude of
troponin elevation and long-term mortality in ACS patients treated with
and without revascularization. Although prognostically important in
patients treated without revascularization, the prognostic implications of
peak troponin level seem to be minimal in revascularized patients.
Copyright &#xa9; 2015 American Heart Association, Inc.

<72>
Accession Number
605197683
Author
Wang Q.; Li Y.-H.; Wang T.-L.; Feng H.; Cai B.
Institution
(Wang, Li, Wang, Feng, Cai) Department of Anesthesiology, Xuan Wu
Hospital, Capital Medical University, Beijing 100053, China
Title
Protective effect of low-dose sevoflurane inhalation and propofol
anesthesia on the myocardium after carotid endarterectomy: A randomized
controlled trial.
Source
Chinese Medical Journal. 128 (14) (pp 1862-1866), 2015. Date of
Publication: 07 Jan 2015.
Publisher
Chinese Medical Association
Abstract
Background: Myocardial infarction is an important cause of mortality after
carotid endarterectomy (CEA). Sevoflurane provides myocardial protection
to patients undergoing coronary surgery, but whether it also reduces the
incidence of myocardial injury in CEA patients is unclear. In this study,
we evaluated the cardioprotective effect of low-dose sevoflurane with
propofol in patients undergoing CEA. Methods: This was a single-center,
prospective, randomized study conducted between November 2011 and December
2013. The study population of 122 patients who underwent CEA were randomly
assigned to two groups. Group A (n = 62) received propofol for anesthetic
maintenance, and Group B (n = 60) additionally received 0.8% end-tidal
sevoflurane. The bispectral index was kept at 40-60. Myocardial injury,
defined as cardiac troponin I (cTnI) levels >0.04 ng/ml, was the primary
end-point. Levels of cTnI were measured before anesthesia, and at 4, 24,
and 72 h after surgery. Perioperative hemodynamic parameters and adverse
cardiovascular events after surgery were also recorded. Results:
Myocardial injury was detected in 18 patients in Group A and 7 in Group B.
The difference was statistically significant (29.0% vs. 11.7%, P = 0.018).
The hemodynamic parameters were comparable between the groups, as were
adverse cardiovascular events (P = 0.619). Conclusions: Low-dose
sevoflurane inhalation along with propofol reduces the incidence of
myocardial injury in symptomatic patients after CEA. Copyright &#xa9;
2015, Chinese Medical Association. All rights reserved.

<73>
Accession Number
604815165
Author
Bagan P.; De Dominicis F.; Hernigou J.; Dakhil B.; Zaimi R.; Pricopi C.;
Le Pimpec Barthes F.; Berna P.
Institution
(Bagan, Hernigou, Dakhil, Zaimi) Department of Thoracic and Vascular
Surgery, Victor Dupouy Hospital, rue du lieut, Prudhon, Argenteuil 95100,
France
(Bagan, De Dominicis, Berna) Department of Thoracic Surgery, Amiens
Picardie University Hospital, Amiens, France
(Bagan, Pricopi, Le Pimpec Barthes) Department of Thoracic Surgery and
Lung Transplantation, Pompidou European Hospital, Paris V University,
Paris, France
Title
Complete thoracoscopic lobectomy for cancer: Comparative study of
three-dimensional high-definition with two-dimensional high-definition
video systems.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (6) (pp 820-824),
2015. Date of Publication: 01 Jun 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES Common video systems for video-assisted thoracic surgery (VATS)
provide the surgeon a two-dimensional (2D) image. This study aimed to
evaluate performances of a new three-dimensional high definition (3D-HD)
system in comparison with a two-dimensional high definition (2D-HD) system
when conducting a complete thoracoscopic lobectomy (CTL). METHODS This
multi-institutional comparative study trialled two video systems: 2D-HD
and 3D-HD video systems used to conduct the same type of CTL. The
inclusion criteria were T1N0M0 non-small-cell lung carcinoma (NSCLC) in
the left lower lobe and suitable for thoracoscopic resection. The CTL was
performed by the same surgeon using either a 3D-HD or 2D-HD system.
Eighteen patients with NSCLC were included in the study between January
and December 2013: 14 males, 4 females, with a median age of 65.6 years
(range: 49-81). The patients were randomized before inclusion into two
groups: to undergo surgery with the use of a 2D-HD or 3D-HD system. We
compared operating time, the drainage duration, hospital stay and the N
upstaging rate from the definitive histology. RESULTS The use of the 3D-HD
system significantly reduced the surgical time (by 17%). However,
chest-tube drainage, hospital stay, the number of lymph-node stations and
upstaging were similar in both groups. CONCLUSIONS The main finding was
that 3D-HD system significantly reduced the surgical time needed to
complete the lobectomy. Thus, future integration of 3D-HD systems should
improve thoracoscopic surgery, and enable more complex resections to be
performed. It will also help advance the field of endoscopically assisted
surgery. Copyright &#xa9; The Author 2015. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.

<74>
Accession Number
613140264
Author
Aldemir M.; Koca H.B.; Baki E.D.; Carsanba G.; Kavrut N.O.; Kavakli A.S.;
Adali F.; Emmiler M.; Darcin O.T.
Institution
(Aldemir, Carsanba, Adali, Darcin) Department of Cardiovascular Surgery,
Faculty of Medicine, Kocatepe University, Afyonkarahisar, Turkey
(Koca) Department of Clinical Biochemistry, Faculty of Medicine, Kocatepe
University, Afyonkarahisar, Turkey
(Baki) Departments of Anesthesiology and Reanimation, Faculty of Medicine,
Kocatepe University, Afyonkarahisar, Turkey
(Kavrut, Kavakli) Departments of Anesthesiology and Reanimation, Antalya
Education and Research Hospital, Antalya, Turkey
(Emmiler) Department of Cardiovascular Surgery, Antalya Education and
Research Hospital, Antalya, Turkey
Title
Effects of N-acetyl cysteine on renal functions evaluated by blood
neutrophil gelatinase-associated lipocalin levels in geriatric patients
undergoing coronary artery bypass grafting.
Source
Anatolian Journal of Cardiology. 16 (7) (pp 504-511), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Recent conflicting studies on the renal effects of N-acetyl
cysteine (NAC) after cardiac surgery have been published. The aim of this
study was to evaluate the renal effects of NAC using neutrophil
gelatinase-associated lipocalin (NGAL) blood levels in elderly patients
undergoing coronary artery bypass grafting (CABG). Methods: This
randomized, double-blinded, placebo-controlled study was conducted among
geriatric patients (>65 years) scheduled to undergo CABG. A total of 60
consecutive patients were randomly assigned to 2 groups. The first group
received I.V. NAC (n=30) and the second group received placebo (n=30) at
induction of anesthesia and then for 20 h. NGAL values were determined and
conventional renal function tests were performed. Statistical analysis was
performed using SPSS 17.0 (IL, Chicago, USA). A p value of <0.05 was
considered statistically significant Results: Plasma creatinine levels at
24 h postoperatively were significantly higher in the placebo group than
in the NAC group (1.41+/-0.63 vs. 1.13+/-0.35; p<0.05). The mean serum
NGAL levels at 3 h postoperatively were higher in the placebo group than
in the NAC group (104.94+/-30.51 vs. 87.82+/-25.18; p<0.05). NGAL levels
were similar between the groups at all other measurement time points.
Plasma creatinine levels of >1.5 mg/dL or >25% of the baseline value at
any time during the study period were observed in 27% of patients in the
NAC group and 37% of patients in the placebo group; the difference was
statistically significant (p<0.05). Conclusion: In the present study, we
found that I.V. NAC infusion in elderly patients undergoing CABG reduced
the incidence of acute kidney injury as determined by blood NGAL and
creatinine levels. Copyright &#xa9; 2016 by Turkish Society of Cardiology.

<75>
Accession Number
613139897
Author
Salim E.F.; Rezk M.E.
Institution
(Salim, Rezk) Cardiothoracic Surgery Department, Benha University, Benha,
Egypt
Title
Predictors of conversion from thoracoscopic to open surgery in management
of postpneumonic empyema.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (2) (pp
194-199), 2016. Date of Publication: 01 Aug 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) has an important
role in management of pleural empyema. The objective of this study was to
assess the predictors for conversion from VATS to open thoracotomy in an
assumed stage II postpneumonic empyema. Methods: This prospective
randomized study included 120 patients admitted to cardio-thoracic surgery
department, Benha University, between 2011 and 2016. All cases were
enrolled for thoracoscopic debridement for an assumed stage II
postpneumonic empyema. If stage III empyema was diagnosed during
thoracoscopy, conversion to thoracotomy became indicated. Predictors for
conversion to thoracotomy were assessed in a univariate, a bivariate
correlation and a multivariate analysis using several variables like age,
sex, associated comorbidities, duration of symptoms, pleural fluid
analysis, and pleural thickness measured by CT scan. Results: Out of 120
patients, thoracoscopic management was successful in 82 (68%) patients,
while conversion to thoracotomy was done in 38 (32%) patients. Conversion
to thoracotomy was higher in patients with long duration of symptoms (p <
0.001) with cutoff value at 18.1 days, increased pleural thickness (p <
0.001) with cutoff value at 3.95 mm, increased LDH with cutoff value at
1854 IU/L, and Gram-negative infection of pleural fluid (p < 0.001).
Multivariate analysis identified that the duration of symptoms,
gram-negative bacteria, LDH and pleural thickness were the significant
predictors for conversion from VATS to thoracotomy. Conclusion: Predictive
factors for conversion to thoracotomy in an assumed stage II postpneumonic
empyema include long duration, Gram-negative bacterial infection,
increased LDH, and increased pleural thickness. Copyright &#xa9; 2016, The
Egyptian Society of Cardio-thoracic Surgery.

<76>
Accession Number
613139863
Author
Wahby E.A.; Abo Elnasr M.M.; Eissa M.I.; Mahmoud S.M.
Institution
(Wahby, Abo Elnasr) Department of Cardiothoracic Surgery, Faculty of
Medicine, Tanta University, Egypt
(Eissa) Department of Cardiothoracic Surgery, National Heart Institute,
Egypt
(Mahmoud) Department of Internal Medicine, Faculty of Medicine, Tanta
University, Egypt
Title
Perioperative glycemic control in diabetic patients undergoing coronary
artery bypass graft surgery.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (2) (pp
143-149), 2016. Date of Publication: 01 Aug 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: The concept of perioperative glycemic control in cardiac
surgery patients was conducted in many studies, however, it remains
unclear how tight the glycemic control should be. Our aim is to study the
effect of perioperative tight glycemic control versus moderate glycemic
control on the outcome of diabetic patients undergoing coronary artery
bypass graft (CABG) surgery. Methods: This study is a randomized
prospective study conducted on 135 diabetic patients planned for CABG
surgery. Patients were divided into 2 groups: group A subjected to tight
glycemic control during operation to maintain blood glucose level between
110 and 149 mg/dl and group B subjected to conventional moderate glycemic
control to achieve blood glucose level between 150 and 180 mg/dl using
continuous insulin infusion started before anesthesia induction and
continued till the patient is extubated in ICU. Both groups were followed
up till 1 month after operation regarding operative mortality and
postoperative outcome. Results: No significant difference between both
groups in mortality, however there was statistical significant
relationship between tight glycemic control group and lowered incidence of
postoperative atrial fibrillation, sternal wound infection, need for
inotropic support and reduced time spent on mechanical ventilation.We
noticed reduction in incidence of acute renal failure in tight glycemic
control with no difference between both groups in neurological insults,
renal dysfunction and perioperative myocardial infarction. Conclusion:
Tight glycemic control improved perioperative outcome in diabetic CABG
patients. Maintaining perioperative blood glucose level between 110 and
149 mg/dl is safe and should be recommended as a routine practice in
diabetic patients undergoing CABG surgery. Copyright &#xa9; 2016, The
Egyptian Society of Cardio-thoracic Surgery.

<77>
Accession Number
613139849
Author
Elghonemy Y.F.; Hussein M.A.
Institution
(Elghonemy) Mansoura University, Egypt
(Hussein) Cairo University, Egypt
Title
Titanium plate fixation versus wire sternal closure in coronary artery
bypass graft patients: Need for rigid sternal fixation.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (2) (pp
150-158), 2016. Date of Publication: 01 Aug 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Sternal dehiscence and deep sternal wound infection mostly
coincide. Approximation and rigid fixation are cornerstones in supporting
good bony union.Wire cerclage is adequate for approximation butmay be
inadequate for sternal stability. So there is a need to study other
methods of sternal fixation (titanium plate fixation) and to compare with
the traditional wire cerclage method. Methods: Thirty isolated coronary
artery bypass graft (CABG) patients were followed in this study regarding
closure of their sternums; 15 with our method of concern: the Sternalock
plates (group A) and 15 with the conventional stainless steel wiring
(group B). The two groups were compared in a prospective non randomized
study in the period of Jan 2013 to Jan 2015. Patients were followed up
over 6 months postoperatively regarding pain among other factors. Results:
The two groups' demographics and perioperative variables were properly
matched. They were followed in-hospital, at one month and over 6 months
postoperatively: no mortalities; pain was much less in group A during
in-hospital and at 1 month follow but at six months; no significant pain
difference was detectable. Less narcotic need in group A but hospital stay
was almost the same. Both groups demonstrated good healing at the end of
the study with slightly higher incidence of wound infection and need for
refixation in group B. Conclusion: Sternal plating following CABG is
reproducible; easy to apply, not time consuming, easy reopening in case of
emergency, inert, with the benefit of less early postoperative pain and
narcotic use. Copyright &#xa9; 2016, The Egyptian Society of
Cardio-thoracic Surgery.

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

<79>
Accession Number
613138844
Author
Orchard T.J.; Backlund J.-Y.C.; Costacou T.; Cleary P.; Lopes-Virella M.;
Levy A.P.; Lachin J.M.
Institution
(Orchard, Costacou) Graduate School of Public Health, University of
Pittsburgh, Pittsburgh, PA, United States
(Backlund, Cleary, Lachin) The Biostatistics Center, The George Washington
University, Rockville, MD, United States
(Lopes-Virella) Medical University of South Carolina, Charleston, SC,
United States
(Levy) Israel Institute of Technology, Haifa, Israel
Title
Haptoglobin 2-2 genotype and the risk of coronary artery disease in the
Diabetes Control and Complications Trial/Epidemiology of Diabetes
Interventions and Complications study (DCCT/EDIC).
Source
Journal of Diabetes and its Complications. 30 (8) (pp 1577-1584), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aims/hypothesis Haptoglobin(Hp) 2-2 genotype has been shown to increase
coronary artery disease (CAD) risk in numerous type 2 diabetes studies but
in only one type 1 diabetes cohort. We assessed the association of Hp2-2
with incident CAD over 26 years of follow-up in 1303 Caucasian
participants of the Diabetes Control and Complications Trial/Epidemiology
of Diabetes Interventions and Complications (DCCT/EDIC) study. Methods
DCCT randomized volunteers with type 1 diabetes to intensive versus
conventional therapy within two cohorts: 'primary prevention' with 1-5
years diabetes duration and 'secondary intervention' with 1-15 years
diabetes duration and early retinopathy, with or without albuminuria, but
no advanced complications. CAD was defined as myocardial infarction (MI)
or death judged to be from CAD, silent MI, angina, coronary
revascularization, or congestive heart failure due to CAD. Results In the
entire DCCTcohort, Hp2-2 was not significantly associated with incident
CAD or MI. However, in pre-specified exploratory subgroup analyses, an
increased MI risk was suggested in the secondary cohort for those with
Hp2-2. Conclusions/interpretation The analysis does not statistically
confirm an overall association between Hp 2-2 and incident CAD, however,
some suggestions of associations were observed in secondary analyses.
Copyright &#xa9; 2016 Elsevier Inc.

<80>
Accession Number
613148285
Author
Celik E.; Zaim M.; Baydar C.; Acar B.; Sener U.
Institution
(Celik, Zaim) Kecioren Training and Research Hospital Department of
Otolaryngology, Pinarbasi Mah. Sanatoryum Cad. Ardahan Sok. i Kecioren,
Ankara, Turkey
(Baydar) Diskapi Yildirim Beyazit Training and Research Hospital,
Department of Norology, Irfan Bastug cad. Diskapi, Ankara, Turkey
(Acar) Kecioren Training and Research Hospital Department of
Otolaryngology, Pinarbasi Mah. Sanatoryum Cad. Ardahan Sok. Kecioren,
Ankara, Turkey
(Sener) Tepecik Training and Research Hospital Department of Norology,
Guney Mahallesi, Yenisehir-KonakIzmir, Turkey
Title
The upper respiratory tract findings that affect the compliance to
positive airway pressure treatment with nasal mask in obstructive sleep
apnea syndrome.
Source
Acta Medica Mediterranea. 32 (4) (pp 991-995), 2016. Date of Publication:
2016.
Publisher
A. CARBONE Editore (E-mail: carbone@imd.it)
Abstract
Introduction: The aim of this study is analysing that the compliance of
patient positive airway pressure treatment through nasal mask and if
necessary positive airway pressure compliance of patient to positive
airway pressure treatment after surgical treatment in the obstructive
sleep apnea syndrome patients. Materials and methods: In The Sleep
Disorder Laboratory of Ataturk Pulmonary Diseases and Thoracic Surgery
Hospital obstructive sleep apnea syndrome diagnosis patients, who are
planed by nasal continuous positive airway pressure treatment are viewed
for their nasal continuous positive airway pressure tolerances and these
patients were signed up as work and control groups. By randomizing these
group were refered to The Otolaryngology of Kecioren Training and Research
Hospital. The patients checked ear-nose-throat examination are reviewed
without awaring of which one is work group or control group. Result: As a
result of our research among the patients groups are able to tolerate or
not able to tolerate to the nasal continuous positive airway pressure
device and in apnea hypopnea index supine and collapse of soft palate
anterioposterior significant statistical differences were observed. (p <
0,05) From the point of septal deviation, inferior concha hypertrophy
significant statistical differences were not found. Conclusions: In spite
of the fact that the nasal pathologies are considered to influence the
compliance, there is no effect to the tolerance. The tolerance of
patients, even if the tongue base is not huge, can be connected with the
collapse in the tongue base and soft palate level.When the patients not
able to tolerated are reviewed, the collapse in the tongue base and soft
palate level are evaluated carefully.

<81>
Accession Number
613281882
Author
Kyavar M.; Karkhaneh S.; Rohanifar R.; Azarfarin R.; Sadeghpour A.;
Alizadehasl A.; Ghadrdoost B.
Institution
(Kyavar, Karkhaneh, Azarfarin, Sadeghpour, Alizadehasl, Ghadrdoost) Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Rohanifar) Shahid Beheshti University of Medical Sciences (SBUMS),
Tehran, Iran, Islamic Republic of
Title
Effect of preferred music listening on pain reduction in mechanically
ventilated patients after coronary artery bypass graft surgery.
Source
Research in Cardiovascular Medicine. 5 (4) (no pagination), 2016. Article
Number: e33769. Date of Publication: November 2016.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Background: Pain is a symptom of discomfort or tissue injury experienced
by patients. Amongpatients in intensive care unit (ICU), pain is a common
phenomenon. Objectives: The purpose of this study was to evaluate the
effect of preferred music listening on behavioral measures of pain, as an
indicator of pain assessment, in patients undergoing coronary artery
bypass graft surgery (CABG). PatientsandMethods: This blinded clinical
trial was performed on 60 patients admitted to ICU following CABG.
Patients intubated and those under mechanical ventilation were unable to
report their pain. The study population was randomly divided into two
groups of control and music intervention groups (preferred music
listening). In the intervention group, preferred music (including
classical, instrumental and traditional music as well as Quran recitation)
was played via a headphone for 30 minutes. In the control group, patients
were in bed at the same time and only mute headphones were used. The pain
levels of patients were assessed at three time intervals; a) during rest,
b) 10 minutes prior to receiving music, following a painful procedure
(e.g., change of position for dressing change) and c) in the final 3
minutes of music following a painful procedure using the method of
"critical care pain observation tools" (CPOT). Results: The mean pain
behavior scale score 10 minutes prior to receiving music, following a
painful procedure, was 2.77+/-1.04 in the music intervention group and
2.33+/-1.12 in the control group. The score increased after a painful
procedure compared to that before the procedure in the control group and
reached 2.67 +/- 1.124; this increase (0.34 unit) in the control group was
statistically significant (P = 0.008). In contrast, the score in the music
intervention group dropped to 2.20+/-1.06 and statistical tests showed a
significantly reduced pain behavior scale score in the music intervention
group (P < 0.001). Conclusions: The results of this study showed
beneficial effect of preferred music listening on reducing pain sensation
during painful procedures in intubated patients after CABG. Copyright
&#xa9; 2016, Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences.

<82>
Accession Number
613281690
Author
Alberto de Agustin J.; Juan Gomez de Diego J.; Mahia P.; Marcos-Alberca
P.; Almeria C.; Luis Rodrigo J.; Luaces M.; Javier Nunez-Gil I.; Macaya
C.; Perez de Isla L.
Institution
(Alberto de Agustin, Juan Gomez de Diego, Mahia, Marcos-Alberca, Almeria,
Luis Rodrigo, Luaces, Javier Nunez-Gil, Macaya, Perez de Isla) Department
of Cardiology, San Carlos University Hospital, Madrid, Spain
Title
Iatrogenic pathology of the aorta after interventional cardiology
procedures.
Source
Research in Cardiovascular Medicine. 5 (4) (no pagination), 2016. Article
Number: e33016. Date of Publication: November 2016.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Context: In this review, we tried to evaluate the incidence, prognosis and
treatment options in patients with iatrogenic pathology of the aortic
artery due to interventional procedures in cardiology. Evidence
Acquisition: Our search strategy involved an investigation in the PUBMED
database for every available article in peer reviewed journals between
1975 and 2015, for subjects related to iatrogenic pathology of the aortic
artery, following interventional procedures in cardiology (coronary
angiography or angioplasty, trans-catheter aortic valve implantation
(TAVI) or intra-aortic balloon pump (IABP) counterpulsation placement).
Results: Iatrogenic pathology of the aorta is a rare, but potentially
lethal complication of invasive vascular techniques. The development of
these complications should be considered in cases of unexplained
hypotension, acidosis or lower limb ischemia after catheter-based
interventions. With increased experience, most of the vascular
complications associated with the transfemoral approach may be managed
percutaneously. Conclusions: With the increase in interventional
procedures in cardiology, iatrogenic pathology of the aorta is seen more
frequently, and every cardiologist should know how to diagnose and treat
this group of diseases. Copyright &#xa9; 2016, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences.

<83>
Accession Number
613098948
Author
Elrggal M.E.; Kotb G.A.; Elghitani A.; Zyada R.
Institution
(Elrggal) Department of Nephrology, Kidney and Urology Center, Alexandria,
Egypt
(Kotb) Department of Nephrology, Alexandria University Students' Hospital,
Alexandria, Egypt
(Elghitani) Department of Clinical Pharmacy, Kidney and Urology Center,
Alexandria, Egypt
(Zyada) Department of Nephrology, Alexandria Main University Hospital,
Alexandria, Egypt
Title
Coronary revascularization in chronic kidney disease patients, external
validity of meta-analysis results.
Source
Kidney International. 90 (5) (pp 1131-1132), 2016. Date of Publication: 01
Nov 2016.
Publisher
Elsevier B.V.

<84>
Accession Number
613098652
Author
Grupper A.; Nativi-Nicolau J.; Maleszewski J.J.; Geske J.R.; Kremers W.K.;
Edwards B.S.; Kushwaha S.S.; Pereira N.L.
Institution
(Grupper, Nativi-Nicolau, Maleszewski, Edwards, Kushwaha, Pereira)
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota,
United States
(Maleszewski) Division of Anatomic Pathology, Mayo Clinic, Rochester,
Minnesota, United States
(Geske, Kremers) Division of Biomedical Statistics and Informatics, Mayo
Clinic, Rochester, Minnesota, United States
Title
Circulating Galectin-3 Levels Are Persistently Elevated After Heart
Transplantation and Are Associated With Renal Dysfunction.
Source
JACC: Heart Failure. 4 (11) (pp 847-856), 2016. Date of Publication: 01
Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study evaluated changes in serum levels of galectin
(Gal)-3 before and after heart transplantation (HTx) and assessed the role
of pre-HTx Gal-3 as a biomarker for post-HTx outcomes. Background Gal-3 is
a novel biomarker that reflects cardiac remodeling and fibrosis. Elevated
serum Gal-3 levels are associated with poor prognosis in heart failure
patients. Whether Gal-3 levels change following HTx and the significance
of post-HTx outcomes are unknown. Methods Serum Gal-3 levels were measured
in 62 patients at 118 days (Interquartile Range [IQR]: 23 to 798 days)
before and 365 days (IQR: 54 to 767 days) post HTx. Cardiac tissue taken
during routine post-HTx endomyocardial biopsy was evaluated to assess the
correlation between tissue Gal-3 staining and serum Gal-3 levels and with
the presence of myocardial hypertrophy and fibrosis. Results Serum Gal-3
levels remained significantly elevated (>17.8 ng/ml) in 35 patients (56%)
post HTx. There was a significant inverse correlation between Gal-3 levels
and glomerular filtration rate measured before and after HTx (p > 0.005).
There was no association between Gal-3 serum level and Gal-3 staining of
myocardial tissue or with the presence of myocyte hypertrophy and
interstitial fibrosis post HTx. Elevated pre-HTx Gal-3 levels were
associated with reduced post-HTx exercise capacity, but this association
was not significant after adjustment for age, body mass index, and
glomerular filtration rate. Conclusions This is the first study to
demonstrate the fact that Gal-3 levels remain elevated in the majority of
patients despite HTx and is associated with renal dysfunction. Our
findings suggest Gal-3 is a systemic rather than cardiac-specific
biomarker. Copyright &#xa9; 2016 American College of Cardiology Foundation

<85>
Accession Number
613090099
Author
Rajeswari K.; Kandaswamy D.; Karthick S.
Institution
(Rajeswari, Kandaswamy, Karthick) Department of Conservative Dentistry and
Endodontics, Faculty of Dental Sciences, Sri Ramachandra University,
Chennai, Tamil Nadu, India
Title
Endodontic management of patients with systemic complications.
Source
Journal of Pharmacy and Bioallied Sciences. 8 (pp S32-S35), 2016. Date of
Publication: October 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Successful endodontic practice requires complete knowledge about the
various medical conditions and appropriateness in planning treatment as
per the need with effective safety measures. This review focuses on a
number of systemic complications encountered in endodontic practice and
directions to be followed for avoiding potential complications. A detailed
PubMed search was carried out using specific keywords, and 25 articles
were referred for finalizing the content. Copyright &#xa9; 2016 Journal of
Pharmacy and Bioallied Sciences
Published by Wolters Kluwer-Medknow.

<86>
Accession Number
613253167
Author
Gaudin D.; Krafcik B.M.; Mansour T.R.; Alnemari A.
Institution
(Gaudin, Alnemari) Department of Surgery, Division of Neurological
Surgery, University of Toledo Medical Center, Toledo, Ohio, United States
(Krafcik, Mansour) University of Toledo College of Medicine, Toledo, Ohio,
United States
Title
Considerations in Spinal Fusion Surgery for Chronic Lumbar Pain:
Psychosocial Factors, Rating Scales, and Perioperative Patient Education-A
Review of the Literature.
Source
World Neurosurgery. 98 (pp 21-27), 2017. Date of Publication: 01 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective Despite widespread use of lumbar spinal fusion as a treatment
for back pain, outcomes remain variable. Optimizing patient selection can
help to reduce adverse outcomes. This literature review was conducted to
better understand factors associated with optimal postoperative results
after lumbar spinal fusion for chronic back pain and current tools used
for evaluation. Methods The PubMed database was searched for clinical
trials related to psychosocial determinants of outcome after lumbar spinal
fusion surgery; evaluation of commonly used patient subjective outcome
measures; and perioperative cognitive, behavioral, and educational
therapies. Reference lists of included studies were also searched by hand
for additional studies meeting inclusion and exclusion criteria. Results
Patients' perception of good health before surgery and low cardiovascular
comorbidity predict improved postoperative physical functional capacity
and greater patient satisfaction. Depression, tobacco use, and litigation
predict poorer outcomes after lumbar fusion. Incorporation of
cognitive-behavioral therapy perioperatively can address these
psychosocial risk factors and improve outcomes. The 36-Item Short Form
Health Survey, European Quality of Life five dimensions questionnaire,
visual analog pain scale, brief pain inventory, and Oswestry Disability
Index can provide specific feedback to track patient progress and are
important to understand when evaluating the current literature.
Conclusions This review summarizes current information and explains
commonly used assessment tools to guide clinicians in decision making when
caring for patients with lower back pain. When determining a treatment
algorithm, physicians must consider predictive psychosocial factors. Use
of perioperative cognitive-behavioral therapy and patient education can
improve outcomes after lumbar spinal fusion. Copyright &#xa9; 2016
Elsevier Inc.

<87>
Accession Number
613010109
Author
Peiyuan H.; Jingang Y.; Haiyan X.; Xiaojin G.; Ying X.; Yuan W.; Wei L.;
Yang W.; Xinran T.; Ruohua Y.; Chen J.; Lei S.; Xuan Z.; Rui F.; Yunqing
Y.; Qiuting D.; Hui S.; Xinxin Y.; Runlin G.; Yuejin Y.
Institution
(Peiyuan, Jingang, Haiyan, Xiaojin, Yuan, Lei, Xuan, Rui, Yunqing,
Qiuting, Hui, Xinxin, Runlin, Yuejin) Department of Cardiology,
Cardiovascular Institute and Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing 100037, China
(Ying) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States
(Wei, Yang, Xinran, Ruohua, Chen) Medical Research and Biometrics Center,
Cardiovascular Institute and Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing 100037, China
Title
The comparison of the outcomes between primary PCI, fibrinolysis, and no
reperfusion in patients > 75 years old with ST-segment elevation
myocardial infarction: Results from the Chinese acute myocardial
infarction (CAMI) registry.
Source
PLoS ONE. 11 (11) (no pagination), 2016. Article Number: e0165672. Date of
Publication: November 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Only a few randomized trials have analyzed the clinical
outcomes of elderly ST-segment elevation myocardial infarction (STEMI)
patients (> 75 years old). Therefore, the best reperfusion strategy has
not been well established. An observational study focused on clinical
outcomes was performed in this population. Methods: Based on the national
registry on STEMI patients, the in-hospital outcomes of elderly patients
with different reperfusion strategies were compared. The primary endpoint
was defined as death. Secondary endpoints included recurrent myocardial
infarction, ischemia driven revascularization, myocardial infarction
related complications, and major bleeding. Multivariable regression
analysis was performed to adjust for the baseline disparities between the
groups. Results: Patients who had primary percutaneous coronary
intervention (PCI) or fibrinolysis were relatively younger. They came to
hospital earlier, and had lower risk of death compared with patients who
had no reperfusion. The guideline recommended medications were more
frequently used in patients with primary PCI during the hospitalization
and at discharge. The rates of death were 7.7%, 15.0%, and 19.9%
respectively, with primary PCI, fibrinolysis, and no reperfusion (P <
0.001). Patients having primary PCI also had lower rates of heart failure,
mechanical complications, and cardiac arrest compared with fibrinolysis
and no reperfusion (P < 0.05). The rates of hemorrhage stroke (0.3%, 0.6%,
and 0.1%) and other major bleeding (3.0%, 5.0%, and 3.1%) were similar in
the primary PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the
multivariable regression analysis, primary PCI outweighs no reperfusion in
predicting the in-hospital death in patients > 75 years old. However,
fibrinolysis does not. Conclusions: Early reperfusion, especially primary
PCI was safe and effective with absolute reduction of mortality compared
with no reperfusion. However, certain randomized trials were encouraged to
support the conclusion. Copyright &#xa9; 2016 Peiyuan et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<88>
Accession Number
612917972
Author
Durham J.; Mackey W.C.
Institution
(Durham, Mackey) Tufts University School of Medicine and Tufts Medical
Center, Boston, Massachusetts, United States
Title
Perioperative beta-Blockade in Noncardiac Surgery: A Cautionary Tale of
Over-reliance on Small Randomized Prospective Trials.
Source
Clinical Therapeutics. 38 (10) (pp 2302-2316), 2016. Date of Publication:
01 Oct 2016.
Publisher
Excerpta Medica Inc.
Abstract
Purpose Our aim was to analyze the current scientific literature relevant
to the use of beta-adrenergic receptor antagonists for the prevention of
cardiovascular morbidity and mortality in patients undergoing noncardiac
surgery. Methods A PubMed search was conducted for the following concepts:
pre- or perioperative, beta-adrenergic receptor antagonist, treatment
outcome, and cardiovascular complication. Randomized clinical trials
measuring the effect of beta-adrenergic blocking agents against that of
placebo on cardiovascular outcomes after noncardiac surgery were included
in the review. Findings Two small randomized controlled trials published
in 1996 and 1999 reported associations between perioperative beta-blockade
and significant reductions in long-term and 30-day cardiac mortality,
respectively. These 2 studies prompted guideline changes in 2002
encouraging perioperative beta-blockade in subsets of noncardiac surgery
patients. However, subsequent trials failed to validate these results. In
2008, the first large randomized controlled trial on the topic was
published and found an association between perioperative beta-blockade and
an increase in perioperative mortality. Furthermore, in 2011, the lead
author of the 1999 study was dismissed from his academic position for
scientific misconduct, casting doubt on the validity of guidelines based
on his work. Existing studies are highly heterogeneous, making comparisons
difficult. Current literature does not support initiating perioperative
beta-blockade in noncardiac surgery patients not already receiving these
medications. Implications Future research on the topic should account for
the influence individual genetic variation can have on outcomes and
beta-blocker metabolism. Additionally, the relationship between outcomes
and the beta-1 selectivity of different beta-blockers should be explored.
Copyright &#xa9; 2016 Elsevier HS Journals, Inc.

<89>
Accession Number
612964686
Author
Zhan L.; Er J.; Zhai W.; Liu J.; Han J.
Institution
(Zhan, Er, Zhai, Liu, Han) Department of Anesthesiology, Tianjin Chest
Hospital, Tianjin, China
Title
Overall effect of sufentanil-propofol general anesthesia combined with
paravertebral block on patients with lung cancer resection.
Source
International Journal of Clinical and Experimental Medicine. 9 (10) (pp
20068-20073), 2016. Article Number: IJCEM0031861. Date of Publication: 30
Oct 2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
To study the overall clinical effect of sufentanil-propofol general
anesthesia combined with paravertebral block on patients underwent lung
cancer resection. 122 lung cancer patients underwent the pulmonary
lobectomy at the department of thoracic surgery from May 2014 to May 2015
were enrolled in this study. According to the digital meter method, they
were randomly divided into two groups, patients in observational group
were underwent CTPVB (continuous thoracic paravertebral block) and the
control group received PCIA (patient-controlled intravenous analgesia)
therapy. The operation time, intraoperative blood lose, eyes opening time
after calling, extubation time and the usage amount of sufentanil and
propofol were recorded in patients of two groups. The mean arterial
pressure (MAP) and heart rate (HR) were respectively recorded at different
time points of anesthesia pre-induction (E0), 5 min preoperatively (E1),
10 min after operation initiation (E2), 30 min after operation initiation
(E3) and the time when operation is finished (E4). Visual analogue scale
(VAS) was also recorded at 2 h, 6 h, 12 h and 24 h after operation. In
respect of comparison of general situations during perioperative period,
there were no significant differences in operative duration of two groups
(P>0.05), however the eyes opening time after calling, extubation time and
the usage amount of sufentanil and propofol were significantly less in
observational group than those of control group, with a statistically
significant difference (P<0.05); In the process of anesthesia, the mean
arterial pressure (MAP) and heart rate (HR) recorded at different time
points of anesthesia pre-induction (E0), 5 min preoperatively (E1), 10 min
after operation initiation (E2), 30 min after operation initiation (E3)
and the time when operation is finished (E4) were significantly lower in
observational group than those of control group, with a statistically
significant difference (P<0.05); the usage amount of sufentanil and
propofol needs to be adjusted to deepen anesthesia depth for patients in
control group; analgesia situation was observed after surgery therapy, and
visual analogue scale (VAS) scores at 2 h, 6 h, 12 h and 24 h after
operation in observational group were significantly less than those of
control group, which demonstrates a better analgesic effect of continuous
thoracic paravertebral block (CTPVB) after operation. Introducing
continuous thoracic paravertebral block in lung cancer resection fits
general anesthesia and brings better clinical effect, with high security
and low incidence of complications, this therapy provides a more effective
and everlasting analgesic activity for patients after surgery, reduces the
usage amount of anesthesia medication or opioid during surgery, has lower
effect on hemodynamics, thus it's suitable to be widely used in clinic.
Copyright &#xa9; 2016, E-Century Publishing Corporation. All rights
reserved.

<90>
Accession Number
613120360
Author
Hoebers L.P.; Nijveldt R.; van Rossum A.C.; Elias J.; van Dongen I.M.;
Claessen B.E.P.M.; Tijssen J.G.; van der Schaaf R.; Tijssen J.G.P.;
Zijlstra F.; de Boer M.-J.; Michels R.; Agostoni P.; van Houwelingen K.G.;
Verberne H.J.; Hirsch A.; Henriques J.P.S.; Piek J.J.; de Winter R.J.;
Koch K.T.; Vis M.M.; Baan J.; Wykrzykowska J.; Ramunddal T.; Ioanes D.;
Laanmets P.; van der Schaaf R.J.; Slagboom T.; Amoroso G.; Eriksen E.;
Tuseth V.; Bax M.; Schotborgh C.E.; Suttorp M.J.; Strauss B.H.; Barbato
E.; Marques K.M.; Bertrand O.; Meuwissen M.; van der Ent M.; Koolen J.
Institution
(Henriques, Hoebers, Elias, van Dongen, Claessen, Tijssen) Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Ramunddal, Ioanes) Sahlgrenska University Hospital, Gothenburg, Sweden
(Laanmets) North Estonia Medical Center, Tallinn, Estonia
(Eriksen) Haukeland University Hospital, Bergen, Norway
(Bax) Haga Teaching Hospital, The Hague, Netherlands
(Suttorp) Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
(Strauss) Sunnybrook Health Sciences Centre, Toronto, Canada
(Barbato) Onze Lieve Vrouwe Ziekenhuis, Aalst, Belgium
(Nijveldt, van Rossum, Marques) VU University Medical Center, Amsterdam,
Netherlands
(van der Schaaf) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
Title
Percutaneous Intervention for Concurrent Chronic Total Occlusions in
Patients With STEMI: The EXPLORE Trial.
Source
Journal of the American College of Cardiology. 68 (15) (pp 1622-1632),
2016. Date of Publication: 11 Oct 2016.
Publisher
Elsevier USA
Abstract
Background In 10% to 15% of patients with ST-segment elevation myocardial
infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a
non-infarct-related artery is present and is associated with increased
morbidity and mortality. Objectives The EXPLORE (Evaluating Xience and
Left Ventricular Function in Percutaneous Coronary Intervention on
Occlusions After ST-Elevation Myocardial Infarction) trial evaluated
whether patients with STEMI and concurrent CTO in a non-infarct-related
artery benefit from additional percutaneous coronary intervention (PCI) of
CTO shortly after primary PCI. Methods From November 2007 through April
2015, we enrolled 304 patients with acute STEMI who underwent primary PCI
and had concurrent CTO in 14 centers in Europe and Canada. A total of 150
patients were randomly assigned to early PCI of the CTO (CTO PCI), and 154
patients were assigned to conservative treatment without PCI of the CTO
(no CTO PCI). Primary outcomes were left ventricular ejection fraction
(LVEF) and left ventricular end diastolic volume (LVEDV) on cardiac
magnetic resonance imaging after 4 months. Results The
investigator-reported procedural success rate in the CTO PCI arm of the
trial was 77%, and the adjudicated success rate was 73%. At 4 months, mean
LVEF did not differ between the 2 groups (44.1 +/- 12.2% vs. 44.8 +/-
11.9%, respectively; p = 0.60). Mean LVEDV at 4 months was 215.6 +/- 62.5
ml in the CTO PCI arm versus 212.8 +/- 60.3 ml in the no-CTO PCI arm (p =
0.70). Subgroup analysis revealed that patients with CTO located in the
left anterior descending coronary artery who were randomized to the CTO
PCI strategy had significantly higher LVEF compared with patients
randomized to the no-CTO PCI strategy (47.2 +/- 12.3% vs. 40.4 +/- 11.9%;
p = 0.02). There were no differences in terms of 4-month major adverse
coronary events (5.4% vs. 2.6%; p = 0.25). Conclusions Additional CTO PCI
within 1 week after primary PCI for STEMI was feasible and safe. In
patients with STEMI and concurrent CTO, we did not find an overall benefit
for CTO PCI in terms of LVEF or LVEDV. The finding that early CTO PCI in
the left anterior descending coronary artery subgroup was beneficial
warrants further investigation. (Evaluating Xience and Left Ventricular
Function in Percutaneous Coronary Intervention on Occlusions After
ST-Segment Elevation Myocardial Infarction; NTR1108) Copyright &#xa9; 2016
American College of Cardiology Foundation

<91>
Accession Number
613259544
Author
Foreman P.M.; Naftel R.P.; Moore T.A.; Hadley M.N.
Institution
(Foreman, Hadley) Department of Neurosurgery, University of Alabama at
Birmingham, 510 20th St. S, FOT 1062, Birmingham, AL 35294-3410, United
States
(Naftel) Department of Neurological Surgery, Vanderbilt University,
Nashville, TN, United States
(Moore) Department of Anesthesia, University of Alabama, Birmingham, AL,
United States
Title
The lateral extracavitary approach to the thoracolumbar spine: A case
series and systematic review.
Source
Journal of Neurosurgery: Spine. 24 (4) (pp 570-579), 2016. Date of
Publication: April 2016.
Publisher
American Association of Neurological Surgeons (E-mail:
jnevro@virginia.edu)
Abstract
OBJECT: Since its introduction in 1976, the lateral extracavitary approach
(LECA) has been used to access ventral and ventrolateral pathology
affecting the thoracolumbar spine. Reporting of outcomes and complications
has been inconsistent. A case series and systematic review are presented
to summarize the available data. METHODS: A retrospective review of
medical records was performed, which identified 65 consecutive patients
who underwent LECA for the treatment of thoracolumbar spine and spinal
cord pathology. Cases were divided according to the presenting pathology.
Neurological outcomes and complications were detailed. In addition, a
systematic review of outcomes and complications in patients treated with
the LECA as reported in the literature was completed. RESULTS: Sixty-five
patients underwent the LECA to the spine for the treatment of thoracic
spine and spinal cord pathology. The most common indication for surgery
was thoracic disc herniation (23/65, 35.4%). Neurological outcomes were
excellent: 69.2% improved, 29.2% experienced no change, and 1.5% were
worse. Two patients (3.1%) experienced a complication. The systematic
review revealed comparable neurological outcomes (74.9% improved) but a
notably higher complication rate (32.2%). CONCLUSIONS: The LECA provides
dorsal and unilateral ventrolateral access to and exposure of the
thoracolumbar spine and spinal cord while allowing for posterior
instrumentation through the same incision. Although excellent neurological
results can be expected, the risk of pulmonary complications should be
considered. Copyright &#xa9;AANS, 2016.

<92>
Accession Number
612986975
Author
Cavalcante R.; Sotomi Y.; Lee C.W.; Ahn J.-M.; Farooq V.; Tateishi H.;
Tenekecioglu E.; Zeng Y.; Suwannasom P.; Collet C.; Albuquerque F.N.;
Onuma Y.; Park S.-J.; Serruys P.W.
Institution
(Cavalcante, Tateishi, Tenekecioglu, Zeng, Albuquerque, Onuma)
Thoraxcenter, Department of Interventional Cardiology, Erasmus University
Medical Center, Rotterdam, Netherlands
(Cavalcante) Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Sotomi, Suwannasom, Collet) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Lee, Ahn, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Farooq) Manchester Heart Centre, Manchester Royal Infirmary, Central
Manchester University Hospitals NHS Trust, Manchester, United Kingdom
(Serruys) International Center for Circulatory Health, Imperial College
London, London, United Kingdom
Title
Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in
Patients With Unprotected Left Main Disease.
Source
Journal of the American College of Cardiology. 68 (10) (pp 999-1009),
2016. Date of Publication: 06 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Currently available randomized data on the comparison between
percutaneous coronary intervention (PCI) and coronary artery bypass graft
(CABG) for the treatment of unprotected left main coronary disease (LMD)
lacks statistical power due to low numbers of patients enrolled.
Objectives This study assessed long-term outcomes of PCI and CABG for the
treatment of LMD in specific subgroups according to disease anatomic
complexity. Methods We conducted a pooled analysis of individual
patient-level data of the LMD patients included in the PRECOMBAT (Bypass
Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With
Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With
TAXUS and Cardiac Surgery) trials. Incidences of major adverse cardiac
events were assessed at 5 years follow-up. Results Study population
comprised 1,305 patients. The incidence of major adverse cardiac and
cerebrovascular events at 5 years was 28.3% in the PCI group and 23.0% in
the CABG group (hazard ratio [HR]: 1.23; 95% confidence interval [CI]:
1.01 to 1.55; p = 0.045). This difference is mainly driven by a higher
rate of repeat revascularization associated with PCI (HR: 1.85; 95% CI:
1.38 to 2.47; p < 0.001). The 2 strategies showed similar rates of the
safety composite endpoint of death, myocardial infarction, or stroke (p =
0.45). In patients with isolated LM or LM + 1-vessel disease, PCI was
associated with a 60% reduction in all-cause mortality (HR: 0.40; 95% CI:
0.20 to 0.83; p = 0.029) and 67% reduction in cardiac mortality (HR: 0.33;
95% CI: 0.12 to 0.88; p = 0.025) when compared with CABG. Conclusions In
patients with unprotected LMD, CABG, and PCI result in similar rates of
the safety composite endpoint of death, myocardial infarction, or stroke.
In patients with isolated LM or LM + 1-vessel disease, PCI is associated
with lower all-cause and cardiac mortality when compared to CABG.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<93>
Accession Number
612919223
Author
Bonaca M.P.; Creager M.A.; Olin J.; Scirica B.M.; Gilchrist I.C.; Murphy
S.A.; Goodrich E.L.; Braunwald E.; Morrow D.A.
Institution
(Bonaca, Scirica, Gilchrist, Murphy, Goodrich, Braunwald, Morrow) TIMI
Study Group, Cardiovascular Division, Department of Medicine, Brigham and
Women's Hospital and Harvard Medical School, Boston, Massachusetts, United
States
(Creager) Dartmouth-Hitchcock Heart and Vascular Center, Geisel School of
Medicine at Dartmouth, Lebanon, New Hampshire, United States
(Olin) Wiener Cardiovascular Institute and Marie-Jose and Henry R. Kravis
Center for Cardiovascular Health, Mount Sinai School of Medicine, New
York, New York, United States
Title
Peripheral Revascularization in Patients With Peripheral Artery Disease
With Vorapaxar: Insights From the TRA 2degreeP-TIMI 50 Trial.
Source
JACC: Cardiovascular Interventions. 9 (20) (pp 2157-2164), 2016. Date of
Publication: 24 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to determine whether the reduction in
peripheral revascularization with vorapaxar in patients with peripheral
artery disease (PAD) is directionally consistent across indications,
including acute limb ischemia, progressively disabling symptoms, or both.
Background The protease-activated receptor-1 antagonist vorapaxar reduces
peripheral revascularization in patients with PAD. Methods The TRA
2degreeP-TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of
Atherothrombotic Ischemic Events-Thrombolysis in Myocardial Infarction 50)
trial randomized 26,449 patients with histories of myocardial infarction,
stroke, or symptomatic PAD to vorapaxar or placebo on a background of
standard therapy. A total of 5,845 patients had a known history of PAD at
randomization. Peripheral revascularization procedures reported by the
site were a pre-specified outcome. We explored whether the benefit of
vorapaxar was consistent across indication and type of procedure. Results
Of the 5,845 patients with known PAD, a total of 934 (16%) underwent at
least 1 peripheral revascularization over 2.5 years (median). More than
one-half (55%) were for worsening claudication, followed by critical limb
ischemia (24%), acute limb ischemia (16%), and asymptomatic severe
stenosis (4%). Vorapaxar significantly reduced peripheral
revascularization (19.3% for placebo, 15.4% for vorapaxar; hazard ratio:
0.82; 95% confidence interval: 0.72 to 0.93; p = 0.003), with a consistent
pattern of efficacy across indication. Conclusions Vorapaxar reduces
peripheral revascularization in patients with PAD. This benefit of
vorapaxar is directionally consistent across type of procedure and
indication. (Trial to Assess the Effects of Vorapaxar [SCH 530348;
MK-5348] in Preventing Heart Attack and Stroke in Patients With
Atherosclerosis [TRA 2degreeP - TIMI 50] [P04737]; NCT00526474) Copyright
&#xa9; 2016 American College of Cardiology Foundation

<94>
Accession Number
613101998
Author
Douglas P.S.; De Bruyne B.; Pontone G.; Patel M.R.; Norgaard B.L.; Byrne
R.A.; Curzen N.; Purcell I.; Gutberlet M.; Rioufol G.; Hink U.; Schuchlenz
H.W.; Feuchtner G.; Gilard M.; Andreini D.; Jensen J.M.; Hadamitzky M.;
Chiswell K.; Cyr D.; Wilk A.; Wang F.; Rogers C.; Hlatky M.A.
Institution
(Douglas, Patel, Chiswell, Cyr) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, North Carolina, United States
(De Bruyne) Cardiovascular Centre Aalst, Aalst, Belgium
(Pontone, Andreini) Cardiovascular CT Unit, Centro Cardiologico Monzino,
IRCCS, University of Milan, Milan, Italy
(Norgaard, Jensen) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Byrne, Hadamitzky) Deutsches Herzzentrum Munchen, Technische Universitat
Munchen, Munich, Germany
(Curzen) University Hospital Southampton NHS Trust, Southampton, United
Kingdom
(Purcell) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Gutberlet) University of Leipzig Heart Centre, Leipzig, Germany
(Rioufol) Hospices Civils de Lyon and CARMEN INSERM 1060, Lyon, France
(Hink) Department of Cardiology, Johannes Gutenberg University Hospital,
Mainz, Germany
(Schuchlenz) LKH Graz West, Graz, Austria
(Feuchtner) Department of Radiology, Innsbruck Medical University,
Innsbruck, Austria
(Gilard) Department of Cardiology, Cavale Blanche Hospital, Brest, France
(Wilk, Wang, Rogers) HeartFlow, Redwood City, California, United States
(Hlatky) Department of Health Research and Policy and Department of
Medicine, Stanford University School of Medicine, Stanford, California,
United States
Title
1-Year Outcomes of FFR<inf>CT</inf>-Guided Care in Patients With Suspected
Coronary Disease: The PLATFORM Study.
Source
Journal of the American College of Cardiology. 68 (5) (pp 435-445), 2016.
Date of Publication: 02 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Coronary computed tomographic angiography (CTA) plus estimation
of fractional flow reserve using CTA (FFR<inf>CT</inf>) safely and
effectively guides initial care over 90 days in patients with stable chest
pain. Longer-term outcomes are unknown. Objectives The study sought to
determine the 1-year clinical, economic, and quality-of-life (QOL)
outcomes of using FFR<inf>CT</inf> instead of usual care. Methods
Consecutive patients with stable, new onset chest pain were managed by
either usual testing (n = 287) or CTA (n = 297) with selective
FFR<inf>CT</inf> (submitted in 201, analyzed in 177); 581 of 584 (99.5%)
completed 1-year follow-up. Endpoints were adjudicated major adverse
cardiac events (MACE) (death, myocardial infarction, unplanned
revascularization), total medical costs, and QOL. Results Patients
averaged 61 years of age with a mean 49% pre-test probability of coronary
artery disease. At 1 year, MACE events were infrequent, with 2 in each arm
of the planned invasive group and 1 in the planned noninvasive cohort
(usual care strategy). In the planned invasive stratum, mean costs were
33% lower with CTA and selective FFR<inf>CT</inf> ($8,127 vs. $12,145
usual care; p < 0.0001); in the planned noninvasive stratum, mean costs
did not differ when using an FFR<inf>CT</inf> cost weight of zero ($3,049
FFR<inf>CT</inf> vs. $2,579; p = 0.82), but were higher when using an
FFR<inf>CT</inf> cost weight equal to CTA. QOL scores improved overall at
1 year (p < 0.001), with similar improvements in both groups, apart from
the 5-item EuroQOL scale scores in the noninvasive stratum (mean change of
0.12 for FFR<inf>CT</inf> vs. 0.07 for usual care; p = 0.02). Conclusions
In patients with stable chest pain and planned invasive coronary
angiography, care guided by CTA and selective FFR<inf>CT</inf> was
associated with equivalent clinical outcomes and QOL, and lower costs,
compared with usual care over 1-year follow-up. (The PLATFORM Study:
Prospective LongitudinAl Trial of FFRct: Outcome and Resource IMpacts
[PLATFORM]; NCT01943903) Copyright &#xa9; 2016 American College of
Cardiology Foundation

<95>
Accession Number
604166192
Author
Yang Z.; Wang J.; Wang W.; Han L.; Zhang Y.; Nie X.; Zhan S.
Institution
(Yang, Wang, Wang, Zhang, Zhang, Nie, Zhan) Department of Epidemiology and
Biostatistics, School of Public Health, Peking University, Beijing, China
(Yang) Shantou-Oxford Clinical Research Unit, Shantou University Medical
College, Shantou, Guangdong, China
(Han) Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Zhang) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
Title
Proportions of staphylococcus aureus and methicillin-resistant
staphylococcus aureus in patients with surgical site infections in
Mainland China: A systematic review and meta-analysis.
Source
PLoS ONE. 10 (1) (no pagination), 2015. Article Number: e0116079. Date of
Publication: 20 Jan 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Sufficient details have not been specified for the
epidemiological characteristics of Staphylococcus aureus (S. aureus) and
methicillin-resistant Staphylococcus aureus (MRSA) among surgical site
infections (SSIs) in mainland China. This systematicreview aimed to
estimate proportions of S. aureus and MRSA in SSIs through available
published studies. Methods: PubMed, Embase and four Chinese electronic
databases were searched to identify relevant primary studies published
between 2007 and 2012. Meta-analysis was conducted on the basis of
logit-transformed metric for proportions of S. aureus and MRSA, followed
by predefined subgroup meta-analysis. Random-effects meta-regression was
also conducted to explore the impact of possible factors on S. aureus
proportions. Results: 106 studies were included, of which 38 studies
involved MRSA. S. aureus accounted for 19.1% (95%CI 17.2-21.0%;
I<inf>2</inf> = 84.1%) of all isolates in SSIs, which was roughly parallel
to 18.5% in the United States (US) (P-value = 0.57) but significantly
exceeded those calculated through the surveillance system in China
(P-value<0.001). In subgroup analysis, S. aureus in patients with thoracic
surgery (41.1%, 95%CI 26.3-57.7%; I<inf>2</inf> = 74.4%) was more common
than in those with gynecologic surgery (20.1%, 95%CI 15.6-25.6%;
I<inf>2</inf> = 33.0%) or abdominal surgery (13.8%, 95%CI 10.3-18.4%;
I<inf>2</inf> = 70.0%). Similar results were found in metaregression. MRSA
accounted for 41.3% (95%CI 36.5-46.3%; I<inf>2</inf> = 64.6%) of S.
aureus, significantly lower than that in the US (P-value = 0.001). MRSA
was sensitive to vancomycin (522/522) and linezolid (93/94), while
79.9%(95%CI 67.4-88.4%; I<inf>2</inf>= 0%) and 92.0% (95%CI 80.2-97.0%;
I<inf>2</inf>= 0%) of MRSA was resistant to clindamycin and erythromycin
respectively. Conclusion: The overall proportion of S. aureus among SSIs
in China was similar to that in the US but seemed higher than those
reported through the Chinese national surveillance system. Proportions of
S. aureus SSIs may vary with different surgery types. Commonly seen in
SSIs, MRSA tended to be highly sensitive to vancomycin and linezolid but
mostly resistant to clindamycin and erythromycin. Copyright &#xa9; 2015
Yang et al.

<96>
Accession Number
613193257
Author
Abd-Allah A.H.; El-Rahman Mohamed A.A.; Amin S.M.; Selim S.; Allam M.
Institution
(Abd-Allah, El-Rahman Mohamed, Amin, Allam) Department of Cardiothoracic
Surgery, Faculty of Medicine, Cairo University, Egypt
(Selim) Department of Chest Diseases, Faculty of Medicine, Cairo
University, Egypt
Title
Immediate pulmonary dysfunction in ischemic heart disease patients
undergoing off-pump versus on-pump CABG.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (1) (pp
15-20), 2016. Date of Publication: 01 May 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Many studies have shown important changes in lung function
tests after coronary artery surgeries. It is controversial if off-pump
surgery can give a better and shorter recovery than the on-pump. The aim
of this work was to study immediate early pulmonary dysfunction in
ischemic heart disease patients undergoing off-pump versus on-pump
coronary artery bypass grafting (CABG) in order to evaluate pulmonary
dysfunction caused by cardio-pulmonary bypass (CPB) in patients undergoing
on-pump CABG. Patients and method: A prospective randomized study was
carried out on 40 patients submitted to coronary artery surgery at Kasr
El-Aini University Hospital, Cairo, Egypt. They were randomly divided into
two groups; group A: 20 patients undergoing CABG using heart-lung machine
(on-pump), and group B: 20 patients undergoing off-pump CABG. All patients
had: spirometric evaluation, 6 min walk test pre-operatively and at the
post-operative fifth day. Measurement of arterial blood gases (ABGs) and
calculation of P/F ratio was recorded pre-operative, post-induction and
post CABG. Post-operative intensive care unit (ICU) events were also
assessed. Results: Post-operative spirometric data and 6 min walk distance
decreased in both groups, when compared to pre-operative values, with
significant differences between the two groups. No significant reduction
in arterial oxygen pressure (PaO2), carbon dioxide pressure
(PaCO<inf>2</inf>) and P/F Ratio occurred post-operatively. Conclusion:
Pulmonary functions deteriorate significantly after coronary artery
revascularization with and without CPB, but to a significant greater
reduction among those on-pump than among those off-pump surgeries.
Copyright &#xa9; 2016, The Egyptian Society of Cardio-thoracic Surgery.

<97>
Accession Number
613193237
Author
Qulisy E.A.; Fakiha A.; Debis R.S.; Jamjoom A.A.; Elassal A.A.; Al-Radi
O.O.
Institution
(Qulisy, Fakiha, Debis, Elassal, Al-Radi) Abdullah Bakhsh Children's Heart
Center, Department of Surgery, Faculty of Medicine, King Abdulaziz
University, Jeddah, Saudi Arabia
(Jamjoom, Al-Radi) Division of Cardiovascular Surgery, The Cardiovascular
Department, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
(Elassal) Cardiothoracic Surgery Department, Faculty of Medicine, Zagazig
University, Zagazig, Egypt
Title
Custodiol versus blood cardioplegia in pediatric cardiac surgery,
two-center study.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (1) (pp
38-42), 2016. Date of Publication: 01 May 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Cold blood cardioplegia is widely used as a method of
myocardial protection in pediatric cardiac surgery. Operative interruption
to administer cardioplegia and need for repeated administration and
occasional direct coronary ostial cannulation are considered a drawbacks
of this technique. Custodiol, a crystalloid solution, has been used in
children as an alternative cardioplegia solution with the potential
advantage of single dose administration with equivalent myocardial
protection. We sought to compare the outcomes of cold blood cardioplegia
versus Custodiol cardioplegia in pediatric cardiac surgery. Methods: A
retrospective cohort study was performed between November 1st, 2013 and
June 30th, 2014. All children who underwent heart surgery at two
institutions with the use of cardiopulmonary bypass and cardioplegia were
included. Patients were identified from a prospective database and
additional data were collected from operative report and electronic and
paper charts. Continuous data were represented as median and interquartile
range, and tested withWilcoxon rank-sum test. Categorical data were
represented as proportions, and tested with Pearson test. A composite
endpoint of all cause death, Low Cardiac Output Syndrome (LCOS), Acute
Kidney Injury (AKI), and significant arrhythmia was analyzed with a
multiple logistic regression model adjusted for complexity using the Risk
Adjustment of Congenital Heart Surgery-1 (RACHS-1) categories. A p-value
of less than 0.05 was considered to be significant. Results: Blood
cardioplegia was administered in 88 (57.1%) patients, and Custodiol
cardioplegia was administered in 66 (42.9%) patients according to
surgeon's preference. In the risk adjusted comparison of the composite
outcome of all-cause death, LCOS, AKI and significant arrhythmia,
Custodiol cardioplegia was found to be an independent predictor of an
adverse outcome, OR 3.17 (95% CI 1.41-7.14, P-value = 0.0054).
Conclusions: Custodial cardioplegia is associated with less optimal
myocardial protection and higher adverse outcomes compared to cold blood
cardioplegia in children undergoing cardiac surgery. A randomized
comparison is warranted. Copyright &#xa9; 2016, The Egyptian Society of
Cardio-thoracic Surgery.

<98>
Accession Number
613003291
Author
Alfonso F.; Perez-Vizcayno M.J.; Garcia del Blanco B.; Otaegui I.; Masotti
M.; Zueco J.; Velaquez M.; Sanchis J.; Garcia-Touchard A.; Lazaro-Garcia
R.; Moreu J.; Bethencourt A.; Cuesta J.; Rivero F.; Cardenas A.; Gonzalo
N.; Jimenez-Quevedo P.; Fernandez C.
Institution
(Alfonso, Cuesta, Rivero) Hospital Universitario de La Princesa, Madrid,
Spain
(Perez-Vizcayno) Fundacion Interhospitalaria Investigacion Cardiovascular,
Madrid, Spain
(Perez-Vizcayno, Cardenas, Gonzalo, Jimenez-Quevedo, Fernandez) Hospital
Universitario Clinico San Carlos, Madrid, Spain
(Garcia del Blanco, Otaegui) Hospital Universitario Vall d'Hebron,
Barcelona, Spain
(Masotti) Hospital Universitario Clinic de Barcelona, Barcelona, Spain
(Zueco) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Velaquez) Hospital Universitario 12 de Octubre, Madrid, Spain
(Sanchis) Hospital Universitario Clinico de Valencia, Valencia, Spain
(Garcia-Touchard) Hospital Universitario Puerta de Hierro-Majadahonda,
Madrid, Spain
(Lazaro-Garcia) Hospital Universitario de Torrecardenas, Almeria, Spain
(Moreu) Hospital Universitario Virgen de la Salud, Toledo, Spain
(Bethencourt) Hospital Universitario Son Espases, Palma de Mallorca, Spain
Title
Long-Term Results of Everolimus-Eluting Stents Versus Drug-Eluting
Balloons in Patients With Bare-Metal In-Stent Restenosis: 3-Year Follow-Up
of the RIBS V Clinical Trial.
Source
JACC: Cardiovascular Interventions. 9 (12) (pp 1246-1255), 2016. Date of
Publication: 27 Jun 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to compare the long-term efficacy of
everolimus-eluting stents (EES) and drug-eluting balloons (DEB) in
patients with bare-metal stent in-stent restenosis (ISR). Background The
relative long-term clinical efficacy of current therapeutic modalities in
patients with ISR remains unknown. Methods The 3-year clinical follow-up
(pre-specified endpoint) of patients included in the RIBS V (Restenosis
Intra-Stent of Bare-Metal Stents: Drug-Eluting Balloon vs
Everolimus-Eluting Stent Implantation) randomized clinical trial was
analyzed. All patients were followed yearly using a pre-defined structured
questionnaire. Results A total of 189 patients with bare-metal stent ISR
were allocated to either EES (n = 94) or DEB (n = 95). Clinical follow-up
at 1, 2, and 3 years was obtained in all patients (100%). Compared with
patients treated with DEB, those treated with EES obtained better
angiographic results, including larger minimal luminal diameter at
follow-up (primary study endpoint; 2.36 +/- 0.6 mm vs. 2.01 +/- 0.6 mm; p
< 0.001). At 3 years, the rates of cardiac death (2% vs. 1%), myocardial
infarction (4% vs. 5%) and target vessel revascularization (9% vs. 5%)
were similar in the DEB and EES arms. Importantly, however, at 3 years,
the rate of target lesion revascularization was significantly lower in the
EES arm (2% vs. 8%; p = 0.04; hazard ratio: 0.23; 95% confidence interval:
0.06 to 0.93). The need for "late" (>1 year) target vessel (3 [3.2%] vs. 3
[3.2%]; p = 0.95) and target lesion (1 [1%] vs. 2 [2.1%]; p = 0.54)
revascularization was low and similar in the 2 arms. Rates of definite or
probable stent thrombosis (1% vs. 0%) were also similar in the 2 arms.
Conclusions The 3-year clinical follow-up of the RIBS V clinical trial
confirms the sustained safety and efficacy of EES and DEB in patients
treated for bare-metal stent ISR. In this setting, EES reduce the need for
target lesion revascularization at very long-term follow-up. (RIBS V
[Restenosis Intra-Stent of Bare Metal Stents: Paclitaxel-Eluting Balloon
vs Everolimus-Eluting Stent] [RIBS V]; NCT01239953) Copyright &#xa9; 2016
American College of Cardiology Foundation

<99>
Accession Number
611290765
Author
Jilaihawi H.; Chen M.; Webb J.; Himbert D.; Ruiz C.E.; Rodes-Cabau J.;
Pache G.; Colombo A.; Nickenig G.; Lee M.; Tamburino C.; Sievert H.;
Abramowitz Y.; Tarantini G.; Alqoofi F.; Chakravarty T.; Kashif M.;
Takahashi N.; Kazuno Y.; Maeno Y.; Kawamori H.; Chieffo A.; Blanke P.;
Dvir D.; Ribeiro H.B.; Feng Y.; Zhao Z.-G.; Sinning J.-M.; Kliger C.;
Giustino G.; Pajerski B.; Imme S.; Grube E.; Leipsic J.; Vahanian A.;
Michev I.; Jelnin V.; Latib A.; Cheng W.; Makkar R.
Institution
(Jilaihawi) Department of Cardiology and Cardiothoracic Surgery, NYU
Langone Medical Center, New York, New York, United States
(Chen, Feng, Zhao) Department of Cardiology, West China Hospital, Sichuan
University, Chengdu, China
(Webb, Blanke, Dvir, Pajerski, Leipsic) St. Paul's Hospital, Vancouver,
Canada
(Himbert, Vahanian) Department of Cardiology, Assistance Publique-Hopitaux
de Paris, Bichat-Claude Bernard Hospital, Paris, France
(Ruiz, Kliger, Jelnin) Lenox Hill Heart and Vascular Institute of New
York, New York, United States
(Rodes-Cabau, Ribeiro) Quebec Heart and Lung Institute, Laval University,
Quebec City, Canada
(Pache, Blanke) University Hospital Freiburg, Freiburg, Germany
(Colombo, Chieffo, Giustino, Michev, Latib) EMO-GVM Centro Cuore Columbus
and San Raffaele Scientific Institute, Milan, Italy
(Nickenig, Sinning, Grube) Department of Internal Medicine and
Cardiology/Pneumology, University of Bonn, Bonn, Germany
(Lee) Division of Cardiology, Department of Medicine, Queen Elizabeth
Hospital, Kowloon, Hong Kong
(Tamburino, Imme) Ferrarotto Hospital, University of Catania, Catania,
Italy
(Sievert) Department of Cardiology and Vascular Medicine, CardioVasculares
Centrum Frankfurt, Frankfurt, Germany
(Abramowitz, Chakravarty, Kashif, Takahashi, Kazuno, Maeno, Kawamori,
Cheng, Makkar) Cedars-Sinai Heart Institute, Los Angeles, United States
(Tarantini) University of Padua, Padua, Italy
(Alqoofi) University of Calgary, Calgary, Canada
Title
A Bicuspid Aortic Valve Imaging Classification for the TAVR Era.
Source
JACC: Cardiovascular Imaging. 9 (10) (pp 1145-1158), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate transcatheter aortic valve
replacement (TAVR) in bicuspid aortic valve (BAV) aortic stenosis (AS),
with a particular emphasis on TAVR-directed bicuspid aortic valve imaging
(BAVi) of morphological classification. Background TAVR has been used to
treat BAV-AS but with heterogeneous outcomes and uncertainty regarding the
relevance of morphology. Methods In 14 centers in the United States,
Canada, Europe, and Asia, 130 BAV-AS patients underwent TAVR. Baseline
cardiac computed tomography (CT) was analyzed by a dedicated Corelab.
Outcomes were assessed in line with Valve Academic Research Consortium
criteria. Results Bicommissural BAV (vs. tricommissural) accounted for
68.9% of those treated in North America, 88.9% in Europe, and 95.5% in
Asia (p = 0.003). For bicommissural bicuspids, non-raphe type (vs. raphe
type) BAV accounted for 11.9% of those treated in North America, 9.4% in
Europe, and 61.9% in Asia (p < 0.001). Overall rates of 30-day mortality
(3.8%) and cerebrovascular events (3.2%) were favorable and similar among
anatomical subsets. The rate of new permanent pacemaker insertion was high
(26.2%) and similar between balloon-expandable (BE) and self-expanding
(SE) designs (BE: 25.5% vs. SE: 26.9%; p = 0.83); there was a trend to
greater permanent pacemaker insertion in BE TAVR in the presence of
coronary cusp fusion BAV morphology. Paravalvular aortic regurgitation
(PAR) > moderate was 18.1% overall but lower at 11.5% in those with
pre-procedural CT. In the absence of pre-procedural CT, there was an
excess of PAR in BE TAVR that was not the case in those with a
pre-procedural CT; SE TAVR required more post-dilation. Predictors of PAR
included intercommissural distance for bicommissural bicuspids (odd ratio
[OR]: 1.37; 95% confidence interval [CI]: 1.02 to 1.84; p = 0.036) and
lack of a baseline CT for annular measurement (OR: 3.03; 95% CI: 1.20 to
7.69; p = 0.018). Conclusions In this multicenter study, TAVR achieved
favorable outcomes in patients with pre-procedural CT, with the exception
of high permanent pacemaker rates for all devices and shapes. Copyright
&#xa9; 2016 American College of Cardiology Foundation

<100>
Accession Number
612994839
Author
Worth L.J.; Epi G.D.; Bull A.L.; Spelman T.; Brett J.; Richards M.J.
Institution
(Worth, Epi, Bull, Spelman, Brett, Richards) Victorian Healthcare
Associated Infection Surveillance System (VICNISS) Coordinating Centre,
Doherty Institute, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
Title
Diminishing Surgical Site Infections in Australia: Time Trends in
Infection Rates, Pathogens and Antimicrobial Resistance Using a
Comprehensive Victorian Surveillance Program, 2002-2013.
Source
Infection Control and Hospital Epidemiology. 36 (4) (pp 409-416), 2015.
Date of Publication: 2015.
Publisher
Cambridge University Press (E-mail: subscriptions@press.uchicago.edu)
Abstract
OBJECTIVE. To evaluate time trends in surgical site infection (SSI) rates
and SSI pathogens in Australia. DESIGN. Prospective multicenter
observational cohort study. SETTING. A group of 81 Australian healthcare
facilities participating in the Victorian Healthcare Associated Infection
Surveillance System (VICNISS). PATIENTS. All patients underwent surgeries
performed between October 1, 2002, and June 30, 2013. National Healthcare
Safety Network SSI surveillance methods were employed by the infection
prevention staff at the participating hospitals. INTERVENTION.
Procedure-specific risk-adjusted SSI rates were calculated.
Pathogen-specific and antimicrobial-resistant (AMR) infections were
modeled using multilevel mixed-effects Poisson regression. RESULTS. A
total of 183,625 procedures were monitored, and 5,123 SSIs were reported.
Each year of observation was associated with 11% risk reduction for
superficial SSI (risk ratio [RR], 0.89; 95% confidence interval [CI],
0.88-0.90), 9% risk reduction for deep SSI (RR, 0.91; 95% CI, 0.90-0.93),
and 5% risk reduction for organ/space SSI (RR, 0.95; 95% CI, 0.93-0.97).
Overall, 3,318 microbiologically confirmed SSIs were reported. Of these
SSIs, 1,174 (35.4%) were associated with orthopedic surgery, 827 (24.9%)
with coronary artery bypass surgery, 490 (14.8%) with Caesarean sections,
and 414 (12.5%) with colorectal procedures. Staphylococcus aureus was the
most frequently identified pathogen, and a statistically significant
increase in infections due to ceftriaxone-resistant Escherichia coli was
observed (RR, 1.37; 95% CI, 1.10-1.70). CONCLUSIONS. Standardized SSI
surveillance methods have been implemented in Victoria, Australia. Over an
11-year period, diminishing rates of SSIs have been observed, although AMR
infections increased significantly. Our findings facilitate the refinement
of recommended surgical antibiotic prophylaxis regimens and highlight the
need for a more expansive national surveillance strategy to identify
changes in epidemiology. Copyright &#xa9; 2015 by The Society for
Healthcare Epidemiology of America. All rights reserved.

<101>
Accession Number
613382401
Author
Vieira de Melo R.M.; Hueb W.; Rezende P.C.; Lima E.G.; Hueb A.C.; Ramires
J.A.; Kalil Filho R.
Institution
(Hueb, Rezende, Lima, Hueb, Ramires, Kalil Filho) Heart Institute (InCor)
University of Sao Paulo, Sao Paulo, Brazil. mass@incor.usp.br
Title
On-pump versus off-pump coronary artery bypass surgery in patients older
than 60 years: five-year follow-up of MASS III trial.
Source
Journal of cardiothoracic surgery. 9 (pp 127), 2014. Date of Publication:
2014.
Abstract
BACKGROUND: We aim to evaluate in-hospital events and long-term clinical
outcomes in patients over 60 years of age with stable coronary artery
disease and preserved left ventricular ejection fraction undergoing
off-pump or on-pump coronary artery bypass grafting.
METHODS: The MASS III was a single-center randomized trial that evaluate
308 patients with stable coronary artery disease and preserved ventricular
function assigned for: 155 to off-pump and 153 to on-pump CABG. Of this,
176 (58.3%) patients were 60 years or older at the time of randomization
(90 of-pump and 86 on-pump). The primary short-term end point was a
composite of myocardial infarction, stroke, and overall mortality
occurring within 30 days after surgery or before discharge, whichever was
later. The primary long-term end point was death from any cause within 5
years, non-fatal myocardial infarction between 30 days and 5 years, or
additional revascularization between 30 days and 5 years.
RESULTS: On-pump CABG had a higher incidence of 30-day composite outcome
than off-pump CABG (15,1% and 5.6%, respectively; P=0.036). However, after
the multivariate analysis, this association lost statistical significance,
P=0.05. After 5-year follow-up, there were no significant differences
between both strategies of CABG in the composite end points 16.7% and
15.1%; Hazard Ratio 1.07; CI 0.41 - 1.82; P=0.71, for off-pump and on-pump
CABG respectively.
CONCLUSIONS: On-pump and off-pump CABG achieved similar results of
combined events at short-term and 5-year follow-up.
TRIAL REGISTRATION: Clinical Trial Registration Information-URL:
http://www.controlled-trials.com.
REGISTRATION NUMBER: ISRCTN59539154.

<102>
Accession Number
613354797
Author
Qi Y.; Uchida T.; Yamamoto M.; Yamamoto Y.; Kido K.; Ito H.; Ohno N.;
Asahara M.; Yamada Y.; Yamaguchi O.; Mitaka C.; Tomita M.; Makita K.
Institution
(Qi, Uchida, Yamamoto, Yamamoto, Kido, Ito, Mitaka, Makita) Department of
Anesthesiology, Tokyo Medical and Dental University, Graduate School of
Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519,
Japan
(Ohno, Asahara, Yamada) Department of Anesthesiology, University of Tokyo,
Graduate School of Medicine, Tokyo, Japan
(Yamaguchi) Department of Critical Care Medicine, Yokohama City University
Medical Center, Kanagawa, Japan
(Tomita) Clinical Research Center, Tokyo Medical and Dental University,
Hospital of Medicine, Tokyo, Japan
Title
Perioperative elevation in cell-free DNA levels in patients undergoing
cardiac surgery: Possible contribution of neutrophil extracellular traps
to perioperative renal dysfunction.
Source
Anesthesiology Research and Practice. 2016 (no pagination), 2016. Article
Number: 2794364. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. This study aimed to determine the perioperative change in
serum double-strand DNA (dsDNA) as a marker potentially reflecting
neutrophil extracellular trap concentration in samples from patients
undergoing cardiac surgery and to analyze a relationship between serum
dsDNA concentrations and perioperative renal dysfunction. Methods. Serum
dsDNA concentrations in samples that were collected during a previously
conducted, prospective, multicenter, observational study were measured.
Eighty patients undergoing elective cardiac surgery were studied. Serum
samples were collected at baseline, immediately after surgery, and the day
after surgery (POD-1). Results. Serum dsDNA concentration was
significantly increased from baseline (median, 398 ng/mL [interquartile
range, 372-475 ng/mL]) to immediately after surgery (median, 540 ng/mL
[437-682 ng/mL], p < 0.001), and they were reduced by POD-1 (median, 323
ng/mL [256-436 ng/mL]). The difference in serum creatinine concentration
between baseline and POD-1 was correlated with dsDNA concentration on
POD-1 (r s = 0.61, p < 0.001). Conclusions. In patients undergoing cardiac
surgery, serum dsDNA concentration is elevated postoperatively. Prolonged
elevation in dsDNA concentration is correlated with perioperative renal
dysfunction. Further large-scale studies are needed to determine the
relationship between serum concentration of circulating dsDNA and
perioperative renal dysfunction. Copyright &#xa9; 2016 Yu Qi et al.

<103>
Accession Number
613337422
Author
Cao Y.; Tian X.-Y.; Zhang R.; Zhao J.-Q.; Zhang M.; Cheng Y.-T.; Li C.-F.;
Liu G.-L.; An Y.
Institution
(Cao, An) Department of Cardiology, Affiliated Hospital, Qingdao
University, No. 59, Haier Road, Laoshan District, Qingdao, Shandong, China
(Cao, Zhang, Zhao, Zhang, Cheng, Li, Liu) Department of Cardiology,
Affiliated Hospital of Jining Medical University, Jining, Shandong, China
(Tian) Department of Health Management, Community Service Center,
Affiliated Hospital of Jining Medical University, Jining, Shandong, China
Title
Short- and long-term efficacy and safety of triple vs. dual antithrombotic
therapy in patients with drug-eluting stent implantation and an indication
for oral anticoagulation: A meta-analysis.
Source
International Journal of Clinical Pharmacology and Therapeutics. 54 (12)
(pp 950-965), 2016. Date of Publication: 2016.
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany)
Abstract
Background: The optimal antithrombotic regimen after coronary stenting in
patients taking oral anticoagulants (OACs) is still unclear. Therefore,
this meta-analysis focused on the short- and long-term efficacy and safety
of triple therapy (TT: OAC, aspirin, and thienopyridine) and dual therapy
(DT: OAC plus single antiplatelet drug or aspirin plus thienopyridine).
Methods: We searched PubMed, Embase, the Cochrane Library, Wangfang
database, and Google Scholar up to December 1, 2015 (January 1, 2000 -
December 2015), from randomized and nonrandomized studies comparing TT and
DT in patients with OACs undergoing drug-eluting stent (DES) implantation.
Major adverse cardiac and cerebrovascular events (MACCE) were the main
outcome. Safety outcome was major bleeding (MB). Results: Of 964
publications identifi ed, 1 randomized study and 27 nonrandomized studies
of 31,346 patients were included. Overall, TT and OAC plus clopidogrel
were associated with a lower risk of MACCE, stroke, MI, and allcause
mortality compared with dual antiplatelet therapy or OAC plus aspirin.
Additionally, short-term use of triple antithrombotic regimen with OAC,
aspirin, and clopidogrel is associated with equivalent risk of major
bleeding and decreased rate of MACCE. Long-term use of OAC plus
clopidogrel after TT was associated with equal or better benefit and
safety outcomes. Conclusion: For patients on OAC after coronary stenting,
triple therapy (OAC, aspirin, clopidogrel) should be considered in the
short term, followed by more long-term therapy with OAC plus clopidogrel.
More randomized studies are needed to confirm these findings. Copyright
&#xa9; 2016 Dustri-Verlag Dr. K. Feistle.

<104>
Accession Number
613276092
Author
Arai T.; Yashima F.; Yanagisawa R.; Tanaka M.; Shimizu H.; Fukuda K.;
Watanabe Y.; Naganuma T.; Araki M.; Tada N.; Yamanaka F.; Shirai S.;
Yamamoto M.; Hayashida K.
Institution
(Arai, Yashima, Yanagisawa, Tanaka, Fukuda, Hayashida) Department of
Cardiology, Keio University School of Medicine, Tokyo, Japan
(Shimizu) Department of Cardiovascular Surgery, Keio University School of
Medicine, Tokyo, Japan
(Watanabe) Division of Cardiology, Department of Internal Medicine, Teikyo
University Hospital, Tokyo, Japan
(Naganuma) Interventional Cardiology Unit, New Tokyo Hospital, Chiba,
Japan
(Araki) Department of Cardiovascular Medicine, Yokohama City Eastern
Hospital, Kanagawa, Japan
(Tada) Cardiovascular Center, Sendai Kosei Hospital, Sendai, Japan
(Yamanaka) Department of Cardiovascular Medicine, Shonan Kamakura General
Hospital, Kanagawa, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
(Yamamoto) Division of Cardiovascular Medicine, Toyohashi Heart Center,
Toyohashi, Japan
Title
Prognostic value of liver dysfunction assessed by MELD-XI scoring system
in patients undergoing transcatheter aortic valve implantation.
Source
International Journal of Cardiology. 228 (pp 648-653), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background There are limited data regarding the influence of liver
dysfunction on outcomes of transcatheter aortic valve implantation (TAVI).
Model for End-stage Liver Disease eXcluding International normalized ratio
(MELD-XI) score, which was originally developed for patients with
cirrhosis awaiting liver transplantation, has been reported as a predictor
of heart disease. The aim of this study was to investigate the prognostic
value of MELD-XI score for patients undergoing TAVI. Methods Data from the
prospectively maintained Optimized transCathEter vAlvular iNtervention
(OCEAN-TAVI) multicenter registry were collected in 749 patients who
underwent TAVI between October 2013 and August 2015. MELD-XI score was
calculated as follows: 11.76 x Ln (creatinine) + 5.11 x Ln (total
bilirubin) + 9.44. Patients were categorized based on MELD-XI score > 10
or < 10, and compared with regard to clinical characteristics and outcomes
of TAVI. Results Higher MELD-XI score was associated with lower 30-day
survival (95.6% vs 98.5%, P = 0.03). Kaplan-Meier analysis revealed that
higher MELD-XI score also was associated with lower 6-month survival (P <
0.01). Multivariate Cox regression analysis showed that MELD-XI score was
an independent predictor of 6-month cumulative mortality. Receiver
operating characteristic analysis revealed that MELD-XI score showed
better accuracy in predicting 6-month mortality compared with Logistic
European System for Cardiac Operative Risk Evaluation, European System for
Cardiac Operative Risk Evaluation II, and Society of Thoracic Surgeons
scores (area under the curve = 0.67, 0.58, 0.57, and 0.60, respectively).
Conclusion Evaluation of liver dysfunction according to MELD-XI score
provides additional risk information for patients undergoing TAVI.
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<105>
Accession Number
613295781
Author
Zhou Y.; Wang Y.; Wu Y.; Zhu J.
Institution
(Zhou, Wu, Zhu) Department of Cardiology, The First Affiliated Hospital,
Zhejiang University, School of Medicine, Hangzhou 310003, China
(Wang) Department of Cardiology, Ningbo Medical Treatment Center Lihuili
Hospital, Ningbo 315000, China
Title
Transcatheter versus surgical aortic valve replacement in low to
intermediate risk patients: A meta-analysis of randomized and
observational studies.
Source
International Journal of Cardiology. 228 (pp 723-728), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve replacement (TAVR) has become the
treatment of choice for patients with aortic stenosis and the preferred
alternative for high surgical risk patients. However, TAVR's suitability
for patients at low to intermediate risk still remains controversial.
Methods PubMed, MEDLINE and Clinical trials were systematically searched
for randomized control trials and observational cohort studies which
reported the clinical outcomes of TAVR versus surgical aortic valve
replacement (SAVR) in patients at low to intermediate surgical risk.
Clinical endpoints including death, acute kidney injury, myocardial
infarction, and major adverse cardiac and cerebrovascular events (MACCE)
were assessed. Results From 2000 to 2016, 7 clinical studies comprising
6214 patients were identified. In each time point (in-hospital or 30 days,
1 year), TAVR was associated with similar incidence of death from any
cause, cardiovascular death and MACCE. TAVR reduced short-term incidence
of myocardial infarction and cerebrovascular events. However, TAVR was
associated with a higher rate of major vascular complications and
permanent pacemaker implantation. Conclusions Comparing with SAVR in
patients at low to intermediate surgical risk, TAVR has similar rates of
mortality and MACCE, lower incidence of acute kidney injury and new-onset
atrial fibrillation, but an increase in major vascular complications and
permanent pacemaker implantation. Copyright &#xa9; 2016

<106>
Accession Number
613411229
Author
Pishvaian M.; Morse M.A.; McDevitt J.; Norton J.D.; Ren S.; Robbie G.J.;
Ryan P.C.; Soukharev S.; Bao H.; Denlinger C.S.
Institution
(Pishvaian) Lombardi Comprehensive Cancer Center, Georgetown University
Medical Center, Washington, DC, United States
(Morse) Division of Hematology/Oncology, Duke Cancer Institute, Duke
University Medical Center, Durham, NC, United States
(McDevitt, Norton, Ren, Robbie, Ryan, Soukharev, Bao) MedImmune,
Gaithersburg, MD, United States
(Denlinger) Department of Hematology/Oncology, Fox Chase Cancer Center,
Philadelphia, PA, United States
Title
Phase 1 Dose Escalation Study of MEDI-565, a Bispecific T-Cell Engager
that Targets Human Carcinoembryonic Antigen, in Patients With Advanced
Gastrointestinal Adenocarcinomas.
Source
Clinical Colorectal Cancer. 15 (4) (pp 345-351), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Micro-Abstract This phase I, multicenter, open-label study evaluated
MEDI-565 (0.75-20 mug to 7.5 mg on days 1-5, 28-day cycles) in 39 adults
with gastrointestinal adenocarcinoma. The maximum tolerated dose was 5 mg
on days 1 through 5 every 28 days with dexamethasone. No objective
responses were observed. A study of MEDI-565 as a continuous infusion in
patients with gastrointestinal adenocarcinomas is ongoing. Copyright
&#xa9; 2016 Elsevier Inc.

<107>
[Use Link to view the full text]
Accession Number
613375878
Author
Zong Z.J.; Shen Q.Y.; Lu Y.; Li Y.H.
Institution
(Zong, Shen, Lu, Li) Department of Anesthesiology, First Affiliated
Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
Title
A simple blind placement of the left-sided double-lumen tubes.
Source
Medicine (United States). 95 (45) (no pagination), 2016. Article Number:
e5376. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
One-lung ventilation (OLV) has been commonly provided by using a
double-lumen tube (DLT). Previous reports have indicated the high
incidence of inappropriate DLT positioning in conventional maneuvers.
After obtaining approval from the medical ethics committee of First
Affiliated Hospital of Anhui Medical University and written consent from
patients, 88 adult patients belonging to American society of
anesthesiologists (ASA) physical status grade I or II, and undergoing
elective thoracic surgery requiring a left-side DLT for OLV were enrolled
in this prospective, single-blind, randomized controlled study. Patients
were randomly allocated to 1 of 2 groups: simple maneuver group or
conventional maneuver group. The simple maneuver is a method that relies
on partially inflating the bronchial balloon and recreating the effect of
a carinal hook on the DLTs to give an idea of orientation and depth. After
the induction of anesthesia the patients were intubated with a left-sided
Robertshaw DLT using one of the 2 intubation techniques. After intubation
of each DLT, an anesthesiologist used flexible bronchoscopy to evaluate
the patient while the patient lay in a supine position. The number of
optimal position and the time required to place DLT in correct position
were recorded. Time for the intubation of DLT took 100+/-16.2seconds
(mean+/-SD) in simple maneuver group and 95.1+/-20.8seconds in
conventional maneuver group. The difference was not statistically
significant (P=0.221). Time for fiberoptic bronchoscope (FOB) took
22+/-4.8seconds in simple maneuver group and was statistically faster than
that in conventional maneuver group (43.6+/-23.7seconds, P<0.001). Nearly
98% of the 44 intubations in simple maneuver group were considered as in
optimal position while only 52% of the 44 intubations in conventional
maneuver group were in optimal position, and the difference was
statistically significant (P<0.001). This simple maneuver is more rapid
and more accurate to position left-sided DLTs, it may be substituted for
FOB during positioning of a left-sided DLT in condition that FOB is
unavailable or inapplicable. Copyright &#xa9; 2016 the Author(s).
Published by Wolters Kluwer Health, Inc. All rights reserved.

<108>
Accession Number
613362572
Author
Volodarskiy A.; Kumar S.; Amin S.; Bangalore S.
Institution
(Volodarskiy) Hofstra Northwell School of Medicine, Manhasset, NY, United
States
(Kumar) Cardiac Clinic of Kissimmee, Fla, United States
(Amin, Bangalore) New York University School of Medicine, United States
Title
Optimal Treatment Strategies in Patients with Chronic Kidney Disease and
Coronary Artery Disease.
Source
American Journal of Medicine. 129 (12) (pp 1288-1298), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Chronic kidney disease is an independent risk factor for
coronary artery disease and is associated with an increase in adverse
outcomes. However, the optimal treatment strategies for patients with
chronic kidney disease and coronary artery disease are yet to be defined.
Methods MEDLINE, EMBASE, and CENTRAL were searched for studies including
at least 100 patients with chronic kidney disease (defined as estimated
glomerular filtration rate <60 mL/min/1.73 m² or on dialysis)
and coronary artery disease treated with medical therapy, percutaneous
coronary intervention, or coronary artery bypass surgery and followed for
at least 1 month and reporting outcomes. The outcome evaluated was
all-cause mortality. Meta-analysis was performed to evaluate the outcomes
with revascularization (percutaneous coronary intervention or coronary
artery bypass surgery) when compared with medical therapy alone. In
addition, outcomes with percutaneous coronary intervention vs coronary
artery bypass surgery were evaluated. Results The search yielded 38
nonrandomized studies that enrolled 85,731 patients. Revascularization
(percutaneous coronary intervention or coronary artery bypass surgery) was
associated with lower long-term mortality (mean 4.0 years) when compared
with medical therapy alone (relative risk [RR] 0.73; 95% confidence
interval [CI], 0.62-0.87), driven by lower mortality with percutaneous
coronary intervention vs medical therapy and coronary artery bypass
surgery vs medical therapy. Coronary artery bypass surgery was associated
with a higher upfront risk of death (RR 1.81; 95% CI, 1.47-2.24) but a
lower long-term risk of death (RR 0.94; 95% CI, 0.89-0.98) when compared
with percutaneous coronary intervention. Conclusions In chronic kidney
disease patients with coronary artery disease, the current data from
nonrandomized studies indicate lower mortality with revascularization, via
either coronary artery bypass surgery or percutaneous coronary
intervention, when compared with medical therapy. These associations
should be tested in future randomized trials. Copyright &#xa9; 2016
Elsevier Inc.

<109>
Accession Number
613403444
Author
Greenberg J.H.; Zappitelli M.; Devarajan P.; Thiessen-Philbrook H.R.;
Krawczeski C.; Li S.; Garg A.X.; Coca S.; Parikh C.R.
Institution
(Greenberg) Section of Nephrology, Department of Pediatrics, Yale
University, School of Medicine, New Haven, CT, United States
(Greenberg, Thiessen-Philbrook, Coca, Parikh) Program of Applied
Translational Research, Yale University, School of Medicine, 60 Temple St,
New Haven, CT 06510, United States
(Zappitelli) Division of Pediatric Nephrology, Department of Pediatrics,
McGill University Health Centre, Montreal, QC, Canada
(Devarajan) Nephrology and Hypertension, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
(Krawczeski) Division of Cardiology, Department of Pediatrics, Stanford
University, School of Medicine, Stanford, CA, United States
(Li) Division of Critical Care, Department of Pediatrics, Maria Fareri
Children's Hospital, Valhalla, NY, United States
(Garg) Division of Nephrology, Department of Medicine, Western University,
London, ON, Canada
(Coca) Section of Nephrology, Department of Internal Medicine, Mount Sinai
School of Medicine, New York, NY, United States
(Parikh) Section of Nephrology, Department of Internal Medicine, Yale
University, School of Medicine, New Haven, CT, United States
(Parikh) VA Medical Center, West Haven, CT, United States
Title
Kidney outcomes 5 years after pediatric cardiac surgery the TRIBE-AKI
study.
Source
JAMA Pediatrics. 170 (11) (pp 1071-1078), 2016. Date of Publication: 01
Nov 2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Acute kidney injury (AKI) after pediatric cardiac surgery is
associated with high short-term morbidity and mortality; however, the
long-term kidney outcomes are unclear. OBJECTIVE To assess long-term
kidney outcomes after pediatric cardiac surgery and to determine if
perioperative AKI is associated with worse long-term kidney outcomes.
DESIGN, SETTING, AND PARTICIPANTS This prospective multicenter cohort
study recruited children between ages 1 month to 18 years who underwent
cardiopulmonary bypass for cardiac surgery and survived hospitalization
from 3 North American pediatric centers between July 2007 and December
2009. Children were followed up with telephone calls and an in-person
visit at 5 years after their surgery. EXPOSURES Acute kidney injury
defined as a postoperative serum creatinine rise from preoperative
baseline by 50% or 0.3mg/dL or more during hospitalization for cardiac
surgery. MAIN OUTCOMES AND MEASURES Hypertension (blood pressure 95th
percentile for height, age, sex, or self-reported hypertension),
microalbuminuria (urine albumin to creatinine ratio >30mg/g), and chronic
kidney disease (serum creatinine estimated glomerular filtration rate
[eGFR] <90 mL/min/1.73m2 or microalbuminuria). RESULTS Overall, 131
children (median [interquartile range] age, 7.7 [5.9-9.9] years)
participated in the 5-year in-person follow-up visit; 68 children (52%)
were male. Fifty-seven of 131 children (44%) had postoperative AKI. At
follow-up, 22 children (17%) had hypertension (10 times higher than the
published general pediatric population prevalence), while 9 (8%), 13
(13%), and 1 (1%) had microalbuminuria, an eGFR less than 90
mL/min/1.73m2, and an eGFR less than 60mL/min/1.73m2, respectively.
Twenty-one children (18%) had chronic kidney disease. Only 5 children (4%)
had been seen by a nephrologist during follow-up. Therewas no significant
difference in renal outcomes between children with and without
postoperative AKI. CONCLUSIONS AND RELEVANCE Chronic kidney disease and
hypertension are common 5 years after pediatric cardiac surgery.
Perioperative AKI is not associated with these complications. Longer
follow-up is needed to ascertain resolution or worsening of chronic kidney
disease and hypertension. Copyright 2016 American Medical Association. All
rights reserved.

<110>
Accession Number
613343204
Author
Balachandran S.; Lee A.; Denehy L.; Lin K.-Y.; Royse A.; Royse C.;
El-Ansary D.
Institution
(Balachandran, Lee, Denehy, Lin, El-Ansary) Physiotherapy Department, The
University of Melbourne, Carlton, Victoria, Australia
(Royse, Royse) Department of Surgery, The University of Melbourne,
Carlton, Victoria, Australia
(Royse) Department of Cardiothoracic Surgery, The Royal Melbourne
Hospital, Parkville, Victoria, Australia
(Royse) Department of Anaesthesia and Pain Management, The Royal Melbourne
Hospital, Parkville, Victoria, Australia
Title
Risk Factors for Sternal Complications After Cardiac Operations: A
Systematic Review.
Source
Annals of Thoracic Surgery. 102 (6) (pp 2109-2117), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier USA
Abstract
Early detection of patients at risk of sternal complications is essential
to facilitate prevention and optimize timely intervention. A systematic
review and meta-analysis was conducted to identify risk factors associated
with sternal complications. The review included 17 full-text studies, of
which 10 were entered into meta-analyses. Female gender, diabetes
mellitus, obesity, bilateral internal mammary artery grafts, reoperation
for postoperative complications, and blood product requirement were
reported as significant predictors of sternal infection. The compilation
of these risk factors may help to screen and stratify patients at risk of
impaired sternal healing and warrants further investigation. Copyright
&#xa9; 2016 The Society of Thoracic Surgeons

<111>
Accession Number
613342764
Author
Wang C.; Hua K.; Yin L.; Wang Y.; Li W.
Institution
(Wang, Yin, Wang, Li) State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union
Medical College and Chinese Academy of Medical Sciences, Beijing, China
(Hua) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Title
A Meta-Analysis of Miniaturized Versus Conventional Extracorporeal
Circulation in Valve Surgery.
Source
Annals of Thoracic Surgery. 102 (6) (pp 2099-2108), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier USA
Abstract
The effects of miniaturized extracorporeal circulation in patients
operated on for heart valve surgery are still inconsistent. We performed a
meta-analysis of eight studies involving 1,011 patients to evaluate the
comprehensive effects of miniaturized extracorporeal circulation. The
results suggested its application significantly reduced the length of stay
in the intensive care unit and total hospital stay after heart valve
surgery, but no significant effects on reducing postoperative morbidity
and mortality were observed. Further studies with long-term follow-up are
needed to confirm our results. Copyright &#xa9; 2016 The Society of
Thoracic Surgeons

<112>
Accession Number
613342714
Author
Repossini A.; Fischlein T.; Santarpino G.; Schafer C.; Claus B.;
Passaretti B.; Di Bacco L.; Giroletti L.; Bisleri G.; Muneretto C.;
Grubitzsch H.
Institution
(Repossini, Di Bacco, Giroletti, Bisleri, Muneretto) Clinical Department
of Cardiac Surgery, University of Brescia, Brescia, Italy
(Fischlein, Santarpino) Department of Cardiac Surgery, Paracelsus Medical
University Nuremberg, Nuremberg, Germany
(Schafer, Claus, Grubitzsch) Department of Cardiovascular Surgery,
Charite-Universitatsmedizin Berlin, Berlin, Germany
(Passaretti) Cliniche Humanitas Gavazzeni, Bergamo, Italy
Title
Pericardial Stentless Valve for Aortic Valve Replacement: Long-Term
Results.
Source
Annals of Thoracic Surgery. 102 (6) (pp 1956-1965), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier USA
Abstract
Background The Freedom Solo (FS) bovine pericardial valve (Sorin Group,
Milan, Italy) is a stentless bioprosthesis that was introduced in 2004 and
approved by the United States Food and Drug Administration in 2014. No
long-term follow-up series are available to date. We report the
multicenter experience of 4 European institutions that began implanting FS
extensively from its introduction, providing the largest series with
long-term follow-up. Methods From 2004 to 2009, 565 patients (242 women
[42.8%]; mean age, 74.6 +/- 8.3 years) underwent isolated (n = 350) or
combined (n = 215) aortic valve replacement with the FS. Mean follow-up,
including clinical and strict echocardiographic evaluation, was 6.9 +/-
3.7 years (maximum, 11.8 years; cumulative 2,965 patient-years). Primary
end point was freedom from structural valve deterioration (SVD), and
secondary end points were freedom from reoperation and overall survival.
Results Mean logistic European System for Cardiac Operative Risk
Evaluation I was 10.3% +/- 6.7%. Overall 30-day mortality was 3.7%, and no
deaths were valve related. There was no severe prostheses-patient
mismatch, and moderate prostheses-patient mismatch occurred only in 1
patient (0.17%). Twenty-eight patients (5.2%) underwent reoperation (20
surgical replacements, 8 transcatheter aortic valve-in-valve replacements)
due to endocarditis in 9, blunt trauma in 1, and SVD in 18. SVD was
reported in 5 other patients alive at time of censoring. Freedom from SVD
and reoperation was 90.8% (95% confidence interval, 89.1% to 92.5%) and
87.3% (95% confidence interval, 85.6% to 89.0%), respectively, at 10 years
of follow-up, and the overall actuarial survival was 56.4% (95% confidence
interval, 53.3% to 59.5%). Conclusions The FS valve provided excellent
long-term durability and hemodynamic performance in this large,
multicenter European experience. Moreover, the FS, given the low rate of
SVD, along with a simple implantability, proved to be a reliable
bioprosthesis in the aortic position as a valid alternative to stented
bioprostheses. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<113>
Accession Number
613211559
Author
Spreadborough P.; Lort S.; Pasquali S.; Popplewell M.; Owen A.; Kreis I.;
Tucker O.; Vohra R.S.
Institution
(Spreadborough, Lort, Popplewell, Vohra) West Midlands Research
Collaborative, University of Birmingham, Edgbaston, Birmingham B15 2TH,
United Kingdom
(Pasquali, Tucker) Department of Upper Gastro-Intestinal Surgery, Queen
Elizabeth Hospital, Birmingham, United Kingdom
(Owen) School of Immunity and Infection, University of Birmingham,
Birmingham, United Kingdom
(Kreis) Clinical Effectiveness Unit, Royal College of Surgeons England,
London, United Kingdom
(Tucker) Academic Department of Surgery, University of Birmingham, Queen
Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom
(Vohra) Nottingham Oesophagi-Gastric unit, Nottingham University Hospitals
NHS Trust, Queens Medical Centre, Nottingham NG7 2UH, United Kingdom
Title
A systematic review and meta-analysis of perioperative oral
decontamination in patients undergoing major elective surgery.
Source
Perioperative Medicine. 5 (1) (no pagination), 2016. Article Number: 6.
Date of Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Oral antiseptics reduce nosocomial infections and
ventilator-associated pneumonia in critically ill medical and surgical
patients intubated for prolonged periods. However, the role of oral
antiseptics given before and after planned surgery is not clear. The aim
of this systematic review and meta-analysis is to determine the effect of
oral antiseptics (chlorhexidine or povidone-iodine) when administered
before and after major elective surgery. Methods: Searches were conducted
of the MEDLINE, EMBASE and Cochrane databases. The analysis was performed
using the random-effects method and the risk ratio (RR) with 95 %
confidence interval (CI). Results: Of 1114 unique identified articles,
perioperative chlorhexidine was administered to patients undergoing
elective surgery in four studies. This identified 2265 patients undergoing
elective cardiac surgery, of whom 1093 (48.3 %) received perioperative
chlorhexidine. Postoperative pneumonia and nosocomial infections were
observed in 5.3 and 20.2 % who received chlorhexidine compared to 10.4 and
31.3 % who received a control preparation, respectively. Oral
perioperative chlorhexidine significantly reduced the risk of
postoperative pneumonia (RR = 0.52; 95 % CI 0.39-0.71; p < 0.01) and
overall nosocomial infections (RR = 0.65; 95 % CI 0.52-0.81; p < 0.01),
with no effect on in-hospital mortality (RR = 1.01; 95 % CI 0.49-2.09; p =
0.98). Conclusions: Perioperative oral chlorhexidine significantly
decreases the incidence of nosocomial infection and postoperative
pneumonia in patients undergoing elective cardiac surgery. There are no
randomised controlled studies of this simple and cheap intervention in
patients undergoing elective non-cardiac surgery. Copyright &#xa9; 2016
Spreadborough et al.

<114>
Accession Number
613197712
Author
McIsaac D.I.; Taljaard M.; Bryson G.L.; Beaule P.E.; Gagne S.; Hamilton
G.; Hladkowicz E.; Huang A.; Joanisse J.; Lavallee L.T.; Moloo H.; Thavorn
K.; van Walraven C.; Yang H.; Forster A.J.
Institution
(McIsaac, Bryson, Gagne, Yang) University of Ottawa, Department of
Anesthesiology and Pain Medicine, Ottawa, Canada
(McIsaac, Bryson, Hladkowicz, Lavallee, Thavorn, van Walraven, Forster)
Ottawa Hospital Research Institute, Ottawa, Canada
(McIsaac, Taljaard) Department of Anesthesiology, The Ottawa Hospital,
Ottawa, Canada
(Taljaard, Thavorn) University of Ottawa, School of Epidemiology, Public
Health and Preventive Medicine, Ottawa, Canada
(Beaule) University of Ottawa and The Ottawa Hospital, Ottawa, Canada
(Hamilton) Anesthesiology Resident, University of Ottawa, Ottawa, Canada
(Huang) Geriatric Medicine, The Ottawa Hospital, Ottawa, Canada
(Joanisse) Hopital Montfort, Ottawa, Canada
(Lavallee) Division of Urology, University of Ottawa, Ottawa, Canada
(Moloo) Division of General Surgery, University of Ottawa, Ottawa, Canada
(Thavorn, van Walraven) Institute for Clinical Evaluative Sciences,
Toronto, Canada
(van Walraven) University of Ottawa, Medicine and Epidemiology, Ottawa,
Canada
(Forster) University of Ottawa, Department of Medicine, Ottawa, Canada
(Forster) The Ottawa Hospital, Ottawa, Canada
Title
Comparative assessment of two frailty instruments for risk-stratification
in elderly surgical patients: Study protocol for a prospective cohort
study.
Source
BMC Anesthesiology. 16 (1) (no pagination), 2016. Article Number: 111.
Date of Publication: 14 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Frailty is an aggregate expression of susceptibility to poor
outcomes, owing to age-, and disease-related deficits that accumulate
within multiple domains. Older patients who are frail before surgery are
at an increased risk of morbidity and mortality, and use a
disproportionately high amount of healthcare resources. While frailty is
now a well-established risk factor for adverse postoperative outcomes, the
perioperative literature lacks studies that: 1) compare the predictive
accuracy of different frailty instruments; 2) consider the impact of
frailty on patient-reported outcome measures; and 3) consider the
acceptability and feasibility of using frailty instruments in clinical
practice. Methods: We will conduct a multicenter prospective cohort study
comparing the predictive accuracy of the modified Fried Index (mFI) with
the Clinical Frailty Scale (CFS) among consenting patients aged 65 years
and older having elective major non-cardiac surgery. The primary outcome
will be disability free survival at 90 days after surgery, a
patient-reported outcome measure. Secondary outcomes will include
complications, length of stay, discharge disposition, readmission and
total health system costs. We will compare the accuracy of frailty
instruments using the relative true positive rate and relative false
positive rate. These measures can be interpreted as the relative
difference in the probability of one instrument identifying a true case of
death or new disability compared to another instrument, or the relative
difference in the probability of one instrument identifying a false case
of death or new disability, respectively. We will also assess the
acceptability and feasibility of each instrument. Discussion: Frailty is
an important prognostic factor in the growing population of older patients
having surgery. This study will provide novel findings regarding the
choice of an accurate, clinically useable frailty instrument in predicting
patient reported outcomes, as well as morbidity, mortality and resource
use. These findings will inform current practice and future research.
Copyright &#xa9; 2016 The Author(s).

<115>
Accession Number
613259923
Author
Vazquez N.H.
Institution
(Vazquez) Servicio de Neumologia, Hospital Universitario del Henares,
Avda. Marie Curie, s/n., Coslada, Madrid 28822, Spain
Title
Update on lung cancer: SEPAR recommendations.
Source
Revista de Patologia Respiratoria. 19 (3) (pp 73-75), 2016. Date of
Publication: 2016.
Publisher
Sociedad Madrinela de Neumologia y Cirugia Toracica (E-mail:
revistaNM@neumomadrid.org)
Abstract
Lung cancer (PC) is the highest incidence and mortality worldwide, so it
is vital that there are recommendations that facilitate diagnosis and
treatment. The Spanish Society of Pneumology and Thoracic Surgery (SEPAR)
has recently published a comprehensive supplement on Recommendations for
the diagnosis and treatment of non-small cell lung cancer. The evidence
does not allow recommending performing chest X-ray and screening in
patients at risk, however, the systematic review of studies that perform
annual screening by computed tomography (CT) low radiation in high-risk
individuals has been shown to reduce mortality. Moreover, at present the
combined use of CT and PET for diagnosis and treatment planning is
recommended. Minimally invasive diagnostic techniques (electromagnetic
navigation bronchoscopy and endobronchial ultrasound) are safe and prevent
complications are possible in patients with comorbidity. Regarding
treatment, TNM classification of the International Association for the
Study of Lung Cancer (IASLC) enables assessment of some surgical patients
directly before they were discarded. There are new molecular markers in
unresectable or inoperable tumors that identify subgroups that may benefit
from specific treatments with higher response rate (gene growth factor
epidermal -EGFR-, translocation gene anaplastic lymphoma kinase
-EML4-ALK-).

<116>
[Use Link to view the full text]
Accession Number
613344592
Author
Filardo G.; Ailawadi G.; Pollock B.D.; Da Graca B.; Sass D.M.; Phan T.K.;
Montenegro D.E.; Thourani V.; Damiano R.
Institution
(Filardo, Pollock, Da Graca, Sass, Phan, Montenegro) Office of the Chief
Quality Officer, Baylor Scott and White Health, 8080 N Central Expressway,
Dallas, TX 75206, United States
(Filardo) Heart Hospital Baylor Plano, TX, United States
(Ailawadi) Division of Thoracic and Cardiovascular Surgery, University of
Virginia, Charlottesville, United States
(Thourani) Division of Cardiothoracic Surgery, Emory University, Atlanta,
GA, United States
(Damiano) Department of Cardiac Surgery, Washington University School of
Medicine, Barnes-Jewish Hospital, St Louis, MO, United States
Title
Sex Differences in the Epidemiology of New-Onset In-Hospital Post-Coronary
Artery Bypass Graft Surgery Atrial Fibrillation: A Large Multicenter
Study.
Source
Circulation: Cardiovascular Quality and Outcomes. 9 (6) (pp 723-730),
2016. Date of Publication: 01 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - New-onset atrial fibrillation (AF) after coronary artery
bypass graft surgery (CABG) is associated with increased morbidity and
poorer long-term survival. Although many studies show differences in
outcome in women versus men after CABG, little is known about the
sex-specific incidence and characteristics of post-CABG AF. Methods and
Results - Overall, 11 236 consecutive patients without preoperative AF
underwent isolated CABG from 2002 to 2010 at 4 US academic medical centers
and 1 high-volume specialty cardiac hospital. Data routinely collected for
the Society of Thoracic Surgeons database were augmented with details on
new-onset post-CABG AF events detected via continuous in-hospital
ECG/telemetry monitoring. Unadjusted incidence of post-CABG AF was 29.5%
(3312/11 236) overall, 30.2% (2485/8214) in men, and 27.4% (827/3022) in
women. After adjustment for Society of Thoracic Surgeons-recognized risk
factors, women had significantly lower risk for post-CABG AF (odds ratio
[95% confidence interval]=0.75 [0.64-0.89]), shorter first, longest, and
total duration of AF episodes (mean difference [95% confidence
interval]=-2.7 [-4.7 to -0.8] hours; -4.1 [-6.9 to -1.2] hours; -2.4 [-2.5
to -2.3] hours, respectively). At 48 hours, AF-free probabilities were 77%
for women and 72% for men (P<0.001). Number of episodes (P=0.18),
operative mortality (P=0.048), stroke (P=0.126), and discharge in AF
(P=0.234) did not differ significantly by sex. Conclusions - These novel
data on sex-specific characteristics of new-onset AF after isolated CABG
show that women had lower adjusted risk for post-CABG AF and experienced
shorter episodes. Investigation of sex-specific impacts on outcomes is
needed to identify optimal strategies for prevention and management to
ensure all patients achieve the best possible outcomes. Copyright &#xa9;
2016 American Heart Association, Inc.

<117>
Accession Number
613227014
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
Direct and adjusted indirect comparisons of perioperative mortality after
sutureless or rapid-deployment aortic valve replacement versus
transcatheter aortic valve implantation.
Source
International Journal of Cardiology. 228 (pp 327-334), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine which procedure, aortic valve replacement (AVR)
with a sutureless or rapid-deployment prosthesis (SL-AVR) or transcatheter
aortic valve implantation (TAVI), achieves better perioperative survival
for severe aortic stenosis (AS), we conducted direct-comparison
meta-analyses (DC-MAs) and an adjusted indirect-comparison meta-analysis
(IDC-MA). Methods We searched MEDLINE, EMBASE, and the Cochrane Central
Register of Controlled Trials through April 2016. Eligible studies were
randomized controlled trials (RCTs) and propensity-score matched (PSM)
studies. We performed a DC-MA-[A] of SL-AVR versus TAVI, a DC-MA-[B] of
SL-AVR versus conventional AVR (C-AVR), and a DC-MA-[C] TAVI versus C-AVR.
Then, we computed a IDC-MA-[A'] of TAVI versus SL-AVR from the results of
the DC-MA-[B] and the DC-MA-[C]. Results We identified 6 RCTs and 30 PSM
studies enrolling a total of 15,887 patients. The 3 DC-MAs demonstrated
significantly lower perioperative (30-day or in-hospital) all-cause
mortality after SL-AVR than after TAVI (odds ratio [OR], 0.48; 95%
confidence interval [CI], 0.28 to 0.80; p = 0.005) and no significant
differences between SL-AVR and C-AVR (OR, 1.07; 95% CI, 0.60 to 1.94; p =
0.81) and between TAVI and C-AVR (1.07; 95% CI, 0.90 to 1.27; p = 0.45).
The computed IDC-MA-[A'] indicated no significant difference in mortality
between SL-AVR and TAVI (1.01; 95% CI, 0.54 to 1.86). Combining the
results of the DC-MA-[A] and IDC-MA [A'] showed significantly lower
mortality after SL-AVR than after TAVI (OR, 0.65; 95% CI, 0.44 to 0.97; p
= 0.03). Conclusions For patients with severe AS, SL-AVR may achieve
better perioperative survival than TAVI. Copyright &#xa9; 2016 Elsevier
Ireland Ltd

<118>
Accession Number
613335187
Author
Kinnaird T.; Kwok C.S.; Narain A.; Butler R.; Ossei-Gerning N.; Ludman P.;
Moat N.; Anderson R.; Mamas M.A.
Institution
(Kinnaird, Ossei-Gerning, Anderson) Department of Cardiology, University
Hospital of Wales, Cardiff, United Kingdom
(Kwok, Butler, Mamas) Academic Department of Cardiology, University
Hospital of North Midlands, Stoke-on-Trent, United Kingdom
(Kwok, Narain, Butler, Mamas) Cardiovascular Research Group, Keele
University, Stoke-on-Trent, United Kingdom
(Ludman) Department of Cardiology, Queen Elizabeth Hospital, Birmingham,
United Kingdom
(Moat) Department of Cardiothoracic Surgery, Royal Brompton Hospital,
United Kingdom
Title
Meta-Analysis of Percutaneous Coronary Intervention With Drug-Eluting
Stent Versus Coronary Artery Bypass Grafting for Isolated Proximal Left
Anterior Descending Coronary Disease.
Source
American Journal of Cardiology. 118 (8) (pp 1171-1177), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We performed a meta-analysis of the studies comparing the efficacy and
safety of coronary artery bypass surgery against percutaneous coronary
intervention with drug-eluting stents (PCI-DES) in patients with isolated
LAD disease. Because of the limited randomized trial data, the optimal
revascularization strategy for patients with isolated LAD disease remains
uncertain. Using MEDLINE and EMBASE to source data, 11 studies (3
randomized trials and 8 cohort studies) including 5,044 participants were
identified. No significant difference in mortality between PCI-DES and
coronary artery bypass surgery (CABG; 111 of 2,122 [5.2%] and 120 of 2,574
[4.7%]; relative risk [RR] 1.23; 95% confidence interval [CI] 0.90 to
1.69) was detected. For MACE, PCI-DES was associated with significant
increase in adverse events (RR 1.41; 95% CI 1.03 to 1.93, 8 studies, 4,230
participants). There were no significant differences in the risk of
myocardial infarction (RR 0.86; 95% CI 0.58 to 1.26) or stroke (RR 2.36;
95% CI 0.54 to 10.43) between the 2 groups. There were 239 target vessel
revascularization (TVR) events among 2,237 participants in the PCI-DES
group (10.7%) and 145 TVR events among 2,793 participants in the CABG
group (5.2%) with a significant increased risk of TVR in the PCI group (RR
2.52; 95% CI 1.69 to 3.77, 5,030 participants) compared with CABG. In
conclusion, for patients with isolated disease of the LAD, meta-analysis
of the available data suggests revascularization with a PCI-DES strategy
offers similar mortality, MI, and stroke rates to CABG at the expense of
increased TVR. Much of the data are derived from registries using
first-generation DES, and further randomized trials with more contemporary
platforms are needed. Copyright &#xa9; 2016 Elsevier Inc.

<119>
[Use Link to view the full text]
Accession Number
613333945
Author
Li T.; Sun Z.-L.; Xie Q.-Y.
Institution
(Li) Department of Emergency, First Affiliated Hospital, Zhejiang
University, Hangzhou, China
(Sun, Xie) Department of Cardiology, Xiangya Hospital, Central South
University, No. 87 Xiangya Road, Kaifu District, Changsha 410008, China
Title
Meta-analysis identifies serum c-reactive protein as an indicator of
atrial fibrillation risk after coronary artery bypass graft.
Source
American Journal of Therapeutics. 23 (6) (pp e1586-e1596), 2016. Date of
Publication: 28 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
A meta-analysis-based study was conducted to examine the clinical value of
serum C-reactive protein (CRP) levels in predicting postoperative atrial
fibrillation (POAF) in patients with coronary artery disease (CAD) who
underwent coronary artery bypass graft. Computer-based search of
scientific literature databases was performed to identify relevant studies
in strict accordance with our inclusion and exclusion criteria. Data
extracted from the selected studies were used to perform metaanalysis
using the STATA 12.0 statistical software. Standardized mean differences
(SMDs) with their 95% confidence interval (95% CI) were calculated. The
database search strategy initially identified 62 articles (Chinese 5 17,
English 5 45). After multiple levels of screening and validation, 15
case-control studies (Chinese 5 1, English 5 14), containing of a total of
3110 atrial fibrillation patients (POAF 5 925, non-POAF 5 2185), were
selected for our meta-analysis. The meta-analysis results confirmed that
serum CRP level was remarkably higher in patients with POAF compared with
non-POAF (SMD 5 1.36; 95% CI, 0.44-2.28; P 5 0.004). Ethnicity-stratified
analysis revealed that elevated serum CRP levels were associated with an
increased risk of POAF in white patients with CAD (SMD 5 0.85; 95% CI,
0.12-1.58; P 5 0.022), but not Asian patients with CAD (SMD 5 3.31, 95%
CI, 20.04 to 6.66; P 5 0.053). Elevated CRP levels, indicating profound
inflammation, may be associated with significantly increased risk of POAF
in patients with CAD who underwent coronary artery bypass graft. Thus,
serum CRP levels are important for early diagnosis and monitoring of POAF
in high-risk patients. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc.

<120>
Accession Number
613319057
Author
Wang Z.; Ma S.; Zappitelli M.; Parikh C.; Wang C.-Y.; Devarajan P.
Institution
(Wang) Department of Research, Connecticut Children's Medical Center,
Hartford, CT, United States
(Ma) Department of Biostatistics, Yale University, New Haven, CT, United
States
(Zappitelli) Division of Nephrology, Department of Pediatrics, Montreal
Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
(Parikh) Section of Nephrology, Program of Applied Translational Research,
Yale University, School of Medicine, New Haven, CT, United States
(Wang) Division of Public Health Sciences, Fred Hutchinson Cancer Research
Center, Seattle, WA, United States
(Devarajan) Department of Nephrology and Hypertension, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH, United States
Title
Penalized count data regression with application to hospital stay after
pediatric cardiac surgery.
Source
Statistical Methods in Medical Research. 25 (6) (pp 2685-2703), 2016. Date
of Publication: 01 Dec 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Pediatric cardiac surgery may lead to poor outcomes such as acute kidney
injury (AKI) and prolonged hospital length of stay (LOS). Plasma and urine
biomarkers may help with early identification and prediction of these
adverse clinical outcomes. In a recent multi-center study, 311 children
undergoing cardiac surgery were enrolled to evaluate multiple biomarkers
for diagnosis and prognosis of AKI and other clinical outcomes. LOS is
often analyzed as count data, thus Poisson regression and negative
binomial (NB) regression are common choices for developing predictive
models. With many correlated prognostic factors and biomarkers, variable
selection is an important step. The present paper proposes new variable
selection methods for Poisson and NB regression. We evaluated regularized
regression through penalized likelihood function. We first extend the
elastic net (Enet) Poisson to two penalized Poisson regression: Mnet, a
combination of minimax concave and ridge penalties; and Snet, a
combination of smoothly clipped absolute deviation (SCAD) and ridge
penalties. Furthermore, we extend the above methods to the penalized NB
regression. For the Enet, Mnet, and Snet penalties (EMSnet), we develop a
unified algorithm to estimate the parameters and conduct variable
selection simultaneously. Simulation studies show that the proposed
methods have advantages with highly correlated predictors, against some of
the competing methods. Applying the proposed methods to the aforementioned
data, it is discovered that early postoperative urine biomarkers including
NGAL, IL18, and KIM-1 independently predict LOS, after adjusting for risk
and biomarker variables. Copyright &#xa9; SAGE Publications.

<121>
Accession Number
613318337
Author
Sommer M.S.; Trier K.; Vibe-Petersen J.; Missel M.; Christensen M.; Larsen
K.R.; Langer S.W.; Hendriksen C.; Clementsen P.F.; Pedersen J.H.; Langberg
H.
Institution
(Sommer, Trier, Vibe-Petersen) Copenhagen Centre for Cancer and Health,
City of Copenhagen, Norre Alle 45, Copenhagen DK-2200, Denmark
(Missel, Christensen, Langer, Hendriksen, Clementsen, Pedersen, Langberg)
University of Copenhagen, Copenhagen, Denmark
(Larsen) Bispebjerg University Hospital, Copenhagen, Denmark
(Clementsen) Gentofte University Hospital, Hellerup, Denmark
Title
Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA): A
Feasibility Study.
Source
Integrative Cancer Therapies. 15 (4) (pp 455-466), 2016. Date of
Publication: 01 Dec 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction. Surgical resection in patients with non-small cell lung
cancer (NSCLC) may be associated with significant morbidity, functional
limitations, and decreased quality of life. Objectives. The safety and
feasibility of a preoperative and early postoperative rehabilitation
program in patients operated for NSCLC was determined in a nonhospital
setting, with focus on high-intensity interval exercise. Methods. Forty
patients with biopsy-proven NSCLC stages I to IIIa referred for surgical
resection at the Department of Cardiothoracic Surgery RT, Rigshospitalet,
University of Copenhagen, were randomly assigned to 1 of 4 groups (3
intervention groups and 1 control group). The preoperative intervention
consisted of a home-based exercise program, while the postoperative
exercise program comprised a supervised group exercise program involving
resistance and high-intensity interval cardiorespiratory exercise 2 hours
weekly for 12 weeks combined with individual counseling. The study
endpoints were inclusion rate, adherence, and number of adverse events.
Results. Forty patients (of 124 screened; 32%) were included and
randomized into the 4 groups. The postoperative exercise was completed by
73% of the patients randomized to this intervention. No adverse events
were observed, indicating that the early postoperative exercise program is
safe. The preoperative home-based exercise program was not feasible due to
interfering diagnostic procedures and fast-track surgery that left only 1
to 2 weeks between diagnosis and surgery. Conclusion. The early
postoperative exercise program for patients with NSCLC was safe and
feasible, but in a fast-track set up, a preoperative home-based exercise
program was not feasible for this population. Copyright &#xa9; The
Author(s) 2016.

<122>
Accession Number
613300045
Author
Vives M.; Callejas R.; Duque P.; Echarri G.; Wijeysundera D.N.; Hernandez
A.; Sabate A.; Bes-Rastrollo M.; Monedero P.
Institution
(Vives) Anaesthesia and Intensive Care, Hospital Universitari Bellvitge,
Universitat de Barcelona, C/ Feixa Llarga, s/n. Hospitalet, Barcelona
08907, Spain
(Callejas, Duque, Echarri, Monedero) Anesthesiology and Critical Care,
Clinica Universidad de Navarra, Avenida Pio 12, 36, Pamplona 31008, Spain
(Wijeysundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
(Wijeysundera) Department of Anesthesia and Institute of Health Policy
Management and Evaluation, University of Toronto, Toronto, Canada
(Wijeysundera) Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Toronto, Canada
(Hernandez) Department of Anesthesiology and Critical Care, University
Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester M23
9LT, United Kingdom
(Sabate) Department of Anesthesiology and Critical Care, Bellvitge
University Hospital, C/ Feixa Llarga, s/n. Hospitalet, Barcelona 08907,
Spain
(Bes-Rastrollo) Department Preventive Medicine and Public Health,
University of Navarra, Av. Pio XII, 36, Pamplona 31008, Spain
(Bes-Rastrollo) CIBERobn, Instituto de Salud Carlos III, Spain
(Bes-Rastrollo) IDISNA, Navarra's Health Research Institute, Spain
Title
Modern hydroxyethyl starch and acute kidney injury after cardiac surgery:
A prospective multicentre cohort.
Source
British Journal of Anaesthesia. 117 (4) (pp 458-463), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Recent trials have shown hydroxyethyl starch (HES) solutions
increase the risk of acute kidney injury (AKI) in critically ill patients.
It is uncertain whether these adverse effects also affect surgical
patients. We sought to determine the renal safety of modern tetrastarch
(6% HES 130/0.4) use in cardiac surgical patients. Methods In this
multicentre prospective cohort study, 1058 consecutive patients who
underwent cardiac surgery from 15th September 2012 to 15th December 2012
were recruited in 23 Spanish hospitals. Results We identified 350 patients
(33%) administered 6% HES 130/0.4 intraoperatively and postoperatively,
and 377 (36%) experienced postoperative AKI (AKI Network criteria).
In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES
group had higher Euroscore and more comorbidities including unstable
angina, preoperative cardiogenic shock, preoperative intra-aortic balloon
pump use, peripheral arterial disease, and pulmonary hypertension. The
non-HES group received more intraoperative vasopressors and had longer
cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES
130/0.4 use was not associated with significantly increased risks of AKI
(adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were
confirmed by propensity score-matched pairs analyses. Conclusions The
intraoperative and postoperative use of modern hydroxyethyl starch 6% HES
130/0.4 was not associated with increased risks of AKI and dialysis after
cardiac surgery in our multicentre cohort. Copyright &#xa9; 2016 The
Author 2016. Published by Oxford University Press on behalf of the British
Journal of Anaesthesia. All rights reserved. For Permissions, please
email: journals.permissions@oup.com.

<123>
Accession Number
613300025
Author
Soh S.; Song J.W.; Shim J.K.; Kim J.H.; Kwak Y.L.
Institution
(Soh, Song, Shim, Kwak) Department of Anaesthesiology and Pain Medicine,
South Korea
(Song, Shim, Kwak) Anaesthesia and Pain Research Institute, Yonsei
Cardiovascular Hospital, Yonsei University College of Medicine, 50
Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
(Kim) Department of Anaesthesiology and Pain Medicine, National Health
Insurance Service Ilsan Hospital, Goyang City, Gyeonggi-do 410-719, South
Korea
Title
Sodium bicarbonate does not prevent postoperative acute kidney injury
after off-pump coronary revascularization: A double-blinded randomized
controlled trial.
Source
British Journal of Anaesthesia. 117 (4) (pp 450-457), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Acute kidney injury (AKI) is a common morbidity after off-pump
coronary revascularization. We investigated whether perioperative
administration of sodium bicarbonate, which might reduce renal injury by
alleviating oxidative stress in renal tubules, prevents postoperative AKI
in off-pump coronary revascularization patients having renal risk factors.
Methods Patients (n=162) having at least one of the following AKI risk
factors were enrolled: (i) age >70 yr; (ii) diabetes mellitus; (iii)
chronic renal disease; (iv) congestive heart failure or left ventricular
ejection fraction <35%; and (v) reoperation or emergency. Patients were
evenly randomized to receive either sodium bicarbonate (0.5 mmol
kg^-1 for 1 h upon induction of anaesthesia followed by 0.15
mmol kg^-1 h^-1 for 23 h) or 0.9% saline. Acute kidney
injury within 48 h after surgery was assessed using the Acute Kidney
Injury Network criteria. Results The incidences of AKI were 21 and 26% in
the bicarbonate and control groups, respectively (P=0.458). Serially
measured serum creatinine concentrations and perioperative fluid balance
were also comparable between the groups. The length of postoperative
hospitalization and incidence of morbidity end points were similar between
the groups, whereas significantly more patients in the bicarbonate group
required prolonged mechanical ventilation (>24 h) relative to the control
group (20 vs 6, P=0.003). Conclusions Perioperative sodium bicarbonate
administration did not decrease the incidence of AKI after off-pump
coronary revascularization in high-risk patients and might even be
associated with a need for prolonged ventilatory care. Clinical trial
registration NCT01840241. Copyright &#xa9; 2016 The Author 2016. Published
by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved. For Permissions, please email:
journals.permissions@oup.com.

<124>
Accession Number
613300007
Author
Joosten A.; Tircoveanu R.; Arend S.; Wauthy P.; Gottignies P.; Van Der
Linden P.
Institution
(Joosten) Department of Anesthesiology and Perioperative Care, Erasme
University Hospital, Universit Libre de Bruxelles, Brussels, Belgium
(Tircoveanu, Arend, Van Der Linden) Department of Anesthesiology and
Perioperative Care, CHU Brugmann, Universit Libre de Bruxelles, Brussels,
Belgium
(Wauthy) Department of Cardiac Surgery, CHU Brugmann, Universit Libre de
Bruxelles, Brussels, Belgium
(Gottignies) Department of Intensive Care, CHU Brugmann, Universit Libre
de Bruxelles, Brussels, Belgium
Title
Impact of balanced tetrastarch raw material on perioperative blood loss: A
randomized double blind controlled trial.
Source
British Journal of Anaesthesia. 117 (4) (pp 442-449), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background As 6% hydroxyethyl starch (HES) 130/0.40 or 130/0.42 can
originate from different vegetable sources, they might have different
clinical effects. The purpose of this prospective, randomized,
double-blind controlled trial was to compare two balanced tetrastarch
solutions, one maize-derived and one potato-derived, on perioperative
blood loss in patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB). Methods We randomly assigned 118 patients undergoing
elective cardiac surgery into two groups, to receive either a maize- or a
potato-derived HES solution. Study fluids were administered
perioperatively (including priming of CPB) until the second postoperative
day (POD#2) using a goal directed algorithm. The primary outcome was
calculated postoperative blood loss up to POD#2. Secondary outcomes
included short-term incidence of acute kidney injury (AKI), and long-term
effect (up to one yr) on renal function. Results Preoperative and
intraoperative characteristics of the subjects were similar between
groups. Similar volumes of HES were administered (1950 ml [1250-2325] for
maize-HES and 2000 ml [1500-2700] for potato-HES; P=0.204). Calculated
blood loss (504 ml [413-672] for maize-HES vs 530 ml [468-705] for
potato-HES; P=0.107) and the need for blood components were not different
between groups. The incidence of AKI was similar in both groups (P=0.111).
Plasma creatinine concentration and glomerular filtration rates did vary
over time, although changes were minimal. Conclusions Under our study
conditions, HES 130/0.4 or 130/0.42 raw material did not have a
significant influence on perioperative blood loss. Moreover, we did not
find any effect of tetrastarch raw material composition on short and
long-term renal function. Clinical trial registration EudraCT number:
2011-005920-16. Copyright &#xa9; 2016 The Author 2016. Published by Oxford
University Press on behalf of the British Journal of Anaesthesia. All
rights reserved. For Permissions, please email:
journals.permissions@oup.com.

<125>
[Use Link to view the full text]
Accession Number
613297177
Author
Gupta P.; Rettiganti M.; Fisher P.L.; Chang A.C.; Rice T.B.; Wetzel R.C.
Institution
(Gupta) Division of Pediatric Cardiology, University of Arkansas for
Medical Sciences, Little Rock, AR, United States
(Rettiganti) Section of Biostatistics, Department of Pediatrics,
University of Arkansas for Medical Sciences, Little Rock, AR, United
States
(Fisher) Department of Statistics, LSU Health Sciences Center, New
Orleans, LA, United States
(Chang) Division of Pediatric Cardiology, Department of Pediatrics,
Children's Hospital of Orange County, Orange, CA, United States
(Chang) Medical Intelligence and Innovation Institute (MI3), Children's
Hospital of Orange County, Orange, CA, United States
(Rice, Wetzel) Virtual PICU Systems, LLC, Los Angeles, CA, United States
(Rice) Division of Pediatric Critical Care, Department of Pediatrics,
Medical College of Wisconsin, Milwaukee, WI, United States
(Wetzel) Division of Critical Care Medicine, Department of Pediatrics and
Anesthesiology, Children's Hospital Los Angeles, USC Keck School of
Medicine, Los Angeles, CA, United States
Title
Association of Freestanding Children's Hospitals with Outcomes in Children
with Critical Illness*.
Source
Critical Care Medicine. 44 (12) (pp 2131-2138), 2016. Date of Publication:
01 Dec 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Little is known about the relationship between freestanding
children's hospitals and outcomes in children with critical illness. The
purpose of this study was to evaluate the association of freestanding
children's hospitals with outcomes in children with critical illness.
Design: Propensity score matching was performed to adjust for potential
confounding variables between patients cared for in freestanding or
nonfreestanding children's hospitals. We tested the sensitivity of our
findings by repeating the primary analyses using inverse probability of
treatment weighting method and regression adjustment using the propensity
score. Setting: Retrospective study from an existing national database,
Virtual PICU Systems (LLC) database. Patients: Patients less than 18 years
old admitted to one of the participating PICUs in the Virtual PICU
Systems, LLC database were included (2009-2014). Interventions: None.
Measurements and Main Results: A total of 538,967 patients from 140
centers were included. Of these, 323,319 patients were treated in 60
freestanding hospitals. In contrast, 215,648 patients were cared for in 80
nonfreestanding hospitals. By propensity matching, 134,656 patients were
matched 1:1 in the two groups (67,328 in each group). Prior to matching,
patients in the freestanding hospitals were younger, had greater
comorbidities, had higher severity of illness scores, had higher incidence
of cardiac arrest, had higher resource utilization, and had higher
proportion of patients undergoing complex procedures such as cardiac
surgery. Before matching, the outcomes including mortality were worse
among the patients cared for in the freestanding hospitals (freestanding
vs nonfreestanding, 2.5% vs 2.3%; p < 0.001). After matching, the majority
of the study outcomes were better in freestanding hospitals (freestanding
vs nonfreestanding, mortality: 2.1% vs 2.8%, p < 0.001; standardized
mortality ratio: 0.77 [0.73-0.82] vs 0.99 [0.87-0.96], p < 0.001;
reintubation: 3.4% vs 3.8%, p < 0.001; good neurologic outcome: 97.7% vs
97.1%, p = 0.001). Conclusions: In this large observational study, we
demonstrated that ICU care provided in freestanding children's hospitals
is associated with improved risk-adjusted survival chances compared to
nonfreestanding children's hospitals. However, the clinical significance
of this change in mortality should be interpreted with caution. It is also
possible that the hospital structure may be a surrogate of other factors
that may bias the results. Copyright &#xa9; 2016 by the Society of
Critical Care Medicine and Wolters Kluwer Health, Inc.

<126>
Accession Number
613296985
Author
Heddle N.M.; Cook R.J.; Arnold D.M.; Liu Y.; Barty R.; Crowther M.A.;
Devereaux P.J.; Hirsh J.; Warkentin T.E.; Webert K.E.; Roxby D.;
Sobieraj-Teague M.; Kurz A.; Sessler D.I.; Figueroa P.; Ellis M.;
Eikelboom J.W.
Institution
(Heddle, Arnold, Liu, Barty, Crowther, Devereaux, Hirsh, Warkentin,
Eikelboom) Department of Medicine, Hamilton, ON, Canada
(Heddle, Crowther, Warkentin, Webert) Department of Pathology and
Molecular Medicine, Hamilton, ON, Canada
(Heddle, Devereaux) Department of Clinical Epidemiology and Biostatistics,
Hamilton, ON, Canada
(Heddle, Cook, Arnold, Liu, Barty, Warkentin, Webert) McMaster Centre for
Transfusion Research, Hamilton, ON, Canada
(Heddle, Arnold, Webert) McMaster University, Canadian Blood Services, HSC
3H51, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada
(Devereaux, Eikelboom) Population Health Research Institute, Hamilton, ON,
Canada
(Eikelboom) Thrombosis and Atherosclerosis Research Institute, Hamilton,
ON, Canada
(Cook) Department of Statistics and Actuarial Science, University of
Waterloo, Waterloo, ON, Canada
(Roxby, Sobieraj-Teague) SA Pathology Transfusion Service, Flinders
Medical Centre, Flinders University, Adelaide, SA, Australia
(Kurz) Department of General Anesthesiology, United States
(Kurz, Sessler) Department of Outcomes Research, Anesthesiology Institute,
United States
(Figueroa) Robert J. Tomsich Pathology and Laboratory Medicine Institute,
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, United
States
(Ellis) Meir Medical Center Kfar Saba and Sackler School of Medicine, Tel
Aviv University, Tel Aviv, Israel
Title
Effect of short-term vs. Long-term blood storage on mortality after
transfusion.
Source
New England Journal of Medicine. 375 (20) (pp 1937-1945), 2016. Date of
Publication: 17 Nov 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Randomized, controlled trials have suggested that the
transfusion of blood after prolonged storage does not increase the risk of
adverse outcomes among patients, although most of these trials were
restricted to high-risk populations and were not powered to detect small
but clinically important differences in mortality. We sought to find out
whether the duration of blood storage would have an effect on mortality
after transfusion in a general population of hospitalized patients.
METHODS In this pragmatic, randomized, controlled trial conducted at six
hospitals in four countries, we randomly assigned patients who required a
red-cell transfusion to receive blood that had been stored for the
shortest duration (short-term storage group) or the longest duration
(long-term storage group) in a 1:2 ratio. Only patients with type A or O
blood were included in the primary analysis, since pilot data suggested
that our goal of achieving a difference in the mean duration of blood
storage of at least 10 days would not be possible with other blood types.
Written informed consent was waived because all the patients received
treatment consistent with the current standard of care. The primary
outcome was in-hospital mortality, which was estimated by means of a
logistic-regression model after adjustment for study center and patient
blood type. RESULTS From April 2012 through October 2015, a total of
31,497 patients underwent randomization. Of these patients, 6761 who did
not meet all the enrollment criteria were excluded after randomization.
The primary analysis included 20,858 patients with type A or O blood. Of
these patients, 6936 were assigned to the short-term storage group and
13,922 to the long-term storage group. The mean storage duration was 13.0
days in the short-term storage group and 23.6 days in the long-term
storage group. There were 634 deaths (9.1%) in the short-term storage
group and 1213 (8.7%) in the long-term storage group (odds ratio, 1.05;
95% confidence interval [CI], 0.95 to 1.16; P = 0.34). When the analysis
was expanded to include the 24,736 patients with any blood type, the
results were similar, with rates of death of 9.1% and 8.8%, respectively
(odds ratio, 1.04; 95% CI, 0.95 to 1.14; P = 0.38). Additional results
were consistent in three prespecified high-risk subgroups (patients
undergoing cardiovascular surgery, those admitted to intensive care, and
those with cancer). CONCLUSIONS Among patients in a general hospital
population, there was no significant difference in the rate of death among
those who underwent transfusion with the freshest available blood and
those who underwent transfusion according to the standard practice of
transfusing the oldest available blood. Copyright &#xa9; 2016
Massachusetts Medical Society.

<127>
Accession Number
613244267
Author
Villablanca P.A.; Mathew V.; Thourani V.H.; Rodes-Cabau J.; Bangalore S.;
Makkiya M.; Vlismas P.; Briceno D.F.; Slovut D.P.; Taub C.C.; McCarthy
P.M.; Augoustides J.G.; Ramakrishna H.
Institution
(Villablanca, Briceno, Slovut, Taub) Division of Cardiovascular Diseases,
Montefiore Medical Center/Albert Einstein College of Medicine, New York,
NY, United States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(Thourani) Emory University School of Medicine, Division of Cardiothoracic
Surgery, Atlanta, GA, United States
(Rodes-Cabau) Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
(Bangalore) New York University School of Medicine, New York, NY, United
States
(Makkiya, Vlismas) Department of Internal Medicine, Montefiore Medical
Center/Albert Einstein College of Medicine, New York, NY, United States
(Slovut) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, New York, NY, United
States
(McCarthy) Division of Cardiac Surgery, Bluhm Cardiovascular Institute,
Northwestern University Feinberg School of Medicine, Chicago, Ill, United
States
(Augoustides) Department of Anesthesiology and Critical Care, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic College of Medicine, Scottsdale, AZ, United States
Title
A meta-analysis and meta-regression of long-term outcomes of transcatheter
versus surgical aortic valve replacement for severe aortic stenosis.
Source
International Journal of Cardiology. 225 (pp 234-243), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve replacement (TAVR) has emerged as an
alternative to surgical aortic-valve replacement (SAVR) for patients with
severe symptomatic aortic stenosis (AS) who are at high operative risk. We
sought to determine the long-term (> 1 year follow-up) safety and efficacy
TAVR compared with SAVR in patients with severe AS. Methods A
comprehensive search of PubMed, EMBASE, Cochrane Central Register of
Controlled Trials, conference proceedings, and relevant Web sites from
inception through 10 April 2016. Results Fifty studies enrolling 44,247
patients met the inclusion criteria. The mean duration follow-up was 21.4
months. No difference was found in long-term all-cause mortality (risk
ratios (RR), 1.06; 95% confidence interval (CI) 0.91-1.22). There was a
significant difference favoring TAVR in the incidence of stroke (RR, 0.82;
95% CI 0.71-0.94), atrial fibrillation (RR, 0.43; 95% CI 0.33-0.54), acute
kidney injury (RR, 0.70; 95% CI 0.53-0.92), and major bleeding (RR, 0.57;
95% CI 0.40-0.81). TAVR had significant higher incidence of vascular
complications (RR, 2.90; 95% CI 1.87-4.49), aortic regurgitation (RR,
7.00; 95% CI 5.27-9.30), and pacemaker implantation (PPM) (RR, 2.02; 95%
CI 1.51-2.68). TAVR demonstrated significantly lower stroke risk compared
to SAVR in high-risk patients (RR, 1.49; 95% CI 1.06-2.10); no differences
in PPM implantation were observed in intermediate-risk patients (RR, 1.68;
95% CI 0.94-3.00). In a meta-regression analysis, the effect of TAVR
baseline clinical features did not affect the long-term all-cause
mortality outcome. Conclusion TAVR and SAVR showed similar long-term
survival in patients with severe AS; with important differences in
treatment-associated morbidity. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<128>
Accession Number
613227729
Author
Mancini G.B.J.; Farkouh M.E.; Brooks M.M.; Chaitman B.R.; Boden W.E.;
Vlachos H.; Hartigan P.M.; Siami F.S.; Sidhu M.S.; Bittner V.; Frye R.;
Fuster V.
Institution
(Mancini) Department of Medicine, University of British Columbia,
Vancouver, British Columbia, Canada
(Farkouh) Department of Medicine, Peter Munk Cardiac Centre and the Heart
and Stroke Richard Lewar Centre of Excellence, University of Toronto,
Toronto, Ontario, Canada
(Brooks, Vlachos) Department of Epidemiology, University of Pittsburgh,
Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
(Chaitman) St. Louis University School of Medicine, St. Louis, Missouri,
United States
(Boden, Sidhu) Department of Medicine, Albany Medical College, Albany, New
York, United States
(Hartigan) West Haven Veterans Administration Coordinating Center, West
Haven, Connecticut, United States
(Siami) New England Research Institutes, Incorporated, Watertown,
Massachusetts, United States
(Bittner) University of Alabama at Birmingham, Birmingham, Alabama, United
States
(Frye) Mayo Clinic, Rochester, Minnesota, United States
(Fuster) Icahn School of Medicine at Mount Sinai, New York, New York,
United States
Title
Medical Treatment and Revascularization Options in Patients With Type 2
Diabetes and Coronary Disease.
Source
Journal of the American College of Cardiology. 68 (10) (pp 985-995), 2016.
Date of Publication: 06 Sep 2016.
Publisher
Elsevier USA
Abstract
Background There are scant outcomes data in patients with type 2 diabetes
and stable coronary artery disease (CAD) stratified by detailed
angiographic burden of CAD or left ventricular ejection fraction (LVEF).
Objectives This study determined the effect of optimal medical therapy
(OMT), with or without percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG), on long-term outcomes with respect
to LVEF and number of diseased vessels, including proximal left anterior
descending artery involvement. Methods A patient-level pooled analysis was
undertaken in 3 federally-funded trials. The primary endpoint was the
composite of death, myocardial infarction (MI), or stroke, adjusted for
trial and randomization strategy. Results Among 5,034 subjects, 15% had
LVEF <50%, 77% had multivessel CAD, and 28% had proximal left anterior
descending artery involvement. During a median 4.5-year follow-up, CABG +
OMT was superior to PCI + OMT for the primary endpoint (hazard ratio [HR]:
0.71; 95% confidence interval [CI]: 0.59 to 0.85; p = 0.0002), death (HR:
0.76; 95% CI: 0.60 to 0.96; p = 0.024), and MI (HR: 0.50; 95% CI: 0.38 to
0.67; p = 0.0001), but not stroke (HR: 1.54; 95% CI: 0.96 to 2.48; p =
0.074). CABG + OMT was also superior to OMT alone for prevention of the
primary endpoint (HR: 0.79; 95% CI: 0.64 to 0.97; p = 0.022) and MI (HR:
0.55; 95% CI: 0.41 to 0.74; p = 0.0001), and was superior to PCI + OMT for
the primary endpoint in patients with 3-vessel CAD (HR: 0.72; 95% CI: 0.58
to 0.89; p = 0.002) and normal LVEF (HR: 0.71; 95% CI: 0.58 to 0.87; p =
0.0012). There were no significant differences in OMT versus PCI + OMT.
Conclusions CABG + OMT reduced the primary endpoint during long-term
follow-up in patients with type 2 diabetes and stable CAD, supporting this
as the preferred management strategy. Copyright &#xa9; 2016 American
College of Cardiology Foundation

<129>
Accession Number
613279987
Author
Franco P.; Fiorentino A.; Dionisi F.; Fiore M.; Chiesa S.; Vagge S.;
Cellini F.; Caravatta L.; Tombolini M.; De Rose F.; Meattini I.;
Mortellaro G.; Apicella G.; Marino L.; Greto D.
Institution
(Franco) Department of Oncology-Radiation Oncology, University of Turin,
Via Genova 3, Turin 10126, Italy
(Fiorentino) Radiation Oncology, Ospedale Sacro Cuore-Don Calabria, Negrar
(Verona), Italy
(Dionisi) Department of Oncology, Proton Therapy Unit, Azienda Provinciale
per i Servizi Sanitari (APSS), Trento, Italy
(Fiore) Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
(Chiesa, Cellini) Radiation Oncology Department-Gemelli ART, Sacred Heart
Catholic University, Rome, Italy
(Vagge) Department of Radio-Oncology, IRCCS AOU San Martino IST, National
Institute for Cancer Research, Genoa, Italy
(Caravatta) Department of Radiation Oncology, Regional Oncological
Hospital, Cagliari, Italy
(Tombolini) Department of Sensory Organs, Institute of
Otorhinolaryngology, Audiology and Phoniatrics, Sapienza University, Rome,
Italy
(De Rose) Radiotherapy and Radiosurgery Department, Humanitas Clinical and
Research Center, Rozzano (Milan), Italy
(Meattini, Greto) Department of Sperimental and Clinical Biomedical
Sciences, Radiation Oncology, AOU Careggi, Florence, Italy
(Mortellaro) Radiation Oncology Department, ARNAS Civico Hospital,
Palermo, Italy
(Apicella) Radiotherapy Department, University Hospital Maggiore della
Carita, Novara, Italy
(Marino) Radiotherapy Department, Centro REM, Catania, Italy
Title
Combined modality therapy for thoracic and head and neck cancers: A review
of updated literature based on a consensus meeting.
Source
Tumori. 102 (5) (pp 459-471), 2016. Date of Publication: September-October
2016.
Publisher
Wichtig Publishing Srl
Abstract
Purpose: Combined modality therapy is a mainstay option for thoracic
malignancies and head and neck cancers. The integration of different
strategies is based on the multidisciplinary approach of modern clinical
oncology. Radiation oncologists have to be educated, trained, and updated
to provide state-of-the-art care to cancer patients and thus educational
meetings are crucial. Methods: The Italian Association of Radiation
Oncology Young Members Working Group (AIRO Giovani) organized its 8th
national meeting, focused on combination therapy in lung, esophageal, and
head and neck cancer (with a specific focus on larynx-preservation
strategies for larynx/hypopharynx tumors), involving young professionals
working in Italy. The meeting was addressed to young radiation
oncologists, presenting state-of-the-art knowledge, based on the latest
evidence in this field. We performed a review of the current literature
based on the highlights of the Congress. Results: The multimodality
approach of head and neck and thoracic malignancies includes surgery,
chemotherapy, and radiotherapy, but also has to take into account new
information and data coming from basic and translational research and
including molecular biology, genetics, and immunology. All these aspects
are crucial for the treatment of non-small-cell lung cancer and
esophageal, esophagogastric junction, and larynx/hypopharynx malignancies.
The integration of different treatments in the clinical decision-making
process to combine therapies is crucial. Conclusions: Combination therapy
has proved to be a consolidated approach in these specific oncologic
settings, highlighting the importance of multimodality management in
modern clinical oncology. Dedicated meetings on specific topics are
helpful to improve knowledge and skills of young professionals in
radiation oncology.

<130>
Accession Number
613277924
Author
Gelsomino S.; La Meir M.; Van Breugel H.N.A.M.; Renzulli A.; Rostagno C.;
Lorusso R.; Parise O.; Lozekoot P.W.J.; Klop I.D.G.; Kumar N.; Luca F.;
Matteucci F.; Serraino F.; Sante P.; Caciolli S.; Vizzardi E.; De Jong M.;
Crijns H.J.G.M.; Gensini G.F.; Maessen J.G.
Institution
(Gelsomino, La Meir, Van Breugel, Parise, Lozekoot, Klop, Kumar, Luca,
Matteucci, De Jong, Crijns, Maessen) University Hospital Maastricht,
Maastricht, Netherlands
(Gelsomino, Rostagno, Luca, Matteucci, Caciolli, Gensini) Careggi
University Hospital, Florence, Italy
(Renzulli, Serraino, Sante) University of Magna Graecia, Catanzaro, Italy
(Lorusso, Vizzardi) Ospedali Riuniti Brescia, Brescia, Italy
Title
Surgical ablation in patients undergoing mitral valve surgery: Impact of
lesion set and surgical techniques on long-term success.
Source
Europace. 18 (10) (pp 1528-1537), 2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To assess the results and impact of lesion set and surgical technique
on long-term success of surgical ablation during mitral surgery. Methods
and results The patient population consisted of 685 subjects with
persistent and long-standing persistent atrial fibrillation (AF)
undergoing cardiac surgery for mitral valve disease as the primary
indication and concomitant ablation between January 2003 and January 2012
at three institutions. One hundred and sixty-six underwent unipolar
(24.2%), 371 (54.2%) bipolar, and 148 (21.6%) had combined ablation.
Median follow-up was 58.4 months (interquartile range 43.3-67.9). To
appropriately account for death, a competing risk model was employed to
identify predictors of cumulative incidence of recurrent AF among lesion
set and surgical techniques. Eight-year freedom from recurrent arrhythmia
without antiarrhythmic drugs was 0.60 +/- 0.02. Success rate was higher
using bipolar radiofrequency (RF) (P < 0.001), after performing mitral
isthmus line (P = 0.003) and following the biatrial technique (P < 0.001).
Competing risk regression revealed that use of unipolar RF [sub-hazard
ratio (SHR) 2.41 (1.52-3.43), P < 0.001], combined unipolar/bipolar
ablation [SHR 1.93 (0.89-2.57), P = 0.003] and the absence of right atrial
ablation [SHR 2.79 (1.27-3.48), P < 0.001] were predictors of cumulative
incidence of long-term recurrence. Conclusions Our experience suggests
that the use of bipolar clamp improves long-term results in surgical
treatment of AF and that right-sided ablation should be routinely added.
Randomized studies are necessary to confirm our findings. Copyright &#xa9;
2015 Published on behalf of the European Society of Cardiology. All rights
reserved. &#xa9; The Author 2015. For permissions please email:
journals.permissions@oup.com.

<131>
Accession Number
613206443
Author
Butter C.; Bramlage P.; Rudolph T.; Jacobshagen C.; Rothe J.; Treede H.;
Kerber S.; Frank D.; Seilerova L.; Schymik G.
Institution
(Butter) Department of Cardiology, Immanuel Clinic Bernau, Heart Center
Brandenburg, Ladeburger Strase 17, Bernau 16321, Germany
(Bramlage) Institute for Pharmacology and Preventive Medicine,
Cloppenburg, Germany
(Rudolph) Herzzentrum, Universitatsklinikum Koln, Cologne, Germany
(Jacobshagen) Herzzentrum, Universitatsklinikum Gottingen, Gottingen,
Germany
(Rothe) University Heart Center Freiburg-Bad Krozingen, Division of
Cardiology and Angiology II, Bad Krozingen, Germany
(Treede) Universitatsklinik und Poliklinik fur Herzchirurgie,
Universitatsklinikum Halle, Halle, Germany
(Kerber) Herz- und Gefas-Klinik, Bad Neustadt, Germany
(Frank) ZHK (German Centre for Cardiovascular Research), Partner Site
Kiel/Hamburg/Lubeck, Hamburg, Germany
(Frank) University Hospital Schleswig-Holstein, Department of Internal
Medicine III (Cardiology and Angiology), Campus Kiel, Germany
(Seilerova) Edwards Lifesciences, Prague, Czech Republic
(Schymik) Medical Clinic IV, Department of Cardiology, Municipal Hospital,
Karlsruhe, Germany
Title
Balloon expandable transcatheter aortic valve implantation via the
transfemoral route with or without pre-dilation of the aortic valve -
rationale and design of a multicentre registry (EASE-IT TF).
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 223. Date of Publication: 15 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Transcatheter aortic valve implantation via the transfemoral
route (TF-TAVI) is commonly performed as a treatment for severe aortic
stenosis (AS) in patients at high surgical risk. Pre-deployment balloon
aortic valvuloplasty (BAV) has generally been considered an essential step
for preparing the valve landing zone for receipt of the prosthesis.
However, there is little evidence supporting the clinical value of BAV,
while several associated complications have been documented. This has
provoked several groups to evaluate the feasibility and safety of omitting
BAV form the TF-TAVI procedure (direct TF-TAVI), with encouraging results.
However, studies comparing the clinical outcomes of direct TF-TAVI to
standard TF-TAVI are lacking. Methods: EASE-IT TF is a prospective,
observational, two-armed, multicentre registry designed to gather data on
procedural aspects, adverse events and survival rates associated with
direct TF-TAVI using the Edwards SAPIEN 3 balloon-expandable prosthesis.
Discussion: EASE-IT-TF data will be analysed firstly to determine the
risks and benefits associated with direct TF-TAVI vs. standard TF-TAVI,
and secondly to identify associations between patient variables and
specific outcomes. This may assist identification of patients who stand to
benefit from direct TF-TAVI, therefore contributing to clinical reductions
in TF-TAVI-associated morbidity and mortality rates in high-risk AS
patients. Trial registrations: Clinictrials.gov: NCT02760771 Copyright
&#xa9; 2016 The Author(s).

<132>
Accession Number
613179298
Author
Rickard C.M.; Edwards M.; Spooner A.J.; Mihala G.; Marsh N.; Best J.;
Wendt T.; Rapchuk I.; Gabriel S.; Thomson B.; Corley A.; Fraser J.F.
Institution
(Rickard, Edwards, Spooner, Marsh, Best, Wendt, Corley, Fraser) AVATAR
Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health
Institute Queensland, Griffith University, Nathan, Queensland 4111,
Australia
(Edwards, Spooner, Best, Wendt, Corley, Fraser) Critical Care Research
Group, The University of Queensland and The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
(Mihala) Centre for Applied Health Economics, Menzies Health Institute
Queensland, School of Medicine, Griffith University, Meadowbrook,
Queensland 4131, Australia
(Marsh) Centre for Clinical Nursing, Royal Brisbane and Women's Hospital,
Herston, Queensland 4006, Australia
(Rapchuk) Department of Anaesthesia, The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
(Gabriel) Cardiac Surgery Research Unit, The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
(Thomson) Department of Cardiac Surgery, The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
Title
A 4-arm randomized controlled pilot trial of innovative solutions for
jugular central venous access device securement in 221 cardiac surgical
patients.
Source
Journal of Critical Care. 36 (pp 35-42), 2016. Date of Publication: 01 Dec
2016.
Publisher
W.B. Saunders
Abstract
Purpose To improve jugular central venous access device (CVAD) securement,
prevent CVAD failure (composite: dislodgement, occlusion, breakage, local
or bloodstream infection), and assess subsequent trial feasibility.
Materials and Methods Study design was a 4-arm, parallel, randomized,
controlled, nonblinded, pilot trial. Patients received CVAD securement
with (i) suture + bordered polyurethane (suture + BPU; control), (ii)
suture + absorbent dressing (suture + AD), (iii) sutureless securement
device + simple polyurethane (SSD + SPU), or (iv) tissue adhesive + simple
polyurethane (TA + SPU). Midtrial, due to safety, the TA + SPU
intervention was replaced with a suture + TA + SPU group. Results A total
of 221 patients were randomized with 2 postrandomization exclusions.
Central venous access device failure was as follows: suture + BPU
controls, 2 (4%) of 55 (0.52/1000 hours); suture + AD, 1 (2%) of 56
(0.26/1000 hours, P = .560); SSD + SPU, 4 (7%) of 55 (1.04/1000 hours, P =
.417); TA + SPU, 4 (17%) of 23 (2.53/1000 hours, P = .049); and suture +
TA + SPU, 0 (0%) of 30 (P = .263; intention-to-treat, log-rank tests).
Central venous access device failure was predicted (P < .05) by baseline
poor/fair skin integrity (hazard ratio, 9.8; 95% confidence interval,
1.2-79.9) or impaired mental state at CVAD removal (hazard ratio, 14.2;
95% confidence interval, 3.0-68.4). Conclusions Jugular CVAD securement is
challenging in postcardiac surgical patients who are coagulopathic and
mobilized early. TA + SPU was ineffective for CVAD securement and is not
recommended. Suture + TA + SPU appeared promising, with zero CVAD failure
observed. Future trials should resolve uncertainty about the comparative
effect of suture + TA + SPU, suture + AD, and SSD + SPU vs suture + BPU.
Copyright &#xa9; 2016 Elsevier Inc.

<133>
Accession Number
613415492
Author
Sabra M.J.; Smotherman C.; Kraemer D.F.; Nussbaum M.S.; Tepas J.J.; Awad
Z.T.
Institution
(Sabra, Nussbaum, Tepas, Awad) Department of SurgeryUniversity of Florida
College of MedicineJacksonville, Florida
(Smotherman, Kraemer) Center for Health Equity and Quality Research
(CHEQR)University of FloridaJacksonville, Florida
Title
The effects of neoadjuvant therapy on morbidity and mortality of
esophagectomy for esophageal cancer: American college of surgeons national
surgical quality improvement program (ACS-NSQIP) 2005-2012.
Source
Journal of Surgical Oncology. (no pagination), 2016. Date of Publication:
2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: This study used a multi-center database to evaluate the impact
of neoadjuvant therapy on the 30-day morbidity and mortality following
esophagectomy for esophageal cancer. Methods: The NSQIP database was
queried for 2005-2012 for patients, who had esophagectomy for esophageal
cancer. Patients were divided into two groups: neoadjuvant therapy and
esophagectomy only. Results: The neoadjuvant group had a lower rates of
sepsis (8% vs. 13%, unadjusted P=0.004) and acute renal failure (0.4% vs.
2%, unadjusted P=0.01), and a higher rate of pulmonary embolism (PE) (3%
vs. 1%, unadjusted P=0.04). The adjusted odds of PE for patients, who
received neoadjuvant therapy were 2.8 times the odds of PE for patients in
the esophagectomy group, controlling for BMI. The association with renal
failure was not significant, when one adjusted for race. There was no
difference in the rates of reoperation, readmission, stroke, cardiac
arrest, MI, surgical site and deep organ infections, anastomosis failure,
blood transfusions, DVT, septic shock, pneumonia, UTI, respiratory
failure, and 30-day mortality between the two groups. Conclusions: We
conclude that neoadjuvant therapy followed by esophagectomy for esophageal
cancer does not have a negative impact on 30-day mortality. Neoadjuvant
therapy is associated with increased odds of PE. Copyright &#xa9; 2016
Wiley Periodicals, Inc.

<134>
Accession Number
613404618
Author
Elmarsafawi A.G.; Abbassi M.M.; Elkaffas S.; Elsawy H.M.; Sabry N.A.
Institution
(Elmarsafawi, Abbassi, Sabry) Clinical Pharmacy and Pharmacy Practice,
Faculty of Pharmacy, Cairo University, Cairo, Egypt
(Elkaffas) Cardiovascular Medicine Department, Faculty of Medicine, Cairo
University, Cairo, Egypt
(Elsawy) Cardiac Surgery Department, National Heart Institute, Giza, Egypt
Title
Efficacy of Different Perioperative Statin Regimens on Protection Against
Post-Coronary Artery Bypass Grafting Major Adverse Cardiocerebral Events.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objectives: Comparing different perioperative statin regimens for the
prevention of post-coronary artery bypass grafting adverse events. Design:
A randomized, prospective study. Setting: Cardiothoracic surgical units in
a government hospital. Participants: The study comprised 94 patients
scheduled for elective, isolated on- or off- pump coronary artery bypass
grafting. Interventions: Patients were assigned randomly to 1 of the
following 3 treatment groups: group I (80 mg of atorvastatin/day for 2
days preoperatively), group II (40 mg of atorvastatin/day for 5-9 days
preoperatively), or group III (80 mg of atorvastatin/day for 5-9 days
preoperatively). The same preoperative doses were restarted
postoperatively and continued for 1 month. Measurements and Main Results:
Cardiac troponin I, creatine kinase, and C-reactive protein (CRP) levels
were assayed preoperatively; at 8, 24, and 48 hours postoperatively; and
at discharge. CRP levels at 24 hours (p = 0.045) and 48 hours (p = 0.009)
were significantly lower in group III compared with the other 2 groups.
However, troponin I levels at 8 hours (p = 0.011) and 48 hours (p = 0.025)
after surgery were significantly lower in group II compared with group
III. The incidence of postoperative major adverse cardiac and
cerebrovascular events was assessed, and there was no significant
difference among the 3 groups. Conclusion: The 3 regimens did not result
in any significant difference in outcomes, but only simple trends. The
higher-dose regimen resulted in a significant reduction in the CRP level.
Thus, more studies are needed to confirm the benefit of higher-dose
statins for the protection from post-coronary artery bypass grafting
adverse events. Copyright &#xa9; 2016 Elsevier Inc.

<135>
Accession Number
613367741
Author
Gu J.; Andreasen J.J.; Melgaard J.; Lundbye-Christensen S.; Hansen J.;
Schmidt E.B.; Thorsteinsson K.; Graff C.
Institution
(Gu, Andreasen, Thorsteinsson) Department of Cardiothoracic Surgery,
Aalborg University Hospital, Aalborg, Denmark
(Gu, Andreasen, Schmidt, Thorsteinsson) Department of Clinical Medicine,
Aalborg University, Aalborg, Denmark
(Gu) Department of Cardiovascular Surgery, Heart Centre of General
Hospital, Ningxia Medical University, Yinchuan, Ningxia, Peoples Republic
of China
(Gu, Andreasen, Lundbye-Christensen, Schmidt) Atrial Fibrillation Study
Group, Aalborg University Hospital, Aalborg, Denmark
(Melgaard, Hansen, Graff) Department of Health Science and Technology,
Aalborg University, Aalborg, Denmark
(Lundbye-Christensen) Unit of Clinical Biostatistics and Bioinformatics,
Aalborg University Hospital, Aalborg, Denmark
(Schmidt) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
Title
Preoperative Electrocardiogram Score for Predicting New-Onset
Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objective: To investigate if electrocardiogram (ECG) markers from routine
preoperative ECGs can be used in combination with clinical data to predict
new-onset postoperative atrial fibrillation (POAF) following cardiac
surgery. Design: Retrospective observational case-control study. Setting:
Single-center university hospital. Participants: One hundred consecutive
adult patients (50 POAF, 50 without POAF) who underwent coronary artery
bypass grafting, valve surgery, or combinations. Interventions:
Retrospective review of medical records and registration of POAF.
Measurements and Main Results: Clinical data and demographics were
retrieved from the Western Denmark Heart Registry and patient records.
Paper tracings of preoperative ECGs were collected from patient records,
and ECG measurements were read by two independent readers blinded to
outcome. A subset of four clinical variables (age, gender, body mass
index, and type of surgery) were selected to form a multivariate clinical
prediction model for POAF and five ECG variables (QRS duration, PR
interval, P-wave duration, left atrial enlargement, and left ventricular
hypertrophy) were used in a multivariate ECG model. Adding ECG variables
to the clinical prediction model significantly improved the area under the
receiver operating characteristic curve from 0.54 to 0.67 (with
cross-validation). The best predictive model for POAF was a combined
clinical and ECG model with the following four variables: age,
PR-interval, QRS duration, and left atrial enlargement. Conclusion: ECG
markers obtained from a routine preoperative ECG may be helpful in
predicting new-onset POAF in patients undergoing cardiac surgery.
Copyright &#xa9; 2016 Elsevier Inc.

<136>
Accession Number
613366191
Author
Wang L.; Li B.; Liu C.; Rong T.; Yu Y.; Gu C.
Institution
(Wang, Li, Liu, Rong, Yu, Gu) Department of Cardiac Surgery, Beijing An
Zhen Hospital of Capital Medical University, Beijing, People's Republic of
China
Title
Short- and Medium-Term Effects of Combined Mitral Valve Surgery and
Coronary Artery Bypass Grafting Versus Coronary Artery Bypass Grafting
Alone for Patients with Moderate Ischemic Mitral Regurgitation: A
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objective: To investigate the short- and medium-term effects of combined
mitral valve surgery (MVS) and coronary artery bypass grafting (CABG)
versus CABG alone for patients with moderate ischemic mitral regurgitation
(IMR). Design: Meta-analysis of 4 randomized controlled trials (RCTs) and
5 observational studies. Setting: Hospitals that perform cardiac surgery.
Participants: The study included 1,256 cardiac surgery patients from 4
RCTs and 5 observational studies. Interventions: None. Measurements and
Main Results: Four RCTs and 5 observational studies were included in this
meta-analysis. Concomitant MVS significantly reduced the residual rate of
postoperative IMR (moderate or severe) (RCTs: OR -0.32, 95% confidence
interval [CI] -0.58 to -0.07, p = 0.01; observational studies: OR -0.23,
95% CI -0.34 to -0.12, p<0.0001) and the proportion of surviving patients
with New York Heart Association class III or IV (RCTs: OR 0.45, 95% CI
0.31-1.8, p = 0.008), but did not improve early mortality (RCTs: OR 0.91,
95% CI 0.30-2.74, p = 0.87; observational studies: OR 1.63, 95% CI
0.88-3.05, p = 0.12) or medium-term mortality (RCTs: OR 0.89, 95% CI
0.46-1.74, p = 0.73; observational studies: OR 0.94, 95% CI 0.65-1.37, p =
0.48) compared with CABG alone. Moreover, adding the mitral valve
procedure did not significantly increase the risk of stroke (RCTs: OR
2.27, 95% CI 0.73-7.08, p = 0.16; observational studies: OR 0.55, 95% CI
0.10-3.06, p = 0.50). Conclusions: The potential benefits of combined MVS
and CABG could outweigh its risks for patients with moderate IMR.
Copyright &#xa9; 2016 Elsevier Inc.

<137>
Accession Number
613358968
Author
Magruder J.T.; Blasco-Colmenares E.; Crawford T.; Alejo D.; Conte J.V.;
Salenger R.; Fonner C.E.; Kwon C.C.; Bobbitt J.; Brown J.M.; Nelson M.G.;
Horvath K.A.; Whitman G.R.
Institution
(Magruder, Crawford, Alejo, Conte, Whitman) Division of Cardiac Surgery,
Department of Medicine, The Johns Hopkins University School of Medicine,
Baltimore, Maryland
(Blasco-Colmenares) Division of Cardiology, Department of Medicine, The
Johns Hopkins University School of Medicine, Baltimore, Maryland
(Salenger, Brown) Division of Cardiac Surgery, University of Maryland
School of Medicine, Baltimore, Maryland
(Fonner) Maryland Cardiac Surgery Quality Initiative, Baltimore, Maryland
(Kwon) Beverly and Jerome Fine Cardiac Valve Center, Sinai Hospital of
Baltimore, Baltimore, Maryland
(Bobbitt) Department of Cardiac Surgery, Washington Adventist Hospital,
Takoma Park, Maryland
(Nelson) The Heart Institute, Western Maryland Health System, Cumberland,
Maryland
(Horvath) Cardiothoracic Surgery Research Program, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Maryland
Title
Variation In Red Blood Cell Transfusion Practices During Cardiac
Operations Among Centers In Maryland: Results From a State
Quality-Improvement Collaborative.
Source
Annals of Thoracic Surgery. (no pagination), 2016. Date of Publication:
2016.
Publisher
Elsevier USA
Abstract
Background: Variation in red blood cell (RBC) transfusion practices exists
at cardiac surgery centers across the nation. We tested the hypothesis
that significant variation in RBC transfusion practices between centers in
our state's cardiac surgery quality collaborative remains even after risk
adjustment. Methods: Using a multiinstitutional statewide database created
by the Maryland Cardiac Surgery Quality Initiative (MCSQI), we included
patient-level data from 8,141 patients undergoing isolated coronary artery
bypass (CAB) or aortic valve replacement at 1 of 10 centers. Risk-adjusted
multivariable logistic regression models were constructed to predict the
need for any intraoperative RBC transfusion, as well as for any
postoperative RBC transfusion, with anonymized center number included as a
factor variable. Results: Unadjusted intraoperative RBC transfusion
probabilities at the 10 centers ranged from 13% to 60%; postoperative RBC
transfusion probabilities ranged from 16% to 41%. After risk adjustment
with demographic, comorbidity, and operative data, significant intercenter
variability was documented (intraoperative probability range, 4% -59%;
postoperative probability range, 13%-39%). When stratifying patients by
preoperative hematocrit quartiles, significant variability in
intraoperative transfusion probability was seen among all quartiles
(lowest quartile: mean hematocrit value, 30.5% +/- 4.1%, probability
range, 17%-89%; highest quartile: mean hematocrit value, 44.8% +/- 2.5%;
probability range, 1%-35%). Conclusions: Significant variation in
intercenter RBC transfusion practices exists for both intraoperative and
postoperative transfusions, even after risk adjustment, among our state's
centers. Variability in intraoperative RBC transfusion persisted across
quartiles of preoperative hematocrit values. Copyright &#xa9; 2016 The
Society of Thoracic Surgeons.

<138>
Accession Number
613351083
Author
Kilic A.; Magruder J.T.; Grimm J.C.; Dungan S.P.; Crawford T.; Whitman
G.J.R.; Conte J.V.
Institution
(Kilic) Division of Cardiovascular Surgery, University of Pennsylvania,
Philadelphia, Pennsylvania
(Magruder, Grimm, Dungan, Crawford, Whitman, Conte) Division of Cardiac
Surgery, Johns Hopkins University, Baltimore, Maryland
Title
Development and Validation of a Score to Predict the Risk of Readmission
After Adult Cardiac Operations.
Source
Annals of Thoracic Surgery. (no pagination), 2016. Date of Publication:
2016.
Publisher
Elsevier USA
Abstract
Background: The purpose of this study was to develop and validate a risk
score for readmissions after cardiac operations. Methods: Adults surviving
to discharge after cardiac operations at a single institution from 2008 to
2013 were randomly divided 3:1 into training and validation cohorts. The
primary outcome was readmission within 30 days of discharge. A
multivariable model was constructed in the training cohort incorporating
variables associated with 30-day readmission in univariate logistic
regression. Points were assigned to predictors in the multivariable model
proportional to their odds ratios. Results: Among 5,193 patients
undergoing cardiac operations and surviving to discharge, the 30-day
readmission rate was 10.3% (n = 537). The most common reasons for
readmission were volume overload (24%; n = 131) and infection (21%; n =
113). The risk score incorporated 5 multivariable predictors and was out
of 20 possible points. The predicted rate of 30-day readmission based on
the training cohort ranged from 5.9% (score = 0) to 54.7% (score = 20).
Patients were categorized as low (score = 0; readmission 5.7%), moderate
(score 1-7; readmission 11.0%), and high risk (score>7; readmission 24.2%)
(p < 0.001). Thirty-day readmission rates based on these score categories
were similar in the validation cohort (low 6.4%, moderate 11.0%, high
17.4%; . p < 0.001). There was a robust correlation between predicted
rates of readmission in the training cohort based on the composite risk
score and actual rates of readmission in the validation cohort (r = 0.95;
. p < 0.001). Conclusions: We developed and validated a risk score for
readmission after cardiac operations that may have utility in targeting
interventions and modifying risk factors in high-risk populations.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<139>
Accession Number
613337945
Author
Mishra B.; Gupta A.; Sagar S.; Singhal M.; Kumar S.
Institution
(Mishra, Gupta, Sagar, Singhal, Kumar) Division of Trauma Surgery and
Critical Care, JPN Apex Trauma Centre, All India Institute of Medical
Sciences, New Delhi, India
Title
Traumatic cardiac injury: Experience from a level-1 trauma centre.
Source
Chinese Journal of Traumatology - English Edition. (no pagination), 2016.
Date of Publication: May 17, 2016.
Publisher
Elsevier B.V.
Abstract
Purpose: Traumatic cardiac injury (TCI) is a challenge for trauma surgeons
as it provides a short therapeutic window and the management is often
dictated by the underlying mechanism and hemodynamic status. The current
study is to evaluate the factors influencing the outcome of TCI. Methods:
Prospectively maintained database of TCI cases admitted at a Level-1
trauma center from July 2008 to June 2013 was retrospectively analyzed.
Hospital records were reviewed and statistical analysis was performed
using the SPSS version 15. Results: Out of 21 cases of TCI, 6 (28.6%) had
isolated and 15 (71.4%) had associated injuries. Ratio between blunt and
penetrating injuries was 2:1 with male preponderance. Mean ISS was 31.95.
Thirteen patients (62%) presented with features suggestive of shock.
Cardiac tamponade was present in 12 (57%) cases and pericardiocentesis was
done in only 6 cases of them. Overall 19 patients underwent surgery.
Perioperatively 8 (38.1%) patients developed cardiac arrest and 7
developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality
was related to cardiac arrest (p = 0.014), arrhythmia (p = 0.014), and
hemorrhagic shock (p = 0.04). The diagnostic accuracy of focused
assessment by sonography in trauma (FAST) was 95.24%. Conclusion: High
index of clinical suspicion based on the mechanism of injury, meticulous
examination by FAST and early intervention could improve the overall
outcome. Copyright &#xa9; 2016 Daping Hospital and the Research Institute
of Surgery of the Third Military Medical University.

<140>
Accession Number
613335338
Author
Kodama A.; Yamamoto M.; Shimura T.; Kagase A.; Koyama Y.; Tada N.; Takagi
K.; Araki M.; Yamanaka F.; Shirai S.; Watanabe Y.; Hayashida K.
Institution
(Kodama, Yamamoto, Shimura, Kagase, Koyama) Department of
CardiologyToyohashi Heart Canter JapanToyohashi
(Yamamoto) Department of CardiologyNagoya Heart Canter JapanNagoya
(Tada) Department of CardiologySendai Kousei HospitalSendai Japan
(Takagi) Department of CardiologyNew Tokyo HospitalChiba Japan
(Araki) Department of CardiologySaiseikai Yokohama City Eastern
HospitalYokohama Japan
(Yamanaka) Department of CardiologySyonan Kamakura General
HospitalKanagawa Japan
(Shirai) Department of CardiologyKokura Memorial HospitalKokura Japan
(Watanabe) Department of CardiologyTeikyo University School of Medicine
Tokyo Japan
(Hayashida) Department of CardiologyKeio University School of Medicine
Tokyo Japan
Title
Comparative data of single versus double proglide vascular preclose
technique after percutaneous transfemoral transcatheter aortic valve
implantation from the optimized catheter valvular intervention
(OCEAN-TAVI) japanese multicenter registry.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2016.
Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study aimed to assess the feasibility of percutaneous
arterial access site closure after percutaneous transfemoral transcatheter
aortic valve implantation (TF-TAVI) using single versus double Perclose
ProGlide devices. Backgrounds: Although suturing with the preclose
technique has been widely adopted during TF-TAVI, the optimal vascular
closure strategy is still under debate. Methods: Data from 279 patients
who underwent TF-TAVI, obtained from the Optimized CathEter vAlvular
iNtervention (OCEAN-TAVI) Japanese multicenter registry. Technical,
procedural, and clinical outcomes were compared between the single
ProGlide group (n=99) and double ProGlide group (n=180). They were also
analyzed by propensity adjusted matching model (single [n=69] vs. double
[n=69]). All patients were treated through a 16-Fr to 20-Fr eSheath.
Technical success of the closure device was defined as hemostasis not
requiring alternative invasive treatment. Access site-related vascular
complications, bleedings, and other procedural complications were defined
according to the Valvular Academic Research Consortium-2 (VARC-2)
criteria. Results: The rates of technical success and access site-related
vascular complications were similar in the 2 groups (94.9% vs. 91.6%,
p=0.44; 5.0% vs. 7.7%, p=0.54, respectively). The prevalence of bleeding
complications did not differ between the 2 groups (1.0% vs. 3.3%, p=0.43).
Thirty-day mortality rate also showed no difference between the 2 groups
(2.0% vs. 1.1%, p=0.95), although these events were not associated with
access site failure. These results were not attenuated in the propensity
matching model. Conclusions: Vascular closure with a single ProGlide in
TF-TAVI could achieve equivalent, acceptable rates of technical success
and procedural complications compared with the double ProGlide technique.
Copyright &#xa9; 2016 Wiley Periodicals, Inc.