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<1>
Accession Number
370222455
Author
Topcuoglu M.A.; Arsava E.M.
Institution
(Topcuoglu, Arsava) Hacettepe Univsersity, Faculty of Medicine, Department
of Neurology, Sihhiye 06100, Ankara, Turkey
Title
Neurosonology of emboli detection and monitoring.
Source
Turk Beyin Damar Hastaliklar Dergisi. 18 (3) (pp 59-71), 2012. Date of
Publication: 2012.
Publisher
Turkish Society of Cerebrovascular Diseases (E-mail: ozdemirg@ogu.edu.tr)
Abstract
Cerebral embolism is the leading cause of ischemic stroke. Detection of
microembolic signals [MES] in cerebral circulation is uniquely attained by
several transcranial Doppler techniques, and can not be obtained with any
other available imaging modality. Albeit no uniform picture has emerged
from the studies, presence and amount of MES can identify a high-risk
status in the setting of potential arterial or cardiac sources of cerebral
embolism. Real-time MES monitoring during vascular procedures with high
cerebral embolism risk seems also promising. The potential of MES
detection in improvement of patient care is usually acknowledged, even
though several aspects remain yet to be scientifically established. We
herein review theory, technique and clinical potential of the
neurosonological emboli detection, and try to add to understanding of the
journal readership about the recent development on this subject.

<2>
Accession Number
607428768
Author
Kosour C.; Dragosavac D.; Antunes N.; Almeida de Oliveira R.A.R.; Martins
Oliveira P.P.; Wilson Vieira R.
Institution
(Kosour) Department of Nursing, Federal University of Alfenas, Alfenas,
Brazil
(Kosour, Dragosavac, Antunes, Martins Oliveira, Wilson Vieira) Department
of Surgery, School of Medical Sciences, State University of Campinas
(Unicamp), Campinas, Barao Geraldo, Brazil
(Almeida de Oliveira) Pontifical University Catholic of Campinas
(PUC-Campinas), Campinas, Brazil
Title
Effect of Ultrafiltration on Pulmonary Function and Interleukins in
Patients Undergoing Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (4) (pp 884-890),
2016. Date of Publication: 01 Aug 2016.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of ultrafiltration on interleukins,
TNF-alpha levels, and pulmonary function in patients undergoing coronary
artery bypass grafting (CABG). Design Prospective, randomized, controlled
trial. Setting University hospital. Participants Forty patients undergoing
CABG were randomized into a group assigned to receive ultrafiltration (UF)
during cardiopulmonary bypass (CPB) or into another group (control) that
underwent the same procedure but without ultrafiltration. Methods
Interleukins and TNF-alpha levels, pulmonary gas exchange, and ventilatory
mechanics were measured in the preoperative, intraoperative, and
postoperative periods. Interleukins and TNF-alpha also were analyzed in
the perfusate of the test group. Measurements and Main Results There were
increases in IL-6 and IL-8 at 30 minutes after CPB and 6, 12, 24, and 36
hours after surgery, along with an increase in TNF-alpha at 30 minutes
after CPB and 24, 36, and 48 hours after surgery in both groups. IL-1
increased at 30 minutes after CPB and 12 hours after surgery, while IL-6
increased 24 and 36 hours after surgery in the UF group. The analysis of
the ultrafiltrate showed the presence of TNF-alpha and traces of IL-1beta,
IL-6, and IL-8. There were alterations in the oxygen index,
alveolar-arterial oxygen difference, deadspace, pulmonary static
compliance and airway resistance after anesthesia and sternotomy, as well
as in airway resistance at 6 hours after surgery in both groups, with no
difference between them. Conclusions Ultrafiltration increased the serum
level of IL-1 and IL-6, while it did not interfere with gas exchange and
pulmonary mechanics in CABG. Copyright &#xa9; 2016 Elsevier Inc.

<3>
Accession Number
612824889
Author
Jelacic S.; Bollag L.; Bowdle A.; Rivat C.; Cain K.C.; Richebe P.
Institution
(Jelacic, Bollag, Bowdle, Rivat, Richebe) Department of Anesthesiology and
Pain Medicine, United States
(Cain) Biostatistics, University of Washington School of Public Health,
Seattle, WA, United States
Title
Intravenous Acetaminophen as an Adjunct Analgesic in Cardiac Surgery
Reduces Opioid Consumption But Not Opioid-Related Adverse Effects: A
Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (4) (pp 997-1004),
2016. Date of Publication: 01 Aug 2016.
Publisher
W.B. Saunders
Abstract
Objectives The authors hypothesized that intravenous acetaminophen as an
adjunct analgesic would significantly decrease 24-hour postoperative
opioid consumption. Design Double-blind, randomized, placebo-controlled
trial. Setting A single academic medical center. Participants The study
was comprised of 68 adult patients undergoing cardiac surgery.
Interventions Patients were assigned randomly to receive either 1,000 mg
of intravenous acetaminophen or placebo immediately after anesthesia
induction, at the end of surgery, and then every 6 hours for the first 24
hours in the intensive care unit, for a total of 6-1,000 mg doses.
Measurements and Main Results The primary outcome was 24-hour
postoperative opioid consumption. The secondary outcomes included 48-hour
postoperative opioid consumption, incisional pain scores, opioid-related
adverse effects, length of mechanical ventilation, length of intensive
care unit stay, and the extent of wound hyperalgesia assessed at 24 and 48
hours postoperatively. The mean+/-standard deviation postoperative 24-hour
opioid consumption expressed in morphine equivalents was significantly
less in the acetaminophen group (45.6+/-29.5 mg) than in the placebo group
(62.3+/-29.5 mg), representing a 27% reduction in opioid consumption (95%
CI, 2.3-31.1 mg; p = 0.024). There were no differences in pain scores and
opioid-related adverse effects between the 2 groups. A significantly
greater number of patients in the acetaminophen group responded "very
much" and "extremely well" when asked how their overall pain experience
met their expectation (p = 0.038). Conclusions The administration of
intravenous acetaminophen during cardiac surgery and for the first 24
hours postoperatively reduced opioid consumption and improved patient
satisfaction with their overall pain experience but did not reduce opioid
side effects. Copyright &#xa9; 2016 Elsevier Inc.

<4>
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Accession Number
610908006
Author
Aso S.; Matsui H.; Fushimi K.; Yasunaga H.
Institution
(Aso, Matsui, Yasunaga) Department of Clinical Epidemiology and Health
Economics, School of Public Health, University of Tokyo, Tokyo, Japan
(Fushimi) Department of Health Policy and Informatics, Tokyo Medical and
Dental University, Graduate School of Medicine, Tokyo, Japan
Title
The Effect of Intraaortic Balloon Pumping under Venoarterial
Extracorporeal Membrane Oxygenation on Mortality of Cardiogenic Patients:
An Analysis Using a Nationwide Inpatient Database.
Source
Critical Care Medicine. 44 (11) (pp 1974-1979), 2016. Date of Publication:
01 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: The role of intraaortic balloon pumping combined with
venoarterial extracorporeal membrane oxygenation in cardiogenic shock
patients remains unknown. This study investigated the effect of
intraaortic balloon pumping combined with venoarterial extracorporeal
membrane oxygenation on reducing mortality of cardiogenic shock patients.
Design: Retrospective cohort study. Setting: The Japanese Diagnosis
Procedure Combination national inpatient database. Patients: Cardiogenic
shock adult patients receiving peripheral venoarterial extracorporeal
membrane oxygenation at admission were identified in the Japanese
Diagnosis Procedure Combination database from July 1, 2010, to March 31,
2013. Interventions: None. Measurements and Main Results: The primary
outcomes were all-cause 28-day mortality and in-hospital mortality, and
the secondary outcome was the proportion of patients weaned from
venoarterial extracorporeal membrane oxygenation, using propensity score
matching. Eligible patients (n = 1,650) were divided into the intraaortic
balloon pumping combined with venoarterial extracorporeal membrane
oxygenation group (n = 604) and the venoarterial extracorporeal membrane
oxygenation-alone group (n = 1,064). Propensity score matching created
matched cohort of 533 pairs. In the propensity score-matched analysis,
all-cause 28-day mortality and in-hospital mortality were significantly
lower in the intraaortic balloon pumping combined with venoarterial
extracorporeal membrane oxygenation group than the venoarterial
extracorporeal membrane oxygenation-alone group (48.4% vs 58.2%; p = 0.001
and 55.9% vs 64.5%; p = 0.004, respectively). In Cox regression, there was
a significant difference in survival between the intraaortic balloon
pumping combined with venoarterial extracorporeal membrane oxygenation
group and the venoarterial extracorporeal membrane oxygenation-alone group
(hazard ratio, 0.74; 95% CI, 0.63-0.86; p < 0.001). The proportion of
patients weaned from venoarterial extracorporeal membrane oxygenation was
significantly higher in the intraaortic balloon pumping combined with
venoarterial extracorporeal membrane oxygenation group than in the
venoarterial extracorporeal membrane oxygenation-alone group (82.6% vs
73.4%; p < 0.001). Conclusions: In a national inpatient database,
intraaortic balloon pumping combined with venoarterial extracorporeal
membrane oxygenation was associated with improved mortality and successful
weaning from venoarterial extracorporeal membrane oxygenation. Randomized
controlled studies are required to confirm the mortality-reducing effect
of intraaortic balloon pumping combined with venoarterial extracorporeal
membrane oxygenation. Copyright &#xa9; 2016 by the Society of Critical
Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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

<6>
Accession Number
613084171
Author
Li M.; Xue L.; Sun H.; Xu S.
Institution
(Li, Xu) Department of Cardiovascular Surgery, The First Affiliated
Hospital of Medical College of Xi'an Jiaotong University, Xi'an Shaanxi,
China, China
(Xue) Department of Laboratory, The Second Affiliated Hospital of Medical
College of Xi'an Jiaotong University, Xi'an Shaanxi, China, China
(Sun) Tumour Hospital of Shaanxi Province, Xi'an Shaanxi, China, China
Title
Myocardial Protective Effects of L-Carnitine on Ischemia-Reperfusion
Injury in Patients With Rheumatic Valvular Heart Disease Undergoing
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1485-1493),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives The authors used L-carnitine as an ingredient in cardioplegic
solution during valve replacement surgery to investigate the protective
effect of L-carnitine on myocardial ischemia-reperfusion injury (MIRI) and
its possible mechanism. Design Prospective, randomized study. Setting A
tertiary-care hospital. Participants The study comprised 90 patients
undergoing valve replacement under cardiopulmonary bypass. Interventions
Patients were divided randomly into 3 groups. L-carnitine was added to the
crystalloid cardioplegic solution for experimental group 1 (3 g/L) and
experimental group 2 (6 g/L), whereas no L-carnitine was used in the
control group. The remainder of the treatment was identical for all 3
groups. Measurements and Main Results Serum was collected from each
patient 1 hour before the surgery and at 2, 6, 24, and 72 hours after
unclamping the aorta, and tissue samples were obtained before cardiac
arrest and after unclamping the aorta. The postoperative levels of serum
aspartate aminotransferase, creatine kinase, creatine kinase-MB isozyme,
and lactic acid dehydrogenase and the apoptotic index were all lower in
the 2 experimental groups than those in the control group. In addition,
each of the aforementioned serum enzyme levels and the apoptotic index in
all 3 groups significantly increased after unclamping the aorta compared
with baseline levels taken before surgery. Bcl-2 expression was higher and
Bax was lower in the 2 experimental groups compared with those of the
control group after unclamping the aorta. However, there was no
significant difference in all the postoperative indices between the 2
experimental groups. Conclusion L-carnitine may reduce cardiopulmonary
bypass-induced myocardial apoptosis through modulating the expressions of
Bcl-2 and Bax, resulting in a protective effect from MIRI. Copyright
&#xa9; 2016 Elsevier Inc.

<7>
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, Egypt
(Elkaffas) Cardiovascular Medicine Department, Faculty of Medicine, Cairo
University, Cairo, Egypt, Egypt
(Elsawy) Cardiac Surgery Department, National Heart Institute, Giza,
Egypt, Egypt
Title
Efficacy of Different Perioperative Statin Regimens on Protection Against
Post-Coronary Artery Bypass Grafting Major Adverse Cardiac and Cerebral
Events.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1461-1470),
2016. Date of Publication: 01 Dec 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.

<8>
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, 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. 30 (6) (pp 1578-1586),
2016. Date of Publication: 01 Dec 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.

<9>
Accession Number
612946616
Author
Codner P.; Levi A.; Gargiulo G.; Praz F.; Hayashida K.; Watanabe Y.;
Mylotte D.; Debry N.; Barbanti M.; Lefevre T.; Modine T.; Bosmans J.;
Windecker S.; Barbash I.; Sinning J.-M.; Nickenig G.; Barsheshet A.;
Kornowski R.
Institution
(Codner, Levi, Barsheshet, Kornowski) Cardiology Department, Rabin Medical
Center, Petah Tikva, Israel
(Codner, Levi, Barsheshet, Kornowski) "Sackler" School of Medicine, Tel
Aviv University, Tel Aviv, Israel
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(Gargiulo, Praz, Windecker) Cardiology Department, Inselspital University
Hospital, Bern, Switzerland
(Hayashida) Keio University School of Medicine, Tokyo, Japan
(Watanabe, Lefevre) Hospital Prive Jacques Cartier, Institut
Cardiovasculaire Paris Sud, Massy, France
(Mylotte) Cardiology Department, Galway University Hospital, Galway,
Ireland
(Debry, Modine) Institut cardio-pneumologique, CHRU, Lille, France
(Barbanti) Cardiology Department, Ferrarotto Hospital, Catania, Italy
(Bosmans) Interventional Cardiology, University Hospital, Antwerp, Belgium
(Barbash) Interventional Cardiology, Sheba Medical Center, Ramat Gan,
Israel
(Sinning, Nickenig) Cardiology Department, Bonn University Hospital, Bonn,
Germany
Title
Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve
Replacement Outcomes in a Large Multicenter Cohort.
Source
American Journal of Cardiology. 118 (12) (pp 1888-1896), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with advanced chronic renal dysfunction were excluded from
randomized trials of transcatheter aortic valve replacement (TAVR). The
potential impact of chronic renal disease on TAVR prognosis is not fully
understood. We aim to evaluate outcomes within a large cohort of patients
who underwent TAVR distinguished by renal function. Baseline
characteristics, procedural data, and clinical follow-up findings were
collected from 10 high-volume TAVR centers in Europe, Israel, and Japan.
Data were analyzed according to renal function. Patients (n = 1,204) were
divided into 4 groups according to pre-TAVR-estimated glomerular
filtration rate (eGFR): group I (eGFR >60), n = 288 (female 45%), group II
(eGFR 31 to 60), n = 452 (female 61%), group III (eGFR <30), n = 398
(female 61%), and group IV (dialysis), n = 66 (female 31%). Mean Society
of Thoracic Surgeons score was higher in patients with lower preprocedural
eGFR. All-cause mortality at 1 year was higher in patients with lower eGFR
(9.0%, 12.1%, 24.3%, and 24.2% for group I, II, III, and IV, respectively,
p <0.001). Multivariate analysis demonstrated that eGFR <30, but not eGFR
31 to 60, was associated with increased risk of death (odds ratio 3),
bleeding (odds ratio 5.2), and device implantation failure (hazard ratio
2.28). For each 10 ml/min decrease in eGFR, there was an associated
relative increase in the risk of death (35%; p <0.001), cardiovascular
death (14%; p = 0.018), major bleeding 35% (p <0.001), and transcatheter
valve failure (16%; p = 0.007). Renal dysfunction was not associated with
stroke or need for pacemaker implantation. In conclusion, among patients
who underwent TAVR, baseline renal dysfunction is an important independent
predictor of morbidity and mortality. Copyright &#xa9; 2016 Elsevier Inc.

<10>
Accession Number
607129139
Author
Patel N.N.; Avlonitis V.S.; Jones H.E.; Reeves B.C.; Sterne J.A.C.; Murphy
G.J.
Institution
(Patel) National Heart & Lung Institute, Imperial College London, London,
United Kingdom
(Avlonitis) Department of Cardiac Surgery, Guy's and St Thomas' NHS
Foundation Trust, London, United Kingdom
(Jones, Sterne) School of Social and Community Medicine, University of
Bristol, Bristol, United Kingdom
(Reeves) Clinical Trials and Evaluation Unit, School of Clinical Sciences,
University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
(Murphy) Leicester Cardiovascular Biomedical Research Unit & Department of
Cardiovascular Sciences, University of Leicester, Glenfield General
Hospital, Leicester, United Kingdom
Title
Indications for red blood cell transfusion in cardiac surgery: a
systematic review and meta-analysis.
Source
The Lancet Haematology. 2 (12) (pp e543-e553), 2015. Date of Publication:
01 Dec 2015.
Publisher
Elsevier Ltd
Abstract
Background Good blood management is an important determinant of outcome in
cardiac surgery. Guidelines recommend restrictive red blood cell
transfusion. Our objective was to systematically review the evidence from
randomised controlled trials and observational studies that are used to
inform transfusion decisions in adult cardiac surgery. Methods We did a
systematic review by searching PubMed, Embase, Cochrane Library, and DARE,
from inception to May 1, 2015, databases from specialist societies, and
bibliographies of included studies and recent relevant review articles. We
included randomised controlled trials that assessed the effect of liberal
versus restrictive red blood cell transfusion in patients undergoing
cardiac and non-cardiac surgery, and observational studies that assessed
the effect of red blood cell transfusion compared with no transfusion on
outcomes in adult cardiac patients after surgery. We pooled adjusted odds
ratios using fixed-effects and random-effects meta-analyses. The primary
outcome was 30-day mortality. Findings We included data from six cardiac
surgical randomised controlled trials (3352 patients), 19 non-cardiac
surgical trials (8361 patients), and 39 observational studies (232 806
patients). The pooled fixed effects mortality odds ratios comparing
liberal versus restrictive transfusion thresholds was 0.70 (95% CI
0.49-1.02; p=0.060) for cardiac surgical trials and 1.10 (95% CI
0.96-1.27; p=0.16) for trials in settings other than cardiac surgery. By
contrast, observational cohort studies in cardiac surgery showed that red
blood cell transfusion compared with no transfusion was associated with
substantially higher mortality (random effects odds ratio 2.72, 95% CI
2.11-3.49; p<0.0001) and other morbidity, although with substantial
heterogeneity and small study effects. Interpretation Evidence from
randomised controlled trials in cardiac surgery refutes findings from
observational studies that liberal thresholds for red blood cell
transfusion are associated with a substantially increased risk of
mortality and morbidity. Observational studies and trials in non-cardiac
surgery should not be used to inform treatment decisions or guidelines for
patients having cardiac surgery. Funding None. Copyright &#xa9; 2015
Elsevier Ltd

<11>
Accession Number
613099930
Author
Kashani R.; Bowles C.; Sareh S.; Toppen W.; Ou R.; Shemin R.; Benharash P.
Institution
(Kashani, Bowles, Sareh, Toppen, Ou, Shemin, Benharash) Division of
Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at
the University of California Los Angeles, Los Angeles, CA, United States
Title
Use of preoperative aspirin in combined coronary and valve operations.
Source
Surgery (United States). 160 (6) (pp 1612-1618), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The aim of this study was to determine the relationship between
preoperative aspirin use and postoperative outcomes in patients undergoing
combined coronary artery bypass grafting and valve operations. Methods All
combined coronary artery bypass grafting and valve procedures from 2008 to
2015 at our institution were identified. After exclusions, patients were
stratified according to those that received preoperative aspirin and those
who did not. Propensity score methodology was used to match the 2 groups
using baseline and operative characteristics. Logistic regression models
were then developed to assess differences in postoperative outcomes
between groups. Results Of the 563 patients identified, 534 met inclusion
criteria: preoperative aspirin = 327 (61.2%), no preoperative aspirin =
207 (38.8%). After propensity matching, 194 patient pairs were analyzed,
with no significant differences in preoperative characteristics. No
significant differences were observed between the preoperative aspirin and
no preoperative aspirin groups in rates of 30-day mortality (3.6% vs 4.1%,
P = 1.00), major adverse cardiovascular events (23.2% vs 24.2%, P = .91),
or 30-day readmission (12.4% vs 11.9%, P = 1.00), among others. Conclusion
Preoperative aspirin use in patients undergoing combined coronary artery
bypass grafting and valve operations was not associated with significant
differences in major postoperative outcomes. Large-scale, randomized
trials are needed to better establish the role of preoperative aspirin in
this population. Copyright &#xa9; 2016 Elsevier Inc.

<12>
Accession Number
613336471
Author
Veronesi G.; Cerfolio R.; Cingolani R.; Rueckert J.C.; Soler L.; Toker A.;
Cariboni U.; Bottoni E.; Fumagalli U.; Melfi F.; Milli C.; Novellis P.;
Voulaz E.; Alloisio M.
Institution
(Veronesi, Cariboni, Bottoni, Novellis, Voulaz, Alloisio) Thoracic
Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
(Cerfolio) Thoracic Surgery, University of Alabama at Birmingham,
Birmingham, United States
(Cingolani) Istituto Italiano Tecnologia, Genova, Italy
(Rueckert) Universitatsmedizin Berlin - Charite Campus Mitte, Berlin,
Germany
(Soler) IRCAD, Strasburg, France
(Toker) Department of Thoracic Surgery, Istanbul Bilim University,
Istanbul, Turkey
(Fumagalli) General Surgery, Humanitas Research Hospital, Rozzano, Milan,
Italy
(Melfi) Chirurgia Toracica, Ospedale Cisanello, Pisa, Italy
(Milli) Direzione amministrativa, Azienda Ospedaliera Cisanello, Pisa,
Italy
Title
Report on first international workshop on robotic surgery in thoracic
oncology.
Source
Frontiers in Oncology. 6 (OCT) (no pagination), 2016. Article Number: 214.
Date of Publication: 24 Oct 2016.
Publisher
Frontiers Research Foundation (E-mail: info@frontiersin.org)
Abstract
A workshop of experts from France, Germany, Italy, and the United States
took place at Humanitas Research Hospital Milan, Italy, on February 10 and
11, 2016, to examine techniques for and applications of robotic surgery to
thoracic oncology. The main topics of presentation and discussion were
robotic surgery for lung resection; robot-assisted thymectomy; minimally
invasive surgery for esophageal cancer; new developments in
computer-assisted surgery and medical applications of robots; the
challenge of costs; and future clinical research in robotic thoracic
surgery. The following article summarizes the main contributions to the
workshop. The Workshop consensus was that since video-assisted
thoracoscopic surgery (VATS) is becoming the mainstream approach to
resectable lung cancer in North America and Europe, robotic surgery for
thoracic oncology is likely to be embraced by an increasing numbers of
thoracic surgeons, since it has technical advantages over VATS, including
intuitive movements, tremor filtration, more degrees of manipulative
freedom, motion scaling, and high-definition stereoscopic vision. These
advantages may make robotic surgery more accessible than VATS to trainees
and experienced surgeons and also lead to expanded indications. However,
the high costs of robotic surgery and absence of tactile feedback remain
obstacles to widespread dissemination. A prospective multicentric
randomized trial (NCT02804893) to compare robotic and VATS approaches to
stages I and II lung cancer will start shortly. Copyright &#xa9; 2016
Veronesi, Cerfolio, Cingolani, Rueckert, Soler, Toker, Cariboni, Bottoni,
Fumagalli, Melfi, Milli, Novellis, Voulaz and Alloisio.

<13>
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).

<14>
Accession Number
613239042
Author
Ammar A.; Mahmoud K.; Elkersh A.; Kasemy Z.
Institution
(Ammar, Mahmoud, Elkersh, Kasemy) Statistics and Community Medicine,
Minoufiya Faculty of Medicine, Shebin Elkoam, Egypt
Title
A randomised controlled trial comparing the effects of propofol with
isoflurane in patients with diastolic dysfunction undergoing coronary
artery bypass graft surgery.
Source
Anaesthesia. 71 (11) (pp 1308-1316), 2016. Date of Publication: 01 Nov
2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
There is a strong association between pre-operative diastolic dysfunction
and difficulty in weaning from cardiopulmonary bypass. We compared the
effects of propofol and isoflurane on left ventricular diastolic function
in patients with pre-existing diastolic dysfunction undergoing coronary
artery bypass grafting. We randomly allocated 60 patients to receive
either propofol or isoflurane anaesthesia, and assessed left ventricular
diastolic function using transoesophageal echocardiography. We measured
early (E), late (A) diastolic velocities, E/A ratio, A-wave duration and
deceleration time using pulsed wave Doppler, and early (Em), late (Am)
diastolic velocities of the mitral annulus, Em/Am ratio and isovolumetric
relaxation time using tissue Doppler. We measured pulmonary venous flow
velocity and recorded values for the peak systolic flow velocity (S), peak
diastolic flow velocity (D), S/D ratio, peak reverse atrial flow velocity
and duration of reverse atrial flow. All data were recorded immediately
after tracheal intubation as a baseline, 5 min before sternotomy
(T<inf>1</inf>), 5 min before aortic cannulation (T<inf>2</inf>) and 15
min after weaning from cardiopulmonary bypass (T<inf>3</inf>). Both
propofol and isoflurane improved left ventricular diastolic function as
evidenced by significant increases in E/A ratios, and significant
decreases in deceleration time and isovolumetric relaxation time; the
improvement was greater in the isoflurane group (between groups, p = 0.001
for both E/A ratio and deceleration time at T<inf>1</inf> and
T<inf>2</inf> and p = 0.006 for isovolumetric relaxation time at both
T<inf>1</inf> and T<inf>2</inf>). Furthermore, Em/Am ratio, S, D and S/D
ratios were significantly better in the isoflurane group. The
administration of isoflurane during cardiac surgery improves diastolic
function comparatively more than propofol. Copyright &#xa9; 2016 The
Association of Anaesthetists of Great Britain and Ireland

<15>
Accession Number
609131466
Author
Vanek J.; Mayer O.; Seidlerova J.; Bruthans J.; Kielbergerova L.;
Wohlfahrt P.; Krajcoviechova A.; Filipovsky J.; Cifkova R.
Institution
(Vanek, Mayer, Seidlerova, Filipovsky) 2nd Department of Internal
Medicine, Medical Faculty of Charles University and University Hospital,
Pilsen, Czech Republic
(Mayer, Seidlerova, Filipovsky) Biomedical Center, Medical Faculty of
Charles University, Pilsen, Czech Republic
(Bruthans, Wohlfahrt, Krajcoviechova, Cifkova) Centre for Cardiovascular
Prevention of the First Faculty of Medicine, Charles University and
Thomayer's Hospital, Prague, Czech Republic
(Kielbergerova, Cifkova) Department of Neurosurgery and Department of
Neurology, University Hospital, Pilsen;, Czech Republic
(Wohlfahrt) International Clinical Research Centre, St. Anne's University
Hospital Brno, Czech Republic
Title
A comparison of secondary prevention practice in poststroke and coronary
heart disease patients.
Source
Public Health. 137 (pp 64-72), 2016. Date of Publication: 01 Aug 2016.
Publisher
Elsevier B.V.
Abstract
Objectives It is evident that patients with atherosclerotic vascular
disease (AVD) benefit from appropriate secondary prevention. In clinical
reality, the secondary prevention in AVD patients other than those with
coronary heart disease (CHD) is often overlooked. Therefore, we compared
the adherence to secondary prevention principles between poststroke and
CHD patients. Study design Descriptive (cross-sectional) study with
prospective mortality follow-up. Methods We examined 1729 chronic patients
with AVD (mean age 65.9 (+/-SD 9.6) years), 964 with CHD, and 765
poststroke (pooled data of Czech samples of EUROASPIRE III, IV, and the
ESH stroke survey). The interview was performed 6-36 months after the
coronary event/revascularization or the first ischemic stroke, while the
mortality follow-up 5 years after this interview. Results Poststroke
patients had a significantly higher risk of persistent smoking, blood
pressure >140/90 mmHg and LDL >2.5 mmol/L than CHD patients [odds ratios
adjusted for age, gender and survey were 1.63 (95% CI: 1.13-2.33), 1.38
(95% CI: 1.13-1.69) and 2.26 (95% CI: 1.84-2.78), respectively]. In
contrast, poststroke patients showed a lower risk of inappropriate glucose
control and hypertriglyceridemia [0.66 (95%CI: 0.54-0.82) and 0.74 (95%CI:
0.61-0.91), respectively]. The prescription rates of
antiplatelets/anticoagulants, antihypertensives and statins were also
significantly lower in poststroke than in CHD patients (89.4 vs 93.7, 85.9
vs 97.5, and 57.7 vs 89.8, respectively). Mortality analysis was performed
in a subsample of 815 subjects interviewed in 2006/07. The 5-year
all-cause mortality rates were 25.8% and 13.3% in poststroke and coronary
patients, respectively (P = 0.0023); the hazard ratio for stroke adjusted
for major risk factors was 1.85 (95% CI: 1.31-2.63). Conclusions Compared
to CHD patients, poststroke patients are strongly handicapped in terms of
poor adherence to secondary prevention target, prescription of basic
pharmacotherapies and mortality risk. Copyright &#xa9; 2016 The Royal
Society for Public Health

<16>
Accession Number
613234060
Author
Opolski M.P.; Staruch A.D.; Jakubczyk M.; Min J.K.; Gransar H.; Staruch
M.; Witkowski A.; Kepka C.; Kim W.-K.; Hamm C.W.; Mollmann H.; Achenbach
S.
Institution
(Opolski, Staruch, Witkowski) Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland
(Jakubczyk) Institute of Econometrics, Warsaw School of Economics, Warsaw,
Poland
(Min) Department of Radiology, The New York-Presbyterian Hospital and
Weill Cornell Medical College, New York, New York, United States
(Gransar) Department of Imaging and Division of Cardiology, Department of
Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, California, United States
(Staruch) Medical University of Warsaw, Warsaw, Poland
(Kepka) Department of Coronary and Structural Heart Diseases, Institute of
Cardiology, Warsaw, Poland
(Kim, Hamm, Mollmann) Department of Cardiology, Kerckhoff Heart Center,
Bad Nauheim, Germany
(Hamm) Department of Cardiology and Angiology, Justus-Liebig University of
Giessen, Giessen, Germany
(Achenbach) Department of Internal Medicine 2 (Cardiology), University of
Erlangen, Erlangen, Germany
Title
CT Angiography for the Detection of Coronary Artery Stenoses in Patients
Referred for Cardiac Valve Surgery: Systematic Review and Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 9 (9) (pp 1059-1070), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study aimed to evaluate the diagnostic accuracy of
coronary computed tomography angiography (CTA) for detecting coronary
artery stenoses in patients with valvular heart disease undergoing valve
surgery. Background Coronary CTA is currently not routinely recommended
for detecting coronary artery stenoses before cardiac valve surgery.
However, recent improvements in computed tomography technology may enable
the identification of the most appropriate candidates for coronary CTA
before valve surgery. Methods A systematic review was performed of PubMed,
EMBASE, and the Cochrane databases for all studies that used >16-detector
row computed tomography scanning to perform coronary CTA in patients with
valvular heart disease scheduled for valve surgery and validated the
results against invasive angiography. Summary diagnostic accuracies were
calculated by using a bivariate random effects model, and a generalized
linear mixed model was applied for heterogeneity analysis. Results
Seventeen studies analyzing 1,107 patients and 12,851 coronary segments
were included. Patient-based analysis revealed a pooled sensitivity of 93%
(95% confidence interval [CI]: 86 to 97), specificity of 89% (95% CI: 86
to 91), a negative likelihood ratio (LR) of 0.07 (95% CI: 0.04 to 0.16),
and a positive LR of 8.44 (95% CI: 6.49 to 10.99) for coronary CTA to
identify individuals with stenosis >50%. Specificity and positive LR were
higher in patients without aortic stenosis (AS) versus those with AS (96%
vs. 87% and 21.2 vs. 7.4, respectively), as well as with >64 detectors
versus <64 detectors (90% vs. 86% and 9.5 vs. 6.9). Heterogeneity analysis
revealed a significant impact of AS and the number of detectors on
specificity of CTA. Conclusions Coronary CTA using currently available
technology is a reliable imaging alternative to invasive angiography with
excellent sensitivity and negative LR for the detection of significant
coronary stenoses in patients undergoing cardiac valve surgery. The
specificity of coronary CTA may be decreased against the background of AS
(Computed Tomography Angiography for the Detection of Coronary Artery
Disease in Patients Referred for Cardiac Valve Surgery: A Meta-Analysis;
CRD42015016213) Copyright &#xa9; 2016 American College of Cardiology
Foundation

<17>
Accession Number
613230914
Author
Ripolles J.; Espinosa A.; Martinez-Hurtado E.; Abad-Gurumeta A.;
Casans-Frances R.; Fernandez-Perez C.; Lopez-Timoneda F.; Calvo-Vecino
J.M.
Institution
(Ripolles, Martinez-Hurtado, Calvo-Vecino) Departamento de Anestesia,
Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid,
Madrid, Spain
(Espinosa) Department of Anesthesia, Blekinge County Council Hospital,
WamoCenter, Karlskrona, Suecia, Sweden
(Abad-Gurumeta) Departamento de Anestesia, Hospital Universitario la Paz,
Madrid, Spain
(Casans-Frances) Departamento de Anestesia, Hospital Universitario Lozano
Blesa, Zaragoza, Spain
(Fernandez-Perez) Departamento de Medicina Preventiva y Salud Publica,
Hospital Clinico San Carlos, Madrid, Spain
(Lopez-Timoneda) Departamento de Anestesia, Hospital Clinico San Carlos,
Universidad Complutense de Madrid, Madrid, Spain
Title
Intraoperative goal directed hemodynamic therapy in noncardiac surgery: a
systematic review and meta-analysis.
Source
Brazilian Journal of Anesthesiology. 66 (5) (pp 513-528), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Editora Ltda
Abstract
Background The goal directed hemodynamic therapy is an approach focused on
the use of cardiac output and related parameters as end-points for fluids
and drugs to optimize tissue perfusion and oxygen delivery. Primary aim:
To determine the effects of intraoperative goal directed hemodynamic
therapy on postoperative complications rates. Methods A meta-analysis was
carried out of the effects of goal directed hemodynamic therapy in adult
noncardiac surgery on postoperative complications and mortality using
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
methodology. A systematic search was performed in Medline PubMed, Embase,
and the Cochrane Library (last update, October 2014). Inclusion criteria
were randomized clinical trials in which intraoperative goal directed
hemodynamic therapy was compared to conventional fluid management in
noncardiac surgery. Exclusion criteria were trauma and pediatric surgery
studies and that using pulmonary artery catheter. End-points were
postoperative complications (primary) and mortality (secondary). Those
studies that fulfilled the entry criteria were examined in full and
subjected to quantifiable analysis, predefined subgroup analysis
(stratified by type of monitor, therapy, and hemodynamic goal), and
predefined sensitivity analysis. Results 51 RCTs were initially
identified, 24 fulfilling the inclusion criteria. 5 randomized clinical
trials were added by manual search, resulting in 29 randomized clinical
trials in the final analysis, including 2654 patients. A significant
reduction in complications for goal directed hemodynamic therapy was
observed (RR: 0.70, 95% CI: 0.62-0.79, p < 0.001). No significant decrease
in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p = 0.30). Quality
sensitive analyses confirmed the main overall results. Conclusions
Intraoperative goal directed hemodynamic therapy with minimally invasive
monitoring decreases postoperative complications in noncardiac surgery,
although it was not able to show a significant decrease in mortality rate.
Copyright &#xa9; 2015 Sociedade Brasileira de Anestesiologia

<18>
Accession Number
613005953
Author
Blichfeldt-Eckhardt M.R.; Laursen C.B.; Berg H.; Holm J.H.; Hansen L.N.;
Ording H.; Andersen C.; Licht P.B.; Toft P.
Institution
(Blichfeldt-Eckhardt, Berg, Holm, Hansen, Andersen, Toft) Department of
Anesthesiology and Intensive Care, Odense University Hospital, Odense,
Denmark
(Laursen) Department of Respiratory Medicine, Odense University Hospital,
Odense, Denmark
(Licht) Department of Cardiothoracic Surgery, Odense University Hospital,
Odense, Denmark
(Ording) Department of Anaesthesiology, Vejle Hospital, Vejle, Denmark
Title
A randomised, controlled, double-blind trial of ultrasound-guided phrenic
nerve block to prevent shoulder pain after thoracic surgery.
Source
Anaesthesia. 71 (12) (pp 1441-1448), 2016. Date of Publication: 01 Dec
2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Moderate to severe ipsilateral shoulder pain is a common complaint
following thoracic surgery. In this prospective, parallel-group study at
Odense University Hospital, 76 patients (aged > 18 years) scheduled for
lobectomy or pneumonectomy were randomised 1:1 using a computer-generated
list to receive an ultrasound-guided supraclavicular phrenic nerve block
with 10 ml ropivacaine or 10 ml saline (placebo) immediately following
surgery. A nerve catheter was subsequently inserted and treatment
continued for 3 days. The study drug was pharmaceutically pre-packed in
sequentially numbered identical vials assuring that all participants,
healthcare providers and data collectors were blinded. The primary outcome
was the incidence of unilateral shoulder pain within the first 6 h after
surgery. Pain was evaluated using a numeric rating scale. Nine of 38
patients in the ropivacaine group and 26 of 38 patients in the placebo
group experienced shoulder pain during the first 6 h after surgery
(absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65%
(95% CI 41-80%); p = 0.00009). No major complications, including
respiratory compromise or nerve injury, were observed. We conclude that
ultrasound-guided supraclavicular phrenic nerve block is an effective
technique for reducing the incidence of ipsilateral shoulder pain after
thoracic surgery. Copyright &#xa9; 2016 The Association of Anaesthetists
of Great Britain and Ireland

<19>
Accession Number
613265024
Author
Sakrana A.A.; Nasr M.M.; Ashamallah G.A.; Abuelatta R.A.; Naeim H.A.;
Tahlawi M.E.
Institution
(Sakrana, Abuelatta, Naeim) Madina Cardiac Center, 23411, AL Madinah Al
Munawwrah, Khaled Bin Al Waleed Road, Saudi Arabia
(Sakrana, Nasr, Ashamallah) Department of Diagnostic and Interventional
Radiology, Mansoura University Hospital, 35112, 12 El-Gomhoreya Street,
Mansoura, Egypt
(Tahlawi) Zagazig University Hospital, Cardiology Department, Zagazig,
Egypt
Title
Paravalvular leak after transcatheter aortic valve implantation: is it
anatomically predictable or procedurally determined? MDCT study.
Source
Clinical Radiology. 71 (11) (pp 1095-1103), 2016. Date of Publication: 01
Nov 2016.
Publisher
W.B. Saunders Ltd
Abstract
Aim To investigate the determinants of paravalvular leak (PVL) occurring
after transcatheter aortic valve implantation (TAVI). Materials and
methods One hundred and eight patients with severe symptomatic aortic
stenosis (mean age 75.5+/-11.8 years, 72.2% male) underwent
contrast-enhanced electrocardiogram (ECG)-gated multidetector computed
tomography (MDCT) then successful TAVI. The following parameters were
determined in the late systolic phase: annular and left ventricular
outflow tract (LVOT) diameters, annular perimeter, ellipticity index,
annular area, indexed annular area, LVOT perimeter, annulus/LVOT perimeter
difference ratio, the LVOT to ascending aorta angle (< LVOT-AO). In the
diastolic phase, the extent of calcification of the aortic valve (AVC) was
assessed visually and graded semi-quantitatively as grade I, II, and III
at the annulus, LVOT, and aortic cusps levels. Pre-discharge transthoracic
echocardiography (TTE) was performed, and the PVL was graded as grade I,
II, and III. The area-dependent device-annulus sizing ratio was
calculated. Results Absence of PVL was observed in 44.44% of the patients,
30.56% had grade I PVL, 25% of the patients had grade II or above, and any
PVL was observed in 55.56%. There was no statistically significant
association between the degree of PVL and the extent or the distribution
of AVC, aortic annulus diameters, ellipticity index, annulus/LVOT
perimeter difference ratio or < LVOT-AO. The frequency of PVL was not
significantly different with the use of balloon-expandable or
self-expandable valves. A larger transcatheter heart valve (THV)/annulus
sizing ratio was associated with a lower incidence and degree of PVL
(p<0.001); there was no detectable PVL with a mean sizing ratio of
14.89+/-7.29, and grade I PVL occurred with a mean sizing ratio
12.43+/-0.84, while PVL of grade II or above occurred using the mean
sizing ratio -0.42+/-5.57. Conclusion The procedure-related THV/annulus
sizing ratio was an important determinant of the degree of PVL after TAVI,
whereas the MDCT-derived anatomical measurements of the aortic root and
AVC were not predictors of PVL. Copyright &#xa9; 2016 The Royal College of
Radiologists

<20>
Accession Number
613116790
Author
Rimac G.; Fearon W.F.; De Bruyne B.; Ikeno F.; Matsuo H.; Piroth Z.;
Costerousse O.; Bertrand O.F.
Institution
(Rimac, Costerousse, Bertrand) Cardiology Department, Quebec Heart-Lung
Institute, Quebec, Quebec, Canada
(Fearon, Ikeno) Stanford University Medical Center, Stanford, CA, United
States
(De Bruyne) Cardiovascular Center Aalst OLV Clinic, Aalst, Belgium
(Matsuo) Department of Cardiovascular Medicine, Gifu Heart Center, Gifu,
Japan
(Piroth) Hungarian Institute of Cardiology, Budapest, Hungary
Title
Clinical value of post-percutaneous coronary intervention fractional flow
reserve value: A systematic review and meta-analysis.
Source
American Heart Journal. 183 (pp 1-9), 2017. Date of Publication: 01 Jan
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Fractional flow reserve (FFR) prior to percutaneous coronary
intervention (PCI) is useful to guide treatment. Whether post-PCI FFR
assessment might have clinical impact is controversial. The aim of this
study is to evaluate the range of post-PCI FFR values and analyze the
relationship between post-PCI FFR and clinical outcomes. Methods We
systematically searched the PubMed, EMBASE, and Cochrane Library databases
with cross-referencing of articles reporting post-PCI FFR and correlating
post-PCI FFR values and clinical outcomes. The outcomes of interest were
the immediate post-PCI FFR values and the correlations between post-PCI
FFR and the incidence of repeat intervention and major adverse cardiac
events (MACE). Results From 1995 to 2015, a total of 105 studies (n =
7470) were included, with 46 studies reporting post-PCI FFR and 59 studies
evaluating relationship between post-PCI and clinical outcomes up to 30
months after PCI. Overall, post-PCI FFR values demonstrated a normal
distribution with a mean value of 0.90 +/- 0.04. There was a positive
correlation between the percentage of stent use and post-PCI FFR (P <
.0001). Meta-regression analysis indicated that higher post-PCI FFR values
were associated with reduced rates of repeat intervention (P < .0001) and
MACE (P = .0013). A post-PCI FFR >0.90 was associated with significantly
lower risk of repeat PCI (odds ratio 0.43, 95% CI 0.34-0.56, P < .0001)
and MACE (odds ratio 0.71, 95% CI 0.59-0.85, P = .0003). Conclusions FFR
measurement after PCI was associated with prognostic significance. Further
investigation is required to assess the role of post-PCI FFR and validate
cutoff values in contemporary clinical practice. Copyright &#xa9; 2016

<21>
Accession Number
613103366
Author
McClure G.R.; Belley-Cote E.P.; Singal R.K.; Jaffer I.H.; Dvirnik N.; An
K.R.; Fortin G.; Spence J.; Whitlock R.P.
Institution
(McClure, An) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Belley-Cote, Dvirnik, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Dvirnik, Whitlock) Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote, Fortin) Department of Medicine, Universite de Sherbrooke,
Sherbrooke, QC, Canada
(Singal) Department of Surgery, University of Manitoba, Manitoba, ON,
Canada
(Singal) I.H. Asper Clinical Research Institute, Winnipeg, MB, Canada
(Jaffer) Thrombosis and Atherosclerosis Research Institute (TaARI),
McMaster University, Hamilton, ON, Canada
(Jaffer, Dvirnik, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, ON, Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
Title
Surgical ablation of atrial fibrillation: A protocol for a systematic
review and meta-analysis of randomised controlled trials.
Source
BMJ Open. 6 (11) (no pagination), 2016. Article Number: e013273. Date of
Publication: 01 Nov 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Atrial fibrillation (AF) affects 10% of patients undergoing
cardiac surgery and is an independent risk factor for all-cause mortality,
ischaemic stroke and heart failure. Surgical AF ablation has been shown to
significantly improve maintenance of sinus rhythm, however, small to
medium size trials conducted to date lack the power required to assess
patient-important outcomes such as mortality, stroke, heart failure and
health-related quality of life. Moreover, a recent randomised trial (RCT)
suggested harm by surgical AF ablation with an almost threefold increase
in the requirement for permanent pacemaker postablation. We aim to perform
a systematic review and meta-analysis to evaluate efficacy and safety of
surgical AF ablation compared to no surgical ablation. Methods and
analysis: We will search Cochrane CENTRAL, MEDLINE and EMBASE for RCTs
evaluating the use of surgical AF ablation, including any lesion set,
versus no surgical AF ablation in adults with AF undergoing any type of
cardiac surgery. Outcomes of interest include mortality, embolic events,
quality of life, rehospitalisation, freedom from AF and adverse events,
including need for pacemaker and worsening heart failure. Independently
and in duplicate, reviewers will screen references, assess eligibility of
potentially relevant studies using predefined eligibility criteria and
collect data using prepiloted forms. We will pool data using a random
effects model and present results as relative risk with 95% CIs for
dichotomous outcomes and as mean difference with 95% CI for continuous
outcomes. We will assess risk of bias using the Cochrane Collaboration
tool, and quality of evidence with the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) approach. Ethics and
dissemination: Our results will help guide clinical practice by providing
the most comprehensive analysis of risks and benefits associated with the
procedure. Our results will be disseminated through publication in
peer-reviewed journals and conference presentations.

<22>
Accession Number
613230136
Author
Clavel M.-A.; Tribouilloy C.; Vanoverschelde J.-L.; Pizarro R.; Suri R.M.;
Szymanski C.; Lazam S.; Oberti P.; Michelena H.I.; Jaffe A.;
Enriquez-Sarano M.
Institution
(Clavel, Suri, Michelena, Jaffe, Enriquez-Sarano) Department of
Cardiology, Division of Cardiovascular Diseases and Internal Medicine,
Mayo Clinic, Rochester, Minnesota, United States
(Tribouilloy, Szymanski) Department of Cardiology, INSERM, ERI-12,
University Hospital, Amiens, France
(Vanoverschelde, Lazam) Department of Cardiology, Universite Catholique de
Louvain, Brussels, Belgium
(Pizarro, Oberti) Department of Cardiology, Hospital Italiano, Buenos
Aires, Argentina
Title
Association of B-Type Natriuretic Peptide With Survival in Patients With
Degenerative Mitral Regurgitation.
Source
Journal of the American College of Cardiology. 68 (12) (pp 1297-1307),
2016. Date of Publication: 20 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Studies suggesting that B-type natriuretic peptide (BNP) may
predict outcomes of mitral regurgitation (MR) are plagued by small size,
inconsistent etiologies, and lack of accounting for shifting normal BNP
ranges with age and sex. Objectives This study assessed the effect of BNP
activation on mortality in a large, multicenter cohort of patients with
degenerative MR. Methods In 1,331 patients with degenerative MR, BNP was
prospectively measured at diagnosis and expressed as BNPratio (ratio to
upper limit of normal for age, sex, and assay). Initial surgical
management was performed within 3 months of diagnosis in 561 patents.
Results The cohort had a mean age of 64 +/- 15 years, was 66% male, and
had a mean ejection fraction 64 +/- 9%, mean regurgitant volume 67 +/- 31
ml, and low mean Charlson comorbidity index of 1.09 +/- 1.76. Median
BNPratio was 1.01 (25th and 75th percentiles: 0.42 to 2.36). Overall,
BNPratio was a powerful, independent predictor of mortality (hazard ratio:
1.33 [95% confidence interval: 1.15 to 1.54]; p < 0.0001), whereas
absolute BNP was not (p = 0.43). In patients who were initially treated
medically (n = 770; 58%), BNPratio was a powerful, independent, and
incremental predictor of mortality after diagnosis (hazard ratio: 1.61
[95% confidence interval: 1.34 to 1.93]; p < 0.0001). Higher BNP
activation was associated with higher mortality (p < 0.0001). All
subgroups, particularly severe MR, incurred similar excess mortality with
BNP activation. After initial surgical treatment (n = 561, 42%) BNP
activation did not impose excess long-term mortality (p = 0.23).
Conclusions In patients with degenerative MR, BNPratio is a powerful,
independent, and incremental predictor of long-term mortality under
medical management. BNPratio should be incorporated into the routine
clinical assessment of patients with degenerative MR. Copyright &#xa9;
2016 American College of Cardiology Foundation

<23>
Accession Number
613174223
Author
Ekeloef S.; Alamili M.; Devereaux P.J.; Gogenur I.
Institution
(Ekeloef, Alamili, Gogenur) Department of Surgery, Center for Surgical
Science, Zealand University Hospital, Koege and Roskilde, Denmark
(Devereaux) Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, ON, Canada
(Devereaux) Department of Medicine, McMaster University, Hamilton, ON,
Canada
Title
Troponin elevations after non-cardiac, non-vascular surgery are predictive
of major adverse cardiac events and mortality: A systematic review and
meta-analysis.
Source
British Journal of Anaesthesia. 117 (5) (pp 559-568), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background: Patients undergoing non-cardiac, non-vascular surgery are at
risk of major cardiovascular complications. In non-cardiac surgery,
troponin elevation has previously been shown to be an independent
predictor of major adverse cardiac events and postoperative mortality;
however, a majority of studies have focused on vascular surgery patients.
The aim of this meta-analysis was to determine whether troponin elevation
is a predictor of major adverse cardiac events and mortality within 30
days and 1 yr after non-cardiac, non-vascular surgery. Methods: A
systematic review and meta-analysis was conducted in January 2016
according to the Meta-analysis Of Observational Studies in Epidemiology
guidelines. Both interventional and observational studies measuring
troponin within the first 4 days after surgery were eligible. A systematic
search was performed in PubMed, EMBASE, Scopus, and the Cochrane Central
Register of Controlled Trials. Results: Eleven eligible clinical studies
(n=2193) were identified. A postoperative troponin elevation was a
predictor of 30 day mortality, odds ratio (OR) 3.52 [95% confidence
interval (CI) 2.21-5.62; I²=0%], and an independent predictor
of 1 yr mortality, adjusted OR 2.53 (95% CI 1.20-5.36; I²=26%).
A postoperative troponin elevation was associated with major adverse
cardiac events at 30 days, OR 5.92 (95% CI 1.67-20.96; I²=86%),
and 1 yr after surgery, adjusted OR 3.00 (95% CI 1.43-6.29;
I²=21%). Conclusions: Postoperative myocardial injury is an
independent predictor of major adverse cardiac events and mortality within
30 days and 1 yr after non-cardiac, non-vascular surgery. The
meta-analysis provides evidence that supports troponin monitoring as a
cardiovascular risk stratification tool. Copyright &#xa9; 2016 The Author.
Published by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved.

<24>
Accession Number
613223949
Author
Poulin M.-F.; Deka A.; Mohamedali B.; Schaer G.L.
Institution
(Poulin) Division of Cardiovascular Medicine, Department of Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Deka, Mohamedali, Schaer) Division of Cardiology, Department of Medicine,
Rush University Medical Center, Chicago, IL, United States
Title
Clinical benefits of stem cells for chronic symptomatic systolic heart
failure: A systematic review of the existing data and ongoing trials.
Source
Cell Transplantation. 25 (11) (pp 1911-1923), 2016. Date of Publication:
2016.
Publisher
Cognizant Communication Corporation (3 Hartsdale Road, Elmsford NY
10523-3701, United States)
Abstract
The benefits of stem cell therapy for patients with chronic symptomatic
systolic heart failure due to ischemic and nonischemic cardiomyopathy (ICM
and NICM, respectively) are unclear. We performed a systematic review of
major published and ongoing trials of stem cell therapy for systolic heart
failure and compared measured clinical outcomes for both types of
cardiomyopathy. The majority of the 29 published studies demonstrated
clinical benefits of autologous bone marrow-derived mesenchymal stem cells
(BM-MSCs). Left ventricular ejection fraction (LVEF) was improved in the
majority of trials after therapy. Cell delivery combined with coronary
artery bypass grafting was associated with the greatest improvement in
LVEF. Left ventricular end-systolic volume (or diameter), New York Heart
Association functional classification, quality of life, and exercise
capacity were also improved in most studies after cell therapy. Most ICM
trials demonstrated a significant improvement in perfusion defects,
infarct size, and myocardial viability. Several larger clinical trials
that are in progress employ alternative delivery modes, cell types, and
longer follow-up periods. Stem cells are a promising therapeutic modality
for patients with heart failure due to ICM or NICM. More data are required
from larger blinded trials to determine which combination of cell type and
delivery mode will yield the most benefit with avoidance of harm in these
patient populations. Copyright &#xa9; 2016 Cognizant, LLC.

<25>
Accession Number
613217600
Author
Gerardin B.; Collet J.-P.; Mustafic H.; Bellemain-Appaix A.; Benamer H.;
Monsegu J.; Teiger E.; Livarek B.; Jaffry M.; Lamhaut L.; Fleischel C.;
Aubry P.
Institution
(Gerardin) Centre Chirurgical Marie Lannelongue, 133, avenue de la
resistance, Le-Plessis-Robinson-Paris 92350, France
(Collet) Univ Paris 06 (UPMC), ACTION Study Group, INSERM UMR-S 1166,
Institut de Cardiologie, PitieSalpetriere Hospital, AP-HP, Paris, France
(Mustafic) Hopital Universitaire de Geneve, rue Gabrielle Perret-Gentil,
Geneve 14 1211, Switzerland
(Bellemain-Appaix) Centre Hospitalier la Fontonne, 107 avenue de Nice,
Antibes 06600, France
(Benamer) Hopital Foch, 40 rue Worth, Suresnes 92151, France
(Monsegu) Groupe Hospitalier Mutualiste de Grenoble, 8, rue du Dr
Calmette, Grenoble 38000, France
(Teiger) Centre Hospitalo-universitaire Henri Mondor, 51 av du marechal de
Lattre de Tassigny, Creteil 94000, France
(Livarek) Hopital Andre Mignot, 177, rue de Versailles, Le Chesnay 78150,
France
(Jaffry, Lamhaut) SAMU 75: Hopital Necker, 149 Rue de Sevres, 75015 Paris,
France, France
(Fleischel) SAMU 92: Hopital de Garches, 104 boulevard Raymond Poincare,
Garches 92380, France
(Aubry) Centre Hospitalo-universitaire Bichat - Claude Bernard, 46 rue
Huchard, Paris 75018, France
Title
Registry on acute cardiovascular events during endurance running races:
The prospective RACE Paris registry.
Source
European Heart Journal. 37 (32) (pp 2531-2541), 2016. Date of Publication:
21 Aug 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aim: Long distance running races are associated with a low risk of
life-threatening events much often attributed to hypertrophic
cardiomyopathy. However, retrospective analyses of aetiology lack
consistency. Methods and results: Incidence and aetiology of
life-threatening/fatal events were assessed in long distance races in the
prospective Registre des Accidents Cardiaques lors des courses d'Endurance
(RACE Paris Registry) from October 2006 to September 2012. Characteristics
of life-threatening/fatal events were analysed by interviewing survivors
and reviewing medical records including post-mortem data of each case.
Seventeen life-threatening events were identified of 511 880 runners of
which two were fatal. The vast majority were cardiovascular events (13/17)
occurring in experienced male runners [mean (+/-SD) age 43 +/- 10 years],
with infrequent cardiovascular risk factors, atypical warning symptoms
prior to the race or negative treadmill test when performed. Acute
myocardial ischaemia was the predominant aetiology (8 of 13) and led to
immediate myocardial revascularization. All cases with initial shockable
rhythm survived. There was no difference in event rate according to
marathons vs. half-marathons and events were clustered at the end of the
race. A meta-analysis of all available studies including the RACE Paris
registry (n = 6) demonstrated a low prevalence of life-threatening events
(0.75/100 000) and that presentation with non-shockable rhythm [OR = 29.9;
95% CI (4.0-222.5), P = 0.001] or non-ischaemic aetiology [OR = 6.4; 95%
CI (1.4-28.8), P = 0.015] were associated with case-fatality. Conclusion:
Life-threatening/fatal events during long distance races are rare, most
often unpredictable and mainly due to acute myocardial ischaemia.
Presentation with non-shockable rhythm and non-ischaemic aetiology are the
major determinant of case fatality. Published on behalf of the European
Society of Cardiology. All rights reserved. Copyright &#xa9; 2015 The
Author.

<26>
Accession Number
613216272
Author
Arora S.; Misenheimer J.A.; Jones W.; Bahekar A.; Caughey M.; Ramm C.J.;
Caranasos T.G.; Yeung M.; Vavalle J.P.
Institution
(Arora, Jones) Campbell University School of Osteopathic Medicine, 212
Aldenwood Place, Apex, NC 27539, United States
(Arora, Bahekar) Cape Fear Valley Medical Center, Fayetteville, NC, United
States
(Misenheimer, Caughey, Ramm, Caranasos, Yeung, Vavalle) University of
North Carolina, Chapel Hill, NC, United States
Title
Transcatheter versus surgical aortic valve replacement in intermediate
risk patients: A meta-Analysis.
Source
Cardiovascular Diagnosis and Therapy. 6 (3) (pp 241-249), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been
approved in patients with high or prohibited surgical risk for surgery for
treatment of severe symptomatic aortic stenosis. Prospective studies
examining the benefits of TAVR in intermediate risk patients are ongoing.
Other smaller studies including lower risk patients have been conducted,
but further meta-Analysis of these studies is required to draw more broad
comparisons. Methods: A Medline search was conducted using standard
methodology to search for clinical trials and observational studies
including intermediate risk patients. We limited our meta-Analysis to
studies matching patient populations by propensity scores or randomization
and examined clinical outcomes between TAVR and surgical aortic valve
replacement (SAVR). Results: Analysis of the TAVR and SAVR cohorts
revealed no significant differences in the outcomes of 30-day [OR (95%
CI): 0.85 (0.57, 1.26)] or 1-year mortality [OR (95% CI): 0.96 (0.75,
1.23)]. A trend towards benefit with TAVR was noted in terms of
neurological events and myocardial infarction (MI) without statistical
significance. A statistically significant decrease in risk of
post-procedural acute renal failure in the TAVR group [OR (95% CI): 0.52
(0.27, 0.99)] was observed, but so was a significantly higher rate of
pacemaker implantations for the TAVR group [OR (95% CI): 6.51 (3.23,
13.12)]. Conclusions: We conclude that in intermediate risk patients
undergoing aortic valve replacement, the risk of mortality, neurological
outcomes, and MI do not appear to be significantly different between TAVR
and SAVR. However, there appears to be a significant reduction in risk of
acute renal failure at the expense of an increased risk of requiring a
permanent pacemaker in low and intermediate risk patients undergoing TAVR
compared to SAVR. Copyright &#xa9; Cardiovascular Diagnosis and Therapy.
All rights reserved.

<27>
Accession Number
613155978
Author
Aydin U.; Yilmaz M.; Duzyol C.; Ata Y.; Turk T.; Orhan A.L.; Kocogullari
C.U.
Institution
(Aydin, Ata, Turk) Department of Cardiovascular Surgery, Bursa Yuksek
Ihtisas Education and Research Hospital, Bursa, Turkey
(Yilmaz, Orhan) Department of Anesthesiology, Kocaeli Derince Education
and Research Hospital, Kocaeli, Turkey
(Duzyol, Kocogullari) Department of Cardiovascular Surgery, Kocaeli
Derince Education and Research Hospital, Kocaeli, Turkey
Title
Efficiency of postoperative statin treatment for preventing new-onset
postoperative atrial fibrillation in patients undergoing isolated coronary
artery bypass grafting: A prospective randomized study.
Source
Anatolian Journal of Cardiology. 15 (6) (pp 491-495), 2015. Date of
Publication: 2015.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Recent studies have demonstrated that preoperative statin
therapy reduces the incidence of postoperative atrial fibrillation (AF).
The objective of this study was to assess the efficacy of statin therapy
started in the early postoperative period for the prevention from
new-onset AF after isolated coronary artery bypass grafting (CABG).
Methods: This prospective and randomized study consisted of 60 consecutive
patients who underwent elective isolated CABG. Patients were divided into
two groups to examine the influence of statins: Those with postoperative
statin therapy (statin group, n=30) and those without it (non-statin
group, n=30). Patient data were collected and analyzed prospectively. In
the statin group, each extubated patient was given 40 mg of atorvastatin
per day, starting from an average of 6 hours after the operation. Results:
The overall incidence of postoperative AF was 30%. Postoperative AF
occurred in 5 patients (16.7%) in the statin group. This was significantly
lower compared with 13 patients (43.3%) in the non-statin group (p=0.049).
According to the multivariate analysis, postoperative atorvastatin reduced
the risk of postoperative AF by 49% [odds ratio (OR) 0.512, 95% confidence
interval (CI) 0.005 to 0.517, p=0.012]. Also, age was an independent
predictor of postoperative AF (OR 1.299, 95% CI 1.115 to 1.514, p=0.001).
Conclusion: Postoperative statin therapy seems to reduce new-onset AF
after isolated CABG in our study. Copyright &#xa9; 2015 by Turkish Society
of Cardiology.

<28>
Accession Number
613134763
Author
Siegel A.J.; Bhatti N.A.; Wasfy J.H.
Institution
(Siegel, Bhatti) Divisions of General Internal Medicine, Massachusetts
General Hospital, Boston, MA, United States
(Siegel, Bhatti, Wasfy) Harvard Medical School, Boston, MA, United States
(Wasfy) Divisions of Cardiology, Massachusetts General Hospital, Boston,
MA, United States
Title
Reprising Ramadan-related angina pectoris: A potential strategy for risk
reduction.
Source
American Journal of Case Reports. 17 (pp 841-844), 2016. Date of
Publication: 10 Nov 2016.
Publisher
Medical Science International (E-mail: office@isl-science.com)
Abstract
Objective: Unusual clinical course Background: A preponderance of evidence
supports short-term aspirin usage to reduce transiently increased
cardiovascular risk in clinical conditions that promote acute myocardial
ischemia. Case Report: We report on the case of a 69-year-old male of
Muslim Indian heritage with multiple cardiovascular risk factors who
experienced the onset of angina pectoris while fasting for Ramadan for
more than 16 hours daily for 30 days in July 2015. While symptom free for
2 months on medical management after ending his fast, he underwent
quadruple coronary artery bypass surgery for severe 4-vessel disease
following an acute anterior myocardial infarction. A percutaneous coronary
intervention with stent placement was subsequently required for persistent
myocardial ischemia on stress-MIBI testing due to occlusion of the graft
to left anterior descending artery. Presently asymptomatic, he decided to
forgo fasting for Ramadan in June 2016. Conclusions: Based on this case,
measures for primary cardiovascular prevention among the 1.2 billion
susceptible males at similar high short-term cardiac risk while fasting
for Ramadan are proposed. The value of aspirin for attenuating high
short-term cardiovascular risk in clinical conditions conferring transient
inflammatory stress is considered. Low-dose aspirin usage at evening meals
while fasting for Ramadan is prudent for primary cardiovascular protection
of males who may have non-obstructive coronary atherosclerosis to mitigate
the risk for rupture of potentially vulnerable plaques. Based in part on
conclusive evidence for protection of middle-aged males from first
myocardial infarction in a randomized prospective primary prevention
trial, this measure is concordant with recommendations from sub-specialty
societies for primary cardiovascular prevention for persons at
above-average risk demonstrated by validated biomarkers and from the
United States Preventive Services Task Force. Copyright &#xa9; Am J Case
Rep.

<29>
Accession Number
613174275
Author
Kang D.-H.; Lee S.; Kim Y.-J.; Kim S.-H.; Kim D.-H.; Yun S.-C.; Song
J.-M.; Chung C.-H.; Song J.-K.; Lee J.-W.
Institution
(Kang, Lee, Kim, Kim, Yun, Song, Chung, Song, Lee) Division of Cardiology,
Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center,
College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu,
Seoul 05505, South Korea
(Kim) Cardiovascular Center, Seoul National University Hospital,
Department of Internal Medicine, Seoul National University College of
Medicine, Seoul, South Korea
Title
Long-term results of early surgery versus conventional treatment for
infective endocarditis trial.
Source
Korean Circulation Journal. 46 (6) (pp 846-850), 2016. Date of
Publication: November 2016.
Publisher
Korean Society of Circulation (E-mail: herz4@circulation.or.kr)
Abstract
Background and Objectives: Compared with conventional treatment, early
surgery significantly reduced the composite end point of allcause death
and embolic events during hospitalization, but long-term data in this area
are lacking. This study sought to compare longterm outcomes of early
surgery with a conventional treatment strategy in patients with infective
endocarditis (IE) and large vegetations. Subjects and Methods: The Early
Surgery versus Conventional Treatment in Infective Endocarditis (EASE)
trial randomly assigned patients with left-sided IE, severe valve disease
and large vegetation to early surgery (37 patients) or conventional
treatment groups (39 patients). The pre-specified end points were
all-cause death, embolic events, recurrence of IE and repeat
hospitalizations due to the development of congestive heart failure
occurring during follow-up. Results: There were no significant differences
between the early surgery and the conventional treatment group in
all-cause mortality at 4 years (8.1% and 7.7%, respectively; hazard ratio
[HR] 1.04; 95% CI, 0.21 to 5.15; p=0.96). The rate of the composite end
point of death from any cause, embolic events or recurrence of IE at 4
years was 8.1% in the early surgery group and 30.8% in the conventional
treatment group (HR, 0.22; 95% CI, 0.06-0.78; p=0.02). The estimated
actuarial rate of end points at 7 years was significantly lower in the
early surgery group than in the conventional treatment group (log-rank
p=0.007). Conclusion: There was a substantial benefit in having early
surgery for patients with IE and large vegetations whose health was
sustained up to 7 years, and late clinical outcome after surgery was
excellent in survivors of IE. Copyright &#xa9; 2016 The Korean Society of
Cardiology.

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

<31>
Accession Number
613173393
Author
Kovac J.; Schuler G.; Gerckens U.; Muller R.; Serruys P.W.; Bonan R.;
Labinaz M.; Den Heijer P.; Mullen M.; Tymchak W.; Grube E.
Institution
(Kovac) Cardiovascular Biomedical Research Unit, University of Leicester,
Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom
(Schuler) University of Leipzig, Leipzig, Germany
(Gerckens, Muller, Grube) HELIOS Heart Center Siegburg, Siegburg, Germany
(Serruys) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Bonan) Institut de Cardiologie de Montreal, Montreal, Canada
(Labinaz) University of Ottawa Heart Institute, Ottawa, Canada
(Den Heijer) Amphia Hospital, Breda, Netherlands
(Mullen) Royal Brompton and Harefield NHS Trust, London, United Kingdom
(Tymchak) University of Alberta, Edmonton, Canada
Title
Four-year experience with the CoreValve transcatheter heart valve.
Source
EuroIntervention. 12 (8) (pp e1039-e1046), 2016. Date of Publication:
October 2016.
Publisher
EuroPCR
Abstract
Aims: Our aim was to evaluate the long-term device performance and
clinical outcomes of patients with symptomatic, severe aortic valve
stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI)
with the CoreValve bioprosthesis. Methods and results: The CoreValve CE
Pivotal Study was a prospective, multicentre, single-arm TAVI trial using
the CoreValve system. Valve performance, patient quality of life (QoL),
New York Heart Association (NYHA) class, and mortality at four years were
analysed in 126 patients (mean age 82.4 years, 42.9% male, mean logistic
EuroSCORE 23.4%) with severe AS. Mean aortic valve gradient decreased from
46.9+/-16.1 mmHg at baseline to 9.8+/-4.1 mmHg at discharge and to
7.8+/-2.7 mmHg at four years. Mean effective orifice area increased from
0.7+/-0.2 cm² to 1.8+/-0.4 cm² after TAVI and was
1.6+/-0.5 cm² at four years. There were no reports of
structural valve deterioration or valve migration. There was sustained
improvement in QoL and NYHA class in surviving patients. All-cause and
cardiac survival was 45.3% and 62.6%, respectively, at four years.
Conclusions: The CoreValve bioprosthesis demonstrates long-term
durability, stable haemodynamic function, and no evidence of structural
deterioration. Most surviving patients continued to have improved NYHA
class and QoL at four years. Copyright &#xa9; 2016 Europa Digital &
Publishing. All rights reserved.

<32>
Accession Number
612986952
Author
Levine G.N.; Bates E.R.; Bittl J.A.; Brindis R.G.; Fihn S.D.; Fleisher
L.A.; Granger C.B.; Lange R.A.; Mack M.J.; Mauri L.; Mehran R.; Mukherjee
D.; Newby L.K.; O'Gara P.T.; Sabatine M.S.; Smith P.K.; Smith S.C.
Title
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.
Source
Journal of the American College of Cardiology. 68 (10) (pp 1082-1115),
2016. Date of Publication: 06 Sep 2016.
Publisher
Elsevier USA

<33>
Accession Number
613103598
Author
Gargiulo G.; Windecker S.; R Da Costa B.; Feres F.; Hong M.-K.; Gilard M.;
ImHyo-Soo K.; Colombo A.; Bhatt D.L.; Kim B.-K.; Morice M.-C.; Park K.W.;
Chieffo A.; Palmerini T.; Stone G.W.; Valgimigli M.
Institution
(Gargiulo, Windecker, R Da Costa, Valgimigli) Department of Cardiology,
Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy
(R Da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Switzerland
(Feres) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Hong, Kim) Division of Cardiology, Severance Cardiovascular Hospital,
Yonsei University College of Medicine, Seoul, South Korea
(Gilard, Morice) Department of Cardiology, CHU de la Cavale Blanche,
Brest, France
(ImHyo-Soo, Park) Department of Internal Medicine, Cardiovascular Center,
Seoul National University Hospital, Seoul, South Korea
(Colombo, Chieffo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Bhatt) Brigham and Women's Hospital, Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Bologna, Italy
(Stone) Columbia University Medical Center, New York-Presbyterian
Hospital, Cardiovascular Research Foundation, New York, NY, United States
Title
Short term versus long term dual antiplatelet therapy after implantation
of drug eluting stent in patients with or without diabetes: Systematic
review and meta-analysis of individual participant data from randomised
trials.
Source
BMJ (Online). 355 (no pagination), 2016. Article Number: i5483. Date of
Publication: 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To compare clinical outcomes between short term (up to 6
months) and long term (12 months) dual antiplatelet therapy (DAPT) after
placement of a drug eluting stent in patients with and without diabetes.
Design: Individual participant data meta-analysis. Cox proportional
regression models stratified by trial were used to assess the impact of
diabetes on outcomes. Data source: Medline, Embase, and Cochrane databases
and proceedings of international meetings searched for randomised
controlled trials comparing durations of DAPT after placement of a drug
eluting stent. Individual patient data pooled from six DAPT trials.
Primary outco me: Primary study outcome was one year risk of major adverse
cardiac events (MACE), defined as cardiac death, myocardial infarction, or
definite/probable stent thrombosis. All analyses were conducted by
intention to treat. Results: Six trials including 11 473 randomised
patients were pooled. Of these patients, 3681 (32.1%) had diabetes and
7708 (67.2%) did not (mean age 63.7 (SD 9.9) and 62.8 (SD 10.1),
respectively), and in 84 (0.7%) the information was missing. Diabetes was
an independent predictor of MACE (hazard ratio 2.30, 95% confidence
interval 1.01 to 5.27; P=0.048 At one year follow-up, long term DAPT was
not associated with a decreased risk of MACE compared with short term DAPT
in patients with (1.05, 0.62 to 1.76; P=0.86) or without (0.97, 0.67 to
1.39; P=0.85) diabetes (P=0.33 for interaction). The risk of myocardial
infarction did not differ between the two DAPT regimens (0.95, 0.58 to
1.54; P=0.82; for those with diabetes and 1.15, 0.68 to 1.94; P=0.60; for
those without diabetes (P=0.84 for interaction). There was a lower risk of
definite/ probable stent thrombosis with long term DAPT among patients
with (0.26, 0.09 to 0.80; P=0.02) than without (1.42, 0.68 to 2.98;
P=0.35) diabetes, with positive interaction testing (P=0.04 for
interaction), although the landmark analysis showed a trend towards
benefit in both groups. Long term DAPT was associated with higher rates of
major or minor bleeding, irrespective of diabetes (P=0.37 for
interaction). Conclusions: Although the presence of diabetes emerged as an
independent predictor of MACE after implantation of a drug eluting stent,
compared with short term DAPT, long term DAPT did not reduce the risk of
MACE but increased the risk of bleeding among patients with stents with
and without diabetes.

<34>
Accession Number
612982015
Author
Stratz C.; Nuhrenberg T.; Amann M.; Cederqvist M.; Kleiner P.; Valina
C.M.; Trenk D.; Neumann F.-J.; Hochholzer W.
Institution
(Stratz, Nuhrenberg, Amann, Cederqvist, Kleiner, Valina, Trenk, Neumann,
Hochholzer) University Heart Center Freiburg - Bad Krozingen, Department
of Cardiology and Angiology II, Bad Krozingen, Germany
Title
Impact of reticulated platelets on antiplatelet response to
thienopyridines is independent of platelet turnover.
Source
Thrombosis and Haemostasis. 116 (5) (pp 941-948), 2016. Date of
Publication: November 2016.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
Reticulated platelets are associated with impaired antiplatelet response
to thienopyridines. It is uncertain whether this interaction is caused by
a decreased drug exposure due to high platelet turnover reflected by
elevated levels of reticulated platelets or by intrinsic properties of
reticulated platelets. This study sought to investigate if the impact of
reticulated platelets on early antiplatelet response to thienopyridines is
mainly caused by platelet turnover as previously suggested. Elective
patients undergoing coronary intervention were randomised to loading with
clopidogrel 600 mg or prasugrel 60 mg (n=200). Adenosine diphosphate
(ADP)-induced platelet reactivity was determined by impedance aggregometry
before, at 30, 60, 90, and 120 minutes and at day 1 after loading.
Immature platelet count was assessed as marker of reticulated platelets by
flow cytometry. Platelet reactivity increased with rising levels of
immature platelet count in both groups. This effect was more distinctive
in patients on clopidogrel as compared to patients on prasugrel. Overall,
immature platelet count correlated well with on-treatment platelet
reactivity at all timepoints (p < 0.001). These correlations did not
change over time in the entire cohort as well as in patients treated with
clopidogrel or prasugrel indicating an effect independent of platelet
turnover (comparison of correlations 120 minutes/day 1: p = 0.64). In
conclusion, the association of immature platelet count with impaired
antiplatelet response to thienopyridines is similar early and late after
loading. This finding suggests as main underlying mechanism another effect
of reticulated platelets on thienopyridines than platelet turnover.
Copyright &#xa9; Schattauer 2016.

<35>
Accession Number
613216258
Author
Tan G.; Chen J.; Liu M.; Yeh J.; Tang W.; Ke J.; Wu W.
Institution
(Tan, Chen, Liu, Tang, Wu) Department of Cardiology, Fifth Affiliated
Hospital of Sun Yat-Sen University, No.52 Meihua East Rd., Zhuhai 519000,
China
(Yeh) National Heart and Lung Institute, Imperial College London, London,
United Kingdom
(Ke) Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen
University, Zhuhai 519000, China
Title
Efficacy and safety of vorapaxar for the prevention of adverse cardiac
events in patients with coronary artery disease: A meta-Analysis.
Source
Cardiovascular Diagnosis and Therapy. 6 (2) (pp 101-108), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Coronary artery disease (CAD) is the leading cause of
morbidity and mortality worldwide. Vorapaxar, a protease-Activated
receptor-1 (PAR-1) antagonist, is a novel antiplatelet agent that may
provide us a new way in antithrombotic therapy. Several studies had been
conducted to evaluate the efficacy of vorapaxar in the treatment of CAD,
but the results were inconsistent. Here a meta-Analysis was made to assess
the efficacy and safety of vorapaxar in reducing adverse cardiac events in
patients with CAD. Methods: A comprehensive literature search was
conducted. The primary efficacy endpoint was the major adverse cardiac
events, which was defined as a composite of cardiovascular death,
myocardial infarction (MI), stroke, urgent coronary revascularization, or
recurrent ischemia with rehospitalization. The primary safety endpoint was
the composite of major or minor bleeding events. Pooled effects were
measured by odds ratios (ORs) with 95% confidence intervals (CIs). A
random-effect or fixed model was used in this meta-Analysis. Results:
Totally, 31,388 patients from four randomized controlled trials (RCTs)
were included in this meta-Analysis. Patients who took vorapaxar combined
with standard dual anti-platelet therapy (aspirin and thienopyridine)
showed a lower incidence in major adverse cardiac events (OR, 0.86, 95%
CI: 0.75-0.99, P=0.03), MI (OR, 0.79, 95% CI: 0.67-0.95, P=0.01) and
ischemic stroke (OR, 0.72, 95% CI: 0.58-0.89, P=0.003) than those who only
took placebo instead. But there was no significant reduction in
cardiovascular death (OR, 0.95, 95% CI: 0.82-1.09, P=0.45). Nevertheless,
the vorapaxar group were associated with a higher risk of bleeding events
(P<0.001). Conclusions: The result of this meta-Analysis indicated that
adding vorapaxar to the standard dual anti-platelet therapy may be
efficient in reducing the incidence of major adverse cardiac events at the
cost of increasing risk of bleeding events.

<36>
[Use Link to view the full text]
Accession Number
611547041
Author
Duerinckx N.; Burkhalter H.; Engberg S.J.; Kirsch M.; Klem M.-L.; Sereika
S.M.; De Simone P.; De Geest S.; Dobbels F.
Institution
(Duerinckx, De Geest, Dobbels) Academic Centre for Nursing and Midwifery,
Department of Public Health and Primary Care, KU Leuven, University of
Leuven, Belgium
(Duerinckx) Heart Transplantation Program, University Hospitals of Leuven,
Belgium
(Burkhalter) Centre of Sleep Medicine, Hirslanden Group Zurich,
Switzerland
(Engberg, Sereika) School of Nursing, University of Pittsburgh,
Pittsburgh, PA, United States
(Kirsch) Department of Anesthesiology, University Hospital of Basel,
Switzerland
(Klem) Health Sciences Library System, University of Pittsburgh,
Pittsburgh, PA, United States
(De Simone) Hepatobiliary Surgery and Liver Transplantation, University of
Pisa Medical School Hospital, Pisa, Italy
(De Geest, Dobbels) Institute of Nursing Science, University of Basel,
Faculty of Medicine, Bernoullistrasse 28, Basel 4056, Switzerland
Title
Correlates and Outcomes of Posttransplant Smoking in Solid Organ
Transplant Recipients: A Systematic Literature Review and Meta-Analysis.
Source
Transplantation. 100 (11) (pp 2252-2263), 2016. Date of Publication: 01
Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Despite smoking being an absolute or relative contraindication
for transplantation, about 11% to 40% of all patients continue or resume
smoking posttransplant. This systematic review with meta-analysis
investigated the correlates and outcomes associated with smoking after
solid organ transplantation. Methods We searched PubMed, EMBASE, CINAHL,
and PsycINFO from inception until January 2016, using state-of-the art
methodology. Pooled odds ratios (ORs) with 95% confidence intervals (CIs)
were computed for correlates/outcomes investigated 5 times or more.
Results Seventy-three studies (43 in kidney, 17 in heart, 12 in liver, 1
in lung transplantation) investigated 95 correlates and 24 outcomes, of
which 6 correlates and 4 outcomes could be included in the meta-analysis.
The odds of smoking posttransplant were 1.33 times higher in men (95% CI,
1.12-1.57). Older individuals were significantly less likely to smoke (OR,
0.48; 95% CI, 0.38-0.62), as were patients with a higher body mass index
(OR, 0.68; 95% CI, 0.52-0.89). Hypertension (OR, 1.16; 95% CI, 0.77-1.75),
diabetes mellitus (OR, 0.52; 95% CI, 0.15-1.78), and having a history of
cardiovascular disease (OR, 0.92; 95% CI, 0.77-1.09) were not significant
correlates. Posttransplant smokers had higher odds of newly developed
posttransplant cardiovascular disease (OR, 1.41; 95% CI, 1.02-1.95),
nonskin malignancies (OR, 2.58; 95% CI, 1.26-5.29), a shorter patient
survival time (OR, 0.59; 95% CI, 0.44-0.79), and higher odds of mortality
(OR, 1.74; 95% CI, 1.21-2.48). Conclusions Posttransplant smoking is
associated with poor outcomes. Our results might help clinicians to
understand which patients are more likely to smoke posttransplant, guide
interventional approaches, and provide recommendations for future
research. Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All rights
reserved.

<37>
Accession Number
613198600
Author
Doumouras B.S.; Alba A.C.; Foroutan F.; Burchill L.J.; Dipchand A.I.; Ross
H.J.
Institution
(Doumouras, Alba, Foroutan, Ross) Heart Failure and Transplant Program,
Toronto General Hospital, University Health Network, University of
Toronto, Toronto, Ontario, Canada
(Burchill) Adult Congenital Heart Disease Program, Knight Cardiovascular
Institute, Oregon Health Science University, Portland, Oregon, United
States
(Dipchand) Labatt Family Heart Centre, The Hospital for Sick Children,
University of Toronto, Toronto, Ontario, Canada
Title
Outcomes in adult congenital heart disease patients undergoing heart
transplantation: A systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. 35 (11) (pp 1337-1347), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Elsevier USA
Abstract
Background Studies assessing mortality and morbidity in adult transplant
recipients with congenital heart disease (CHD) are limited. We conducted a
systematic review and meta-analysis comparing post-transplant outcomes in
these 2 populations. Methods After conducting an electronic database
search, we selected studies evaluating mortality, cause-specific
mortality, and risk of reoperation and dialysis in adult CHD vs non-CHD
patients. We used random-effects models for the meta-analysis. Results
Thirty-day mortality was significantly higher in CHD vs non-CHD patients
(risk ratio [RR], 2.18; 95% confidence interval [CI], 1.62-2.93;
I² = 41%). This was influenced by increased mortality in
Fontan/Glenn patients compared with non-CHD patients (RR, 3.3; 95% CI,
1.89-5.77; I² = 0%). Mortality at 1 and 5 years was higher in
the CHD population, although neither achieved statistical significance.
Ten-year mortality was significantly lower in CHD patients (RR, 0.75; 95%
CI, 0.60-0.95, I² = 42%). Deaths caused by malignancy,
infection, rejection, and cardiac allograft vasculopathy were decreased in
CHD patients, although only death from malignancy achieved significance.
Death secondary to primary graft failure, stroke, and hemorrhage was
significantly higher in CHD patients. Risk of reoperation and dialysis
were not statistically different between the 2 groups. Conclusions
Although adult CHD patients have higher early mortality,
post-transplantation long-term survival is superior to non-CHD recipients.
The challenge is to identify the CHD patients who will benefit from
transplantation vs those who are higher risk. Copyright &#xa9; 2016
International Society for Heart and Lung Transplantation

<38>
Accession Number
613197806
Author
Ladapo J.A.; Hoffmann U.; Lee K.L.; Coles A.; Huang M.; Mark D.B.; Dolor
R.J.; Pelberg R.A.; Budoff M.; Sigurdsson G.; Severance H.W.; Douglas P.S.
Institution
(Ladapo) Department of Medicine, David Geffen School of Medicine,
University of California Los Angeles, Los Angeles, CA, United States
(Ladapo) Departments of Medicine and Population Health, New York
University School of Medicine, New York, NY, United States
(Hoffmann) Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Lee, Coles, Huang, Mark, Dolor, Douglas) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC, United States
(Pelberg) Lindner Clinical Trial Center, Cincinnati, OH, United States
(Budoff) Los Angeles Biomedical Research Institute, Torrance, CA, United
States
(Sigurdsson) University of Iowa Hospitals and Clinics, Iowa City, IA,
United States
(Severance) Erlanger Institute for Clinical Research, Chattanooga, TN,
United States
Title
Changes in medical therapy and lifestyle after anatomical or functional
testing for coronary artery disease.
Source
Journal of the American Heart Association. 5 (10) (no pagination), 2016.
Article Number: e003807. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Diagnostic testing in the care of patients newly presenting
with symptoms suggestive of coronary artery disease may influence risk
factor management, independent of test type or test results. However,
little is known about changes in medications and lifestyle after
anatomical or functional testing. Methods and Results-We examined what
factors influenced preventive medical therapy and lifestyle practices at
60 days among 10 003 symptomatic patients (53% women; mean age 61 years)
randomly assigned to anatomical testing with coronary computed tomographic
angiography or functional testing (NCT01174550). We also assessed the
association of preventive changes with major cardiovascular events. There
were no differences in medications/lifestyle at baseline. At 60 days,
relative to baseline, the computed tomographic angiography strategy was
associated with a higher proportion of patients newly initiating aspirin
(11.8% versus 7.8%), statins (12.7% versus 6.2%), and b-blockers (8.1%
versus 5.3%), compared to functional testing (P < 0.0001 for each). No
significant differences between computed tomographic angiography and
functional testing strategies were observed for initiation of exercise,
quitting smoking, or weight loss in overweight/obese patients, though
overall prevalence of healthy eating was higher after computed tomographic
angiography (P=0.002) while obese/overweight status was lower (P=0.040).
Positive initial test results and revascularization demonstrated stronger
associations with preventive medications and lifestyle than test type.
Medication initiation was not associated with fewer cardiovascular events.
Conclusions-Positive initial test results and revascularization are
primary drivers of changes in preventive medical and lifestyle practices,
with test type making secondary contributions. However, substantial
opportunities exist to further reduce cardiovascular risk. Copyright
&#xa9; 2016 The Authors.

<39>
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.

<40>
Accession Number
613197549
Author
Kim D.H.; Kim C.A.; Placide S.; Lipsitz L.A.; Marcantonio E.R.
Institution
(Kim, Kim, Lipsitz) Beth Israel Deaconess Medical Center, 110 Francis
Street, Boston, MA 02215, United States
(Placide) Albert Einstein College of Medicine, 1300 Morris Park Avenue,
Bronx, NY 10461, United States
(Marcantonio) Division of General Medicine and Primary Care, Beth Israel
Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United
States
Title
Preoperative frailty assessment and outcomes at 6 months or later in older
adults undergoing cardiac surgical procedures: A systematic review.
Source
Annals of Internal Medicine. 165 (9) (pp 650-660), 2016. Date of
Publication: 01 Nov 2016.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Frailty assessment may inform surgical risk and prognosis not
captured by conventional surgical risk scores. Purpose: To evaluate the
evidence for various frailty instruments used to predict mortality,
functional status, or major adverse cardiovascular and cerebrovascular
events (MACCEs) in older adults undergoing cardiac surgical procedures.
Data Sources: MEDLINE and EMBASE (without language restrictions), from
their inception to 2 May 2016. Study Selection: Cohort studies evaluating
the association between frailty and mortality or functional status at 6
months or later in patients aged 60 years or older undergoing major or
minimally invasive cardiac surgical procedures. Data Extraction: 2
reviewers independently extracted study data and assessed study quality.
Data Synthesis: Mobility, disability, and nutrition were frequently
assessed domains of frailty in both types of procedures. In patients
undergoing major procedures (n = 18 388; 8 studies), 9 frailty instruments
were evaluated. There was moderate-quality evidence to assess mobility or
disability and very-low-to lowquality evidence for using a multicomponent
instrument to predict mortality or MACCEs. No studies examined functional
status. In patients undergoing minimally invasive procedures (n = 5177; 17
studies), 13 frailty instruments were evaluated. There was moderate-to
high-quality evidence for assessing mobility to predict mortality or
functional status. Several multicomponent instruments predicted mortality,
functional status, or MACCEs, but the quality of evidence was low to
moderate. Multicomponent instruments that measure different frailty
domains seemed to outperform single-component ones. Limitation:
Heterogeneity of frailty assessment, limited generalizability of
multicomponent frailty instruments, few validated frailty instruments, and
potential publication bias. Conclusion: Frailty status, assessed by
mobility, disability, and nutritional status, may predict mortality at 6
months or later after major cardiac surgical procedures and functional
decline after minimally invasive cardiac surgery. Copyright &#xa9; 2016
American College of Physicians.

<41>
[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.

<42>
Accession Number
611100832
Author
Fuernau G.; Fengler K.; Desch S.; Eitel I.; Neumann F.-J.; Olbrich H.-G.;
de Waha A.; de Waha S.; Richardt G.; Hennersdorf M.; Empen K.; Hambrecht
R.; Jung C.; Bohm M.; Poss J.; Strasser R.H.; Schneider S.; Ouarrak T.;
Schuler G.; Werdan K.; Zeymer U.; Thiele H.
Institution
(Fuernau, Desch, Eitel, de Waha, Poss, Thiele) Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), University Heart Center
Lubeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160,
Lubeck 23538, Germany
(Fuernau, Fengler, Schuler) Department of Internal Medicine/Cardiology,
University of Leipzig Heart Center, Leipzig, Germany
(Fuernau, Desch, Eitel, de Waha, Poss, Thiele) German Centre for
Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lubeck, Lubeck,
Germany
(Neumann) Department of Cardiology, Bad Krozingen Heart Center, University
of Freiburg, Bad Krozingen, Germany
(Olbrich) Department of Internal Medicine I, Hospital Langen, Langen,
Germany
(de Waha) Department of Cardiology, German Heart Center Munich, Munich,
Germany
(Richardt) Department of Cardiology/Angiology, Bad Segeberg Heart Center,
Bad Segeberg, Germany
(Hennersdorf) Department of Internal Medicine I, Klinikum am
Gesundbrunnen, Heilbronn, Germany
(Empen) Department of Internal Medicine B, University of Greifswald,
Greifswald, Germany
(Hambrecht) Department of Cardiology/Angiology, Klinikum Links der Weser,
Bremen, Germany
(Jung) Division of Cardiology, Pulmonology and Vascular Medicine,
Department of Internal Medicine, Heinrich-Heine-University, Dusseldorf,
Germany
(Bohm) Department of Internal Medicine III, University of Homburg,
Homburg/Saar, Germany
(Strasser) Clinic for Internal Medicine/Cardiology, University of
Dresden-Heart Center, Dresden, Germany
(Schneider, Ouarrak, Zeymer) Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Werdan) Department of Internal Medicine III, Martin-Luther-University
Halle-Wittenberg, Halle/Saale, Germany
Title
Culprit lesion location and outcome in patients with cardiogenic shock
complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial.
Source
Clinical Research in Cardiology. 105 (12) (pp 1030-1041), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: In myocardial infarction without cardiogenic shock (CS), the
affected coronary vessel has significant influence on the final infarct
size and patient prognosis. CS data on this relation are scarce. The
objective of this study was to determine the prognostic relevance of the
culprit lesion location in patients with CS complicating acute myocardial
infarction. Methods: In the Intraaortic Balloon Pump in Cardiogenic Shock
II (IABP-SHOCK II) trial patients with CS were randomized to therapy with
intraaortic balloon pump or control. Additional CS patients not eligible
for the randomized trial were included in a registry. We compared the
location of the culprit lesions in these patients with regard to the
affected coronary vessel [left main (LM), left anterior descending (LAD),
left circumflex (LCX) and right coronary artery (RCA)] and location within
the vessel (proximal, mid or distal) regarding short- and long-term
outcome. Results: Of 758 patients, the majority had the culprit lesion in
the LAD (44 %) compared to RCA (27 %), LCX (19 %) or LM (10 %). Proximal
lesions were more frequent than mid or distal culprit lesions (60 vs. 27
vs. 13 %, p < 0.001). No differences were observed for mortality with
respect to either culprit vessel (log-rank p value = 0.54). In contrast, a
higher mortality was observed for patients with distal culprit lesions
after 1 year (log-rank p value = 0.04). This difference persisted after
multivariable adjustment (hazard ratio for distal lesions 1.40; 95 %
confidential interval 1.03-1.90; p = 0.03). Conclusion: For patients with
CS complicating myocardial infarction, the culprit vessel seems to be
unrelated with mortality whereas distal culprit lesions may have a worse
outcome Copyright &#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<43>
Accession Number
613488204
Author
Yuan X.; Du J.; Liu Q.; Zhang L.
Institution
(Yuan, Zhang) Department of Nephrology, the Second Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Du) Department of Cardiology, the Second Affiliated Hospital of Chongqing
Medical University, Chongqing, China
(Liu) Institute for Viral Hepatitis, Key Laboratory of Molecular Biology
for Infectious Diseases, the Second Affiliated Hospital of Chongqing
Medical University, Chongqing, China
Title
Defining the role of perioperative statin treatment in patients after
cardiac surgery: A meta-analysis and systematic review of 20 randomized
controlled trials.
Source
International Journal of Cardiology. 228 (pp 958-966), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Although statin use has been indicated to prevent atrial
fibrillation in previous observational and experimental trials, the issue
remains inadequately and insufficiently explored. We therefore performed
this meta-analysis to evaluate the effects of perioperative statin therapy
on complications and short-term prognosis following cardiac surgery.
Methods A search of the PubMed, EMBASE and the Cochrane database of
controlled trials was performed from inception to June 2016 to identify
relevant randomized controlled trials (RCTs). The primary endpoints
included postoperative atrial fibrillation, acute kidney injury and
all-cause mortality. Results Twenty studies involving 4338 patients were
included in the meta-analysis. Among the patients who underwent cardiac
surgery, perioperative statin therapy was significantly associated with a
decreased risk of postoperative atrial fibrillation (OR: 0.50; P =
0.0004), particularly in the subgroup of patients who used atorvastatin
and those who underwent isolated coronary artery bypass grafting (CABG)
surgery. Moreover, perioperative statin use significantly decreased the
length of hospital stay (weighted mean difference (WMD): - 0.43; P =
0.002). However, no reductions were observed in acute kidney injury,
myocardial infarction, postoperative serum creatinine concentration or the
length of intensive care unit (ICU) stay. Conclusions Perioperative statin
therapy might be promising for the prevention of postoperative atrial
fibrillation following cardiac surgery, especially for patients undergoing
isolated CABG surgery or atorvastatin administration. Additionally, statin
use can decrease the length of the hospital stay. Copyright &#xa9; 2016

<44>
Accession Number
613513126
Author
Kotsoeva O.T.
Institution
(Kotsoeva) Department of Medical Rehabilitation, North-Caucasian
Multidisciplinary Medical Center, 139a, Frieva str., Beslan 363025,
Russian Federation
Title
Comparison of impact of medical therapy and surgical treatment on overall
mortality in patients with severe chronic heart failure: A meta-analysis.
Source
Russian Open Medical Journal. 5 (3) (no pagination), 2016. Article Number:
e0304. Date of Publication: 2016.
Publisher
Russian Open Medical Journal (E-mail: rusomj@mail.ru)
Abstract
Aim - Meta-analysis of clinical trials comparing the efficacy of medical
therapy (MT) and surgical treatment, including cardiac resynchronization
therapy with and without cardioversion-defibrillation (CRT and CRT-D),
circulatory support system (CSS) and heart transplantation (HT), in terms
of decreasing overall mortality in patients with severe chronic heart
failure (CHF). Material and Methods - Meta-analysis included 39 clinical
trials with a total number of 30,257 patients. Search was performed in
MEDLINE, Medscape, Pubmed databases and on web resources, dedicated to
clinical trials (National Institutes of Health, Clinical Center,
ClinicalStudyResults.org, ClinicalTrials.gov). Results - There was no
significant overall mortality reduction in patients receiving MT when
compared to control group: OR=0.97 (95% CI: 0.85-1.10), p=0.211. Treatment
with CRT and CRT-D, as well as CSS implantation and HT reduced overall
mortality: OR=0.67 (95% CI: 0.57-0.79), p < 0.001 for CRT/CRT-D and
OR=0.46 (95% CI: 0.24-0.86), p = 0.018 for CSS/HT. Conclusion -
Superiority of surgical treatment over traditional MT in terms of overall
mortality was observed in patients with severe CHF. Copyright &#xa9; 2016,
Kotsoeva O.T.

<45>
Accession Number
613365639
Author
Windecker S.; Tijssen J.; Giustino G.; Guimaraes A.H.C.; Mehran R.;
Valgimigli M.; Vranckx P.; Welsh R.C.; Baber U.; van Es G.-A.; Wildgoose
P.; Volkl A.A.; Zazula A.; Thomitzek K.; Hemmrich M.; Dangas G.D.
Institution
(Windecker, Valgimigli) Bern University Hospital, Bern, Switzerland
(Windecker, Tijssen, Valgimigli, Vranckx, van Es) European Cardiovascular
Research Institute (ECRI), Rotterdam, Netherlands
(Tijssen) Academic Medical Center-University of Amsterdam, Amsterdam,
Netherlands
(Giustino, Mehran, Baber, Dangas) The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New
York City, NY, United States
(Guimaraes, van Es) Cardialysis, Clinical Research Organization,
Rotterdam, Netherlands
(Vranckx) Hartcentrum Hasselt, Hasselt, Belgium
(Welsh) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
(Wildgoose, Volkl) Janssen Pharmaceuticals Inc, Raritan, NJ, United States
(Zazula) Bayer, Sao Paulo, Brazil
(Thomitzek, Hemmrich) Bayer Pharma AG, Berlin, Germany
Title
Trial design: Rivaroxaban for the prevention of major cardiovascular
events after transcatheter aortic valve replacement: Rationale and design
of the GALILEO study.
Source
American Heart Journal. 184 (pp 81-87), 2017. Date of Publication: 01 Feb
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Optimal antithrombotic treatment after transcatheter aortic
valve replacement (TAVR) is unknown and determined empirically. The direct
factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related
thrombotic complications and premature valve failure. Design GALILEO is an
international, randomized, open-label, event-driven, phase III trial in
more than 1,520 patients without an indication for oral anticoagulation
who underwent a successful TAVR (ClinicalTrials.gov NCT02556203). Patients
are randomized (1:1 ratio), 1 to 7 days after a successful TAVR, to either
a rivaroxaban-based strategy or an antiplatelet-based strategy. In the
experimental arm, subjects receive rivaroxaban (10 mg once daily [OD])
plus acetylsalicylic acid (ASA, 75-100 mg OD) for 90 days followed by
rivaroxaban alone. In the control arm, subjects receive clopidogrel (75 mg
OD) plus ASA (as above) for 90 days followed by ASA alone. In case
new-onset atrial fibrillation occurs after randomization, full oral
anticoagulation will be implemented with maintenance of the original
treatment assignment. The primary efficacy end point is the composite of
all-cause death, stroke, myocardial infarction, symptomatic valve
thrombosis, pulmonary embolism, deep venous thrombosis, and systemic
embolism. The primary safety end point is the composite of
life-threatening, disabling, and major bleeding, according to the Valve
Academic Research Consortium definitions. Conclusions GALILEO will test
the hypothesis that a rivaroxaban-based antithrombotic strategy reduces
the risk of thromboembolic complications post-TAVR with an acceptable risk
of bleeding compared with the currently recommended antiplatelet
therapy-based strategy in subjects without need of chronic oral
anticoagulation. Copyright &#xa9; 2016 The Authors

<46>
Accession Number
613497694
Author
Liu X.; Zhang K.; Wang W.; Xie G.; Cheng B.; Wang Y.; Hu Y.; Fang X.
Institution
(Liu, Zhang, Wang, Xie, Cheng, Wang, Fang) Departments of Anesthesiology
and Intensive Care Unit, First Affiliated Hospital, School of Medicine,
Zhejiang University, Hangzhou, Zhejiang, China
(Hu) Anesthesiology, Children's Hospital, School of MedicineZhejiang
University, Hangzhou, Zhejiang, China
Title
Dexmedetomidine Versus Propofol Sedation Improves Sublingual
Microcirculation After Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1509-1515),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives To compare the effects of dexmedetomidine and propofol on
sublingual microcirculation in patients after cardiac surgery. Design A
prospective, randomized, single-blind study. Setting University hospital.
Participants Adult patients undergoing elective valve surgery with
cardiopulmonary bypass. Interventions On arrival in the intensive care
unit (ICU), patients were assigned randomly to receive either
dexmedetomidine (0.2-1.5 mug/kg/h) or propofol (5-50 mug/kg/min) with
open-label titration to a target Richmond Agitation-Sedation Scale of 0 to
-3. Measurements and Main Results Sublingual microcirculation was recorded
using sidestream dark-field imaging at ICU admission (baseline [T1]) and 4
hours (T2) and 24 hours after ICU admission (T3). At T2, median changes in
perfused small-vessel density and the De Backer score from baseline were
significantly greater in the dexmedetomidine group (n = 29) than in the
propofol group (n = 32) (1.3 v 0 mm/mm², p = 0.025; 0.9 v
-0.1/mm, p = 0.005, respectively); median changes in small-vessel density
and the proportion of perfused small vessels from baseline also tended to
be higher in the dexmedetomidine group compared with the propofol group
(1.0 v -0.1 mm/mm², p = 0.050; 2.1% v 0.5%, p = 0.062,
respectively). At T3, there still was a trend toward greater improvements
in the small-vessel density, proportion of perfused small-vessels,
perfused small-vessel density, and De Backer score from baseline in the
dexmedetomidine group than in the propofol group. Conclusions This trial
demonstrated that dexmedetomidine sedation may be better able to improve
microcirculation in cardiac surgery patients during the early
postoperative period compared with propofol. Copyright &#xa9; 2016

<47>
Accession Number
613497553
Author
Ushio M.; Egi M.; Wakabayashi J.; Nishimura T.; Miyatake Y.; Obata N.;
Mizobuchi S.
Institution
(Ushio) Department of Anesthesia, Kakogawa West City Hospital, Kakogawa
City, Hyogo, Japan
(Egi, Wakabayashi, Nishimura, Obata, Mizobuchi) Department of
Anesthesiology, Kobe University Hospital, Kobe City, Hyogo, Japan
(Miyatake) Department of Surgery Related, Kobe University Graduate School
of Medicine, Kobe City, Hyogo 650-0017, Japan
Title
Impact of Milrinone Administration in Adult Cardiac Surgery Patients:
Updated Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1454-1460),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objective To determine the effects of milrinone on short-term mortality in
cardiac surgery patients with focus on the presence or absence of
heterogeneity of the effect. Design A systematic review and meta-analysis.
Setting and Participants Five hundred thirty-seven adult cardiac surgery
patients from 12 RCTs. Interventions Milrinone administration.
Measurements and Main Results The authors conducted a systematic Medline
and Pubmed search to assess the effect of milrinone on short-term
mortality in adult cardiac surgery patients. Subanalysis was performed
according to the timing for commencement of milrinone administration and
the type of comparators. The primary outcome was any short-term mortality.
Overall analysis showed no difference in mortality rates in patients who
received milrinone and patients who received comparators (odds ratio =
1.25, 95% CI 0.45-3.51, p = 0.67). In subanalysis for the timing to
commence milrinone administration and the type of comparators, odds ratio
for mortality varied from 0.19 (placebo as control drug, start of
administration after cardiopulmonary bypass) to 2.58 (levosimendan as
control drug, start of administration after cardiopulmonary bypass).
Conclusions Among RCTs to assess the effect of milrinone administration in
adult cardiac surgery patients, there are wide variations of the odds
ratios of administration of milrinone for short-term mortality according
to the comparators and the timing of administration. This fact may suggest
that a simple pooling meta-analysis is not applicable for assessing the
risk and benefit of milrinone administration in an adult cardiac surgery
cohort. Copyright &#xa9; 2016 Elsevier Inc.

<48>
Accession Number
613497551
Author
Freiermuth D.; Mets B.; Bolliger D.; Reuthebuch O.; Doebele T.; Scholz M.;
Gregor M.; Haschke M.; Seeberger M.D.; Fassl J.
Institution
(Freiermuth, Bolliger, Gregor, Seeberger, Fassl) Department of
Anesthesiology and Intensive Care Medicine, University Hospital Basel,
Basel, Switzerland
(Mets) Department of Anesthesiology and Perioperative Medicine, Penn State
Hershey Medical Center, Hershey, PA, United States
(Reuthebuch, Doebele) Division of Cardiac Surgery, Department of Surgery,
University Hospital Basel, Basel, Switzerland
(Scholz) Institute of Medical Informatics, Statistics and Epidemiology,
University Leipzig, Leipzig, Germany
(Haschke) Division of Clinical Pharmacology and Toxicology, University
Hospital Basel, Basel, Switzerland
(Seeberger) Institute of Anesthesia and Intensive Care Medicine, Klinik
Hirslanden Zurich, Zurich, Switzerland
Title
Sevoflurane and Isoflurane-Pharmacokinetics, Hemodynamic Stability, and
Cardioprotective Effects During Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1494-1501),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives This study aimed to evaluate the pharmacokinetic profiles of
sevoflurane and isoflurane during use of minimized extracorporeal
circulation to perform coronary artery bypass graft surgery. Furthermore,
cardiovascular stability during bypass and the postoperative release of
troponins were evaluated. Design Prospective, randomized study. Setting
University hospital. Participants The study comprised 31 adult patients
undergoing coronary artery bypass grafting. Interventions The
pharmacokinetic measurements of the concentration of the volatile
anesthetics in the arterial and venous blood, air inlet, air outlet, and
gas exhaust of the extracorporeal circulation were recorded. Secondary
end-points were cardiovascular stability during bypass, amount of
postoperative release of troponin, time to extubation, time to discharge
from the intensive care unit and the hospital, and 30-day mortality.
Measurements and Main Results Thirty patients completed the protocol. The
pharmacokinetics of isoflurane and sevoflurane were almost identical, with
a rapid wash-in (time to reach 50% of arterial steady state) concentration
of 0.87+/-0.97 minutes and 1.14+/-0.35 minutes for isoflurane and
sevoflurane, respectively, and a biphasic venous elimination with a
terminal half-life of approximately 10 minutes for both compounds. There
was a correlation between the gas inlet and the gas exhaust of the
extracorporeal circulation. No difference in cardiovascular stability was
found. High-sensitivity troponin concentrations on the first postoperative
morning were 0.355+/-0.312 micro&#32;g/mL and 0.225+/-0.111 micro&#32;g/mL
in the isoflurane and sevoflurane groups, respectively (p = 0.147).
Conclusions The study found similar pharmacokinetics regarding wash-in and
wash-out for sevoflurane and isoflurane. In addition, no difference in
cardiovascular stability was found. The markers of cardiac damage were not
different between the two anesthetics. Based on these data, sevoflurane
and isoflurane might be used equivalently in patients undergoing coronary
artery bypass graft surgery with extracorporeal circulation. Copyright
&#xa9; 2016 Elsevier Inc.

<49>
Accession Number
613487568
Author
El Ashkar A.M.; Khallaf A.N.
Institution
(El Ashkar) Cardio-thoracic Surgery Department, Benisuef University,
Benisuef, Egypt
(Khallaf) Cardio-thoracic Surgery Department, Fayoum University, Fayoum,
Egypt
Title
Video-assisted minimally invasive mitral valve surgery: Early experience.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (3) (pp
223-227), 2016. Date of Publication: 01 Oct 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: The post-operative complications of median sternotomy,
especially the post-operative pain and wound complications, has led many
surgeons to adopt less invasive techniques to perform open heart surgery.
Video-assisted mitral valve surgery via mini thoracotomy is now widely
used and is becoming the standard of care in many centers all-over the
world. Aim of the study: Comparing the early post-operative outcome of
video-assisted minimally invasive mitral valve replacement versus the
conventional approach via median sternotomy. Patients and methods: 34
patients undergoing mitral valve replacement (MVR) were randomly selected
for this study and were divided in 2 equal groups. Group (A) included 17
patients who had MVR via median sternotomy while group (B) included 17
patients who had MVR via video-assisted anterior minithoracotomy. Results:
The cross-clamp time was 63.7 +/- 2.34 min in group (A) versus 83.4 +/-
7.21 min in group (B), which was statistically significant. The operative
time was 3.27 +/- 1.22 h in group (A) versus 5.62 +/- 1.67 h in group (B),
which was statistically significant. The duration of mechanical
ventilation and the mean units of blood needed were significantly higher
in group (A) compared to group (B). There was no statistically significant
difference between the 2 groups regarding the postoperative complications
including mortality, bleeding or mediastinitis. Conclusion: Minimally
invasive mitral valve replacement is a safe procedure, with comparable
post-operative outcome to conventional median sternotomy. Copyright &#xa9;
2016, The Egyptian Society of Cardio-thoracic Surgery.

<50>
Accession Number
613487514
Author
Mourad F.A.; Fadala M.A.; Ibrahim A.A.; Ammar A.M.; Elnahas Y.M.; Elghanam
M.A.; Elkilany I.S.
Institution
(Mourad, Fadala, Ibrahim, Ammar, Elnahas, Elghanam, Elkilany) Department
of Cardiothoracic Surgery, Ain Shams University, Cairo, Egypt
Title
Myocardial protection during CABG: Warm blood versus cold crystalloid
cardioplegia, is there any difference?.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (3) (pp
215-222), 2016. Date of Publication: 01 Oct 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Up till now there is lack of consensus to the optimal method
for cardioplegia delivery in coronary artery bypass graft (CABG) patients.
Various strategies have been developed to minimize ischemic-reperfusion
injury. The aim of this study was to compare cold crystalloid cardioplegia
and warm blood cardioplegia in patients undergoing CABG. Methods: Patients
(n = 100) undergoing CABG were prospectively randomized into group 1 (n =
50) which received antegrade cold crystalloid cardioplegia, group 2 (n =
50) which received antegrade warm blood cardioplegia. Blood samples were
collected immediately, 12, and 24 h postoperatively and CK, CKMB, and
Cardiac Troponin I were measured and compared between the two groups which
were the indicator of myocardial cell injury (the primary end point of
this study). Other indicators such as spontaneous defibrillation, use of
intra-aortic balloon counter pulsation (IABC), and use of inotropic
support were also documented. Results: Preoperative demographic and
clinical variables were matched in both groups. However, intraoperatively,
the use of inotropic support was significantly higher in Group I compared
to Group II (P = 0.032). Postoperative CK, CKMB and Troponin I were
significantly higher in group (I) compared to group (II). Conclusion: A
significant reduction in the release of cardiac enzymes in patients who
received antegrade warm blood cardioplegia suggests better myocardial
protection compared to cold crystalloid cardioplegia. Copyright &#xa9;
2016, The Egyptian Society of Cardio-thoracic Surgery.

<51>
Accession Number
613486335
Author
Momeni M.; Gaudin A.
Institution
(Momeni, Gaudin) Department of Anesthesiology, Universite Catholique de
Louvain, Cliniques Universitaires Saint Luc, Avenue Hippocrate 10,
Brussels 1200, Belgium
Title
Intraoperative cerebral hypoperfusion and electroencephalogram suppression
resulting in neurological complications after cardiac surgery: The need
for an in depth investigation.
Source
Acta Anaesthesiologica Belgica. 67 (2) (pp 73-79), 2016. Date of
Publication: 2016.
Publisher
ARSMB-KVBMG (Avenue W. Churchill-laan 11/30, Brussels B-1180, Belgium)
Abstract
Reports on the demographic profile of older populations estimate that, in
2050, 19 countries will have at least 10% of their population aged 80
years or more. Many high risk elderly patients undergo cardiac surgery. In
addition, advanced age has been shown to be a strong predictor of adverse
neurological outcome. Despite significant improvements achieved in the
perioperative care of cardiac surgical patients, neurological
complications remain a global health issue. Recent findings have pointed
out that cerebral hypoperfusion and too deep levels of anesthesia are
major sources of adverse neurological outcomes. Cerebral near-infrared
spectroscopy provides information about cerebral perfusion non-invasively,
and is increasingly used. Depth of anesthesia is evaluated using monitors
that are based on processed electroencephalogram. This non-systematic
review focuses on the results of studies performed with each monitor
separately, and the need for a combined evaluation of their utility and
eventual impact on neurological outcomes. The use of a combined cerebral
monitoring strategy based on the two aforementioned monitors is proposed
in order to optimize cerebral outcomes. Copyright &#xa9; Acta
Anoesthesiologica Belgica, 2016.

<52>
Accession Number
613355207
Author
Roncada G.
Institution
(Roncada) Jessa Hospital, Heart Centre Hasselt, Stadsomvaart 11, Hasselt
3500, Belgium
(Roncada) Commission for Osteopathic Research, Practice and Promotion,
Mechelen, Belgium
Title
Effects of osteopathic treatment on pulmonary function and chronic
thoracic pain after coronary artery bypass graft surgery (OstinCaRe):
Study protocol for a randomised controlled trial.
Source
BMC Complementary and Alternative Medicine. 16 (1) (no pagination), 2016.
Article Number: 482. Date of Publication: 25 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Coronary artery bypass graft surgery (CABG) is an effective
and widespread coronary revascularisation technique, nevertheless there
are a number of long-term postoperative complications from which patients
can suffer. One year after CABG surgery pulmonary function is decreased by
12% and 30% of the patients suffer from chronic thoracic pain. To date and
to our knowledge there are no effective treatments for these conditions.
The aim of the present clinical trial is to explore the effectiveness of
osteopathic treatment on these conditions. Methods: The study is designed
as a randomised controlled trial with two parallel groups. Group A will
receive a standard cardiac rehabilitation programme during 12 weeks and
group B will receive the same standard cardiac rehabilitation programme
supplemented with four osteopathic treatments (OT). OT will be performed
at week 4, 5, 8 and 12 after surgery. Three hundred and eight patients
(Group A: n = 154, Group B: n = 154) will be enrolled from the
cardiothoracic surgery department of the Jessa Hospital Hasselt. Blinding
will be assured for the staff of the cardiac rehabilitation centre and
outcome assessors. Primary outcome measure will be the mean difference in
change from baseline in slow vital capacity (SVC) at 12 weeks after
surgery between groups. Secondary outcome measures will be the change from
baseline in quality of life, pain, thoracic stiffness and maximal aerobic
capacity at 12 weeks after surgery. A follow-up is planned 52 weeks after
surgery for SVC, quality of life, pain and thoracic stiffness. Intention
to treat analysis will be executed. Discussion: The OstinCare study has
been designed to explore the potential long-term added value of
osteopathic treatment in the management of decreased pulmonary function,
chronic thoracic pain and diminished thoracic mobility after CABG surgery.
Trial registration: The protocol has been retrospectively registered on
ClinicalTrials.gov (NCT01714791). Copyright &#xa9; 2016 The Author(s).

<53>
Accession Number
613500210
Author
Yanagawa B.; Nedadur R.; Puskas J.D.
Institution
(Yanagawa, Nedadur) Division of Cardiac Surgery, St. Michael's Hospital,
Toronto, Canada
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Saint Luke's
Hospital, New York, NY, United States
Title
The future of off-pump coronary artery bypass grafting: A North American
perspective.
Source
Journal of Thoracic Disease. 8 (pp S832-S838), 2016. Date of Publication:
2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Off-pump coronary artery bypass graft (OPCAB) is currently performed
routinely in a minority of specialized centers and in many more centers,
utilized only when a porcelain aorta mandates a no-touch aortic technique.
The OPCAB literature can be summarized as follows: (I) large-scale
randomized trials in relatively low risk patients that include surgeons
with a range of experience demonstrating no consistent beneficial
differences in major cardiovascular and cerebrovascular outcomes but lower
transfusion rates and shorter length of stay, tempered by some reports of
higher rates of incomplete revascularization and lower rates of long term
graft patency; (II) smaller randomized controlled trials (RCTs) from
highly specialized programs demonstrating equivalent or superior outcomes
with OPCAB and similar completeness of revascularization and graft
patency; and (III) observational data from large databases demonstrating a
consistent benefit of OPCAB, especially in higher-risk patient subsets.
Our rationale for OPCAB remains that if complete and precise
revascularization can be safely and routinely accomplished, then the
patient should benefit by avoiding the morbidities that can be attributed
to aortic cannulation/clamping, cardiopulmonary bypass (CPB),
hemodilution, hypothermia and global myocardial ischemia/cardioplegia. We
further believe that OPCAB procedures should emphasize the use of arterial
grafts to optimize long term patency and minimize aortic manipulation to
limit the risk of stroke. Moving forward, the off-pump surgical community
and specialty societies must address the challenge of training surgeons
and their teams to master this technically demanding procedure.
Furthermore, OPCAB opens the door to minimally-invasive surgical
revascularization via hybrid coronary revascularization (HCR). A large
NIH-funded RCT is currently underway to determine whether hybrid
revascularization can offer a superior alternative to multi-vessel
percutaneous coronary intervention for patients with low SYNTAX score and
proximal LAD disease. Copyright &#xa9; Journal of Thoracic Disease. All
rights reserved.

<54>
Accession Number
613500209
Author
Taggart D.P.
Institution
(Taggart) Department of Cardiovascular Surgery, University of Oxford,
Oxford, United Kingdom
Title
Off-pump coronary artery bypass grafting (OPCABG)-a 'personal' European
perspective.
Source
Journal of Thoracic Disease. 8 (pp S829-S831), 2016. Date of Publication:
2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Although popularised over two decades ago off-pump coronary artery bypass
grafting (OPCABG) has seen a decrease in utilisation especially over the
last decade. This has been due to publication of a number of trials which
suggested inferior outcomes with OPCABG. However, the validity of the
findings in these trials has been questioned on the basis of doubts over
operator experience as witnessed by large numbers of cross-overs. Two more
recent large randomised trials have shown very similar outcomes between on
and off-pump surgery up to 1- and 5-year outcomes are imminently due.
Furthermore several meta-analyses have reported that OPCABG reduces
mortality, myocardial infarction and major morbidity in higher risk
patients. Consequently there is a clear rationale for OPCABG in certain
cohorts of patients and especially when combined with a no touch aortic
technique in those with significant disease of the ascending aorta. The
article discusses the importance of routine performance of OPCABG if it is
to produce high quality results and especially in higher risk patients.
Copyright &#xa9; Journal of Thoracic Disease. All rights reserved.

<55>
Accession Number
613500206
Author
Chivasso P.; Guida G.A.; Fudulu D.; Bruno V.D.; Marsico R.; Sedmakov H.;
Zakkar M.; Rapetto F.; Bryan A.J.; Angelini G.D.
Institution
(Chivasso, Guida, Fudulu, Bruno, Marsico, Sedmakov, Zakkar, Rapetto,
Bryan, Angelini) Bristol Heart Institute, Bristol University, Upper
Maudlin Street, Bristol BS2 8HW, United Kingdom
Title
Impact of off-pump coronary artery bypass grafting on survival: Current
best available evidence.
Source
Journal of Thoracic Disease. 8 (pp S808-S817), 2016. Date of Publication:
2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
The superiority of either off-pump (OPCAB) or on-pump (ONCAB) coronary
artery bypass grafting (CABG) remains unclear despite a large body of
literature evidence comparing the two approaches. The potential advantages
of avoiding cardiopulmonary bypass (CPB), minimizing aortic manipulation
and maintaining pulsatile flow may be associated with reduced inflammatory
responses and embolic events. Numerous studies compared OPCAB with ONCAB
and the cumulative data have been presented in metaanalyses of both
randomized and observational studies. Although there is an abundance of
data with respect to the operative morbidity and mortality and the
short-term outcomes associated with these two strategies, not much is
known about how they impact long-term survival and recurrence of
myocardial ischaemic events. Recent studies and meta-analyses have focused
on long-term survival and major secondary outcomes in OPCAB vs. ONCAB
within the general population. Significant limitations in methodology,
however, have raised concerns about the strength of several randomized
trials with restrictive inclusion criteria that reduced the populations to
those at low risk only, thus creating result bias. Here, we present a
review of the best available evidence with a focus on long-term outcomes.
Copyright &#xa9; Journal of Thoracic Disease. All rights reserved.

<56>
Accession Number
613500201
Author
Davierwala P.M.
Institution
(Davierwala) Department of Cardiac Surgery, Heart Center, University of
Leipzig, Herzzentrum Leipzig, Struempellstrase 39, Leipzig 04289, Germany
Title
Current outcomes of off-pump coronary artery bypass grafting: Evidence
from real world practice.
Source
Journal of Thoracic Disease. 8 (pp S772-S786), 2016. Date of Publication:
2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Coronary artery bypass grafting (CABG) can be performed conventionally
using cardiopulmonary bypass (CPB) and aortic clamping or on a beating
heart (BH) without the use of CPB, the so-called off-pump CABG. Some
surgeons, who are proponents of off-pump CABG, preferentially use this
technique for the majority of operations, whereas others use it only in
certain situations which warrant avoidance of CPB. Ever since the
conception of off-pump CABG, the never-ending debate about which technique
of CABG is safe and efficacious continues to date. Several randomized
controlled trials (RCTs) have been conducted that have either favored
on-pump CABG or have failed to show a significant difference in outcomes
between the two techniques. However, these RCTs have been fraught with
claims that they do not represent the majority of patients undergoing CABG
in real world practice. Therefore, assessment of the benefits and
drawbacks of each technique through observational and registry studies
would be more representative of patients encountered in daily practice.
The present review examines various retrospective studies and
meta-analyses of observational studies that compare the early and
long-term outcomes of off- and on-pump CABG, which assesses their safety
and efficacy. Additionally, their outcomes in older patients, females, and
those with diabetes mellitus, renal dysfunction, presence of ascending
aortic disease, and/or acute coronary syndrome (ACS) have also been
discussed separately. The general consensus is that early results of
off-pump CABG are comparable to or in some cases better than on-pump CABG.
However, on-pump CABG provides a survival benefit in the long term
according to a majority of publications in literature. Copyright &#xa9;
Journal of Thoracic Disease. All rights reserved.

<57>
Accession Number
613500200
Author
Fudulu D.; Benedetto U.; Pecchinenda G.G.; Chivasso P.; Bruno V.D.;
Rapetto F.; Bryan A.; Angelini G.D.
Institution
(Fudulu, Benedetto, Pecchinenda, Chivasso, Bruno, Rapetto, Bryan,
Angelini) Bristol Heart Institute, University Hospitals Bristol, Bristol,
United Kingdom
Title
Current outcomes of off-pump versus on-pump coronary artery bypass
grafting: Evidence from randomized controlled trials.
Source
Journal of Thoracic Disease. 8 (pp S758-S771), 2016. Date of Publication:
2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Coronary artery bypass grafting remains the standard treatment for
patients with extensive coronary artery disease. Coronary surgery without
use of cardiopulmonary bypass avoids the deleterious systemic inflammatory
effects of the extracorporeal circuit. However there is an ongoing debate
surrounding the clinical outcomes after on-pump versus off-pump coronary
artery bypass (ONCAB versus OPCAB) surgery. The current review is based on
evidence from randomized controlled trials (RCTs) and metaanalyses of
randomized studies. It focuses on operative mortality, mid- and long-term
survival, graft patency, completeness of revascularisation, neurologic and
neurophysiologic outcomes, perioperative complications and outcomes in the
high risk groups. Early and late survival rates for both OPCAB and ONCAB
grafting are similar. Some studies suggest early poorer vein graft patency
with off-pump when compared with onpump, comparable midterm arterial
conduit patency with no difference in long term venous and arterial graft
patency. A recent, pooled analysis of randomised trials shows a reduction
in stroke rates with use offpump techniques. Furthermore, OPCAB grafting
seems to reduce postoperative renal dysfunction, bleeding, transfusion
requirement and respiratory complications while perioperative myocardial
infarction rates are similar to ONCAB grafting. The high risk patient
groups seem to benefit from off-pump coronary surgery. Copyright &#xa9;
Journal of Thoracic Disease. All rights reserved.

<58>
Accession Number
613401192
Author
Morgan C.; Al-Aklabi M.; Garcia Guerra G.
Institution
(Morgan) 4-557 Edmonton Clinic Health Academy, Division of Nephrology,
Department of Pediatrics, 11405 - 87 Avenue, Edmonton, AB T6G 1C9, Canada
(Al-Aklabi) 4A7.C Mazankowski Heart Institute, Division of Cardiac
Surgery, Department of Medicine, 8440 - 112 Street, Edmonton, AB T6G 2B7,
Canada
(Garcia Guerra) 4-548 Edmonton Clinic Health Academy, Division of
Pediatric Critical Care, Department of Pediatrics, 11405 - 87 Avenue,
Edmonton, AB T6G 1C9, Canada
Title
Chronic kidney disease in congenital heart disease patients: A narrative
review of evidence.
Source
Canadian Journal of Kidney Health and Disease. 2 (1) (no pagination),
2015. Article Number: 27. Date of Publication: 11 Aug 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Purpose of review: Patients with congenital heart disease have a number of
risk factors for the development of chronic kidney disease (CKD). It is
well known that CKD has a large negative impact on health outcomes. It is
important therefore to consider that patients with congenital heart
disease represent a population in whom long-term primary and secondary
prevention strategies to reduce CKD occurrence and progression could be
instituted and significantly change outcomes. There are currently no clear
guidelines for clinicians in terms of renal assessment in the long-term
follow up of patients with congenital heart disease. Consolidation of
knowledge is critical for generating such guidelines, and hence is the
purpose of this view. This review will summarize current knowledge related
to CKD in patients with congenital heart disease, to highlight important
work that has been done to date and set the stage for further
investigation, development of prevention strategies, and re-evaluation of
appropriate renal follow-up in patients with congenital heart disease.
Sources of information: The literature search was conducted using PubMed
and Google Scholar. Findings: Current epidemiological evidence suggests
that CKD occurs in patients with congenital heart disease at a higher
frequency than the general population and is detectable early in follow-up
(i.e. during childhood). Best evidence suggests that approximately 30 to
50% of adult patients with congenital heart disease have significantly
impaired renal function. The risk of CKD is higher with cyanotic
congenital heart disease but it is also present with non-cyanotic
congenital heart disease. Although significant knowledge gaps exist, the
sum of the data suggests that patients with congenital heart disease
should be followed from an early age for the development of CKD.
Implications: There is an opportunity to mitigate CKD progression and
negative renal outcomes by instituting interventions such as stringent
blood pressure control and reduction of proteinuria. There is a need to
invest time, thought and money to fill existing knowledge gaps to improve
health outcomes in this population. This review should serve as an impetus
for generation of follow-up guidelines of kidney health evaluation in
patients with congenital heart disease. Copyright &#xa9; 2015 Morgan et
al.

<59>
Accession Number
613254306
Author
Oster M.E.; Kelleman M.; McCracken C.; Ohye R.G.; Mahle W.T.
Institution
(Oster, Mahle) Children's Healthcare of Atlanta, GA, United States
(Oster, Kelleman, McCracken, Mahle) University School of Medicine,
Atlanta, GA, United States
(Ohye) University of Michigan Medical School, Ann Arbor, MI, United States
Title
Association of digoxin with interstage mortality: Results from the
pediatric heart network single ventricle reconstruction trial public use
dataset.
Source
Journal of the American Heart Association. 5 (1) (pp 1-7), 2016. Date of
Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Mortality for infants with single ventricle congenital heart
disease remains as high as 8% to 12% during the interstage period, the
time between discharge after the Norwood procedure and before the stage II
palliation. The objective of our study was to determine the association
between digoxin use and interstage mortality in these infants. Methods and
Results-We conducted a retrospective cohort study using the Pediatric
Heart Network Single Ventricle Reconstruction Trial public use dataset,
which includes data on infants with single right ventricle congenital
heart disease randomized to receive either a Blalock-Taussig shunt or
right ventricle-to-pulmonary artery shunt during the Norwood procedure at
15 institutions in North America from 2005 to 2008. Parametric survival
models were used to compare the risk of interstage mortality between those
discharged to home on digoxin versus those discharged to home not on
digoxin, adjusting for center volume, ascending aorta diameter, shunt
type, and socioeconomic status. Of the 330 infants eligible for this
study, 102 (31%) were discharged home on digoxin. Interstage mortality for
those not on digoxin was 12.3%, compared to 2.9% among those on digoxin,
with an adjusted hazard ratio of 3.5 (95% CI, 1.1-11.7; P=0.04). The
number needed to treat to prevent 1 death was 11 patients. There were no
differences in complications between the 2 groups during the interstage
period. Conclusions-Digoxin use in infants with single ventricle
congenital heart disease is associated with significantly reduced
interstage mortality. (J Am Heart Assoc. 2016;5:e002566 doi:
10.1161/JAHA.115.002566). Copyright &#xa9; 2016 The Authors.

<60>
Accession Number
613254259
Author
Brown D.W.; Mangeot C.; Anderson J.B.; Peterson L.E.; King E.C.; Lihn
S.L.; Neish S.R.; Fleishman C.; Phelps C.; Hanke S.; Beekman R.H.; Lannon
C.M.
Institution
(Brown, Lihn) Department of Cardiology, Boston Children's Hospital,
Boston, MA, United States
(Mangeot, Anderson, King, Hanke, Beekman, Lannon) Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
(Peterson) BostonMAUnited States
(Neish) University of Texas Health Science Center, San Antonio, TX, United
States
(Fleishman) Arnold Palmer Hospital for Children, Orlando, FL, United
States
(Phelps) Nationwide Children's Hospital, Columbus, OH, United States
Title
Digoxin use is associated with reduced interstage mortality in patients
with no history of arrhythmia after stage i palliation for single
ventricle heart disease.
Source
Journal of the American Heart Association. 5 (1) (no pagination), 2016.
Article Number: e002376. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Interstage mortality (IM) remains significant after stage 1
palliation (S1P) for single-ventricle heart disease (SVD), with many
deaths sudden and unexpected. We sought to determine whether digoxin use
post-S1P is associated with reduced IM, utilizing the multicenter database
of the National Pediatric Cardiology Quality Improvement Collaborative
(NPCQIC). Methods and Results-From June 2008 to July 2013, 816 infants
discharged after S1P from 50 surgical sites completed the interstage to
stage II palliation, transplant, or IM. Arrhythmia during S1P
hospitalization or discharge on antiarrhythmic medications were exclusions
(n=270); 2 patients were lost to follow-up. Two analyses were performed:
(1) propensity-score adjusted logistic regression with IM as outcome and
(2) retrospective cohort analysis for patients discharged on digoxin
versus not, matched for surgical site and other established IM risk
factors. Of 544 study patients, 119 (21.9%) were discharged on digoxin.
Logistic regression analysis with propensity score, site-size group, and
digoxin use as predictor variables showed an increased risk of IM in those
not discharged on digoxin (odds ratio, 8.6; lower confidence limit, 1.9;
upper confidence limit, 38.3; P<0.01). The retrospective cohort analysis
for 60 patients on digoxin (matched for site of care, type of S1P,
post-S1P ECMO use, genetic syndrome, discharge feeding route, ventricular
function, tricuspid regurgitation, and aortic arch gradient) showed 0% IM
in the digoxin at discharge group and an estimated IM difference between
the 2 groups of 9% (P=0.04). Conclusions-Among SVD infants in the NPCQIC
database discharged post-S1P with no history of arrhythmia, use of digoxin
at discharge was associated with reduced IM. Copyright &#xa9; 2016 The
Authors.

<61>
Accession Number
613479062
Author
Smelt J.L.C.; Phillips S.; Hamilton C.; Fricker P.; Spray D.; Nowell J.L.;
Jahangiri M.
Institution
(Smelt, Nowell, Jahangiri) Department of Cardiothoracic Surgery, St.
George's Hospital, London, United Kingdom
(Phillips, Hamilton, Fricker) Department of Perfusion, St. George's
Hospital, London, United Kingdom
(Spray) Department of Anesthesia, St. George's Hospital, London, United
Kingdom
Title
Simulator Teaching of Cardiopulmonary Bypass Complications: A Prospective,
Randomized Study.
Source
Journal of Surgical Education. 73 (6) (pp 1026-1031), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective Complications of cardiopulmonary bypass (CPB) are rare, but
life-threatening events that need prompt and rehearsed actions involving a
team. This is not adequately taught to cardiothoracic surgical trainees.
The objective of this study was to assess the knowledge of cardiothoracic
trainees required to manage these events after simulation-based vs.
lecture-based teaching. Participants and Design Totally, 17 cardiac
surgical trainees with no formal teaching in intraoperative complications
of CPB management were randomly assigned by computer to either a study
group receiving simulation-based complications of CPB teaching via the
Orpheus simulator (n = 9) or a control group receiving complications of
CPB teaching via a lecture (n = 8). Each subject undertook a written test
comprising 20 multiple choice questions on complications of CPB before and
after teaching. Trainees were then asked to rate their satisfaction with
each session from 1 to 5, with 5 being most satisfied. Setting St George
Simulation and Clinical Skills Laboratory, St George's Hospital, London.
Results There was no significant difference in the pretest scores between
the 2 groups (p = 0.29). After teaching, both groups showed a
statistically significant improvement in their knowledge (p < 0.05). The
trainees in the simulation group performed better than the lecture-based
group; however, this was not statistically significant (p = 0.21).
Satisfaction levels in both the lecture session and the simulation session
were very high with means of 4.4/5 and 4.8/5, respectively. Conclusion
Despite the familiarity with CPB during surgery, the simulation group
performed at least as well as the lecture group. Cardiothoracic trainees
would benefit from formal teaching of complications of CPB management via
either learning modality being incorporated into their training. Copyright
&#xa9; 2016 Association of Program Directors in Surgery

<62>
Accession Number
613401068
Author
Pipanmekaporn T.; Chittawatanarat K.; Chaiwat O.; Thawitsri T.;
Wacharasint P.; Kongsayreepong S.; Morakul S.; Fuengfoo P.;
Chatmongkolchar S.; Akaraborworn O.; Pathonsamit C.; Poopipatpab S.;
Chanthawong S.; Chau-In W.; Kusumaphanyo C.; Buppha P.
Institution
(Pipanmekaporn) Chiang Mai University, Department of Anesthesiology,
Faculty of Medicine, 110, Intavarorote Rd, Chiang Mai, Muang District
50200, Thailand
(Chittawatanarat) Chiang Mai University, Department of Surgery, Faculty of
Medicine, Chiang Mai 50200, Thailand
(Chaiwat, Kongsayreepong) Mahidol University, Department of
Anesthesiology, Faculty of Medicine, Siriraj Hospital, Bangkok 10700,
Thailand
(Thawitsri) King Chulalongkorn Memorial Hospital, Department of
Anesthesiology, Faculty of Medicine, Bangkok 10330, Thailand
(Wacharasint) Phramongkutklao Hospital, Department of Anesthesiology,
Bangkok 10400, Thailand
(Morakul) Department of Anesthesiology, Faculty of Medicine, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Fuengfoo) Department of Surgery, Phramongkutklao Hospital, Bangkok,
Thailand
(Chatmongkolchar) Department of Anesthesiology, Faculty of Medicine,
Prince of Songkhla University, Songkhla, Thailand
(Akaraborworn) Department of Surgery, Faculty of Medicine, Prince of
Songkhla University, Songkhla, Thailand
(Pathonsamit, Poopipatpab) Department of Anesthesiology, University of
Bangkok, Metropolis and Vajira Hospital, Bangkok, Thailand
(Chanthawong, Chau-In) Department of Anesthesiology, Faculty of Medicine,
Khon Kaen University, Khon Kaen, Thailand
(Kusumaphanyo, Buppha) Department of Anesthesiology, Faculty of Medicine,
Srinakharinwirot University, Nakorn Nayok, Thailand
Title
Incidence and risk factors of delirium in multi-center Thai surgical
intensive care units: A prospective cohort study.
Source
Journal of Intensive Care. 3 (1) (no pagination), 2015. Article Number:
53. Date of Publication: 02 Dec 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Delirium in intensive care units increases morbidity and
mortality risk. The incidence and risk factors of delirium among studies.
This study therefore aimed to determine the incidence and risk factors of
delirium in Thai university-based surgical intensive care units. Methods:
A multi-center, prospective cohort study was conducted. All patients who
had been admitted to surgical intensive care units (SICU) between April
2011 and January 2012 were enrolled. Delirium was diagnosed using the
Intensive Care Delirium Screening Checklists (ICDSC). The univariable and
multivariable risk regression analyses were analyzed and presented as risk
ratio (RR) and 95 % confidence interval (CI). Results: The overall
incidence of delirium was 3.6 % (162 of 4450, 95 % CI 3.09-4.19 %) whilst
the incidences of delirium for patients being admitted <48 and >48 h were
0.7 % (21 of 2967, 95 % CI 0.41-1.01 %) and 8.3 % (141 of 1685, 95 % CI
7.04-9.68 %), respectively. The incidence of delirium on each study site
was significantly different (range between 0 and 13.9 %, P < 0.001).
Delirious patients had a significantly higher age (65.3 +/- 15.6 versus
61.8 +/- 17.3 years, P = 0.013), higher Acute Physiology and Chronic
Health Evaluation II score (APACHE II score) (16 (12-23) versus 10 (7-15),
P < 0.001), and higher sequential organ failure assessment score (5 (2-8)
versus 2 (1-5), P < 0.001). The median duration of delirium was 3 (1-5)
days. Delirious patients had significantly longer duration of ICU stay (8
(5-19) versus 2 (1-4), P < 0.001) and higher ICU mortality rate (23.5
versus 8.1 %, P < 0.001). Sepsis (RR = 3.70, 95 % CI 2.33-5.90, P <
0.001), exposure to sedative medications (RR = 3.54, 95 % CI 2.13-5.87, P
< 0.001), higher APACHE II score (RR = 2.79, 95 % CI 1.98-3.95, P <
0.001), thoracic surgery (RR = 1.74, 95 % CI 1.09-2.78, P = 0.021), and
emergency surgery (RR = 1.70, 95 % CI 1.09-2.65, P = 0.019) were
independent risk factors of delirium in SICU. Conclusions: Sepsis,
exposure to sedative medications, higher APACHE II score, thoracic
surgery, and emergency surgery were independent risk factors of delirium
in Thai university-based surgical intensive care units. Copyright &#xa9;
2015 Pipanmekaporn et al.

<63>
Accession Number
613439296
Author
Mansukhani N.A.; Yoon D.Y.; Teter K.A.; Stubbs V.C.; Helenowski I.B.;
Woodruff T.K.; Kibbe M.R.
Institution
(Mansukhani, Yoon, Teter, Stubbs, Helenowski, Kibbe) Department of
Surgery, Northwestern University, Chicago, IL, United States
(Woodruff) Department of Obstetrics and Gynecology, Northwestern
University, Chicago, IL, United States
(Woodruff, Kibbe) Women's Health Research Institute, Northwestern
University, Chicago, IL, United States
(Kibbe) JAMA Surgery, United States
(Kibbe) Department of Surgery, University of North Carolina at Chapel
Hill, 4041 Burnett Womack, 101 Manning Dr, Campus Box 7050, Chapel Hill,
NC 27599, United States
Title
Determining if sex bias exists in human surgical clinical research.
Source
JAMA Surgery. 151 (11) (pp 1022-1030), 2016. Date of Publication: 01 Nov
2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Sex is a variable that is poorly controlled for in clinical
research. OBJECTIVES To determine if sex bias exists in human surgical
clinical research, to determine if data are reported and analyzed using
sex as an independent variable, and to identify specialties in which the
greatest and least sex biases exist. Design, Setting, and Participants:
For this bibliometric analysis, datawere abstracted from 1303 original
peer-reviewed articles published from January 1, 2011, through December
31, 2012, in 5 surgery journals. Main Outcomes and Measures: Study type,
location, number and sex of participants, degree of sex matching of
included participants, and inclusion of sex-based reporting, statistical
analysis, and discussion of data. Results: Of 2347 articles reviewed, 1668
(71.1%) included human participants. After excluding 365 articles, 1303
remained: 17 (1.3%) included males only, 41 (3.1%) included females only,
1020 (78.3%) included males and females, and 225 (17.3%) did not document
the sex of the participants. Although female participants represent more
than 50% (n = 57 688 606) of the total number (115 377 213) included,
considerable variability existed with the number of male (46 111 818),
female (58 805 665), and unspecified (10 459 730) participants included
among the journals, between US domestic and international studies, and
between single vs multicenter studies. For articles included in the study,
38.1% (497 of 1303) reported these data by sex, 33.2%(432 of 1303)
analyzed these data by sex, and 22.9% (299 of 1303) included a discussion
of sex-based results. Sex matching of the included participants in the
research overall was poor, with 45.2%(589 of 1303) of the studies matching
the inclusion of both sexes by 50%. During analysis of the different
surgical specialties, a wide variation in sex-based inclusion, matching,
and data reporting existed, with colorectal surgery having the best
matching of male and female participants and cardiac surgery having the
worst. Conclusions and Relevance: Sex bias exists in human surgical
clinical research. Few studies included men and women equally, less than
one-third performed data analysis by sex, and there was wide variation in
inclusion and matching of the sexes among the specialties and the journals
reviewed. Because clinical research is the foundation for evidence-based
medicine, it is imperative that this disparity be addressed so that
therapies benefit both sexes. Copyright &#xa9; 2016 American Medical
Association. All rights reserved.

<64>
Accession Number
613441012
Author
Franzone A.; Piccolo R.; Siontis G.C.M.; Lanz J.; Stortecky S.; Praz F.;
Roost E.; Vollenbroich R.; Windecker S.; Pilgrim T.
Institution
(Franzone, Piccolo, Siontis, Lanz, Stortecky, Praz, Vollenbroich,
Windecker, Pilgrim) Department of Cardiology, Swiss Cardiovascular Center,
University Hospital, Bern, Switzerland
(Roost) Department of Cardiovascular Surgery, University Hospital, Bern,
Switzerland
Title
Transcatheter Aortic Valve Replacement for the Treatment of Pure Native
Aortic Valve Regurgitation: A Systematic Review.
Source
JACC: Cardiovascular Interventions. 9 (22) (pp 2308-2317), 2016. Date of
Publication: 28 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to summarize available evidence on
transcatheter aortic valve replacement (TAVR) for the treatment of native
pure aortic regurgitation (AR). Background Surgical aortic valve
replacement (SAVR) is the gold standard for the treatment of AR. However,
case series of high-risk patients undergoing TAVR for native pure AR were
reported. Methods We systematically searched Medline, Embase, and Scopus
for reports of at least 5 patients with native pure AR undergoing TAVR.
Patients' and procedural characteristics were summarized. The primary
outcome of interest was all-cause mortality. Pooled estimates were
calculated using a random-effects meta-analysis. The study protocol was
registered in PROSPERO (CRD42016038422). Results Thirteen reports
including 237 patients were included in the analysis. Self-expandable
prostheses were used in 79% of patients, whereas 21% of the patients were
treated with a balloon-expandable valve. Device success ranged between 74%
and 100%. Seventeen patients (7%) required the implantation of a second
valve. Conversion to SAVR was reported in 6 (2.5%) cases. The rate of
all-cause mortality at 30 days amounted to 7% (95% confidence interval
[CI]: 3% to 13%; I² = 37%). Cerebrovascular events were rare
(0%, 95% CI: 0% to 1%; I² = 0); major bleeding and vascular
complications occurred in 2% (95% CI: 0% to 7%; I² = 41%), and
3% (95% CI: 1% to 7%; I² = 0%), respectively. Permanent
pacemaker implantation was required in 11% of patients (95% CI: 5% to 19%;
I² = 50%). The rate of moderate or severe post-procedural AR
amounted to 9% (95% CI: 0% to 28%; I² = 90%). Conclusions Among
selected patients with native pure AR deemed at high risk for SAVR, TAVR
is technically feasible and associated with an acceptable risk of early
mortality. Copyright &#xa9; 2016 American College of Cardiology Foundation

<65>
Accession Number
613440971
Author
Capodanno D.; Gargiulo G.; Buccheri S.; Chieffo A.; Meliga E.; Latib A.;
Park S.-J.; Onuma Y.; Capranzano P.; Valgimigli M.; Narbute I.; Makkar
R.R.; Palacios I.F.; Kim Y.-H.; Buszman P.E.; Chakravarty T.; Sheiban I.;
Mehran R.; Naber C.; Margey R.; Agnihotri A.; Marra S.; Leon M.B.; Moses
J.W.; Fajadet J.; Lefevre T.; Morice M.-C.; Erglis A.; Alfieri O.; Serruys
P.W.; Colombo A.; Tamburino C.
Institution
(Capodanno, Gargiulo, Buccheri, Capranzano, Tamburino)
Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(Chieffo, Latib, Alfieri, Colombo) Department of Cardio-Thoracic and
Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy
(Meliga) Interventional Cardiology Unit, A. O. Ordine Mauriziano Umberto
I, Turin, Italy
(Park, Kim) Department of Cardiology, Center for Medical Research and
Information, University of Ulsan College of Medicine, Asan Medical Center,
Seoul, South Korea
(Onuma, Serruys) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Valgimigli) Bern University Hospital, Bern, Switzerland
(Narbute, Erglis) Latvian Centre of Cardiology, Pauls Stradins Clinical
University Hospital, Institute of Cardiology, University of Latvia, Riga,
Latvia
(Makkar, Chakravarty, Margey) Cedars-Sinai Heart Institute, Cedars-Sinai
Medical Center, Los Angeles, California, United States
(Palacios, Agnihotri) Cardiac Catheterization Laboratory, Massachusetts
General Hospital and Harvard Medical School, Boston, Massachusetts, United
States
(Buszman) Center for Cardiovascular Research and Development of American
Heart of Poland, Katowice, Poland
(Sheiban, Marra) Interventional Cardiology, Division of Cardiology,
University of Turin, S. Giovanni Battista Molinette Hospital, Turin, Italy
(Mehran) Mount-Sinai Medical Center, New York, New York, United States
(Naber) Klinik fur Kardiologie und Angiologie, Elisabeth-Krankenhaus,
Essen, Germany
(Leon, Moses) Columbia University Medical Center and Cardiovascular
Research Foundation, New York, New York, United States
(Fajadet) Clinique Pasteur, Toulouse, France
(Lefevre, Morice) Hopital prive Jacques Cartier, Ramsay Generale de Sante,
Massy, France
Title
Computing Methods for Composite Clinical Endpoints in Unprotected Left
Main Coronary Artery Revascularization: A Post Hoc Analysis of the DELTA
Registry.
Source
JACC: Cardiovascular Interventions. 9 (22) (pp 2280-2288), 2016. Date of
Publication: 28 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to investigate the impact of different
computing methods for composite endpoints other than time-to-event (TTE)
statistics in a large, multicenter registry of unprotected left main
coronary artery (ULMCA) disease. Background TTE statistics for composite
outcome measures used in ULMCA studies consider only the first event, and
all the contributory outcomes are handled as if of equal importance.
Methods The TTE, Andersen-Gill, win ratio (WR), competing risk, and
weighted composite endpoint (WCE) computing methods were applied to ULMCA
patients revascularized by percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG) at 14 international centers.
Results At a median follow-up of 1,295 days (interquartile range: 928 to
1,713 days), all analyses showed no difference in combinations of death,
myocardial infarction, and cerebrovascular accident between PCI and CABG.
When target vessel revascularization was incorporated in the composite
endpoint, the TTE (p = 0.03), Andersen-Gill (p = 0.04), WR (p = 0.025),
and competing risk (p < 0.001) computing methods showed CABG to be
significantly superior to PCI in the analysis of 1,204 propensity-matched
patients, whereas incorporating the clinical relevance of the component
endpoints using WCE resulted in marked attenuation of the treatment effect
of CABG, with loss of significance for the difference between
revascularization strategies (p = 0.10). Conclusions In a large study of
ULMCA revascularization, incorporating the clinical relevance of the
individual outcomes resulted in sensibly different findings as compared
with the conventional TTE approach. In particular, using the WCE computing
method, PCI and CABG were no longer significantly different with respect
to the composite of death, myocardial infarction, cerebrovascular
accident, or target vessel revascularization at a median of 3 years.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<66>
Accession Number
613449381
Author
Thongprayoon C.; Cheungpasitporn W.; Podboy A.J.; Gillaspie E.A.; Greason
K.L.; Kashani K.B.
Institution
(Thongprayoon, Cheungpasitporn, Kashani) Division of Nephrology and
Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN,
United States
(Podboy) Department of Hospital Internal Medicine, Department of Internal
Medicine, Mayo Clinic, Rochester, MN, United States
(Gillaspie, Greason) Division of Cardiovascular Surgery, Department of
Surgery, Mayo Clinic, Rochester, MN, United States
(Kashani) Division of Pulmonary and Critical Care Medicine, Department of
Internal Medicine, Mayo Clinic, Rochester, MN, United States
Title
The effects of contrast media volume on acute kidney injury after
transcatheter aortic valve replacement: a systematic review and
meta-analysis.
Source
Journal of Evidence-Based Medicine. 9 (4) (pp 188-193), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Blackwell Publishing (E-mail: info@asia.blackpublishing.com.au)
Abstract
Objective: The goal of this systematic review was to assess the effects of
contrast media volume on transcatheter aortic valve replacement-related
acute kidney injury. Methods: A literature search was performed using
Medline, EMbase, the Cochrane Database of Systematic Reviews, and
clinicaltrials.gov from the inception of these databases through December
2015. Studies that reported relative risk, odds ratio, or hazard ratio
comparing the risks of acute kidney injury following transcatheter aortic
valve replacement in patients who received high contrast media volume were
included. Pooled risk ratio (RR) and 95% confidence intervals (95% CI)
were calculated using a random-effect, generic inverse variance method.
Results: Four cohort studies composed of 891 patients were included in the
analyses to assess the risk of acute kidney injury after transcatheter
aortic valve replacement in patients who received high contrast media
volume. The pooled RR of acute kidney injury after transcatheter aortic
valve replacement in patients who received a large volume of contrast
media was 1.41 (95% CI, 0.87 to 2.28) compared with low contrast media
volume. The meta-analysis was limited to studies using standard acute
kidney injury definitions, and the pooled RR of acute kidney injury in
patients who received high contrast media volume is 1.12 (95% CI, 0.78 to
1.62). Conclusion: Our meta-analysis shows no significant association
between contrast media volume and risk of acute kidney injury after
transcatheter aortic valve replacement. Copyright &#xa9; 2016 Chinese
Cochrane Center, West China Hospital of Sichuan University and John Wiley
& Sons Australia, Ltd

<67>
Accession Number
613241007
Author
Zhang W.; Wei Y.; Jiang H.; Xu J.; Yu D.
Institution
(Zhang, Wei, Jiang, Xu, Yu) The second affiliated hospital of Nanchang
University, Department of Cardiothoracic surgery, 1 Minde Rd, Nanchang,
Jiangxi Province 330006, China
Title
Thoracotomy is better than thoracoscopic lobectomy in the lymph node
dissection of lung cancer: A systematic review and meta-analysis.
Source
World Journal of Surgical Oncology. 14 (1) (no pagination), 2016. Article
Number: 290. Date of Publication: 17 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of this study was to investigate which surgical method
is better in lymph node (LN) dissection of lung cancer. Methods: A
comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Web of Science,
ScienceDirect, the Cochrane Library, Scopus, and Google Scholar was
performed to identify studies comparing thoracoscopic lobectomy
(video-assisted thoracic surgery (VATS) group) and thoracotomy (open
group) in LN dissection. Results: Twenty-nine articles met the inclusion
criteria and involved 2763 patients in the VATS group and 3484 patients in
the open group. The meta-analysis showed that fewer total LNs (95%
confidence interval [CI] -1.52 to -0.73, p<0.0001) and N2 LNs (95% CI
-1.25 to -0.10, p=0.02) were dissected in the VATS group. A similar number
of total LN stations, N2 LN stations, and N1 LNs were harvested in both
groups. Only one study reported that fewer N1 LN stations were dissected
in the VATS group (1.4+/-0.5 vs. 1.6+/-0.6, p=0.04). Conclusions: Open
lobectomy could achieve better LN dissection efficacy than thoracoscopic
lobectomy in the treatment of lung cancer, especially in the N2 LNs
dissection. These findings require validation by high-quality, large-scale
randomized controlled trials. Copyright &#xa9; 2016 The Author(s).

<68>
Accession Number
613488447
Author
Keawnantawat P.; Thanasilp S.; Preechawong S.
Institution
(Keawnantawat, Thanasilp, Preechawong) Chulalongkorn University Faculty of
Nursing Bangkok Thailand
Title
Translation and Validation of the Thai Version of a Modified Brief Pain
Inventory: A Concise Instrument for Pain Assessment in Postoperative
Cardiac Surgery.
Source
Pain Practice. (no pagination), 2016. Date of Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Acute pain after cardiac surgery can be assessed using
validated instruments such as the modified interference subscale of the
Brief Pain Inventory (mod-BPI). Despite the available knowledge, the Thai
version of a mod-BPI has not yet been presented. Objectives: To translate
a mod-BPI into the Thai language (BPI-T) and to validate it in acute pain
after cardiac surgery. Methods: This multisetting, cross-sectional study
was done from 4 cardiac centers. With a convenience sampling technique,
132 cardiac surgery patients were enrolled during the first 72
postoperative hours. A BPI-T composed of 4 items on the intensity subscale
and 6 items on the interference subscale was translated following
Brislin's model. Convergent validity against the numeric rating scale
(NRS), confirmatory factor analysis (CFA), and internal consistency
reliability were examined. Results: Of the total sample, 70% experienced
moderate to severe pain (cutoff points of worst pain > 4/10), and 65% had
moderate to severe interference with deep breathing and coughing, 53% with
general activity, and 49% with walking. The CFA confirmed the 2-factor
structure of intensity and interference subscales consistent with the
original version (root-mean-square error of approximation = 0.08,
comparative fit index = 0.95, chi² = 39.00, df = 27,
chi²/df = 1.44, P = 0.06). The physical and mental
subdimensions under the interference subscale were determined
(standardized factor loading = 0.70 and 0.42, respectively). The BPI-T
also has good internal consistency (Cronbach's alpha coefficients 0.76 and
0.85). Pearson's correlation coefficients at 0.35 to 0.70 supported the
convergent validity to the NRS. Conclusions: The BPI-T is a concise
instrument for pain assessment in postoperative cardiac surgery. Copyright
&#xa9; 2016 World Institute of Pain.

<69>
Accession Number
613487706
Author
Kavrut Ozturk N.; Kavakli A.S.
Institution
(Kavrut Ozturk, Kavakli) Department of Anesthesiology and Reanimation,
Antalya Education and Research Hospital, Antalya, Turkey
Title
Use of McGrath MAC Videolaryngoscope to Assist Transesophageal
Echocardiography Probe Insertion in Intubated Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objectives: Transesophageal echocardiography (TEE) probe insertion with
the conventional blind insertion technique may be difficult in
anesthetized and intubated patients. The use of a videolaryngoscope may
facilitate the insertion of the TEE probe. The aim of this study was to
compare the conventional technique with the use of the McGrath MAC
videolaryngoscope for TEE probe insertion in terms of success rate,
duration of insertion, and complications in patients undergoing
cardiovascular surgery. Design: A prospective, randomized study. Setting:
Training and research hospital. Participants: Eighty-six adult patients
undergoing cardiovascular surgery were included. Interventions: Eighty-six
adult patients were randomized into 2 groups: conventional group (n = 43)
and McGrath videolaryngoscope group (n = 43). Success rates, duration of
insertion, complications, and hemodynamic changes during insertion were
recorded. Measurements and Main Results: The success rate of TEE probe
insertion at the first attempt was higher in the McGrath videolaryngoscope
group (90.5%) than in the conventional group (43.9%) (p = 0.012). The mean
duration for successful insertion of the TEE probe at the first attempt
was longer in the McGrath videolaryngoscope group (24 s . v 11 s) (p =
0.016). The total time for successful insertion of the TEE probe was
similar in both groups. Pharyngeal injuries were observed more frequently
in the conventional group (17.1% . v 2.4%) (p = 0.037). The rate of blood
presence on the probe tip in the conventional group was higher than in the
McGrath group (21.9% . v 4.8%). There were no statistical differences
between the 2 groups in systolic blood pressure, mean arterial pressure,
diastolic blood pressure, and heart rate before and after TEE insertion.
Conclusions: The use of the McGrath MAC videolaryngoscope for TEE
insertion in cardiovascular surgery patients increases the success rate
and reduces pharyngeal injuries compared to the conventional technique.
The use of the McGrath MAC videolaryngoscope for TEE insertion causes
similar hemodynamic changes as in the conventional blind insertion
technique. Copyright &#xa9; 2016 Elsevier Inc.

<70>
Accession Number
613483673
Author
Douzjian D.J.; Kulik A.
Institution
(Douzjian, Kulik) Lynn Heart and Vascular Institute, Boca Raton Regional
Hospital, and Charles E. Schmidt College of Medicine, Florida Atlantic
University, Boca Raton, FL
Title
Old Drug, New Route: A Systematic Review of Intravenous Acetaminophen
After Adult Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders

<71>
Accession Number
613473672
Author
Sukul D.; Seth M.; Dixon S.R.; Zainea M.; Slocum N.K.; Pielsticker E.J.;
Gurm H.S.
Institution
(Sukul, Seth, Gurm) Division of Cardiovascular Medicine, Department of
MedicineUniversity of MichiganAnn Arbor, Michigan
(Dixon) Division of Cardiology, Department of MedicineBeaumont
HospitalRoyal Oak, Michigan
(Zainea) McLaren Macomb HospitalRoseville, Michigan
(Slocum) Traverse Heart and VascularTraverse City, Michigan
(Pielsticker) Michigan HeartSt Joseph Mercy Health SystemJackson, Michigan
(Gurm) Veterans Affairs Medical CenterAnn Arbor, Michigan
Title
Clinical outcomes of percutaneous coronary intervention in patients turned
down for surgical revascularization.
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: We examined clinical outcomes following percutaneous coronary
intervention (PCI) in patients turned down for surgical revascularization
across a broad population. Background: Prior studies suggest that surgical
ineligibility is associated with increased mortality in patients with
unprotected left main or multivessel coronary artery disease undergoing
PCI. Methods: This study included consecutive patients who underwent PCI
in a multicenter registry in Michigan from January 2010 to December 2014.
Surgical ineligibility required documentation indicating that a cardiac
surgeon deemed the patient ineligible for surgery. In-hospital outcomes
included mortality (primary outcome), cardiogenic shock, cerebrovascular
accident, contrast-induced nephropathy (CIN), and a new requirement for
dialysis (NRD). Results: Of 99,370 patients at 33 hospitals with on-site
surgical backup, 1,922 (1.9%) were surgically ineligible. The rate of
ineligibility did not vary by hospital (range: 1.5-2.5%; P=0.79). Overall,
there were no major differences in baseline characteristics or outcomes
between surgically ineligible patients and the rest (i.e., nonineligible
patients): mortality (0.52% vs. 0.52%; P>0.5), cardiogenic shock (0.68%
vs. 0.73%; P>0.5), cerebrovascular accident (0.05% vs. 0.19%; P=0.28), NRD
(0.16% vs. 0.19%; P>0.5), CIN (2.7% vs. 2.3%; P=0.27). Among 1,074
patients who underwent unprotected left main PCI, 20 (1.9%) were
surgically ineligible and experienced increased rates of mortality (20.0%
vs. 5.3%; P=0.022; adjusted OR=7.38; P<0.001) and other complications as
compared to the remainder. Conclusions: PCI in a broad population of
surgically ineligible patients is generally safe. However, among patients
who underwent unprotected left main PCI, those deemed surgically
ineligible experienced significantly worse outcomes as compared to the
rest. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<72>
Accession Number
613459465
Author
Cholette J.M.; Swartz M.F.; Rubenstein J.; Henrichs K.F.; Wang H.; Powers
K.S.; Daugherty L.E.; Alfieris G.M.; Gensini F.; Blumberg N.
Institution
(Cholette, Rubenstein, Powers, Daugherty) Department of Pediatrics,
University of Rochester, Rochester, New York
(Swartz, Alfieris, Gensini) Department of Surgery, University of
Rochester, Rochester, New York
(Henrichs, Blumberg) Department of Pathology and Laboratory Medicine,
University of Rochester, Rochester, New York
(Wang) Department of Biostatistics, University of Rochester, Rochester,
New York
Title
Outcomes Using a Conservative Versus Liberal Red Blood Cell Transfusion
Strategy in Infants Requiring Cardiac Operation.
Source
Annals of Thoracic Surgery. (no pagination), 2016. Date of Publication:
2016.
Publisher
Elsevier USA
Abstract
Background: The optimal hemoglobin for infants after cardiac operation is
unknown. Red blood cells (RBCs) are commonly transfused to maintain high
hemoglobin concentrations in the absence of a clinical indication. We
hypothesized that infants can be managed with a postoperative conservative
RBC transfusion strategy, resulting in lower daily hemoglobin
concentrations, without evidence of impaired oxygen delivery (ie, lactate,
arteriovenous oxygen difference [avO<inf>2</inf>diff]), or adverse
clinical outcomes. Methods: Infants weighing 10 kg or less undergoing
biventricular repair or palliative (nonseptated) operation were randomly
assigned to either a postoperative conservative or liberal transfusion
strategy. Conservative group strategy was RBC transfusion for a hemoglobin
less than 7.0 g/dL for biventricular repairs or less than 9.0 g/dL for
palliative procedures plus a clinical indication. Liberal group strategy
was RBC transfusion for hemoglobin less than 9.5 g/dL for biventricular
repairs or less than 12 g/dL for palliative procedures regardless of
clinical indication. Results: After the operation of 162 infants (82
conservative [53 biventricular, 29 palliative], 80 liberal [52
biventricular, 28 palliative]), including 12 Norwood procedures (6
conservative, 6 liberal), daily hemoglobin concentrations were
significantly lower within the conservative group than the liberal group
by postoperative day 1 and remained lower for more than 10 days. The
percentage of patients requiring a RBC transfusion, number of
transfusions, and volume of transfusions were all significantly lower
within the conservative group. Despite lower hemoglobin concentrations
within the conservative group, lactate, avO<inf>2</inf>diff, and clinical
outcomes were similar. Conclusions: Infants undergoing cardiac operation
can be managed with a conservative RBC transfusion strategy. Clinical
indications should help guide the decision for RBC transfusion even in
this uniquely vulnerable population. Larger multicenter trials are needed
to confirm these results, and focus on the highest risk patients would be
of great interest. Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<73>
Accession Number
613456820
Author
Landes U.; Barsheshet A.; Finkelstein A.; Guetta V.; Assali A.; Halkin A.;
Vaknin-Assa H.; Segev A.; Bental T.; Ben-Shoshan J.; Barbash I.M.;
Kornowski R.
Institution
(Landes, Barsheshet, Assali, Vaknin-Assa, Bental, Kornowski) Department of
Cardiology, Beilinson Hospital Rabin Medical Center Petah Tikva Israel
(Finkelstein, Halkin, Ben-Shoshan) Department of Cardiology Tel Aviv
Medical Center Israel
(Guetta, Segev, Barbash) Leviev Heart Center, Sheba Medical Center Ramat
Gan Israel
(Guetta, Segev, Barbash) Sackler Faculty of Medicine, Tel Aviv University
Israel
Title
Temporal trends in transcatheter aortic valve implantation, 2008-2014:
Patient characteristics, procedural issues, and clinical outcome.
Source
Clinical Cardiology. (no pagination), 2016. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: About a decade past the first transcatheter aortic valve
implantation (TAVI), data are limited regarding temporal trends
accompanying its evolution from novel technology to mainstream therapy. We
evaluated these trends in a large multicenter TAVI registry. Hypothesis:
TAVI is changing and improving with time. Methods: Patients who underwent
TAVI between January 2008 and December 2014 at 3 high-volume Israeli
centers were divided into 5 time quintiles according to procedure date.
Outcomes were analyzed and reported according to Valve Academic Research
Consortium-2. Results: A total of 1285 patients were studied (43% male;
mean age, 83+/-3 years; mean Society of Thoracic Surgeons [STS] score,
5.5+/-3.6). Over time, there was a shift toward treating patients at lower
STS score, increased use of conscious sedation and transfemoral approach,
and decreased use of balloon predilatation. The balloon-expandable to
self-expandable valve utilization ratio decreased, the valve-in-valve
experience increased from 4% to 17% of all TAVI volume, and length of
hospital stay was halved (P = 0.006). Kaplan-Meier survival curves showed
gradual decrease in mortality risk (P = 0.031), but there was no
significant 1-year mortality decrease by multivariable analysis. Each year
increment was associated with an adjusted 20%, 15%, and 12% decrease in
new pacemaker obligation (P = 0.004), new pacemaker obligation or left
bundle branch block (P = 0.008), and in-hospital infections (P = 0.082),
respectively. Conclusions: Temporal trends accompanying TAVI evolution
include its utilization in lower-risk patients, procedural simplification,
improved overall survival, decreased pacemaker obligation, and shorter
hospital stay. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<74>
Accession Number
613437635
Author
Pilarczyk K.; Haake N.; Heckmann J.; Carstens H.; Haneya A.; Cremer J.;
Jakob H.; Pizanis N.; Kamler M.
Institution
(Pilarczyk, Haake) Department of Intensive Care Medicine imland Klinik
Rendsburg Rendsburg Germany
(Pilarczyk, Heckmann, Carstens, Jakob, Pizanis, Kamler) Department of
Thoracic and Cardiovascular Surgery West German Heart and Vascular Center
Essen University Hospital Essen Essen Germany
(Haneya, Cremer) Department of Cardiovascular Surgery University of
Schleswig-Holstein Kiel Germany
Title
Is universal antifungal prophylaxis mandatory in adults after lung
transplantation? A review and meta-analysis of observational studies.
Source
Clinical Transplantation. (no pagination), 2016. Date of Publication:
2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Lung transplant (LTX) recipients are at high risk of invasive
Aspergillus infections (IAI). However, no randomized-controlled trials
(RCT) or international guidelines on antifungal prophylaxis (AFP) in the
LTX population exist. Methods: A meta-analysis was performed to determine
whether AFP reduces the rate of IAI after LTX. A total of six eligible
observational studies (five with no prophylaxis, one with targeted
prophylaxis, three studies including heart/lung transplantation) with a
total of 748 patients were included. Results: The pooled odds ratio (OR)
for IAI (62 IFI in the intervention arm and 82 in the control group) was
0.234 (95% confidence interval [CI] 0.097-0.564, P=0.001, z=-3.237).
Pooled studies were characterized by substantial heterogeneity
(I²=66.64%); number needed to treat was 6.8. A subgroup
analyses with exclusion of heart transplant recipients also showed a
statistically significant reduction in IAI with AFP (OR 0.183, 95% CI
0.0449-0.744, P=0.018). Conclusion: This study suggests that universal
antifungal prophylaxes reduces incidence of IAI after LTX. However,
included studies are limited by small sample size, single-center structure
without randomization, mixed population (including heart/heart-lung
transplant), and heterogeneity due to variations in immunosuppression,
type, and duration of AFP. Therefore, there is a clear need for an
adequately powered RCT. Copyright &#xa9; 2016 John Wiley & Sons A/S.

<75>
Accession Number
613437623
Author
Martinez-Parachini J.R.; Karatasakis A.; Karmpaliotis D.; Alaswad K.;
Jaffer F.A.; Yeh R.W.; Patel M.; Bahadorani J.; Doing A.; Nguyen-Trong
P.-K.; Danek B.A.; Karacsonyi J.; Alame A.; Rangan B.V.; Thompson C.A.;
Banerjee S.; Brilakis E.S.
Institution
(Martinez-Parachini, Karatasakis, Nguyen-Trong, Danek, Karacsonyi, Alame,
Rangan, Banerjee, Brilakis) VA North Texas Healthcare System and UT
Southwestern Medical Center Dallas, TX USA
(Karmpaliotis) Columbia University New York, NY USA
(Alaswad) Henry Ford Hospital Detroit, MI USA
(Jaffer) Massachusetts General Hospital and Harvard Medical School Boston,
MA USA
(Yeh) Beth Israel Deaconess Medical Center and Harvard Medical School
Boston, MA USA
(Patel, Bahadorani) VA San Diego Healthcare System and University of
California San Diego San Diego, CA USA
(Doing) Medical Center of the Rockies Loveland, CO USA
(Thompson) Boston Scientific Natick, MA USA
(Brilakis) Minneapolis Heart Institute Minneapolis, MN USA
Title
Impact of diabetes mellitus on acute outcomes of percutaneous coronary
intervention in chronic total occlusions: Insights from a US multicentre
registry.
Source
Diabetic Medicine. (no pagination), 2016. Date of Publication: 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aim: To examine the impact of diabetes mellitus on procedural outcomes of
patients who underwent percutaneous coronary intervention for chronic
total occlusion. Methods: We assessed the impact of diabetes mellitus on
the outcomes of percutaneous coronary intervention for chronic total
occlusion among 1308 people who underwent such procedures at 11 US centres
between 2012 and 2015. Results: The participants' mean +/- sd age was 66
+/- 10 years, 84% of the participants were men and 44.6% had diabetes. As
compared with participants without diabetes, participants with diabetes
were more likely to have undergone coronary artery bypass graft surgery
(38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%;
P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They
also had a higher BMI (31 +/- 6 kg/m² vs 29 +/- 6
kg/m²; P = 0.001), similar Japanese chronic total occlusion
scores (2.6 +/- 1.2 vs 2.5 +/- 1.2; P = 0.82) and similar final successful
crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66),
retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs
25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%;
P = 0.93) success was similar in the two groups, as was the incidence of
major adverse cardiac events (2.2 vs 2.5%; P = 0.61). Conclusions: In a
contemporary cohort of people undergoing percutaneous coronary
intervention for chronic total occlusion, nearly one in two (45%) had
diabetes mellitus. Procedural success and complication rates were similar
in people with and without diabetes. Copyright &#xa9; 2016 Diabetes UK.