EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 100

Results Generated From:
Embase <1980 to 2016 Week 51>
Embase (updates since 2016-12-09)

<1>
Accession Number
612433655
Author
Rex C.E.; Heiberg J.; Klaaborg K.-E.; Hjortdal V.E.
Institution
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Cardiothoracic & Vascular
Surgery, Aarhus University Hospital, Aarhus, Denmark
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
Title
Health-related quality-of-life after transapical transcatheter aortic
valve implantation.
Source
Scandinavian Cardiovascular Journal. 50 (5-6) (pp 377-382), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose. Transcatheter aortic valve implantation (TA-TAVI) is a
well-established treatment for aortic valve stenosis in high-risk patients
and indications have been continuously expanding to also include
intermediate-risk patients. However, in low-risk patients, experiences are
still sparse and although clinical outcomes have been shown favorable
results, HRQoL has remained unexplored. The aim of this report was to
describe the long-term health-related quality-of-life (HRQoL) in low-risk
patients randomized to TA-TAVI or surgical aortic valve replacement
(SAVR). Methods. In a prospective, randomized trial, patients with aortic
valve stenosis were randomized to either TA-TAVI or SAVR. TA-TAVI was
performed through a mini thoracotomy with the introduction of prosthesis
via the apex of the heart and antegradely advancement over the pre-dilated
native valve. SAVR was performed during cardiopulmonary bypass with
resection of the native valve and replacement with a prosthesis valve
through a median sternotomy. Afterwards, patients were followed yearly
with echocardiography and HRQoL assessment. Results. A total of 58
patients were included; 29 patients for TA-TAVI and 29 patients for SAVR.
The only difference in HRQoL was found in the physical component summary
after 1 year; 44 +/- 9 in the TA-TAVI group compared with 36 +/- 9 in the
SAVR group, p =.03. There were no differences in any of the remaining
timepoints in neither physical nor mental component summary, p =.19 and p
=.98, respectively, and there were no differences in survival during the 5
years. Conclusions. In low-risk patients with aortic valve stenosis
undergoing TA-TAVI, no differences appeared in HRQoL compared with SAVR
during a 5-year follow-up period. Copyright &#xa9; 2016 Informa UK
Limited, trading as Taylor & Francis Group.

<2>
Accession Number
611158362
Author
Basciani R.; Kroninger F.; Gygax E.; Jenni H.; Reineke D.; Stucki M.;
Hagenbuch N.; Carrel T.; Eberle B.; Erdoes G.
Institution
(Basciani, Kroninger, Stucki, Eberle, Erdoes) Department of Anesthesiology
and Pain Therapy, Inselspital, Bern University Hospital, University of
Bern, Bern, Switzerland
(Gygax, Jenni, Reineke, Carrel) Department of Cardiovascular Surgery,
Swiss Cardiovascular Center, Inselspital, Bern University Hospital,
University of Bern, Bern, Switzerland
(Hagenbuch) Private Statistician, Spiez, Switzerland
Title
Cerebral Microembolization During Aortic Valve Replacement Using Minimally
Invasive or Conventional Extracorporeal Circulation: A Randomized Trial.
Source
Artificial Organs. 40 (12) (pp E280-E291), 2016. Date of Publication: 01
Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
To compare intraoperative cerebral microembolic load between minimally
invasive extracorporeal circulation (MiECC) and conventional
extracorporeal circulation (CECC) during isolated surgical aortic valve
replacement (SAVR), we conducted a randomized trial in patients undergoing
primary elective SAVR at a tertiary referral hospital. The primary outcome
was the procedural phase-related rate of high-intensity transient signals
(HITS) on transcranial Doppler ultrasound. HITS rate was used as a
surrogate of cerebral microembolism in pre-defined procedural phases in
SAVR using MiECC or CECC with (+F) or without (-F) an oxygenator with
integrated arterial filter. Forty-eight patients were randomized in a 1:1
ratio to MiECC or CECC. Due to intraprocedural Doppler signal loss (n =
3), 45 patients were included in final analysis. MiECC perfusion regimen
showed a significantly increased HITS rate compared to CECC (by a factor
of 1.75; 95% confidence interval, 1.19-2.56). This was due to different
HITS rates in procedural phases from aortic cross-clamping until
declamping [phase 4] (P = 0.01), and from aortic declamping until stop of
extracorporeal perfusion [phase 5] (P = 0.05). Post hoc analysis revealed
that MiECC-F generated a higher HITS rate than CECC+F (P = 0.005), CECC-F
(P = 0.05) in phase 4, and CECC-F (P = 0.03) in phase 5, respectively. In
open-heart surgery, MiECC is not superior to CECC with regard to gaseous
cerebral microembolism. When using MiECC for SAVR, the use of oxygenators
with integrated arterial line filter appears highly advisable. Only with
this precaution, MiECC confers a cerebral microembolic load comparable to
CECC during this type of open heart surgery. Copyright &#xa9; 2016
International Center for Artificial Organs and Transplantation and Wiley
Periodicals, Inc.

<3>
Accession Number
610463283
Author
Gudbjartsson T.; Jeppsson A.; Sjogren J.; Steingrimsson S.; Geirsson A.;
Friberg O.; Dunning J.
Institution
(Gudbjartsson, Steingrimsson, Geirsson) Department of Cardiothoracic
Surgery, Landspitali University Hospital, Faculty of Medicine, University
of Iceland, Reykjavik, Iceland
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Sjogren) Department of Cardiothoracic Surgery, Skane University Hospital,
Lund, Sweden
(Friberg) Department of Cardiothoracic Surgery, Orebro University
Hospital, Orebro, Sweden
(Dunning) Department of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom
Title
Sternal wound infections following open heart surgery-a review.
Source
Scandinavian Cardiovascular Journal. 50 (5-6) (pp 341-348), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Surgical site infections (SSIs) are common complications after open heart
surgery. Fortunately, most are superficial and respond to minor wound
debridement and antibiotics. However, 1-3% of patients develop deep
sternal wound infections that can be fatal. Late infections with
sternocutaneous fistulas, are encountered less often, but represent a
complex surgical problem. This evidence-based review covers etiology, risk
factors, prevention and treatment of sternal SSIs following open heart
surgery with special focus on advances in treatment, especially
negative-pressure wound therapy. Copyright &#xa9; 2016 Informa UK Limited,
trading as Taylor & Francis Group.

<4>
Accession Number
612636007
Author
Ando T.; Briasoulis A.; Holmes A.A.; Takagi H.; Slovut D.P.
Institution
(Ando) Department of Internal Medicine, Mount Sinai Beth Israel, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Briasoulis) Division of Cardiology, Wayne State University/Detroit
Medical Center, Detroit, MI, United States
(Holmes) Leon H. Charney Division of Cardiology, NYU Langone Medical
Center, New York, NY, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Slovut) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, Bronx, NY, United
States
(Slovut) Division of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
Title
Percutaneous versus surgical cut-down access in transfemoral transcatheter
aortic valve replacement: A meta-analysis.
Source
Journal of Cardiac Surgery. 31 (12) (pp 710-717), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The transfemoral (TF) approach has become the preferred
approach for transcatheter aortic valve replacement (TAVR) because of its
low risk profile. However, the relative safety of the percutaneous
approach (PC) compared to surgical cut-down (SC) remains unclear. Our aim
was to compare the outcomes between PC versus SC access in patients
undergoing TF-TAVR using a meta-analysis. Methods: We conducted a
systematic electronic database search for studies reporting major and
minor vascular complications (VC), major and minor bleeding, and
perioperative all-cause mortality, in PC versus SC TF-TAVR cases.
Complications were reported based on the Valve Academic Research
Consortium criteria. A random-effects model was used to calculate odds
ratios and 95% confidence intervals. Results: Eight observational cohort
studies and one randomized control trial (2513 patients in PC and 1767
patients in SC) were included in the analysis. Major and minor VC, as well
as bleeding complications, were comparable between the two approaches. The
need for surgical intervention for VC was comparable between PC and SC.
There was no difference in perioperative all-cause mortality. Conclusions:
PC and SC have similar safety profiles and outcomes when used
appropriately in selected patients. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<5>
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. 30 (12) (pp 1522-1531), 2016. Date of
Publication: 01 Dec 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.
Published by John Wiley & Sons Ltd

<6>
Accession Number
613553363
Author
Murkin J.M.; Turkstra T.; Mayer R.
Institution
(Murkin, Turkstra, Mayer) Anesthesiology and Perioperative Medicine, LHSC,
Schulich School of Medicine, UWO, London, ON, Canada
Title
Initial assessment of automated SSEP for detection of intraoperative
positional neuropraxia in cardiac surgery.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S215), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: In anesthetised patients positional neuropraxia may be an
accompaniment to inadvertent compression or traction of peripheral nerves,
of which upper limb and brachial plexus nerves are particularly
vulnerable. The incidence of clinically apparent upper limb neuropraxia in
cardiac surgery has been estimated at between 0.5% to 37.5%, depending on
the type and duration of retractor usage, patient positioning and is
variably influenced by patient comorbidities.^1,2
Intraoperatively, peripheral nerve function can be monitored noninvasively
using somatosensory evoked potentials (SSEP) however, conventional SSEP
monitoring requires presence of a trained SSEP technician, use of needle
electrodes and currently bulky SSEP equipment and is thus not practical
for routine clinical usage. In this study we report our initial
experiences with a non-invasive, miniaturized and automated SSEP device
(EPAD, SafeOpSurgical, Hunt Valley, MD) METHODS: Following review board
approval and written patient consent, 17 patients undergoing cardiac
surgery with median sternotomy and cardiopulmonary bypass were enrolled.
Adhesive stimulating electrodes were placed on bilateral wrist in median
and ulnar nerve distribution with adhesive receiving electrode placed on
posterior neck in C5 position and adhesive ground electrode placed on
forehead and variably covered with transparent film dressings. Patient's
arms were padded and placed neutral (thumbs vertical) at sides. The SSEP
monitor screen alternately displayed a 'good' or 'alert' homunculus of
relevant nerve signals, or a time-based display of current SSEP data for
each nerve, with alert threshold trigger at > 10% increase from baseline
latency or 50% decrease in signal amplitude. RESULTS: Of 17 patients, I
died of cardiac failure postoperatively and in a further 3 patients
electrode failure resulted in irretrievable data loss. Accordingly
electrode adhesive was modified and transparent film dressings applied to
all subsequent cases. Of 13 surviving patients with complete SSEP data,
intraoperative 'alert' was detected and persisted through end of surgery
in 2 patients. No relevant symptoms were reported in 11 patients but of
patients with persistent SSEP changes, all complained of numbness and/or
tingling in ipsilateral hand on clinical examination. Electromyography
studies were performed in these 2 symptomatic patients one of which
demonstrated mild left ulnar neuropathy and other showed bilateral ulnar
neuropathies worse on symptomatic left side with symptoms suggestive of
traction injury to lower brachial plexus. CONCLUSION: This pilot study
shows efficacy and ease of use of a non-invasive automated SSEP device and
consistent with other such studies demonstrates an incidence of
intraoperative neuropraxia that is associated with a 15% incidence of
persistent clinical symptomatology. A randomized blinded clinical trial is
underway to determine whether intraoperative interventions can decrease
this morbidity.

<7>
Accession Number
613553292
Author
Foley M.R.; Connolly M.; Vander Wielen B.; Shnider M.; Hess P.
Institution
(Foley) Anesthesiology, Northwestern University, Chicago, IL, United
States
(Connolly, Vander Wielen, Shnider, Hess) Anesthesiology, Beth Israel
Deaconess Medical Center, Boston, MA, United States
Title
Uniport and multiport epidural catheters in post-surgical patients.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S320), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: A properly functioning epidural is the gold standard
analgesic modality for many thoracic and abdominal procedures
post-operatively. However, epidural analgesia has been studied almost
exclusively in the lumbar spaces of parturient^1-4 and not the
thoracic spaces of post-surgical patients. Integral to the spread of local
anesthetic within the epidural space, and ultimately providing pain
relief, is whether the catheter design has one endhole, or multiple side
holes. These two catheter designs provide equivalent analgesia in laboring
patients¹. However, this may not be true in post-surgical
patients wherein lower volumes are typically used for longer duration and
the thecal sac is thinner and narrower. We hypothesize that flexible
multi-port thoracic epidural catheters will provide superior analgesia
when compared to flexible uniport catheters for post-surgical patients as
measured by epidural failure rate (primary outcome defined as the need to
use adjunctive opioids, replacing or removing the epidural) and pain
scores (secondary outcomes). METHODS: This is an IRB approved randomized,
doubleblind, prospective trial registered with clinicaltrials.gov.
Patients undergoing thoracic or abdominal surgery, requesting a thoracic
epidural expected to be in place >24 hours, and ages 18 to 75 were
approached by an investigator. Exclusion criteria included any chronic
pain/opioids, BMI >40, delirium and dementia. Using alpha=0.05, beta=0.80
and an analgesic failure difference of 20%, power analysis predicted 91
patients would be needed per group. The placement team was unblinded to
catheter type but the acute pain service that followed the patient post-op
and recorded outcomes was blinded (the catheters appear identical).
Ultimately, a blinded interim analysis was performed after the first 100
patients due to significant pushback to end the study from our acute pain
service citing time constraints. A t-test was used to compare continuous
pain score data and Kaplan-Meier curves displaying epidural "survival"
were calculated for each catheter. RESULTS: 100 patients were enrolled and
underwent randomization. A significant number of patients were excluded
from data analysis because the epidural was never used (post-op
intubation, hemodynamic instability). 31 patients received the "green" and
35 patients received the "blue" catheter. CONCLUSIONS: One of the catheter
designs appears to provide superior analgesia (although both have a higher
incidence of failure than typically seen in obstetrics). VNAS scores at
PACU admit and discharge and on POD 1 and 2 are all lower, but only PACU
discharge and POD 1 are statistically significant. The Kaplan Meier curves
demonstrate that more epidurals are functioning appropriately in the blue
group at all time points. This interim analysis provided us the necessary
data to convince our acute pain service to continue enrollment until
criteria was reached.

<8>
Accession Number
613553270
Author
Rao S.; Lavigne P.M.; Helwani M.A.; Nagele P.
Institution
(Rao, Helwani, Nagele) Anesthesiology, Washington University, St. Louis,
MO, United States
(Lavigne) Medicine (Cardiovascular), Washington University, St. Louis, MO,
United States
Title
Pathophysiology of perioperative acute coronary syndromes: A coronary
angiographic investigation.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S412), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Approximately 5% of patients age 45 or older undergoing
noncardiac surgery experience a cardiac complication, with perioperative
myocardial infarction (PMI) being most prevalent. The pathophysiology of
PMI remains poorly understood. Although mismatch in myocardial blood
supply-oxygen demand (type 2) has classically been believed to antecede
many perioperative MIs, strong evidence to support this hypothesis remains
lacking. Other studies have suggested that plaque rupture (type 1) may be
an underappreciated etiology of PMI. While a plethora of studies have
focused on risk assessment and prevention of myocardial ischemia in the
perioperative period, limited evidence exists regarding the etiology of
PMI. METHODS: Following IRB approval, we reviewed hospital records and
coronary angiograms of adult patients who underwent angiography for acute
coronary syndrome (ACS) within 30 days of noncardiac surgery at a major
tertiary hospital between 1/2008- 12/2015. Angiograms were retrospectively
reviewed independently by an interventional cardiologist and an
interventional cardiology fellow who were initially blinded to clinical
data and outcomes, and when interpretation was discordant,
electrocardiogram, procedure note and/or echocardiogram findings were
reviewed to reach consensus. Based on the findings, the etiology was
classified as type 1 (plaque rupture), type 2 (supply/demand mismatch), or
type 4b (stent thrombosis). RESULTS: 145 patients were identified. More
than half of patients (51%) had pre-existing CAD and 44% were on
beta-blockers at the time of surgery. The distribution of MI types 1
(plaque rupture), 2 (supply/demand mismatch), and 4b (stent thrombosis)
was 26.9% (39/145), 71% (103/145), and 2.1% (3/145), respectively.
Thirtyday mortality was 3.4% (5/145); one patient died following type I
MI, and four patients following type II. Median peak post-operative
troponin I was 3.2 ng/ml (IQR 0.9-8.2), and median time to peak troponin
was 1.8 days (IQR 0.8-2.9). The median hospital length of stay was 9.3
days (IQR 6.3-14.3). CONCLUSIONS: In this single center cohort, nearly 3
out of 4 patients who underwent coronary angiography for ACS following
noncardiac surgery had supply/demand mismatch compared to a primary
coronary event as the etiology. To date this is the largest angiographic
series of patients with perioperative ACS.

<9>
Accession Number
613553260
Author
Smith L.; Smith D.K.; Linton M.F.; Billings F.T.
Institution
(Smith) Anesthesiology, Vanderbilt University Medical Center, Nashville,
TN, United States
(Smith) Biostatistics, Vanderbilt University Medical Center, Nashville,
TN, United States
(Linton) Departments of Medicine and Pharmacology, Division of
Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville,
TN, United States
(Billings) Anesthesiology, Vanderbilt University, Nashville, TN, United
States
Title
A novel association between high density lipoprotein levels and the risk
of acute kidney injury after cardiac surgery.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S455), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION AND GENERAL PURPOSE OF THE STUDY: Acute kidney injury (AKI)
after cardiac surgery occurs in up to 30% of patients and is an
independent predictor of death.¹ HDL has known anti-oxidant and
anti-inflammatory properties2 and may attenuate mechanisms of AKI. We
hypothesized that a high preoperative HDL cholesterol concentration is
protective against postoperative AKI. METHODS: After IRB approval, data
were obtained from a prospective, 393-subject trial of perioperative
atorvastatin to prevent post-cardiac surgery AKI. Statin-using patients
were randomized to placebo or 80mg atorvastatin the morning of surgery and
40mg on postoperative day 1. Stain-naive patients were randomized to
placebo or 80mg the day prior to surgery and 40mg daily thereafter during
hospitalization. The association between HDL level and maximum serum
creatinine change from baseline in the first 48 postoperative hours was
assessed using a two-component latent variable mixture model with
potential confounders and AKI risk factors. Regression analyses assessed
interactions of chronic statin use, perioperative atorvastatin treatment,
and HDL level on AKI risk. RESULTS AND MAJOR FINDINGS: Postoperative AKI
occurred in 99 patients (25.2%). Median (10th, 90th percentile)
preoperative HDL was 37.6 (25.0, 54.0) mg/dl and postoperative creatinine
change 0.09 (-0.11, 0.59) mg/dl. Lower HDL levels were independently
associated with increased creatinine rise (p=0.02) (Figure 1). Regression
analysis showed this association was present in statin-using but not
statin-naive patients (p=0.008) (Figure 2). The protective effect of high
HDL in chronic statin users was enhanced with perioperative atorvastatin
treatment (p=0.004) (Figure 3) and with increasing chronic statin dose
(p=0.003) (Figure 4). Similar analyses using LDL found no association with
postoperative AKI risk (p=0.51). CONCLUSIONS: Higher preoperative HDL was
associated with less risk of AKI. Statin exposure modified this
association. Specifically, subjects with higher HDL levels on chronic
statin therapy had less creatinine rise and appeared to further benefit
from higher chronic statin dose and perioperative atorvastatin therapy.
These findings support a possible pleotropic effect of statins on HDL in
the context of AKI and a potential new role for HDL during the
perioperative period. Future work involves identifying the biological
mechanism underlying these associations.

<10>
Accession Number
613553240
Author
Elmi-Sarabi M.; Deschamps A.; Delisle S.; Denault A.
Institution
(Elmi-Sarabi, Deschamps, Denault) Anesthesiology, Montreal Heart
Institute, Montreal, QC, Canada
(Delisle) Intensive Care Unit, Hopital Sacre-Coeur de Montreal, Montreal,
QC, Canada
Title
A systematic review and meta-analysis of inhalation agents for the
treatment of pulmonary hypertension in cardiac surgical patients.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S83), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: In cardiac surgery, pulmonary hypertension (PH) is an
important prognostic factor for which several treatments have been
suggested over time. In this systematic review, we compared the efficacy
of inhaled pulmonary vasodilators to placebo in the treatment of PH during
cardiac surgery. METHODS: We searched MEDLINE, CENTRAL, EMBASE, The Web of
Science and clinicaltrials.gov databases up to October 2015 for randomized
controlled trials comparing the efficacy of inhaled agents to placebo in
cardiac surgical patients. Hemodynamic profile was assessed as the primary
outcome. Secondary outcomes included mortality, length of stay in hospital
and in intensive care unit, and mean dosage of inotropic and vasopressor
agents. RESULTS: Of the 2897 citations identified, 5 studies were included
comprising a total of 211 patients.^1-5 No significant
hemodynamically meaningful differences were observed between inhaled
agents and placebo defined as heart rate, mean pulmonary artery pressure,
mean arterial pressure, pulmonary vascular resistance, pulmonary capillary
wedge pressure and central venous pressure (Table 1). Sensitivity analyses
were consistent with these findings. Secondary outcomes could not be
evaluated due to insufficient data. CONCLUSIONS: A systematic review of
the literature revealed that to date very few trials have reported on the
efficacy of inhaled vasodilator agents compared to placebo. Furthermore,
these are small trials with few participants. A meta-analysis of these
studies reported no significant meaningful differences in hemodynamic
variables between inhaled agents and placebo. Moreover, due to the limited
number of studies reporting on the use of inhaled agents in cardiac
surgical patients, the effect on clinically relevant end-points could not
be assessed. Further research is therefore warranted in this area of
research and should focus on clinically significant outcomes.

<11>
Accession Number
613553235
Author
Adams P.S.; Zahid M.; Khalifa O.; Lo C.W.
Institution
(Adams) Anesthesiology, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States
(Zahid, Khalifa, Lo) Developmental Biology, University of Pittsburgh
School of Medicine, Pittsburgh, PA, United States
Title
Increased use of inhaled nitric oxide in single ventricle patients with
low nasal nitric oxide undergoing congenital heart surgery.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S453), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cardiopulmonary bypass impairs endogenous production of
nitric oxide (NO) leading to increased pulmonary vascular resistance (PVR)
and associated increased stress on an already vulnerable ventricle1.
Supplemental inhaled NO (iNO) decreases PVR and has improved post-bypass
mortality1. We hypothesized nasal NO (nNO), which can be sampled in a
quick, easy, non-invasive bedside test, may be a biomarker for endogenous
NO homeostasis, thus patients with low nNO undergoing cardiac surgery may
be predicted to have increased perioperative iNO use. METHODS: With
institutional review board approval, 132 congenital heart disease patients
undergoing cardiac surgery were consented into the study. Nasal NO was
obtained using an Eco Physics CLD 88sp NO analyzer. Patients were
categorized as having normal or low nNO based on established cutoff
values2,3. Charts were reviewed for perioperative iNO administration. All
health care providers were blinded to the study. RESULTS: Sixty-four
patients had low nNO (48.5%). Of these, 35 patients (54.7%) received
perioperative iNO compared to 21/68 (30.9%) patients with normal nNO
(p=0.006, OR 2.7 [1.3-5.5]) (Table 1). There were significantly more
single ventricle physiology (SV) patients in the low nNO group (29/64 vs.
16/68, p=0.008). Subgroup analysis showed the incidence of receiving
perioperative iNO was significantly higher in SV patients with low nNO
than in SV patients with normal nNO (21/29 [72.4%] vs. 5/16 [31.2%],
p=0.007, OR 5.8 [1.5-21.9]). There was no significant difference in iNO
use between SV and two-ventricle (2V) patients with normal nNO (5/16 vs.
16/52, p=1), but there was a difference in the low nNO groups (21/29 vs.
14/35, p=0.01). CONCLUSIONS: SV patients with low nNO undergoing cardiac
surgeries are more likely to receive perioperative supplemental iNO.
Patients with normal nNO and 2V patients with low nNO are less likely to
receive perioperative iNO. These findings suggest that nNO sampling
obtained at the bedside can help identify patients who can benefit from
supplemental iNO for their cardiac procedure. By mitigating delays in
treatment with iNO, this may help improve postsurgical outcome by
preventing severe hemodynamic derangements due to NO deficiency.

<12>
Accession Number
613553216
Author
Lane-Fall M.B.; Pascual J.; Gutsche J.; Di Taranti L.J.; Buddai S.; Barg
F.; Fleisher L.
Institution
(Lane-Fall, Gutsche, Di Taranti, Buddai, Fleisher) Department of
Anesthesiology and Critical Care, University of Pennsylvania Perelman
School of Medicine, Philadelphia, PA, United States
(Pascual) Department of Surgery, Surgical Critical Care and Emergency
Surgery, University of Pennsylvania Perelman Sch of Medicine,
Philadelphia, PA, United States
(Barg) Department of Family Medicine and Community Health, United Kingdom
Title
Handoff standardization in two mixed surgical intensive care units
improves teamwork and information exchange: Preliminary findings from the
handoffs and transitions in critical care (Hatricc) study.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S451), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Operating room (OR) to intensive care unit (ICU) handoffs have
been shown to place patients at increased risk of preventable harm.
Previous studies showed improvements in handoff quality with
standardization, but this has been primarily reported in the context of
pediatric cardiac surgery. The present study aims to explore these
findings in adult mixed surgical populations, developing a standardized
OR-to-ICU handoff process to improve postoperative communication and care
quality. METHODS: This ongoing study is a prospective interventional
cohort study based in two mixed surgical ICUs in the same urban academic
health system (Table 1). The study employs qualitative and quantitative
research techniques and has 3 phases: Evaluation of the current handoff
process, including observations and clinician interviews, focus groups,
and surveys (Phase 1, 7/2014-4/2015); development, in-situ simulation, and
implementation of a new handoff process (Phase 2, 4/2015-6/2015); and
evaluation of the new process (Phase 3, 7/2015-present). The primary
outcome is number of information omissions, but qualitative and patient
outcomes will also be analyzed (Table 2). The study utilizes a pre-post
design, but patient data from a similar non-study ICU within the same
health system will be analyzed to test whether secular changes explain any
observed differences in patient outcomes before and after the
intervention. For bivariate analyses by phase, Fisher's exact test
(categorical variables) and the Mann-Whitney U test (continuous variables)
were used to compare differences in study outcomes. RESULTS: Phase 1: 61
OR-to-ICU transfers were observed, but bedside handoff did not occur for 8
of these transfers. For the 53 observed handoffs, out of 13 possible key
information elements, a mean 6.5+/-2.8 elements were observed. In 24 (45%)
handoffs, teamwork was deemed unsatisfactory due to lack of coordination/
cooperation or unclear provider responsibility. In interviews and focus
groups, clinicians reported that time pressure and role ambiguity were
barriers to achieving satisfactory handoffs. Phase 2: a choreographed
handoff process and information template were developed, tested, adapted,
and implemented. Phase 3: 86 handoffs have been observed. Information
elements transmitted increased to 8.1+/-2.5 (25% increase, p<0.0001). 14
of 86 (16.3%) handoffs had unsatisfactory communication, a decrease of
28.7% (p<0.001). Handoff duration increased from a mean 3.4 minutes to 8.3
minutes (p<0.001). In interviews, focus groups, and surveys, clinicians
report improved reliability of the process, improved satisfaction, and,
for ICU clinicians, less time spent gathering patient information after
the handoff. CONCLUSIONS: Preliminary data suggest that standardizing
ORto- ICU handoffs in two mixed surgical ICUs improved information
exchange, teamwork, and provider satisfaction with the handoff process.
More study is needed to determine whether learned improvements in process
outcomes are retained for extended time frames and translate to better
patient outcomes.

<13>
Accession Number
613553211
Author
Trinh M.; Uysal S.; Fischer G.; Lin H.; Reich D.
Institution
(Trinh, Fischer, Reich) Anesthesiology, Mount Sinai, New York, NY, United
States
(Uysal) Anesthesiology, Icahn School of Medicine at Mount Sinai, New York,
NY, United States
(Lin) Biostatistics, Icahn School of Medicine, New York City, NY, United
States
Title
Optimizing cerebral saturation in cardiac surgical patients.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S79), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cerebral oximetry based on near infrared spectroscopy (NIRS)
measures regional cerebral tissue oxygen saturation (SctO<inf>2</inf>). It
is used intraoperatively as a continuous monitor for detection of cerebral
ischemia and potential brain injury in cardiac surgical patients. Past
research has shown that optimizing SctO<inf>2</inf> during cardiac surgery
is associated with reduced incidence of major organ morbidity or
mortality.1 Several studies have shown an association between prolonged
desaturations and postoperative cognitive decline.<inf>2,3</inf> We
conducted a randomized controlled trial to determine if optimizing
SctO<inf>2</inf> during cardiac surgery will lead to improved cerebral
oxygen saturation and better neurocognitive outcomes. METHODS: 125 adult
(>18 yo) patients who underwent elective cardiac surgery requiring CPB
were studied. Patients with severe preoperative cognitive impairment or
end-stage organ failure were excluded. Patients were randomly assigned to
either a treatment or a blinded control group. Data extracted from the
medical record included: basic demographics, variables for computing
Euroscores and Charlson Comorbidity Index scores, and NYHA classification.
Cerebral oxygen saturation was monitored intraoperatively using the
Fore-Sight cerebral oximeter (CAS Medical Systems). In the treatment
group, an intervention algorithm (Fig 1) was used to improve SctO2 if
desaturation occurred <60 for >1min at either probe. In the control group,
the SctO2 data were hidden from the perioperative team, unless a critical
low value, SctO2 <40 for >1 min triggered an alarm. The SctO2 data were
then revealed, and the intervention protocol was followed until SctO2 was
restored to >60. Cognitive function was assessed using the Cognitive
Stability Index (CSI) HeadMinder computerized test battery, which assesses
response speed, cognitive processing speed, attention, and memory. The
test battery was administered preoperatively (n=125) and postoperatively
at 3 (n=92) and 6 months (n=78). Data analysis was performed using
X²/Fischer's exact tests on categorical data and
t-test/Wilcoxon rank sum on continuous variables. The level of statistical
significance was set to 0.05. RESULTS: The treatment and control groups
were similar with respect to demographics, preoperative risk scores,
baseline cognitive test scores, surgery duration, and CPB duration. The
groups did not differ in incidence of desaturation episodes, mean time
under threshold (TUT), or area under threshold (total time x depth under
threshold). Of patients with desaturations, intervention was associated
with less TUT and AUT (Table 1). Over all subjects, intervention was
associated with better memory function postoperatively (Table 2).
CONCLUSIONS: NIRS-guided optimization of cerebral oxygenation during
cardiac surgery is effective in reducing time and depth of intraoperative
desaturation episodes in cardiac patients. In patients with desaturations,
intervention is associated with better postoperative memory function.

<14>
Accession Number
613553134
Author
Mendis N.; Hamilton G.M.; McIsaac D.I.; Fergusson D.; Wunsch H.; Turgeon
A.; Lalu M.M.
Institution
(Mendis, Hamilton) Anesthesiology, University of Ottawa, Ottawa, ON,
Canada
(McIsaac) Anesthesiology, Ottawa Hospital, University of Ottawa, Ottawa,
ON, Canada
(Fergusson) Medicine, Surgery, and Epidemiology and Community Medicine,
Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Wunsch) Anesthesia and Critical Care, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
(Turgeon) Anesthesia and Critical Care, Universite Laval, Quebec, QC,
Canada
(Lalu) Anesthesiology, Ottawa Hospital, University of Ottawa, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
Title
Impact of surgical special care units: A systematic review.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S234), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Perioperative intermediate care units (termed surgical
special care unit, or SSCU) may improve surveillance and identification of
at-risk surgical patients. Institution of an SSCU may lead to global
improvements across patient outcomes, as well as reduce the workload and
financial burden at a systems level. We conducted a systematic review in
order to investigate the effects of a 3-level model of care delivery (i.e.
ward, SSCU, ICU) compared to a 2-level model of care (i.e. ward, ICU) on
post-operative mortality, morbidity, and healthcare resource utilization.
METHODS: Our protocol was registered with PROSPERO (CRD 20154025155).
Randomized controlled trials (RCTs) and nonrandomized comparator studies
(NRCTs) that compared a three vs two level model of care of perioperative
non-cardiac surgery patients were included. A systematic search of
Medline, CINAHL, Embase, and the Cochrane library was performed
(inception-01/2015). Retrieved citations were screened and data extracted
independently in duplicate. Data were extracted for mortality (primary
outcome) as well as serious adverse events (SAEs), length of stay, and
hospital costs (secondary outcomes). We planned pooling data (relative
risk) using random effect models with the DerSimonian and Laird method, if
applicable. RESULTS: 1868 citations were retrieved by our search and 21
studies met eligibility criteria (2 RCTs, 19 NRCTs, 44134 patients). SSCUs
were characterized by continuous monitoring (11 studies), absence of
mechanical ventilation (7 studies), nursing:patient ratios (range
1:2-1:4), and number of beds (5, 3-33; median, range). Thirteen studies
reported on mortality, three of which reported overall in-hospital
mortality in a 2 vs. 3-level model of care. Significant methodological
heterogeneity precluded pooled analysis, however two of the three studies
demonstrated no difference in overall hospital mortality, and one
demonstrated an increased mortality in a 3-level model of care vs 2-level
model. Four studies reported ICUspecific mortality, two of which
demonstrated an increased ICU mortality in a 3-level model of care. Four
studies compared total inhospital costs, two of which demonstrated
reductions with a 3-level model of care. Nine studies reported on hospital
length of stay and demonstrated no significant difference. Four studies
reported SAE data, however heterogeneity in reporting precluded analysis.
CONCLUSIONS: In this first systematic review of SSCUs, we observed
significant heterogeneity in SSCU design and reporting of outcomes.
Available data may suggest a 3-level model of care may increase in-ICU
mortality with no difference in overall in-hospital mortality. This may
reflect a 'decanting' of lower acuity patients from the ICU to the SSCU in
a 3-level model of care. The potential effects of a 3-level model of care
on hospitalization costs warrants further investigation.

<15>
Accession Number
613553062
Author
Lenart J.; Cho E.; Clark B.; Andrews G.D.; Applegate R.
Institution
(Lenart, Cho, Clark, Andrews, Applegate) Anesthesiology, Loma Linda
University School of Medicine, Loma Linda, CA, United States
Title
The effect of Cricoid pressure on apneic oxygen reserve in adult patients
undergoing endotracheal intubation for scheduled surgery.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S11), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Cricoid pressure is commonly used during anesthesia
induction with planned endotracheal intubation. It is believed that
applying cricoid pressure decreases a patient's risk to aspirate gastric
contents between the time of anesthesia induction and endotracheal
intubation. However, there is evidence that application of cricoid
pressure increases heart rate and blood pressure, which may result in
faster oxygen consumption1. This pilot study was designed to investigate
the effect size such an increase in oxygen consumption could have on the
time to desaturation. METHODS: Adult patients 18-65 years scheduled for
surgery including anesthesia with planned endotracheal intubation gave
written consent to participate in this LLU IRB approved study. Exclusion
criteria were suspected or known difficult mask ventilation/intubation;
elevated ICP; ASA PS 4; ASA PS 3 with cardiopulmonary disease; planned
cardiothoracic surgery; or risk for aspiration of gastric contents.
Patients were randomly assigned to cricoid pressure or sham, with
concealment until after consent. The surgical and anesthetic team and
research staff collecting data were blinded to group allocation. Standard
monitors were applied with processed EEG monitoring (PSI). Vital signs
were continuously collected to computer, and noted every 60 seconds from
anesthesia induction after intubation. Patients were preoxygenated to
FeO2/ FiO2 > 0.9 prior to induction; or withdrawn for failure to attain
this ratio. After administration of anesthetic and relaxant drugs and
before endotracheal intubation, research staff placed their hands on the
patients neck, concealed by a drape. The staff that applied cricoid
pressure were trained and demonstrated ability to reliably reproduce 30N
of force^2,3 prior to study participation. Timing started at the
onset of apnea (lack of respiratory effort; no EtCO2; time 0). No mask
ventilation or supplemental oxygen was applied after time zero. Cricoid
pressure patients had 30N of cricoid pressure applied at time 0; held
until SpO<inf>2</inf> < 95% or 6 minutes had elapsed. Cricoid presssure
was released prior to endotracheal intubation. Time to lowest
SpO<inf>2</inf> and intubation were calculated. The primary outcome
measure was the difference in time to lowest SpO<inf>2</inf>. Secondary
measures included difference in the lowest SpO<inf>2</inf> and the number
of patients with SpO<inf>2</inf><95%. RESULTS: 40 patients consented, with
2 from each group withdrawn for preoxygenation failure. There were no
significant differences in patient characteristics (Fig 1). We did not
find a significant difference in time to reach lowest SpO<inf>2</inf> or
lowest SpO<inf>2</inf> (Fig 2, 3). CONCLUSIONS: Application of 30N cricoid
pressure was not associated with a difference in time to lowest
SpO<inf>2</inf> or lowest SpO<inf>2</inf> in preoxygenated patients. Prior
reports showing cardiovascular activation used 40N cricoid pressure. It is
possible that excess pressure may cause more sympathetic response than the
recommended 30N cricoid pressure.

<16>
Accession Number
613553037
Author
Raghunathan K.; McCartney S.L.; Barbeito A.; Khangulov V.; Peyerl F.;
Berger M.; Shaw A.
Institution
(Raghunathan, Barbeito) Department of Anesthesiology, Division of Veterans
Affairs, Duke University Medical Center, Durham, NC, United States
(McCartney, Berger) Department of Anesthesiology, Duke University Medical
Center, Durham, NC, United States
(Khangulov, Peyerl) Boston Strategic Partners, Inc., Boston, MA, United
States
(Shaw) Department of Anesthesiology, Vanderbilt University Medical Center,
Nashville, TN, United States
Title
Acute kidney injury after cardiac surgery among patients with and without
preexisting chronic kidney disease: Effects of perioperative crystalloid
choice.
Source
Anesthesia and Analgesia. Conference: 2016 Annual Meeting of the
International Anesthesia Research Society, IARS 2016. United States.
Conference Start: 20160321. Conference End: 20160324. 122 (5 Supplement 3)
(pp S61), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: In observational studies, increased perioperative AKI has
been associated with the use of chloride-liberal (0.9% saline) rather than
chloride-restrictive (Plasma-Lyte, PL, or Ringer's Lactate, LR)
crystalloids,^1-4 but a recent randomized trial (SPLIT study)
reported no such differences.⁵ Studies also suggest that
Cardiac Surgery associated-Acute Kidney Injury (CSA-AKI) increases with
pre-existing Chronic Kidney Disease (CKD).⁶ To explore possible
reasons for discordance between observational studies and the SPLIT study,
we examined whether the variation in CSA-AKI is influenced by
perioperative crystalloid choice in relation to baseline CKD. METHODS:
After IRB approval, we used data contained in the Cerner Healthfacts
repository of Electronic Health Records (Cerner Inc., Kansas City, MO) to
identify all adults that had undergone cardiac surgery (CS) between
January 2009 and June 2013 (Figure 1). We then categorized patients as
with or without baseline CKD (based on ICD-9-CM codes). We compared rates
of incident CSAAKI, in-hospital mortality, and differences in peak versus
baseline (delta) serum chloride values among patients receiving saline
exclusively (chloride-liberal group) versus those also receiving PL or LR
(chloride-restrictive group) using propensity score (PS) based matching
and multivariate regression methods for risk-adjustment of baseline
differences. RESULTS: The odds of CSA-AKI (KDIGO Stage > 0) and inhospital
mortality were lower without (total n=4378 in the PS matched cohort)
versus with baseline CKD (total n=702 in the PS matched cohort, Figure 2).
Unlike the SPLIT study, we found that rates of incident CSA-AKI differed
with exposure to chloride-liberal versus chloride-restrictive crystalloids
in patients with baseline CKD (KDIGO>0 rate of 59% versus 46%,
respectively) and without CKD (KDIGO>0 rate of 25% versus 19%,
respectively). Delta chloride values were higher with CKD (mean increase
in chloride 2.25 versus 1.35 mEq/L) despite similar volume-adjusted
chlorideload (Table 1). The mean baseline creatinine among patients with
CKD in our study (1.66-1.96) was significantly higher than in the SPLIT
study (0.98-0.99, Table 1). CONCLUSIONS: We found that rates of CSA-AKI
were significantly higher when patients had CKD at baseline and,
differences relative to crystalloid choice were greater with CKD than
without (OR 0.57 vs. 0.72, respectively, when PL or LR was received versus
saline only). Results of the SPLIT study may differ from observational
studies for several reasons including potential unmeasured confounding or
inadequate risk-adjustment in observational studies, use of PL as the
default fluid in the SPLIT study, and better baseline renal function in
the SPLIT study. Further study of the effects of crystalloid choice is
warranted, especially among patients with CKD.

<17>
Accession Number
607727048
Author
Wachtell K.; Lagerqvist B.; Olivecrona G.K.; James S.K.; Frobert O.
Institution
(Wachtell, Frobert) Department of Cardiology, Orebro University, Orebro,
Sweden
(Wachtell) Section Cardiology Intervention, Department of Cardiology,
Division of Cardiovascular and Pulmonary Diseases, Oslo University
Hospital, Oslo, Norway
(Lagerqvist, James) Department of Medical Sciences, Cardiology, and
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
(Olivecrona) Department of Coronary Heart Disease, Skane University
Hospital, Clinical Sciences Section, Lund University, Lund, Sweden
Title
Novel Trial Designs: Lessons Learned from Thrombus Aspiration During
ST-Segment Elevation Myocardial Infarction in Scandinavia (TASTE) Trial.
Source
Current Cardiology Reports. 18 (1) (pp 1-10), 2016. Article Number: 11.
Date of Publication: 01 Jan 2016.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
In ST-elevation myocardial infarction (STEMI), thrombus material is often
present in partial or total coronary occlusion of the coronary vessel.
However, prior to the thrombus aspiration during ST-Segment Elevation
Myocardial Infarction in Scandinavia (TASTE) trial, it remained unclear
whether routine thrombus aspiration during percutaneous coronary
intervention (PCI) treatment of STEMI would result in patients overall
survival benefit. The TASTE trial was a multicenter, prospective,
open-label, randomized, controlled clinical trial. In order to randomize
patients to treatment and collect data, the infrastructure of a clinical
population-based registry was used. Online data collection used the
national comprehensive Swedish Coronary Angiography and Angioplasty
Registry, a part of the SWEDEHEART registry. Monitoring and adjudication
was done as part of the regular registry validation. There was no
separate, dedicated monitoring or adjudication of endpoints. Included were
7244 patients with STEMI with chest pain and time of symptoms to hospital
admission <24 h, in addition to new electrocardiographic ST-segment
elevation or left bundle-branch block. Exclusion criteria were the need
for emergency coronary artery bypass grafting. All-cause mortality at 30
days occurred in 2.8 % of the patients in the thrombus-aspiration group,
as compared with 3.0 % in the PCI-only group (hazard ratio [HR] 0.94, 95 %
confidence interval [CI] 0.72-1.22; p = 0.63). All-cause mortality at 1
year occurred in 5.3 % of the patients in the thrombus-aspiration group,
as compared with 5.6 % in the PCI-only group (HR 0.94, 95 % CI 0.78-1.15;
p = 0.57). No patients were lost to follow-up at 1 year. The incremental
cost for trial execution was approximately US$ 300,000 or $50 per patient.
Routine thrombus aspiration during PCI in patients with STEMI did not
reduce the rate of all-cause mortality at 1 year. It is possible to design
and conduct mega-trial at only small cost compared to a similar-sized
conventional randomized clinical trial. Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<18>
Accession Number
613333292
Author
Silverman M.G.; Ference B.A.; Im K.; Wiviott S.D.; Giugliano R.P.; Grundy
S.M.; Braunwald E.; Sabatine M.S.
Institution
(Silverman, Im, Wiviott, Giugliano, Braunwald, Sabatine) TIMI Study Group,
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard
Medical School, 75 Francis St, Boston, MA 02115, United States
(Ference) Division of Cardiovascular Medicine, Wayne State University
School of Medicine, Detroit, MI, United States
(Grundy) Center for Human Nutrition, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, United States
Title
Association between lowering LDL-C and cardiovascular risk reduction among
different therapeutic interventions: A systematic review and
meta-analysis.
Source
JAMA - Journal of the American Medical Association. 316 (12) (pp
1289-1297), 2016. Date of Publication: 27 Sep 2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The comparative clinical benefit of nonstatin therapies that
reduce low-density lipoprotein cholesterol (LDL-C) remains uncertain.
OBJECTIVE To evaluate the association between lowering LDL-C and relative
cardiovascular risk reduction across different statin and nonstatin
therapies. DATA SOURCES AND STUDY SELECTION The MEDLINE and EMBASE
databaseswere searched (1966-July 2016). The key inclusion criteria were
that the study was a randomized clinical trial and the reported clinical
outcomes includedmyocardial infarction (MI). Studies were excluded if the
duration was less than 6 months or had fewer than 50 clinical events.
Studies of 9 different types of LDL-C reduction approaches were included.
DATA EXTRACTION AND SYNTHESIS Two authors independently extracted and
entered data into standardized data sheets and data were analyzed
usingmeta-regression. MAIN OUTCOMES AND MEASURES The relative risk (RR) of
major vascular events (a composite of cardiovascular death, acute MI or
other acute coronary syndrome, coronary revascularization, or stroke)
associated with the absolute reduction in LDL-C level; 5-year rate of
major coronary events (coronary death or MI) associated with achieved
LDL-C level. RESULTS A total of 312 175 participants (mean age, 62 years;
24%women; mean baseline LDL-C level of 3.16 mmol/L [122.3mg/dL]) from 49
trials with 39 645 major vascular eventswere included. The RR for major
vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C level was
0.77 (95%CI, 0.71-0.84; P < .001) for statins and 0.75 (95%CI, 0.66-0.86;
P = .002) for established nonstatin interventions thatwork primarily via
upregulation of LDL receptor expression (ie, diet, bile acid sequestrants,
ileal bypass, and ezetimibe) (between-group difference, P = .72). For
these 5 therapies combined, the RRwas 0.77 (95%CI, 0.75-0.79, P < .001)
for major vascular events per 1-mmol/L reduction in LDL-C level. For other
interventions, the observed RRs vs the expected RRs based on the degree of
LDL-C reduction in the trialswere 0.94 (95%CI, 0.89-0.99) vs 0.91 (95%CI,
0.90-0.92) for niacin (P = .24); 0.88 (95%CI, 0.83-0.92) vs 0.94 (95%CI,
0.93-0.94) for fibrates (P = .02), whichwas lower than expected (ie,
greater risk reduction); 1.01 (95%CI, 0.94-1.09) vs 0.90 (95%CI,
0.89-0.91) for cholesteryl ester transfer protein inhibitors (P = .002),
whichwas higher than expected (ie, less risk reduction); and 0.49 (95%CI,
0.34-0.71) vs 0.61 (95%CI, 0.58-0.65) for proprotein convertase
subtilisin/kexin type 9 inhibitors (P = .25). The achieved absolute LDL-C
levelwas significantly associated with the absolute rate of major coronary
events (11 301 events, including coronary death or MI) for primary
prevention trials (1.5%lower event rate [95%CI, 0.5%-2.6%] per each
1-mmol/L lower LDL-C level; P = .008) and secondary prevention trials
(4.6%lower event rate [95%CI, 2.9%-6.4%] per each 1-mmol/L lower LDL-C
level; P < .001). CONCLUSIONS AND RELEVANCE In this meta-regression
analysis, the use of statin and nonstatin therapies that act via
upregulation of LDL receptor expression to reduce LDL-C were associated
with similar RRs of major vascular events per change in LDL-C. Lower
achieved LDL-C levels were associated with lower rates of major coronary
events. &#xa9; Copyright 2016 American Medical Association. All rights
reserved.

<19>
Accession Number
613553650
Author
Bavishi C.; Chatterjee S.; Stone G.W.
Title
Does Current Evidence Favor Drug-Eluting Stents Over Bare-Metal Stents for
Saphenous Venous Graft Interventions?: Insights From an Updated
Meta-Analysis of Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. 9 (23) (pp 2456-2458), 2016. Date of
Publication: 12 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<20>
Accession Number
613458226
Author
Venkatesh R.R.; Kumar P.; Trissur R.R.; George S.K.
Institution
(Venkatesh, Kumar, Trissur, George) Department of Anaesthesiology, PIMS,
Pondicherry, India
Title
A randomized controlled study of 0.5% bupivacaine, 0.5% ropivacaine and
0.75% ropivacaine for supraclavicular brachial plexus block.
Source
Journal of Clinical and Diagnostic Research. 10 (12) (pp UC09-UC12), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Journal of Clinical and Diagnostic Research (No 3, 1/9 Roop Nagar, G T
Road, Delhi 110007, India)
Abstract
Introduction: For any surgery in the upper extremity that does not involve
the shoulder, a supraclavicular block is preferred, as it is a safe
procedure associated with rapid onset and reliable anaesthesia. Although
ropivacaine has been extensively studied for epidural anaesthesia, very
few reports exist on its use in supraclavicular brachial plexus block.
Aim: This study was conducted to investigate and compare the effectiveness
of supraclavicular brachial plexus anaesthesia with two different
concentrations of ropivacaine (0.5% and 0.75%) and to compare them with
the standard 0.5% bupivacaine. Materials and Methods: Ninety patients of
age 18 to 60 years belonging to American Society of Anaesthesiologists
(ASA) status 1 or 2, admitted to Pondicherry Institute of Medical Sciences
were chosen for the study and were divided into three groups. Group A
received 30 ml of 0.5% bupivacaine, group B received 30 ml of 0.5%
ropivacaine and group C received 30 ml of 0.75% ropivacaine into the
supraclavicular region, by a nerve-stimulator technique. Onset time of
each of the drug was recorded both for the sensory and motor block.
Duration of sensory and motor block was recorded along with peri-operative
haemodynamic monitoring. Results: The onset of complete sensory and motor
block observed with both ropivacaine groups and bupivacaine was similar
(16.85 +/- 6.67 min in group A, 17.79 +/- 5.03 min in group B and 18.48
+/- 6.14 in group C, p < 0.05); onset of motor block (21.45 +/- 4.45 min
in group A, 22.23 +/- 4.05 min in group B and 22.33 +/- 5.17 in group C, p
< 0.05). The duration of sensory block with 0.5% bupivacaine was 11.58
hours, with 0.5% ropivacaine was 9.02 hours with 0.75% ropivacaine was
8.87 hours (p<0.001). The duration of motor block with 0.5% bupivacaine
was 12.94 hours, with 0.5% ropivacaine was 8.29 hours with 0.75%
ropivacaine was 7.89 hours (p<0.001). Multiple comparison test with
Bonferroni correction showed there was statistically significant
difference in mean duration of sensory block between Group A (0.5%
bupivacaine) and Group B (0.5% ropivacaine) and also between Group A (0.5%
bupivacaine) and Group C (0.75% ropivacaine). However, there were no
statistically significant difference in mean duration of sensory block
between Group B (0.5% ropivacaine) and Group C (0.75% ropivacaine). The
preoperative, intra operative and postoperative heart rate, systolic &
diastolic blood pressure and oxygen saturation were comparable among the
three study groups (p>0.05). No side effects were recorded in the study.
Conclusion: The onset of sensory and motor block was similar in all the
three groups. However, when compared to bupivacaine group, recovery of
motor functions was faster in both the ropivacaine groups. Patients in all
the 3 groups did not experience any adverse effects. Copyright &#xa9;
2016, Journal of Clinical and Diagnostic Research. All rights reserved.

<21>
Accession Number
613242361
Author
Kuck K.-H.; Furnkranz A.; Chun K.R.J.; Metzner A.; Ouyang F.; Schluter M.;
Elvan A.; Lim H.W.; Kueffer F.J.; Arentz T.; Albenque J.-P.; Tondo C.;
Kuhne M.; Sticherling C.; Brugada J.
Institution
(Kuck, Metzner, Ouyang, Schluter) Department of Cardiology, Asklepios
Klinik St. Georg, Lohmuhlenstr. 5, Hamburg 20099, Germany
(Furnkranz, Chun) Cardioangiologisches Centrum Bethanien, Frankfurt,
Germany
(Elvan) Isala Klinieken, Zwolle, Netherlands
(Lim, Kueffer) Medtronic Inc., Minneapolis, MN, United States
(Arentz) Herz-Zentrum, Bad Krozingen, Germany
(Albenque) Clinique Pasteur, Toulouse, France
(Tondo) Centro Cardiologico Monzino, University of Milan, Milan, Italy
(Kuhne, Sticherling) Universitatsspital Basel, Basel, Switzerland
(Brugada) Hospital Clinic, University of Barcelona, Barcelona, Spain
Title
Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial
fibrillation: Reintervention, rehospitalization, and quality-of-life
outcomes in the FIRE and ICE trial.
Source
European Heart Journal. 37 (38) (pp 2858-2865), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims The primary safety and efficacy endpoints of the randomized FIRE AND
ICE trial have recently demonstrated non-inferiority of cryoballoon vs.
radiofrequency current (RFC) catheter ablation in patients with
drug-refractory symptomatic paroxysmal atrial fibrillation (AF). The aim
of the current study was to assess outcome parameters that are important
for the daily clinical management of patients using key secondary
analyses. Specifically, reinterventions, rehospitalizations, and
quality-of-life were examined in this randomized trial of cryoballoon vs.
RFC catheter ablation. Methods and results Patients (374 subjects in the
cryoballoon group and 376 subjects in the RFC group) were evaluated in the
modified intention-to-treat cohort. After the index ablation, log-rank
testing over 1000 days of follow-up demonstrated that there were
statistically significant differences in favour of cryoballoon ablation
with respect to repeat ablations (11.8% cryoballoon vs. 17.6% RFC; P =
0.03), direct-current cardioversions (3.2% cryoballoon vs. 6.4% RFC; P =
0.04), all-cause rehospitalizations (32.6% cryoballoon vs. 41.5% RFC; P =
0.01), and cardiovascular rehospitalizations (23.8% cryoballoon vs. 35.9%
RFC; P < 0.01). There were no statistical differences between groups in
the quality-of-life surveys (both mental and physical) as measured by the
Short Form-12 health survey and the EuroQol five-dimension questionnaire.
There was an improvement in both mental and physical quality-of-life in
all patients that began at 6 months after the index ablation and was
maintained throughout the 30 months of follow-up. Conclusion Patients
treated with cryoballoon as opposed to RFC ablation had significantly
fewer repeat ablations, direct-current cardioversions, all-cause
rehospitalizations, and cardiovascular rehospitalizations during
follow-up. Both patient groups improved in quality-of-life scores after AF
ablation. Copyright &#xa9; 2016 The Author 2016.

<22>
Accession Number
611632756
Author
Cevallos P.C.; Rose M.J.; Armsby L.B.; Armstrong A.K.; El-Said H.;
Foerster S.R.; Glatz A.C.; Goldstein B.H.; Hainstock M.R.; Kreutzer J.;
Latson L.A.; Leahy R.A.; Petit C.J.; Torres A.; Shahanavaz S.; Zampi J.D.;
Bergersen L.
Institution
(Cevallos, Rose, Bergersen) Department of Cardiology, Boston Children's
Hospital, Bader 607, 300 Longwood Avenue, Boston, MA 02115, United States
(Armsby) Pediatric Cardiology Department, Doernbecher Children's Hospital,
Portland, OR, United States
(Armstrong) Department of Cardiology, Nationwide Children's Hospital,
Columbus, OH, United States
(El-Said) Department of Cardiology, Rady Children's Hospital, San Diego,
CA, United States
(Foerster) Division of Cardiology, Children's Hospital of Wisconsin,
Milwaukee, WI, United States
(Glatz) Cardiac Center, The Children's Hospital of Philadelphia,
Philadelphia, PA, United States
(Goldstein) Department of Cardiology, Cincinnati Children's Hospital,
Cincinnati, OH, United States
(Hainstock) Division of Pediatric Cardiology, University of Virginia
Medical Center, Charlottesville, VA, United States
(Kreutzer) Division of Pediatric Cardiology, Children's Hospital of
Pittsburgh, Pittsburgh, PA, United States
(Latson) Department of Cardiology, Joe DiMaggio Children's Hospital,
Hollywood, FL, United States
(Leahy) Department of Cardiology, Kosair Children's Hospital, Louisville,
KY, United States
(Petit) Department of Cardiology, Children's Healthcare of Atlanta Sibley
Heart Center, Atlanta, GA, United States
(Torres) Division of Pediatric Cardiology, Morgan Stanley Children's
Hospital, New York, NY, United States
(Shahanavaz) Division of Pediatric Cardiology, St. Louis Children's
Hospital, St. Louis, MO, United States
(Zampi) Department of Pediatric Cardiology, University of Michigan, Ann
Arbor, MI, United States
Title
Implementation of Methodology for Quality Improvement in Pediatric Cardiac
Catheterization: A Multi-center Initiative by the Congenital Cardiac
Catheterization Project on Outcomes-Quality Improvement (C3PO-QI).
Source
Pediatric Cardiology. 37 (8) (pp 1436-1445), 2016. Date of Publication: 01
Dec 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The Congenital Cardiac Catheterization Project on Outcomes (C3PO) launched
in 2007 as a multi-center collaborative to establish standardized and
comparable metrics for pediatric cardiac catheterization procedures. The
limitations of larger registries at the time led to the development of the
next phase in 2013, C3PO-Quality Improvement (C3PO-QI), focusing on
instituting QI initiatives within the field. The objective of this
manuscript is to provide a detailed overview of C3PO-QI and report data on
case characteristics and outcome metrics being explored. C3PO-QI was
designed to cultivate institutional collaboration during implementation of
its initiatives. A database and website were developed to support data
entry and on-demand reporting. The registry prospectively captures
pediatric cardiac catheterization data among 15 hospitals. The present
study includes case demographic data (n) and quality metric reporting by
case type, age, and radiation dose variables. This dataset includes 13,135
cases entered into the database between 1/1/2014 and 12/31/2015.
Interventional cases make up the highest percentage by case mix
distribution (48 %), and patients <1 years make up the highest percentage
by age distribution (26 %). The ratio of diagnostic and interventional
procedures performed changes by age group. Application of QI metric shows
all procedure types surpassing metric goals. Large volume data collection,
such as in C3PO-QI, allows for meaningful interpretation of data. C3PO-QI
is uniquely poised to deliver fast-paced changes in the field. Although
the project initiatives are specific to pediatric cardiac catheterization,
the implementation of the project and utilization of real-time reporting
is generalizable to other specialties and multi-center collaboratives.
Copyright &#xa9; 2016, Springer Science+Business Media New York.

<23>
Accession Number
613238456
Author
Mugnai G.; Benfari G.; Fede A.; Rossi A.; Chierchia G.-B.; Vassanelli F.;
Menegatti G.; Ribichini F.L.
Institution
(Mugnai, Benfari, Fede, Rossi, Vassanelli, Menegatti, Ribichini)
Department of Cardiology, University Hospital of Verona, Italy
(Chierchia) Heart Rhythm Management Centre, UZ Brussel-VUB, Belgium
Title
Tpeak-to-Tend/QT is an independent predictor of early ventricular
arrhythmias and arrhythmic death in anterior ST elevation myocardial
infarction patients.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (6) (pp 473-480),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The aim of our study was to analyse the markers of transmural
dispersion of ventricular repolarization, especially Tpeak-to-Tend and
Tpeak-to-Tend /QT ratio, in patients with anterior ST elevation myocardial
infarction on admission and to evaluate their association with in-hospital
life-threatening arrhythmias and mortality. Methods and results: A total
of 223 consecutive patients with anterior wall ST elevation myocardial
infarction admitted to our Division of Cardiology between January 2010 and
December 2012 were prospectively evaluated. A standard electrocardiogram
was obtained on admission and then analysed. The primary end point was
constituted by in-hospital ventricular arrhythmias and arrhythmic death.
At univariate analysis heart rate (odds ratio = 1.03; 95% confidence
intervals 1.006-1.05; p=0.001), maximal ST elevation (odds ratio =1.25;
95% confidence intervals 1.10-1.43; p=0.0001), QTc Bazett (odds ratio =
1.01; 95% confidence intervals 1.006-1.02; p=0.002), QT dispersion (odds
ratio = 1.02; 95% confidence intervals 1.002-1.04; p=0.02) and both
Tpeak-to-Tend and Tpeak-to-Tend/QT (odds ratio = 1.02; 95% confidence
intervals 1.01-1.03; p<0.0001 and OR = 1.07; 95% confidence intervals
1.03-1.11; p<0.0001 respectively) were significantly associated with
ventricular arrhythmias and arrhythmic mortality. Of note, Tpeak-to-Tend
/QT remained a predictor of early ventricular arrhythmias and arrhythmic
death (odds ratio = 1.04; 95% confidence intervals 1.003 - 1.10; p=0.03)
independently from heart rate and maximal ST elevation. Receiver operating
characteristic curve analysis showed that Tpeak-to-Tend /QT values <0.31
had a predictive negative value of 92% for the prediction of the composite
outcome. Conclusions: Tpeak-to-Tend /QT was an independent predictor of
early ventricular arrhythmias and arrhythmic mortality in patients with
anterior ST elevation myocardial infarction. Especially, Tpeak-to-Tend /QT
<0.31 may identify a subgroup of ST elevation myocardial infarction
patients with low risk of early arrhythmias and arrhythmic death.
Copyright &#xa9; The European Society of Cardiology 2015.

<24>
Accession Number
611840479
Author
Hill G.D.; Rudd N.A.; Ghanayem N.S.; Hehir D.A.; Bartz P.J.
Institution
(Hill, Rudd, Bartz) Divison of Cardiology, Department of Pediatrics,
Medical College of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI 53226,
United States
(Ghanayem) Division of Critical Care, Department of Pediatrics, Medical
College of Wisconsin, Milwaukee, WI, United States
(Hehir) Division of Cardiac Critical Care, Department of Pediatrics,
Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, United
States
(Bartz) Division of Adult Cardiovascular Medicine, Department of Internal
Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
Title
Center Variability in Timing of Stage 2 Palliation and Association with
Interstage Mortality: A Report from the National Pediatric Cardiology
Quality Improvement Collaborative.
Source
Pediatric Cardiology. 37 (8) (pp 1516-1524), 2016. Date of Publication: 01
Dec 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
For infants with single-ventricle lesions with aortic arch hypoplasia, the
interstage period from discharge following stage 1 palliation (S1P) until
stage 2 palliation (S2P) remains high risk. Significant variability among
institutions exists around the timing of S2P. We sought to describe
institutional variation in timing of S2P, determine the association
between timing of S2P and interstage mortality, and determine the impact
of earlier S2P on hospital morbidity and mortality. The National Pediatric
Cardiology Quality Improvement Collaborative registry was queried. Centers
were divided based on median age at S2P into early (n = 15) and late (n =
16) centers using a cutoff of 153 days. Groups were compared using
Chi-squared or Wilcoxon rank-sum test. Multivariable logistic regression
was used to determine risk factors for interstage mortality. The final
cohort included 789 patients from 31 centers. There was intra- and
inter-center variability in timing of S2P, with the median age by center
ranging from 109 to 214 days. Late centers had a higher mortality (9.9 vs.
5.7 %, p = 0.03) than early centers. However, the event rate (late: 8.2
vs. early: 5.8 deaths per 10,000 interstage days) was not different by
group (p = 0.26). Survival to hospital discharge and hospital length of
stay following S2P were similar between groups. In conclusion, in a large
multi-institution collaborative, the median age at S2P varies among
centers. Although optimal timing of S2P remains unclear, centers
performing early S2P did not experience worse S2P outcomes and experienced
less interstage mortality. Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<25>
Accession Number
613296985
Author
Heddle N.M.; Cook R.J.; Arnold D.M.; Liu Y.; Barty R.; Crowther M.A.;
Devereaux P.J.; Hirsh J.; Warkentin T.E.; Webert K.E.; Roxby D.;
Sobieraj-Teague M.; Kurz A.; Sessler D.I.; Figueroa P.; Ellis M.;
Eikelboom J.W.
Institution
(Heddle, Arnold, Liu, Barty, Crowther, Devereaux, Hirsh, Warkentin,
Eikelboom) Department of Medicine, Hamilton, ON, Canada
(Heddle, Crowther, Warkentin, Webert) Department of Pathology and
Molecular Medicine, Hamilton, ON, Canada
(Heddle, Devereaux) Department of Clinical Epidemiology and Biostatistics,
Hamilton, ON, Canada
(Heddle, Cook, Arnold, Liu, Barty, Warkentin, Webert) McMaster Centre for
Transfusion Research, Hamilton, ON, Canada
(Heddle, Arnold, Webert) McMaster University, Canadian Blood Services, HSC
3H51, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada
(Devereaux, Eikelboom) Population Health Research Institute, Hamilton, ON,
Canada
(Eikelboom) Thrombosis and Atherosclerosis Research Institute, Hamilton,
ON, Canada
(Cook) Department of Statistics and Actuarial Science, University of
Waterloo, Waterloo, ON, Canada
(Roxby, Sobieraj-Teague) SA Pathology Transfusion Service, Flinders
Medical Centre, Flinders University, Adelaide, SA, Australia
(Kurz) Department of General Anesthesiology, United States
(Kurz, Sessler) Department of Outcomes Research, Anesthesiology Institute,
United States
(Figueroa) Robert J. Tomsich Pathology and Laboratory Medicine Institute,
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, United
States
(Ellis) Meir Medical Center Kfar Saba and Sackler School of Medicine, Tel
Aviv University, Tel Aviv, Israel
Title
Effect of short-term vs. Long-term blood storage on mortality after
transfusion.
Source
New England Journal of Medicine. 375 (20) (pp 1937-1945), 2016. Date of
Publication: 17 Nov 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Randomized, controlled trials have suggested that the
transfusion of blood after prolonged storage does not increase the risk of
adverse outcomes among patients, although most of these trials were
restricted to high-risk populations and were not powered to detect small
but clinically important differences in mortality. We sought to find out
whether the duration of blood storage would have an effect on mortality
after transfusion in a general population of hospitalized patients.
METHODS In this pragmatic, randomized, controlled trial conducted at six
hospitals in four countries, we randomly assigned patients who required a
red-cell transfusion to receive blood that had been stored for the
shortest duration (short-term storage group) or the longest duration
(long-term storage group) in a 1:2 ratio. Only patients with type A or O
blood were included in the primary analysis, since pilot data suggested
that our goal of achieving a difference in the mean duration of blood
storage of at least 10 days would not be possible with other blood types.
Written informed consent was waived because all the patients received
treatment consistent with the current standard of care. The primary
outcome was in-hospital mortality, which was estimated by means of a
logistic-regression model after adjustment for study center and patient
blood type. RESULTS From April 2012 through October 2015, a total of
31,497 patients underwent randomization. Of these patients, 6761 who did
not meet all the enrollment criteria were excluded after randomization.
The primary analysis included 20,858 patients with type A or O blood. Of
these patients, 6936 were assigned to the short-term storage group and
13,922 to the long-term storage group. The mean storage duration was 13.0
days in the short-term storage group and 23.6 days in the long-term
storage group. There were 634 deaths (9.1%) in the short-term storage
group and 1213 (8.7%) in the long-term storage group (odds ratio, 1.05;
95% confidence interval [CI], 0.95 to 1.16; P = 0.34). When the analysis
was expanded to include the 24,736 patients with any blood type, the
results were similar, with rates of death of 9.1% and 8.8%, respectively
(odds ratio, 1.04; 95% CI, 0.95 to 1.14; P = 0.38). Additional results
were consistent in three prespecified high-risk subgroups (patients
undergoing cardiovascular surgery, those admitted to intensive care, and
those with cancer). CONCLUSIONS Among patients in a general hospital
population, there was no significant difference in the rate of death among
those who underwent transfusion with the freshest available blood and
those who underwent transfusion according to the standard practice of
transfusing the oldest available blood. Copyright &#xa9; 2016
Massachusetts Medical Society.

<26>
Accession Number
613537098
Author
Haleem A.; Chiang H.-Y.; Vodela R.; Behan A.; Pottinger J.M.; Smucker J.;
Greenlee J.D.; Clark C.; Herwaldt L.A.
Institution
(Haleem, Chiang, Herwaldt) Department of Internal Medicine, University of
Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA
52242-1081, United States
(Vodela) Mercy Health West Hospital, Cincinnati, OH, United States
(Behan) Mercy Health Lourdes Hospital, Paducah, KT, United States
(Pottinger, Herwaldt) Clinical Quality, Safety, and Process Improvement,
University of Iowa Hospitals and Clinics, Iowa City, IA, United States
(Smucker) Indiana Spine Group, Carmel Facility, Carmel, IN, United States
(Greenlee) Department of Neurosurgery, University of Iowa Carver College
of Medicine, Iowa City, IA, United States
(Clark) Department of Orthopaedics, University of Iowa Carver College of
Medicine, Iowa City, IA, United States
(Herwaldt) Department of Epidemiology, University of Iowa College of
Public Health, Iowa City, IA, United States
Title
Risk Factors for Surgical Site Infections Following Adult Spine
Operations.
Source
Infection Control and Hospital Epidemiology. 37 (12) (pp 1458-1467), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Cambridge University Press (E-mail: subscriptions@press.uchicago.edu)
Abstract
OBJECTIVE To identify risk factors for surgical site infections (SSIs)
after spine operations. DESIGN Case-control study of SSIs among patients
undergoing spine operations. SETTING An academic health center. PATIENTS
We studied patients undergoing spinal fusions or laminectomies at the
University of Iowa Hospitals and Clinics from January 1, 2007, through
June 30, 2009. We included patients who acquired SSIs meeting the National
Healthcare Safety Network definition. We randomly selected controls among
patients who had spine operations during the study period and did not meet
the SSI definition. RESULTS In total, 54 patients acquired SSIs after
2,309 spine operations (2.3 per 100 procedures). SSIs were identified a
median of 20 days after spinal fusions and 17 days after laminectomies;
90.7% were identified after discharge and 72.2% were deep incisional or
organ-space infections. Staphylococcus aureus caused 53.7% of SSIs. Of
patients with SSIs, 64.9% (fusion) and 70.6% (laminectomy) were readmitted
and 59.5% (fusion) and 64.7% (laminectomy) underwent reoperation. By
multivariable analysis, increased body mass index, Surgical Department A,
fusion of 4-8 vertebrae, and operation at a thoracic or lumbar/sacral
level were significant risk factors for SSIs after spinal fusions. Lack of
private insurance and hypertension were significant risk factors for SSIs
after laminectomies. Surgeons from Department A were more likely to use
nafcillin or vancomycin for perioperative prophylaxis and to do more
multilevel fusions than surgeons from Department B. CONCLUSIONS SSIs after
spine operations significantly increase utilization of healthcare
resources. Possible remediable risk factors include obesity, hypertension,
and perioperative antimicrobial prophylaxis. Copyright &#xa9; 2016 by The
Society for Healthcare Epidemiology of America.

<27>
Accession Number
602861440
Author
Opfermann P.; Derhaschnig U.; Felli A.; Wenisch J.; Santer D.; Zuckermann
A.; Dworschak M.; Jilma B.; Steinlechner B.
Institution
(Opfermann, Felli, Dworschak, Steinlechner) Division of Cardiothoracic and
Vascular Anesthesia and Intensive Care, Medical University of Vienna,
Vienna, Austria
(Derhaschnig, Jilma) Department of Clinical Pharmacology, Medical
University of Vienna, Vienna, Austria
(Wenisch) Department of Internal Medicine I, Department of Clinical
Pharmacology, Medical University of Vienna, Vienna, Austria
(Zuckermann) Division of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Santer) Division of Cardiovascular Surgery, Hietzing Hospital, Vienna,
Austria
Title
A pilot study on reparixin, a CXCR1/2 antagonist, to assess safety and
efficacy in attenuating ischaemia-reperfusion injury and inflammation
after on-pump coronary artery bypass graft surgery.
Source
Clinical and Experimental Immunology. 180 (1) (pp 131-142), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Summary: Reparixin, a CXCR 1/2 antagonist, has been shown to mitigate
ischaemia-reperfusion injury (IRI) in various organ systems in animals,
but data in humans are scarce. The aim of this double-blinded,
placebo-controlled pilot study was to evaluate the safety and efficacy of
reparixin to suppress IRI and inflammation in patients undergoing on-pump
coronary artery bypass grafting (CABG). Patients received either reparixin
or placebo (n=16 in each group) after induction of anaesthesia until 8h
after cardiopulmonary bypass (CPB). We compared markers of systemic and
pulmonary inflammation, surrogates of myocardial IRI and clinical outcomes
using Mann-Whitney U- and Fisher's exact tests. Thirty- and 90-day
mortality was 0% in both groups. No side effects were observed in the
treatment group. Surgical revision, pleural and pericardial effusion,
infection and atrial fibrillation rates were not different between groups.
Reparixin significantly reduced the proportion of neutrophil granulocytes
in blood at the beginning [49%, interquartile range (IQR)=45-57 versus
58%, IQR=53-66, P=0.035], end (71%, IQR=67-76 versus 79%, IQR=71-83,
P=0.023) and 1h after CPB (73%, IQR=71-75 versus 77%, IQR=72-80, P=0.035).
Reparixin patients required a lesser positive fluid balance during surgery
(2575ml, IQR=2027-3080 versus 3200ml, IQR=2928-3778, P=0.029) and during
ICU stay (2603ml, IQR=1023-4288 versus 4200ml, IQR=2313-8160, P=0.021).
Numerically, more control patients required noradrenaline > 0.11mug/kg/min
(50 versus 19%, P=0.063) and dobutamine (50 versus 25%, P=0.14).
Therefore, administration of reparixin in CABG patients appears to be
feasible and safe. It concurrently attenuated postoperative granulocytosis
in peripheral blood. Copyright &#xa9; 2014 British Society for Immunology.

<28>
[Use Link to view the full text]
Accession Number
605865087
Author
Wrobel K.; Stevens S.R.; Jones R.H.; Selzman C.H.; Lamy A.; Beaver T.M.;
Djokovic L.T.; Wang N.; Velazquez E.J.; Sopko G.; Kron I.L.; Dimaio J.M.;
Michler R.E.; Lee K.L.; Yii M.; Leng C.Y.; Zembala M.; Rouleau J.L.; Daly
R.C.; Al-Khalidi H.R.
Institution
(Wrobel) Allenort Hospital, Warsaw, Poland
(Wrobel) John Paul II Hospital, Krakow, Poland
(Stevens) Duke Clinical Research Institute, Durham, NC, United States
(Jones, Velazquez, Lee, Al-Khalidi) Duke University, School of Medicine,
Duke Clinical Research Institute, Durham, NC, United States
(Selzman) University of Utah, Salt Lake City, UT, United States
(Lamy) Hamilton General Hospital, McMaster University, Hamilton, ON,
Canada
(Beaver) Shands Hospital, University of Florida, Gainesville, FL, United
States
(Djokovic) Dedinje Cardiovascular Institute, Belgrade, Serbia
(Wang) Loma Linda University Medical Center, CA, United States
(Sopko) National Institutes of Health, National Heart, Blood, and Lung
Institute, Bethesda, MD, United States
(Kron) University of Virginia, Charlottesville, VA, United States
(Dimaio) Baylor University Medical Center, Dallas, TX, United States
(Michler) Montefiore Medical Center, Albert Einstein College of Medicine,
New York, NY, United States
(Yii) St. Vincent's Hospital Melbourne, University of Melbourne, Australia
(Leng) National Heart Centre Singapore, Singapore, Singapore
(Zembala) Silesian Center for Heart Diseases in Zabrze, Zabrze, Poland
(Rouleau) Montreal Heart Institute, University de Montreal, Canada
(Daly) Mayo Clinic, Rochester, MN, United States
Title
Influence of baseline characteristics, operative conduct, and
postoperative course on 30-day outcomes of coronary artery bypass grafting
among patients with left ventricular dysfunction: Results from the
Surgical Treatment for Ischemic Heart Failure (STICH) trial.
Source
Circulation. 132 (8) (pp 720-730), 2015. Date of Publication: 25 Aug 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
Background - Patients with severe left ventricular dysfunction, ischemic
heart failure, and coronary artery disease suitable for coronary artery
bypass grafting (CABG) are at higher risk for surgical morbidity and
mortality. Paradoxically, those patients with the most severe coronary
artery disease and ventricular dysfunction who derive the greatest
clinical benefit from CABG are also at the greatest operative risk, which
makes decision making regarding whether to proceed to surgery difficult in
such patients. To better inform such decision making, we analyzed the
Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for
detailed information on perioperative risk and outcomes. Methods and
Results - In both STICH trials (hypotheses), 2136 patients with a left
ventricular ejection fraction of <35% and coronary artery disease were
allocated to medical therapy, CABG plus medical therapy, or CABG with
surgical ventricular reconstruction. Relationships of baseline
characteristics and operative conduct with morbidity and mortality at 30
days were evaluated. There were a total of 1460 patients randomized to and
receiving surgery, and 346 (=25%) of these high-risk patients developed a
severe complication within 30 days. Worsening renal insufficiency, cardiac
arrest with cardiopulmonary resuscitation, and ventricular arrhythmias
were the most frequent complications and those most commonly associated
with death. Mortality at 30 days was 5.1% and was generally preceded by a
serious complication (65 of 74 deaths). Left ventricular size, renal
dysfunction, advanced age, and atrial fibrillation/flutter were
significant preoperative predictors of mortality within 30 days.
Cardiopulmonary bypass time was the only independent surgical variable
predictive of 30-day mortality. Conclusions - CABG can be performed with
relatively low 30-day mortality in patients with left ventricular
dysfunction. Serious postoperative complications occurred in nearly 1 in 4
patients and were associated with mortality. Copyright &#xa9; 2015
American Heart Association, Inc.

<29>
Accession Number
601339973
Author
Herbeck Belnap B.; Schulberg H.C.; He F.; Mazumdar S.; Reynolds III;
Rollman B.L.
Institution
(Herbeck Belnap, Rollman) Division of General Internal Medicine, Center
for Research on Health Care, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States
(Schulberg) Department of Psychiatry, Weill Cornell Medical College, White
Plains, NY, United States
(He, Mazumdar) Department of Biostatistics, University of Pittsburgh
Graduate School of Public Health, Pittsburgh, PA, United States
(Reynolds) Department of Psychiatry, University of Pittsburgh School of
Medicine, Pittsburgh, PA, United States
Title
Electronic protocol for suicide risk management in research participants.
Source
Journal of Psychosomatic Research. 78 (4) (pp 340-345), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To describe an electronic, telephone-delivered, suicide risk
management protocol (SRMP) that is designed to guide research staff and
safely triage study participants who are at risk for self-harm. Methods:
We tested the SRMP in the context of the NIH-funded randomized clinical
trial "Bypassing the Blues" in which 302 patients who had undergone
coronary artery bypass graft surgery (CABG) were screened for depression
and assessed by telephone 2-weeks following hospital discharge and at 2-,
4-, and 8-month follow-up. We programmed the SRMP to assign different risk
levels based on patients' answers from none to imminent with action items
for research staff keyed to each of them. We describe frequency of
suicidal thinking, SRMP use, and completion of specific steps in the SRMP
management process over the 8-month follow-up period. Results: Suicidal
ideation was expressed by 74 (25%) of the 302 study participants in 139
(13%) of the 1069 blinded telephone assessments performed by research
staff. The SRMP was launched in 103 (10%) of assessments, and the suicidal
risk level was classified as moderate or high in 10 (1%) of these
assessments, thereby necessitating an immediate evaluation by a study
psychiatrist. However, no hospitalizations, emergency room visits, or
deaths ascribed to suicidal ideation were discovered during the study
period. Conclusion: The SRMP was successful in systematically and safely
guiding research staff lacking specialty mental health training through
the standardized risk assessment and triaging research participants at
risk for self-harm. Copyright &#xa9; 2014.

<30>
[Use Link to view the full text]
Accession Number
603861373
Author
Wang A.; Sangli C.; Lim S.; Ailawadi G.; Kar S.; Herrmann H.C.; Grayburn
P.; Foster E.; Weissman N.J.; Glower D.; Feldman T.
Institution
(Wang) Department of Medicine, Duke University Medical Center, Durham, NC
27710, United States
(Glower) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Sangli) Abbott Vascular Structural Heart, Menlo Park, CA, United States
(Lim) Department of Medicine, University of Virginia, Charlottesville, VA,
United States
(Ailawadi) Department of Surgery, University of Virginia, Charlottesville,
VA, United States
(Kar) Department of Medicine, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Grayburn) Department of Cardiology, Baylor University Medical Center,
Baylor Heart and Vascular Institute, Dallas, TX, United States
(Foster) Department of Medicine, University of California, San Francisco,
CA, United States
(Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Feldman) Department of Medicine, Evanston Hospital, NorthShore University
Health System, Evanston, IL, United States
Title
Evaluation of renal function before and after percutaneous mitral valve
repair.
Source
Circulation: Cardiovascular Interventions. 8 (1) (no pagination), 2015.
Article Number: e001349. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
Background-Chronic kidney disease (CKD) is strongly related to outcome in
cardiovascular diseases. The relationship between treatment of mitral
regurgitation (MR) and renal function is not well described. We sought to
evaluate renal function before and after mitral valve repair by the
MitraClip device. Methods and Results-Patients with moderate-to-severe or
severe (3+ or 4+, respectively) MR by core laboratory determination who
underwent transcatheter mitral valve repair with the MitraClip device in
multicenter, investigational trials were included in this study. Estimated
glomerular filtration rate (eGFR) was evaluated before and at hospital
discharge, 30 days, 6 months, and 1 year after mitral valve repair. Eight
hundred fifty-four patients with baseline mean eGFR 61.5+/-23.1
mL/min/1.73 m<inf>2</inf> were studied, including 438 (51.3%) with eGFR
>60 mL/min/1.73 m<inf>2</inf> (CKD stage 1 or 2), 371 (42.6%) with eGFR 30
to 59 mL/min/1.73 m<inf>2</inf> (CKD stage 3), and 52 (6.1%) with eGFR <30
mL/min/1.73 m<inf>2</inf> (CKD stage 4 or 5). Baseline renal dysfunction
was more prevalent in older patients with a history of heart failure,
coronary artery disease, cerebrovascular disease, diabetes mellitus,
hypertension, and atrial fibrillation. Baseline eGFR was associated with
1-year survival (P<0.001) after MitraClip repair. At 1-year follow-up, the
mean change in eGFR for the overall cohort was -1.0+/-15.1 mL/min/1.73
m<inf>2</inf>; for patients with CKD stage 1 or 2, stage 3, or stage 4 or
5, mean change was -4.1+/-16.6, +2.6+/-12.4, and +4.8+/-9.5 mL/min/1.73
m<inf>2</inf>, respectively. Linear mixed effect modeling demonstrated a
strong association between MR and eGFR, and a statistically significant
improvement in eGFR in patients with CKD stage 4 or 5 associated with MR
reduction to <2+ (P=0.007). Conclusions-Renal dysfunction is associated
with lower survival in patients with severe MR even after percutaneous
mitral valve repair. Reduction in MR severity by the MitraClip device is
associated with improvement in renal function at 1 year in patients with
baseline renal dysfunction. Copyright &#xa9; 2015 American Heart
Association, Inc.

<31>
Accession Number
605682389
Author
Raksakietisak M.; Ngamlamiad C.; Duangrat T.; Soontarinka S.; Raksamani K.
Institution
(Raksakietisak, Ngamlamiad, Duangrat, Soontarinka, Raksamani) Department
of Anesthesiology, Mahidol University, Bangkok, Thailand
Title
The changes in cortisol levels during cardiac surgery: A randomized
double-blinded study between two induction agents etomidate and
thiopentone.
Source
Journal of the Medical Association of Thailand. 98 (8) (pp 775-781), 2015.
Date of Publication: 01 Aug 2015.
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: To study the changes in cortisol levels during and after
cardiac surgery after an inductive dose of either etomidate or thiopentone
and their consequences. Material and Method: A prospective, randomized,
double-blinded study was conducted in 26 patients undergoing elective
cardiac surgery. They received either etomidate or thiopentone for
induction. Serum cortisol levels were measured preoperatively, and then at
2-, 4-, 8-, and 24-hour. All of the patients received standard anesthesia
and surgery. The data also included patients perioperative management and
outcome. Results: There is no difference in patients' characteristics. The
baseline plasma morning cortisols in the two groups were comparable
(11.7?7.5 mcg/dL in etomidate group vs. 12.0?8.2 mcg/dL in thiopentone
group). In both groups, during surgery, the cortisol levels rose to higher
levels and reached peak levels at four to eight hours and related to
surgical stress. At all times, the etomidate group had lower cortisol
levels but only at 8-hour, the etomidate group had significantly lower
cortisol level (39.9+/-14.2 vs. 65.9+/-20.0 mcg/dL). At 24 hours, in both
groups, cortisol levels were lower than at 8-hour but did not return to
normal baseline levels. There were no differences in the dose of inotropic
use and ICU stay. However, surprisingly the etomidate group had shorter
hospital stay. Conclusion: A single dose of etomidate used for induction
in elective cardiac patients can partially and reversibly inhibit of the
cortisol synthesis for, at least, 24 hours, but its association with any
hemodynamic consequences cannot be concluded. Registration:
ClinicalTrials.gov as NCT01495949. Copyright &#xa9; 2015, Medical
Association of Thailand. All rights reserved.

<32>
Accession Number
603518757
Author
Dillon J.; Yakub M.A.; Kong P.K.; Ramli M.F.; Jaffar N.; Gaffar I.F.
Institution
(Dillon, Yakub, Kong) Department of Cardiothoracic Surgery, National Heart
Institute, 145 Jalan Tun Razak, Kuala Lumpur 50400, Malaysia
(Ramli, Jaffar, Gaffar) Clinical Research Department, National Heart
Institute, Kuala Lumpur, Malaysia
Title
Comparative long-term results of mitral valve repair in adults with
chronic rheumatic disease and degenerative disease: Is repair for
"burnt-out" rheumatic disease still inferior to repair for degenerative
disease in the current era'.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (3) (pp 771-779),
2015. Date of Publication: 01 Mar 2015.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Mitral valve repair is perceived to be of limited durability for
advanced rheumatic disease in adults. We aim to examine the long-term
outcomes of repair for rheumatic disease, identify predictors of
durability, and compare with repair for degenerative disease. Methods
Rheumatic and degenerative mitral valve repairs in patients aged 40 years
or more were prospectively analyzed. The primary outcomes investigated
were mortality, freedom from reoperation, and valve failure. Logistic
regression analysis was performed to define predictors of poor outcome.
Results Between 1997 and 2011, 253 rheumatic and 148 degenerative mitral
valves were repaired. The age of patients in both groups was similar, with
a mean of 54.1 +/- 8.4 years versus 55.6 +/- 7.3 years (P =.49). Freedom
from reoperation for rheumatic valves at 5 and 10 years was 98.4%,
comparable to 95.3% (P =.12) for degenerative valves. Freedom from valve
failure at 5 and 10 years was 91.4% and 81.5% for rheumatic repairs and
82.5% and 75.4% for degenerative repairs, respectively (P =.15). The
presence of residual mitral regurgitation greater than 2+ before discharge
was the only significant independent predictor of reoperation, whereas
residual mitral regurgitation greater than 2+ and leaflet procedures were
significant risk factors for valve failure. Conclusions The durability of
rheumatic mitral valve repair in the current era has improved and is
comparable to the outstanding durability of repairs for degenerative
disease, even in the adult rheumatic population. Modifications of standard
repair techniques, adherence to the importance of good leaflet coaptation,
and strict quality control with stringent use of intraoperative
transesophageal echocardiography have all contributed to the improved
long-term results. Copyright &#xa9; 2015 The American Association for
Thoracic Surgery.

<33>
Accession Number
603518713
Author
Smit Y.; Vlayen J.; Koppenaal H.; Eefting F.; Kappetein A.P.; Mariani M.A.
Institution
(Smit) Independent Researcher, Leuth, Netherlands
(Vlayen) ME-TA, Rotselaar, Belgium
(Koppenaal) Independent Researcher, Vlissingen, Netherlands
(Eefting) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Kappetein) Department of Cardiothoracic Surgery, Erasmus Medisch Centrum,
Rotterdam, Netherlands
(Mariani) Department of Cardiothoracic Surgery, University Medical Centre
Groningen, University of Groningen, P.O. Box 30.001, Groningen 9700 RB,
Netherlands
Title
Percutaneous coronary invervention versus coronary artery bypass grafting:
A meta-Analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 149 (3) (pp 831-838.e13),
2015. Date of Publication: 01 Mar 2015.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To compare the effectiveness of percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) in patients
with coronary artery disease. Methods MEDLINE, Embase, and Cochrane
Central were searched, and randomized controlled trials were included.
Outcomes were assessed at maximum available follow-up. Results This
meta-Analysis includes 31 trials with 15,004 patients. As regards death,
more patients died after PCI compared with CABG across all types of
patients (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0-1.3; P
=.05) as well as in patients with multivessel disease (OR, 1.2; 95% CI,
1.0-1.4; P =.02) or diabetes (OR, 1.6; 95% CI, 1.2-2.1; P <.01).
Myocardial infarction occurred as frequently after PCI (OR, 1.2; 95% CI,
0.9-1.5; P =.28). Repeat revascularization was more common after PCI (OR,
4.5; 95% CI, 3.5-5.8; P <.01), with a progressive decline in ORs from the
pre-stent era (OR, 7.0; 95% CI, 5.1-9.7; P <.01), to the bare metal stent
era (OR, 4.5; 95% CI, 3.6-5.5; P <.01), and to the drug-eluting stent era
(OR, 2.5; 95% CI, 1.8-3.4; P <.01). Stroke was more common after CABG (OR,
0.7; 95% CI, 0.5-0.9; P =.01). Conclusions Compared with PCI, CABG had a
lower risk of death in multivessel disease or diabetes patients eligible
for either intervention, a lower risk of repeat revascularization, but a
higher risk of stroke. Copyright &#xa9; 2015 The American Association for
Thoracic Surgery.

<34>
Accession Number
610943985
Author
Landis R.C.
Institution
(Landis) Edmund Cohen Laboratory for Vascular Research, Chronic Disease
Research Centre, University of the West Indies BB11115, Barbados
Title
20 years on: Is it time to redefine the systemic inflammatory response to
cardiothoracic surgery?.
Source
Journal of Extra-Corporeal Technology. 47 (1) (pp 5-9), 2015. Date of
Publication: 2015.
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
The "systemic inflammatory response" has never been defined from a
cardiothoracic surgery perspective, but borrowed its definition from the
critical care field at a landmark 1992 definition conference on sepsis. It
is unclear why the diagnostic criteria for the Systemic Inflammatory
Response Syndrome (SIRS) were adopted in isolation, ignoring other
potentially more useful definitions for Severe Septic Shock or Secondary
Multiple Organ Dysfunction Syndrome. The 1992 SIRS definition for sepsis
has since been updated at a conference in 2001 advocating PIRO
(Predisposition, Infection, host Response, Organ dysfunction) as a
hypothetical model to better link sepsis with clinical outcome. PIRO is
readily adaptable to cardiothoracic surgery and provides the precedent and
road map for how to update a definition. The need is obvious since the
current definition of SIRS is widely disregarded in heart surgery: a
dwindling proportion (14%) of articles on the systemic inflammatory
response even mention SIRS and 0% monitored SIRS criteria in the past
decade in an evidence-based review of anti-inflammatory interventions. The
name "inflammatory response" is also problematic; it is too narrow and
might be replaced with host response (the R in PIRO) to better convey the
wide spectrum of host defensive pathways activated during heart surgery
(i.e., complement, coagulation, fibrinolysis, kinins, cytokines,
proteases, hemolysis, oxidative stress). A variant on PIRO could allow
these elements of the host Response (R) to be anchored within the context
of Premorbid conditions (P) and the inevitable Insult (I) from surgery, to
better link risk exposures to Organ dysfunction (O) in heart surgery. The
precedent of PIRO suggests the following steps will be required to
redefine the systemic inflammatory response: 1) buy-in from the leading
societies for cardiothoracic surgery, anesthesia, and perfusion on the
need for a re-definition conference, 2) assigning relative risk scores to
different premorbid exposures, operative insults, and host response
factors on clinical outcome, 3) validation of the risk model in a
prospective cohort, and 4) development of algorithms or "apps" to
facilitate rapid diagnosis and staging of care at bedside.

<35>
Accession Number
605447392
Author
Fink H.A.; Hemmy L.S.; MacDonald R.; Carlyle M.H.; Olson C.M.; Dysken
M.W.; McCarten J.R.; Kane R.L.; Garcia S.A.; Rutks I.R.; Ouellette J.;
Wilt T.J.
Institution
(Fink, Hemmy, Dysken, McCarten) Geriatric Research Education and Clinical
Center, Veterans Affairs Health Care System (11-G), One Veterans Drive,
Minneapolis, MN 55417, United States
(MacDonald, Wilt) Center for Chronic Disease Outcomes Research (111-0),
Veterans Affairs Health Center, One Veterans Drive, Minneapolis, MN 55417,
United States
(Carlyle) Optum Health, 12125 Technology Drive, Eden Prairie, MN 55344,
United States
(Olson) Veterans Affairs Health Care System, Building 9, One Veterans
Drive, Minneapolis, MN 55417, United States
(Kane, Ouellette) University of Minnesota, School of Public Health, Mayo
D351, MMC 197, 420 Delaware Street SE, Minneapolis, MN 55455, United
States
(Garcia) Division of Cardiology, Veterans Affairs Health Care System, One
Veterans Drive (111-C), Minneapolis, MN 55417, United States
(Rutks) Center for Chronic Disease Outcomes Research (152), Veterans
Affairs Health Care System, One Veterans Drive, Minneapolis, MN 55417,
United States
Title
Intermediate- and long-term cognitive outcomes after cardiovascular
procedures in older adults a systematic review.
Source
Annals of Internal Medicine. 163 (2) (pp 107-117), 2015. Date of
Publication: 21 Jul 2015.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Risks for intermediate- and long-term cognitive impairment
after cardiovascular procedures in older adults are poorly understood.
Purpose: To summarize evidence about cognitive outcomes in adults aged 65
years or older at least 3 months after coronary or carotid
revascularization, cardiac valve procedures, or ablation for atrial
fibrillation. Data Sources: MEDLINE, Cochrane, and Scopus databases from
1990 to January 2015; ClinicalTrials.gov; and bibliographies of reviews
and eligible studies. Study Selection: English-language trials and
prospective cohort studies. Data Extraction: One reviewer extracted data,
a second checked accuracy, and 2 independently rated quality and strength
of evidence (SOE). Data Synthesis: 17 trials and 4 cohort studies were
included; 80% of patients were men, and mean age was 68 years. Cognitive
function did not differ after the procedure between on- and off-pump
coronary artery bypass grafting (CABG) (n = 6; low SOE), hypothermic and
normothermic CABG (n = 3; moderate to low SOE), or CABG and medical
management (n = 1; insufficient SOE). One trial reported lower risk for
incident cognitive impairment with minimal versus conventional
extracorporeal CABG (risk ratio, 0.34 [95% CI, 0.16 to 0.73]; low SOE).
Two trials found no difference between surgical carotid revascularization
and carotid stenting or angioplasty (low and insufficient SOE,
respectively). One cohort study reported increased cognitive decline after
transcatheter versus surgical aortic valve replacement but had large
selection and outcome measurement biases (insufficient SOE). Limitations:
Mostly low to insufficient SOE; no pertinent data for ablation; limited
generalizability to the most elderly patients, women, and persons with
substantial baseline cognitive impairment; and possible selective
reporting and publication bias. Conclusion: Intermediate- and long-term
cognitive impairment in older adults attributable to the studied
cardiovascular procedures may be uncommon. Nevertheless, clinicians
counseling patients before these procedures should discuss the uncertainty
in their risk for adverse cognitive outcomes. Primary Funding Source:
Agency for Healthcare Research and Quality. Copyright &#xa9; 2015 American
College of Physicians.

<36>
Accession Number
53197362
Author
Nguyen B.A.V.; Suleiman M.-S.; Anderson J.R.; Evans P.C.; Fiorentino F.;
Reeves B.C.; Angelini G.D.
Institution
(Nguyen, Anderson, Evans, Fiorentino, Reeves, Angelini) Department of
Cardiothoracic Surgery, Hammersmith Hospital, Imperial College, London,
United Kingdom
(Suleiman) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
(Evans) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
Title
Metabolic derangement and cardiac injury early after reperfusion following
intermittent cross-clamp fibrillation in patients undergoing coronary
artery bypass graft surgery using conventional or miniaturized
cardiopulmonary bypass.
Source
Molecular and Cellular Biochemistry. 395 (1-2) (pp 167-175), 2014. Date of
Publication: October 2014.
Publisher
Kluwer Academic Publishers
Abstract
Myocardial ischemic stress and early reperfusion injury in patients
undergoing coronary artery bypass grafting (CABG) operated on using
intermittent cross-clamp fibrillation (ICCF) are not presently known. The
role of mini-cardiopulmonary bypass (mCPB) versus conventional CPB (cCPB)
during ICCF has not been investigated. These issues have been addressed as
secondary objective of randomised controlled trial (ISRCTN30610605)
comparing cCPB and mCPB. Twenty-six patients undergoing primary elective
CABG using ICCF were randomised to either cCPB or mCPB. Paired left
ventricular biopsies collected from 21 patients at the beginning and at
the end of CPB were used to measure intracellular substrates (ATP and
related compounds). Cardiac troponin T (cTnT) and CK-MB levels were
measured in plasma collected from all patients preoperatively and after 1,
30, 60, 120, and 300 min after institution of CPB. ICCF was associated
with significant ischemic stress as seen by fall in energy-rich phosphates
early after reperfusion. There was also a fall in nicotinamide adenine
dinucleotide (NAD⁺) indicating cardiomyocyte death which was
confirmed by early release of cTnT and CK-MB during CPB. Ischemic stress
and early myocardial injury were similar for cCPB and mCPB. However, the
overall cardiac injury was significantly lower in the mCPB group as
measured by cTnT (mean +/- SEM: 96 +/- 14 vs. 59 +/- 8 mug/l, p = 0.02),
but not with CK-MB. ICCF is associated with significant metabolic
derangement and early myocardial injury. This early outcome was not
affected by the CPB technique. However, the overall cardiac injury was
lower for mCPB only when measured using cTnT. &#xa9; 2014 Springer
Science+Business Media.

<37>
Accession Number
53068131
Author
Brierley R.C.M.; Pike K.; Miles A.; Wordsworth S.; Stokes E.A.; Mumford
A.D.; Cohen A.; Angelini G.D.; Murphy G.J.; Rogers C.A.; Reeves B.C.
Institution
(Brierley, Pike, Miles, Rogers, Reeves) Clinical Trials and Evaluation
Unit, School of Clinical Sciences, University of Bristol, Bristol Royal
Infirmary, Bristol BS2 8HW, United Kingdom
(Wordsworth, Stokes) Health Economics Research Centre, Nuffield Department
of Population Health, University of Oxford, Old Road Campus, Old Road,
Headington, Oxford OX3 7LF, United Kingdom
(Mumford, Angelini) Bristol Heart Institute, University Hospitals Bristol
NHS Foundation Trust, Bristol Royal Infirmary, Bristol BS2 8HW, United
Kingdom
(Cohen) Directorate of Specialised Services, Bristol Royal Infirmary,
University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, United
Kingdom
(Murphy) Department of Cardiovascular Sciences, University of Leicester,
Clinical Sciences Wing, Glenfield General Hospital, Leicester LE3 9QP,
United Kingdom
Title
A multi-centre randomised controlled trial of Transfusion Indication
Threshold Reduction on transfusion rates, morbidity and healthcare
resource use following cardiac surgery: Study protocol.
Source
Transfusion and Apheresis Science. 50 (3) (pp 451-461), 2014. Date of
Publication: 2014.
Publisher
Elsevier Ltd
Abstract
Thresholds for red blood cell transfusion following cardiac surgery vary
by hospital and surgeon. The TITRe2 multi-centre randomised controlled
trial aims to randomise 2000 patients from 17 United Kingdom centres, and
tests the hypothesis that a restrictive transfusion threshold will reduce
postoperative morbidity and health service costs compared to a liberal
threshold. Patients consent to take part in the study pre-operatively but
are only randomised if their haemoglobin falls below 9. g/dL during their
post-operative hospital stay. The primary outcome is a binary composite
outcome of any serious infectious or ischaemic event in the first three
months after randomisation. Many challenges have been encountered in the
set-up and running of the study. Copyright &#xa9; 2014 The Authors.

<38>
Accession Number
603474379
Author
McCrindle B.W.; Clarizia N.A.; Khaikin S.; Holtby H.M.; Manlhiot C.;
Schwartz S.M.; Caldarone C.A.; Coles J.G.; Van Arsdell G.S.; Scherer S.W.;
Redington A.N.
Institution
(McCrindle, Clarizia, Khaikin, Holtby, Manlhiot, Schwartz, Caldarone,
Coles, Van Arsdell, Redington) Labatt Family Heart Centre, The Hospital
for Sick Children, Toronto, ON, Canada
(Scherer) The Centre for Applied Genomics, The Hospital for Sick Children,
Toronto, ON, Canada
(McCrindle, Redington) Department of Pediatrics, University of Toronto,
Toronto, ON, Canada
(Holtby) Department of Anesthesiology, University of Toronto, Toronto, ON,
Canada
(Schwartz) Department of Critical Care Medicine, University of Toronto,
Toronto, ON, Canada
(Caldarone, Coles, Van Arsdell) Department of Surgery, University of
Toronto, Toronto, ON, Canada
(Scherer) The McLaughlin Centre, University of Toronto, Toronto, ON,
Canada
Title
Remote ischemic preconditioning in children undergoing cardiac surgery
with cardiopulmonary bypass: A single-center double-blinded randomized
trial.
Source
Journal of the American Heart Association. 3 (4) (no pagination), 2014.
Article Number: e000964. Date of Publication: 2014.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Remote ischemic preconditioning (RIPC) harnesses an innate
defensive mechanism that protects against inflammatory activation and
ischemia-reperfusion injury, known sequelae of cardiac surgery with
cardiopulmonary bypass. We sought to determine the impact of RIPC on
clinical outcomes and physiological markers related to
ischemia-reperfusion injury and inflammatory activation after cardiac
surgery in children. Methods and Results: Overall, 299 children (aged
neonate to 17 years) were randomized to receive an RIPC stimulus
(inflation of a blood pressure cuff on the left thigh to 15 mm Hg above
systolic for four 5-minute intervals) versus a blinded sham stimulus
during induction with a standardized anesthesia protocol. Primary outcome
was duration of postoperative hospital stay, with serial clinical and
laboratory measurements for the first 48 postoperative hours and clinical
follow-up to discharge. There were no significant baseline differences
between RIPC (n=148) and sham (n=151). There were no in-hospital deaths.
No significant difference in length of postoperative hospital stay was
noted (sham 5.4 versus RIPC 5.6 days; difference +0.2; adjusted P=0.91),
with the 95% confidence interval (-0.7 to +0.9) excluding a prespecified
minimal clinically significant differences of 1 or 1.5 days. There were
few significant differences in other clinical outcomes or values at time
points or trends in physiological markers. Benefit was not observed in
specific subgroups when explored through interactions with categories of
age, sex, surgery type, Aristotle score, or first versus second half of
recruitment. Adverse events were similar (sham 5%, RIPC 6%; P=0.68).
Conclusions: RIPC is not associated with important improvements in
clinical outcomes and physiological markers after cardiac surgery in
children. Copyright &#xa9; 2014 The Authors.

<39>
Accession Number
373361210
Author
Cornu C.; Dufays C.; Gaillard S.; Gueyffier F.; Redonnet M.; Sebbag L.;
Roussoulieres A.; Gleissner C.A.; Groetzner J.; Lehmkuhl H.B.; Potena L.;
Gullestad L.; Cantarovich M.; Boissonnat P.
Institution
(Cornu, Dufays, Gaillard, Gueyffier) INSERM, CIC201, Hopital Louis Pradel,
28 Avenue du Doyen Lepine, F-69677 Bron, France
(Cornu, Dufays, Gaillard, Gueyffier) CHU Lyon, Service de Pharmacologie
Clinique, Lyon, France
(Cornu, Dufays, Gaillard, Gueyffier) Universite de Lyon, UMR 5558, Lyon,
France
(Cornu, Dufays, Gaillard, Gueyffier) Hospices Civils de Lyon, Hopital
Louis Pradel, Bron cedex, France
(Redonnet) Departement de Chirurgie Cardiaque, Hopital Charles Nicolle,
Universite de Rouen, Rouen, France
(Sebbag, Roussoulieres, Boissonnat) Hospices Civils de Lyon, Hopital Louis
Pradel, Pole Medico-chirurgical de Transplantation Cardiaque Adulte, Bron
cedex, France
(Gleissner) Department of Cardiology, Angiology and Pneumonology,
University of Heidelberg, Heidelberg, Germany
(Groetzner) Department of Cardiac Surgery, Ludwig-Maximilians-University
Grosshadern, Munich, Germany
(Lehmkuhl) Deutsches Herzzentrum Berlin, Berlin, Germany
(Potena) Dipartimento Cardiovascolare, Policlinico S. Orsola-Malpighi,
Bologna, Italy
(Gullestad) Department of Cardiology, Oslo University Hospital,
Rikshospitalet Oslo, Norway
(Gullestad) Faculty of Medicine, University of Oslo, Oslo, Norway
(Cantarovich) Department of Medicine, McGill University Health Center,
Royal Victoria Hospital, Montreal QC, Canada
Title
Impact of the reduction of calcineurin inhibitors on renal function in
heart transplant patients: A systematic review and meta-analysis.
Source
British Journal of Clinical Pharmacology. 78 (1) (pp 24-32), 2014. Date of
Publication: July 2014.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims Calcineurin inhibitors (CNIs) taken after heart transplantation lead
to excellent short-term outcomes, but long-term use may cause chronic
nephrotoxicity. Our aim was to identify, appraise, select and analyse all
high-quality research evidence relevant to the question of the clinical
impact of CNI-sparing strategies in heart transplant patients. Methods We
carried out a systematic review and meta-analysis of randomized controlled
trials on CNI reduction in heart transplant recipients. Primary outcomes
were kidney function and acute rejection after 1 year. Secondary outcomes
included graft loss, all-cause mortality and adverse events. Results Eight
open-label studies were included, with 723 patients (four tested de novo
CNI reduction and four maintenance CNI reduction). Calcineurin inhibitor
reduction did not improve creatinine clearance at 12 months 5.46 [-1.17,
12.03] P-=-0.32 I ²-=-65.4%. Acute rejection at 12 months
(55/360 vs. 52/332), mortality (18/301 vs. 15/270) and adverse event rates
(55/294 vs. 52/281) did not differ between the low-CNI and standard-CNI
groups. There was significant benefit on creatinine clearance in patients
with impaired renal function at 6 months [+12.23 (+5.26, +18.82)
ml-min^-1, P = 0.0003] and at 12 months 4.63 [-4.55, 13.82]
P-=-0.32 I²-=-75%. Conclusions This meta-analysis did not
demonstrate a favourable effect of CNI reduction on kidney function, but
there was no increase in acute rejection. To provide a better analysis of
the influence of CNI reduction patterns and associated treatments, a
meta-analysis of individual patient data should be performed. &#xa9; 2013
The British Pharmacological Society.

<40>
Accession Number
373714847
Author
Guedon-Moreau L.; Lacroix D.; Sadoul N.; Clementy J.; Kouakam C.; Hermida
J.-S.; Aliot E.; Kacet S.
Institution
(Guedon-Moreau, Lacroix, Kouakam, Kacet) Centre Hospitalier Regional
Universitaire, F-59037 Lille, France
(Sadoul, Aliot) Centre Hospitalier Universitaire Brabois, F-54500 Nancy,
France
(Clementy) Centre Hospitalier Universitaire Haut-Leveque, F-33064 Pessac,
France
(Hermida) Centre Hospitalier Universitaire, F-80054 Amiens, France
Title
Costs of remote monitoring vs. ambulatory follow-ups of implanted
cardioverter defibrillators in the randomized ECOST study.
Source
Europace. 16 (8) (pp 1181-1188), 2014. Date of Publication: August 2014.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims The Effectiveness and Cost of ICD follow-up Schedule with
Telecardiology (ECOST) trial evaluated prospectively the economic impact
of long-term remote monitoring (RM) of implantable cardioverter
defibrillators (ICDs). Methods and results The analysis included 310
patients randomly assigned to RM (active group) vs. ambulatory follow-ups
(control group). Patients in the active group were seen once a year unless
the system reported an event mandating an ambulatory visit, while patients
in the control group were seen in the ambulatory department every 6
months. The costs of each follow-up strategy were compared, using the
actual billing documents issued by the French health insurance system,
including costs of (i) (a) ICD-related ambulatory visits and
transportation, (b) other ambulatory visits, (c) cardiovascular treatments
and procedures, and (ii) hospitalizations for the management of
cardiovascular events. The ICD and RM system costs were calculated on the
basis of the device remaining longevity at the end of the study. The
characteristics of the study groups were similar. Over a follow-up of 27
months, the mean non-hospital costs per patient-year were 1695 +/- 1131 in
the active, vs. 1952 +/- 1023 in the control group (P = 0.04), a 257
difference mainly due to device management. The hospitalization costs per
patient-year were 2829 +/- 6382 and 3549 +/- 9714 in the active and
control groups, respectively (P = 0.46). Adding the ICD to the
non-hospital costs, the savings were 494 (P = 0.005) or, when the
monitoring system was included, 315 (P = 0.05) per patient-year.
Conclusion From the French health insurance perspective, the remote
management of ICD patients is cost saving. Clinical trials registration
NCT00989417, www.clinicaltrials.gov &#xa9; 2014 The Author 2014. Published
by Oxford University Press on behalf of the European Society of
Cardiology.

<41>
Accession Number
613320463
Author
Drepper M.D.; Spahr L.; Frossard J.L.
Institution
(Drepper, Spahr, Frossard) Division of Gastroenterology, Department of
Internal Medicine, Geneva University Hospital, 14 Geneva CH-1211,
Switzerland
Title
Clopidogrel and proton pump inhibitors - Where do we stand in 2012?.
Source
World Journal of Gastroenterology. 18 (18) (pp 2161-2171), 2012. Date of
Publication: 14 May 2012.
Publisher
Baishideng Publishing Group Co., Limited (E-mail: wejd@public.bta.cn)
Abstract
Clopidogrel in association with aspirine is considered state of the art of
medical treatment for acute coronary syndrome by reducing the risk of new
ischemic events. Concomitant treatment with proton pump inhibitors in
order to prevent gastrointestinal side effects is recommended by clinical
guidelines. Clopidogrel needs metabolic activation predominantly by the
hepatic cytochrome P450 isoenzyme Cytochrome 2C19 (CYP2C19) and proton
pump inhibitors (PPIs) are extensively metabolized by the CYP2C19
isoenzyme as well. Several pharmacodynamic studies investigating a
potential clopidogrel-PPI interaction found a significant decrease of the
clopidogrel platelet antiaggregation effect for omeprazole, but not for
pantoprazole. Initial clinical cohort studies in 2009 reported an
increased risk for adverse cardiovascular events, when under clopidogrel
and PPI treatment at the same time. These observations led the United
States Food and Drug Administration and the European Medecines Agency to
discourage the combination of clopidogrel and PPI (especially omeprazole)
in the same year. In contrast, more recent retrospective cohort studies
including propensity score matching and the only existing randomized trial
have not shown any difference concerning adverse cardiovascular events
when concomitantly on clopidogrel and PPI or only on clopidogrel. Three
meta-analyses report an inverse correlation between clopidogrel-PPI
interaction and study quality, with high and moderate quality studies not
reporting any association, rising concern about unmeasured confounders
biasing the low quality studies. Thus, no definite evidence exists for an
effect on mortality. Because PPI induced risk reduction clearly overweighs
the possible adverse cardiovascular risk in patients with high risk of
gastrointestinal bleeding, combination of clopidogrel with the less
CYP2C19 inhibiting pantoprazole should be recommended. Copyright &#xa9;
2012 Baishideng. All rights reserved.

<42>
Accession Number
613276092
Author
Arai T.; Yashima F.; Yanagisawa R.; Tanaka M.; Shimizu H.; Fukuda K.;
Watanabe Y.; Naganuma T.; Araki M.; Tada N.; Yamanaka F.; Shirai S.;
Yamamoto M.; Hayashida K.
Institution
(Arai, Yashima, Yanagisawa, Tanaka, Fukuda, Hayashida) Department of
Cardiology, Keio University School of Medicine, Tokyo, Japan
(Shimizu) Department of Cardiovascular Surgery, Keio University School of
Medicine, Tokyo, Japan
(Watanabe) Division of Cardiology, Department of Internal Medicine, Teikyo
University Hospital, Tokyo, Japan
(Naganuma) Interventional Cardiology Unit, New Tokyo Hospital, Chiba,
Japan
(Araki) Department of Cardiovascular Medicine, Yokohama City Eastern
Hospital, Kanagawa, Japan
(Tada) Cardiovascular Center, Sendai Kosei Hospital, Sendai, Japan
(Yamanaka) Department of Cardiovascular Medicine, Shonan Kamakura General
Hospital, Kanagawa, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
(Yamamoto) Division of Cardiovascular Medicine, Toyohashi Heart Center,
Toyohashi, Japan
Title
Prognostic value of liver dysfunction assessed by MELD-XI scoring system
in patients undergoing transcatheter aortic valve implantation.
Source
International Journal of Cardiology. 228 (pp 648-653), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background There are limited data regarding the influence of liver
dysfunction on outcomes of transcatheter aortic valve implantation (TAVI).
Model for End-stage Liver Disease eXcluding International normalized ratio
(MELD-XI) score, which was originally developed for patients with
cirrhosis awaiting liver transplantation, has been reported as a predictor
of heart disease. The aim of this study was to investigate the prognostic
value of MELD-XI score for patients undergoing TAVI. Methods Data from the
prospectively maintained Optimized transCathEter vAlvular iNtervention
(OCEAN-TAVI) multicenter registry were collected in 749 patients who
underwent TAVI between October 2013 and August 2015. MELD-XI score was
calculated as follows: 11.76 x Ln (creatinine) + 5.11 x Ln (total
bilirubin) + 9.44. Patients were categorized based on MELD-XI score > 10
or < 10, and compared with regard to clinical characteristics and outcomes
of TAVI. Results Higher MELD-XI score was associated with lower 30-day
survival (95.6% vs 98.5%, P = 0.03). Kaplan-Meier analysis revealed that
higher MELD-XI score also was associated with lower 6-month survival (P <
0.01). Multivariate Cox regression analysis showed that MELD-XI score was
an independent predictor of 6-month cumulative mortality. Receiver
operating characteristic analysis revealed that MELD-XI score showed
better accuracy in predicting 6-month mortality compared with Logistic
European System for Cardiac Operative Risk Evaluation, European System for
Cardiac Operative Risk Evaluation II, and Society of Thoracic Surgeons
scores (area under the curve = 0.67, 0.58, 0.57, and 0.60, respectively).
Conclusion Evaluation of liver dysfunction according to MELD-XI score
provides additional risk information for patients undergoing TAVI.
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<43>
Accession Number
613510698
Author
Altun D.; Cinar O.; Ozker E.; Turkoz A.
Institution
(Altun, Cinar, Turkoz) Department of Anesthesiology, Baskent University
Istanbul Training and Medical Research Center, Istanbul, Turkey
(Ozker) Department of Cardiovascular Surgery, Baskent University Istanbul
Training and Medical Research Center, Istanbul, Turkey
Title
The effect of tramadol plus paracetamol on consumption of morphine after
coronary artery bypass grafting.
Source
Journal of Clinical Anesthesia. 36 (pp 189-193), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study of objective To compare the effects of oral tramadol + paracetamol
combination on morphine consumption following coronary artery bypass
grafting (CABG) in the patient-controlled analgesia (PCA) protocol. Design
A prospective, double-blind, randomized, clinical study. Setting
Single-institution, tertiary hospital. Patients Fifty cardiac surgical
patients undergoing primary CABG surgery. Interventions After surgery, the
patients were allocated to 1 of 2 groups. Both groups received morphine
according to the PCA protocol after arrival to the coronary intensive care
unit (bolus 1 mg, lockout time 15 minutes). In addition to morphine
administration 2 hours before operation and postoperative 2nd, 6th, 12th,
18th, 24th, 30th, 36th, 42th, and 48th hours, group T received tramadol +
paracetamol (Zaldiar; 325 mg paracetamol, 37.5 mg tramadol) and group P
received placebo. Sedation levels were measured with the Ramsay Sedation
Scale, whereas pain was assessed with the Pain Intensity Score during
mechanical ventilation and with the Numeric Rating Scale after extubation.
If the Numeric Rating Scale score was >3 and Pain Intensity Score was >3,
0.05 mg/kg morphine was administered additionally. Measurements
Preoperative patient characteristics, risk assessment, and intraoperative
data were similar between the groups. Main results Cumulative morphine
consumption, number of PCA demand, and boluses were higher in group P (P <
.01). The amount of total morphine (in mg) used as a rescue analgesia was
also higher in group P (5.06 +/- 1.0), compared with group T (2.37 +/-
0.52; P < .001). The patients who received rescue doses of morphine were 8
(32%) in group T and 18 (72%) in group P (P < .001). Duration of
mechanical ventilation in group P was longer than group T (P < .01).
Conclusion Tramadol + paracetamol combination along with PCA morphine
improves analgesia and reduces morphine requirement up to 50% after CABG,
compared with morphine PCA alone. Copyright &#xa9; 2016 Elsevier Inc.

<44>
Accession Number
613373166
Author
Wang L.; Zhao X.; Mao S.; Liu S.; Guo X.; Guo L.; Du T.; Yang H.; Zhao F.;
Wu K.; Cong H.; Wu Y.; Yang P.C.; Chen K.; Zhang M.
Institution
(Wang, Zhao, Mao, Guo, Zhang) Department of Critical Care Medicine, 2nd
Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou
510120, China
(Wang, Zhao, Mao, Guo, Zhang) Chest Pain Center, Guangdong Provincial
Hospital of Chinese Medicine, Guangzhou 510120, China
(Liu, Guo) China-Australia International Research Centre for Chinese
Medicine (CAIRC-CM), Guangdong Provincial Academy of Traditional Chinese
Medicine, Guangzhou 510120, China
(Du) Department of Cardiovascular Medicine, First Affiliated Hospital,
Henan College of TCM, Zhengzhou 450004, China
(Yang) Department of Cardiovascular Medicine, Wuyi Hospital of TCM of
Jiangmen City, Jiangmen 529000, China
(Zhao, Chen) Department of Cardiology, Xiyuan Hospital, Chinese Academy of
Traditional Chinese Medicine, Beijing 100091, China
(Wu) Department of Cardiology, Affiliated Hospital, Guangdong Medical
College, Zhanjiang 524023, China
(Cong) Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051,
China
(Wu) Department of Cardiovascular Medicine, Oriental Hospital, Beijing
University of Traditional Chinese Medicine, Beijing 100078, China
(Yang) Department of Cardiovascular Medicine, Stanford University School
of Medicine, Stanford, CA 94305, United States
Title
Efficacy of danlou tablet in patients with non-st elevation acute coronary
syndrome undergoing percutaneous coronary intervention: Results from a
multicentre, placebo-controlled, randomized trial.
Source
Evidence-based Complementary and Alternative Medicine. 2016 (no
pagination), 2016. Article Number: 7960503. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
This study seeks to investigate potential cardioprotection of Danlou
Tablets in patients undergoing PCI with non-ST elevation acute coronary
syndrome (NSTE-ACS). 219 patients with NSTE-ACS were randomised to Danlou
Tablet pretreatment (n = 109) or placebo (n = 110). No patients received
statins prior to PCI and all patients were given atorvastatin (10 mg/day)
after procedure. The main endpoint was the composite incidence of major
adverse cardiac events (MACEs) within 30 days after PCI. The proportion of
patients with elevated levels of cTn I>5 x 99% of upper reference limit
was significantly lower in the Danlou Tablet group at 8 h (22.0% versus
34.5%, p = 0.04) and 24 h (23.9% versus 38.2%, p = 0.02) after PCI. The
30-day MACEs occurred in 22.0% of the Danlou Tablet group and 33.6% in the
placebo group (p = 0.06). The incidence of MACE at 90-day follow-up was
significantly decreased in the Danlou Tablet group compared to the placebo
group (23.9% versus 37.3%, p = 0.03). The difference between the groups at
90 days was the incidence of nonfatal myocardial infarction (22% versus
34.5%, p = 0.04). These findings might support that treatment with Danlou
Tablet could reduce the incidence of periprocedural myocardial infarction
in patients with ACS undergoing PCI. Copyright &#xa9; 2016 Lei Wang et al.

<45>
[Use Link to view the full text]
Accession Number
612933593
Author
McCormick P.J.; Levin M.A.; Lin H.-M.; Sessler D.I.; Reich D.L.
Institution
(McCormick, Levin, Reich) Department of Anesthesiology, Icahn School of
Medicine at Mount Sinai, L. Levy Place Box 1010, New York, NY, United
States
(Levin) Department of Genetics and Genomic Sciences, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Lin) Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Sessler) Department of Outcomes Research, Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
Title
Effectiveness of an Electronic Alert for Hypotension and Low Bispectral
Index on 90-day Postoperative Mortality: A Prospective, Randomized Trial.
Source
Anesthesiology. 125 (6) (pp 1113-1120), 2016. Date of Publication: 01 Dec
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: We tested the hypothesis that an electronic alert for a
"double low" of mean arterial pressure less than 75 mmHg and a bispectral
index less than 45 reduces the primary outcome of 90-day mortality.
Methods: Adults having noncardiac surgery were randomized to receive
either intraoperative alerts for double-low events or no alerts.
Anesthesiologists were not blinded and not required to alter care based
upon the alerts. The primary outcome was all-cause 90-day mortality.
Results: Patients (20,239) were randomized over 33 months, and 19,092 were
analyzed. After adjusting for age, comorbidities, and perioperative
factors, patients with more than 60 min of cumulative double-low time were
twice as likely to die (hazard ratio, 1.99; 95% CI, 1.2 to 3.2; P =
0.005). The median number of double-low minutes (quartiles) was only
slightly lower in the alert arm: 10 (2 to 30) versus 12 (2 to 34) min.
Ninety-day mortality was 135 (1.4%) in the alert arm and 123 (1.3%) in the
control arm. The difference in percent mortality was 0.18% (99% CI, -0.25
to 0.61). Conclusions: Ninety-day mortality was not significantly lower in
patients cared for by anesthesiologists who received automated alerts to
double-low states. Prolonged cumulative double-low conditions were
strongly associated with mortality. Copyright &#xa9; 2016, the American
Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights
Reserved.

<46>
Accession Number
613279987
Author
Franco P.; Fiorentino A.; Dionisi F.; Fiore M.; Chiesa S.; Vagge S.;
Cellini F.; Caravatta L.; Tombolini M.; De Rose F.; Meattini I.;
Mortellaro G.; Apicella G.; Marino L.; Greto D.
Institution
(Franco) Department of Oncology-Radiation Oncology, University of Turin,
Via Genova 3, Turin 10126, Italy
(Fiorentino) Radiation Oncology, Ospedale Sacro Cuore-Don Calabria, Negrar
(Verona), Italy
(Dionisi) Department of Oncology, Proton Therapy Unit, Azienda Provinciale
per i Servizi Sanitari (APSS), Trento, Italy
(Fiore) Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
(Chiesa, Cellini) Radiation Oncology Department-Gemelli ART, Sacred Heart
Catholic University, Rome, Italy
(Vagge) Department of Radio-Oncology, IRCCS AOU San Martino IST, National
Institute for Cancer Research, Genoa, Italy
(Caravatta) Department of Radiation Oncology, Regional Oncological
Hospital, Cagliari, Italy
(Tombolini) Department of Sensory Organs, Institute of
Otorhinolaryngology, Audiology and Phoniatrics, Sapienza University, Rome,
Italy
(De Rose) Radiotherapy and Radiosurgery Department, Humanitas Clinical and
Research Center, Rozzano (Milan), Italy
(Meattini, Greto) Department of Sperimental and Clinical Biomedical
Sciences, Radiation Oncology, AOU Careggi, Florence, Italy
(Mortellaro) Radiation Oncology Department, ARNAS Civico Hospital,
Palermo, Italy
(Apicella) Radiotherapy Department, University Hospital Maggiore della
Carita, Novara, Italy
(Marino) Radiotherapy Department, Centro REM, Catania, Italy
Title
Combined modality therapy for thoracic and head and neck cancers: A review
of updated literature based on a consensus meeting.
Source
Tumori. 102 (5) (pp 459-471), 2016. Date of Publication: September-October
2016.
Publisher
Wichtig Publishing Srl
Abstract
Purpose: Combined modality therapy is a mainstay option for thoracic
malignancies and head and neck cancers. The integration of different
strategies is based on the multidisciplinary approach of modern clinical
oncology. Radiation oncologists have to be educated, trained, and updated
to provide state-of-the-art care to cancer patients and thus educational
meetings are crucial. Methods: The Italian Association of Radiation
Oncology Young Members Working Group (AIRO Giovani) organized its 8th
national meeting, focused on combination therapy in lung, esophageal, and
head and neck cancer (with a specific focus on larynx-preservation
strategies for larynx/hypopharynx tumors), involving young professionals
working in Italy. The meeting was addressed to young radiation
oncologists, presenting state-of-the-art knowledge, based on the latest
evidence in this field. We performed a review of the current literature
based on the highlights of the Congress. Results: The multimodality
approach of head and neck and thoracic malignancies includes surgery,
chemotherapy, and radiotherapy, but also has to take into account new
information and data coming from basic and translational research and
including molecular biology, genetics, and immunology. All these aspects
are crucial for the treatment of non-small-cell lung cancer and
esophageal, esophagogastric junction, and larynx/hypopharynx malignancies.
The integration of different treatments in the clinical decision-making
process to combine therapies is crucial. Conclusions: Combination therapy
has proved to be a consolidated approach in these specific oncologic
settings, highlighting the importance of multimodality management in
modern clinical oncology. Dedicated meetings on specific topics are
helpful to improve knowledge and skills of young professionals in
radiation oncology.

<47>
Accession Number
613179298
Author
Rickard C.M.; Edwards M.; Spooner A.J.; Mihala G.; Marsh N.; Best J.;
Wendt T.; Rapchuk I.; Gabriel S.; Thomson B.; Corley A.; Fraser J.F.
Institution
(Rickard, Edwards, Spooner, Marsh, Best, Wendt, Corley, Fraser) AVATAR
Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health
Institute Queensland, Griffith University, Nathan, Queensland 4111,
Australia
(Edwards, Spooner, Best, Wendt, Corley, Fraser) Critical Care Research
Group, The University of Queensland and The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
(Mihala) Centre for Applied Health Economics, Menzies Health Institute
Queensland, School of Medicine, Griffith University, Meadowbrook,
Queensland 4131, Australia
(Marsh) Centre for Clinical Nursing, Royal Brisbane and Women's Hospital,
Herston, Queensland 4006, Australia
(Rapchuk) Department of Anaesthesia, The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
(Gabriel) Cardiac Surgery Research Unit, The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
(Thomson) Department of Cardiac Surgery, The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
Title
A 4-arm randomized controlled pilot trial of innovative solutions for
jugular central venous access device securement in 221 cardiac surgical
patients.
Source
Journal of Critical Care. 36 (pp 35-42), 2016. Date of Publication: 01 Dec
2016.
Publisher
W.B. Saunders
Abstract
Purpose To improve jugular central venous access device (CVAD) securement,
prevent CVAD failure (composite: dislodgement, occlusion, breakage, local
or bloodstream infection), and assess subsequent trial feasibility.
Materials and Methods Study design was a 4-arm, parallel, randomized,
controlled, nonblinded, pilot trial. Patients received CVAD securement
with (i) suture + bordered polyurethane (suture + BPU; control), (ii)
suture + absorbent dressing (suture + AD), (iii) sutureless securement
device + simple polyurethane (SSD + SPU), or (iv) tissue adhesive + simple
polyurethane (TA + SPU). Midtrial, due to safety, the TA + SPU
intervention was replaced with a suture + TA + SPU group. Results A total
of 221 patients were randomized with 2 postrandomization exclusions.
Central venous access device failure was as follows: suture + BPU
controls, 2 (4%) of 55 (0.52/1000 hours); suture + AD, 1 (2%) of 56
(0.26/1000 hours, P = .560); SSD + SPU, 4 (7%) of 55 (1.04/1000 hours, P =
.417); TA + SPU, 4 (17%) of 23 (2.53/1000 hours, P = .049); and suture +
TA + SPU, 0 (0%) of 30 (P = .263; intention-to-treat, log-rank tests).
Central venous access device failure was predicted (P < .05) by baseline
poor/fair skin integrity (hazard ratio, 9.8; 95% confidence interval,
1.2-79.9) or impaired mental state at CVAD removal (hazard ratio, 14.2;
95% confidence interval, 3.0-68.4). Conclusions Jugular CVAD securement is
challenging in postcardiac surgical patients who are coagulopathic and
mobilized early. TA + SPU was ineffective for CVAD securement and is not
recommended. Suture + TA + SPU appeared promising, with zero CVAD failure
observed. Future trials should resolve uncertainty about the comparative
effect of suture + TA + SPU, suture + AD, and SSD + SPU vs suture + BPU.
Copyright &#xa9; 2016 Elsevier Inc.

<48>
Accession Number
613270946
Author
Ghanta R.K.; Kron I.L.
Institution
(Ghanta, Kron) Division of Thoracic and Cardiovascular Surgery, Department
of Surgery, University of Virginia, Charlottesville, VA, United States
Title
Patient-prosthesis mismatch: Surgical aortic valve replacement versus
transcatheter aortic valve replacement in high risk patients with aortic
stenosis.
Source
Journal of Thoracic Disease. 8 (10) (pp E1441-E1443), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Patient prosthesis mismatch (PPM) can occur when a prosthetic aortic valve
has an effective orifice area (EOA) less than that of a native valve. A
recent study by Zorn and colleagues evaluated the incidence and
significance of PPM in high risk patients with severe aortic stenosis who
were randomized to transcatheter aortic valve replacement (TAVR) or
surgical aortic valve replacement (SAVR). TAVR is associated with
decreased incidence of severe PPM compared to traditional SAVR valves.
Severe PPM increases risk for death at 1 year postoperatively in high risk
patients. The increased incidence of PPM is largely due to differences in
valve design and should encourage development of newer SAVR valves to
reduce risk for PPM. In addition more vigorous approaches to root
enlargement in small annulus should be performed with SAVR to prevent PPM.
Copyright &#xa9; Journal of Thoracic Disease. All rights reserved.

<49>
Accession Number
613270940
Author
Klemm W.; Frese S.; Leschber G.; Nemat A.; Wilhelm T.
Institution
(Klemm, Frese, Leschber) Department of Thoracic Surgery, ELK Berlin Chest
Hospital, Berlin, Germany
(Nemat) Division of Thoracic Surgery, Sana Krankenhaus Gerresheim,
Dusseldorf, Germany
(Wilhelm) Department of Otolaryngology, Head/Neck and Facial Plastic
Surgery, Sana Kliniken Leipziger Land, Borna, Germany
Title
Transoral endoscopic mediastinal surgery (TOEMS)-results of a first
clinical study for scarless mediastinal lymph node biopsies.
Source
Journal of Thoracic Disease. 8 (10) (pp 2717-2723), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Video-assisted mediastinoscopy (VAM) represents the standard
procedure for mediastinal lymph node biopsies. This operation results in a
scar at prominent position at the anterior neck. Since there is a trend to
less invasive procedures, natural orifice transluminal endoscopic surgery
(NOTES) was introduced to different fields of surgery. Based on NOTES we
developed a new approach for mediastinoscopy: transoral endoscopic
mediastinal surgery (TOEMS). In previous studies using human cadavers and
living pigs the feasibility of TOEMS was shown. It was unclear whether
TOEMS could be safely applied in patients requiring mediastinal lymph node
biopsies. Methods: We conducted a clinical phase I study recruiting ten
patients with unclear mediastinal lymphadenopathy not resolved by prior
bronchoscopy. All patients underwent TOEMS for mediastinal lymph node
biopsy. The duration of the procedure and complications were monitored. In
addition, all patients were examined for pain, swallowing dysfunction and
sensation disturbance. Results: TOEMS was accomplished in eight patients.
In two patients operation was converted to VAM due to technical problems.
Mediastinal lymph nodes were dissected in all patients who finished with
TOEMS. On average, two separate lymph stations were reached by TOEMS.
Duration of the procedure was 159+/-22 min. Permanent palsy of the right
recurrent laryngeal nerve was noticed in one patient postoperatively.
Conclusions: This is the first report for a human application of NOTES in
thoracic surgery. In fact, transoral endoscopic surgery seems to be a
feasible approach for mediastinal lymph node biopsies. Further studies are
needed to show whether this procedure has an advantage over VAM in terms
of pain, complications and accessibility of mediastinal lymph node
stations. Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<50>
Accession Number
613254797
Author
Ozturk S.; Sacar M.; Baltalarli A.; Ozturk I.
Institution
(Ozturk) Department of Cardiovascular Surgery, Dr. Siyami Ersek
Cardiothoracic and Vascular Surgery Education and Research Hospital,
Istanbul, Turkey
(Sacar) Department of Cardiovascular Surgery, 18 Mart Univesity, Faculty
of Medicine, Canakkale, Turkey
(Baltalarli) Department of Cardiovascular Surgery, Pamukkale Univesity,
Faculty of Medicine, Denizli, Turkey
(Ozturk) Department of Anesthesiology, Goztepe Education and Research
Hospital, Istanbul, Turkey
Title
Effect of the type of cardiopulmonary bypass pump flow on postoperative
cognitive function in patients undergoing isolated coronary artery
surgery.
Source
Anatolian Journal of Cardiology. 16 (11) (pp 875-880), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Pulsatile flow, generated by a pump during cardiopulmonary
bypass, has been accepted as more physiological in coronary artery bypass
grafting surgery (CABG). Therefore, we aimed to investigate the effects of
pulsatile and nonpulsatile flow on postoperative cognitive function and to
review relationship with the biomarkers S100beta and neuron-specific
enolase (NSE). Methods: Patients who underwent isolated CABG were included
this prospective, randomized, double-blind study, which was performed
between March 2010 and December 2010. Patients were divided into two
groups: pulsatile (Group I, n=20) and nonpulsatile (Group II, n=20) flow.
Blood samples were collected 1 day before surgery and in the sixth
postoperative hour for the analysis of S100beta and NSE. In addition,
Mini- Mental State Examination (MMSE) was performed during preoperative
period and on third postoperative day. Outcomes were determination of
effects of pump flow type on cognitive function and relationships with
concentrations of S100beta and NSE. Results: Forty patients were included.
No differences were observed between the groups with respect to
complications, mortality, S100beta (Group I: 1.9+/-0.2 mu/L; Group II:
2.0+/-0.2 mu/L), NSE (Group I: 12.5+/-0.8 mu/L; Group II: 12.4+/-0.7
mu/L), MMSE scores [Group I: 25 (23-27); Group II: 25 (23-27)], and
postoperative cognitive dysfunction (POCD) (p>0.05). No correlation was
observed between MMSE scores and concentrations of S100beta (r=-0.032) and
NSE (r=-0.423) (p>0.05). Conclusion: There was no difference between types
of pump flow for POCD and no relationship between cognitive dysfunction
and S100beta and NSE concentrations. Pump flow type does not affect NSE
concentrations. Copyright &#xa9; 2016 by Turkish Society of Cardiology.

<51>
Accession Number
613227729
Author
Mancini G.B.J.; Farkouh M.E.; Brooks M.M.; Chaitman B.R.; Boden W.E.;
Vlachos H.; Hartigan P.M.; Siami F.S.; Sidhu M.S.; Bittner V.; Frye R.;
Fuster V.
Institution
(Mancini) Department of Medicine, University of British Columbia,
Vancouver, British Columbia, Canada
(Farkouh) Department of Medicine, Peter Munk Cardiac Centre and the Heart
and Stroke Richard Lewar Centre of Excellence, University of Toronto,
Toronto, Ontario, Canada
(Brooks, Vlachos) Department of Epidemiology, University of Pittsburgh,
Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
(Chaitman) St. Louis University School of Medicine, St. Louis, Missouri,
United States
(Boden, Sidhu) Department of Medicine, Albany Medical College, Albany, New
York, United States
(Hartigan) West Haven Veterans Administration Coordinating Center, West
Haven, Connecticut, United States
(Siami) New England Research Institutes, Incorporated, Watertown,
Massachusetts, United States
(Bittner) University of Alabama at Birmingham, Birmingham, Alabama, United
States
(Frye) Mayo Clinic, Rochester, Minnesota, United States
(Fuster) Icahn School of Medicine at Mount Sinai, New York, New York,
United States
Title
Medical Treatment and Revascularization Options in Patients With Type 2
Diabetes and Coronary Disease.
Source
Journal of the American College of Cardiology. 68 (10) (pp 985-995), 2016.
Date of Publication: 06 Sep 2016.
Publisher
Elsevier USA
Abstract
Background There are scant outcomes data in patients with type 2 diabetes
and stable coronary artery disease (CAD) stratified by detailed
angiographic burden of CAD or left ventricular ejection fraction (LVEF).
Objectives This study determined the effect of optimal medical therapy
(OMT), with or without percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG), on long-term outcomes with respect
to LVEF and number of diseased vessels, including proximal left anterior
descending artery involvement. Methods A patient-level pooled analysis was
undertaken in 3 federally-funded trials. The primary endpoint was the
composite of death, myocardial infarction (MI), or stroke, adjusted for
trial and randomization strategy. Results Among 5,034 subjects, 15% had
LVEF <50%, 77% had multivessel CAD, and 28% had proximal left anterior
descending artery involvement. During a median 4.5-year follow-up, CABG +
OMT was superior to PCI + OMT for the primary endpoint (hazard ratio [HR]:
0.71; 95% confidence interval [CI]: 0.59 to 0.85; p = 0.0002), death (HR:
0.76; 95% CI: 0.60 to 0.96; p = 0.024), and MI (HR: 0.50; 95% CI: 0.38 to
0.67; p = 0.0001), but not stroke (HR: 1.54; 95% CI: 0.96 to 2.48; p =
0.074). CABG + OMT was also superior to OMT alone for prevention of the
primary endpoint (HR: 0.79; 95% CI: 0.64 to 0.97; p = 0.022) and MI (HR:
0.55; 95% CI: 0.41 to 0.74; p = 0.0001), and was superior to PCI + OMT for
the primary endpoint in patients with 3-vessel CAD (HR: 0.72; 95% CI: 0.58
to 0.89; p = 0.002) and normal LVEF (HR: 0.71; 95% CI: 0.58 to 0.87; p =
0.0012). There were no significant differences in OMT versus PCI + OMT.
Conclusions CABG + OMT reduced the primary endpoint during long-term
follow-up in patients with type 2 diabetes and stable CAD, supporting this
as the preferred management strategy. Copyright &#xa9; 2016 American
College of Cardiology Foundation

<52>
Accession Number
612097776
Author
Vroomen M.; Pison L.
Institution
(Vroomen, Pison) Department of Cardiology, Maastricht University Medical
Center, PO Box 5800, Maastricht, Netherlands
(Vroomen, Pison) Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
Title
Hybrid ablation for atrial fibrillation: a systematic review.
Source
Journal of Interventional Cardiac Electrophysiology. 47 (3) (pp 265-274),
2016. Date of Publication: 01 Dec 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Hybrid ablation for AF is performed in a growing number of
centers. Due to absence of guidelines, operative approaches and
perioperative care differ per center. In this review, an overview of
findings from published studies on hybrid ablations is given, and related
topics are discussed (e.g., one- and two-stage approaches, lesion sets,
and patient management). Methods: A systematic literature search was
performed in the PubMed and Embase databases. All identified articles were
screened and checked for eligibility by the two authors. Results: Twelve
studies describing a total of 563 patients were selected. Due to
substantial differences in approaches (one-stage, two-stage, sequential),
surgical techniques (bilateral or monolateral thoracoscopy, subxiphoideal,
transabdominal), energy sources (unipolar, bipolar), lesion sets (applying
left or right atrial lesions), periprocedural care and endpoints
(monitoring, definition of recurrence), and success rates (sinus rhythm
after a mean of 26 months) are difficult to compare and varied from 27 %
(without antiarrhythmic drugs, AADs) to 94 % (with AADs). For studies
using bipolar devices, success rates with the use of antiarrhythmic drugs
were at least 71 %. Major complications such as bleeding, sternotomy, and
death occurred in 7 % of the total population (of which ten complications,
16 %, occurred in the concomitant cardiac surgery hybrid group).
Conclusion: The field of AF ablation has dramatically changed over the
past years, with one of the most recent developments the hybrid AF
ablation. Lack of matching data hinders drawing conclusions and creating
guidelines. Early results however are encouraging. More data are awaiting
and needed. Copyright &#xa9; 2016, The Author(s).

<53>
Accession Number
613314911
Author
Leonardi S.; Frigoli E.; Rothenbuhler M.; Navarese E.; Calabro P.;
Bellotti P.; Briguori C.; Ferlini M.; Cortese B.; Lupi A.; Lerna S.;
Zavallonito-Parenti D.; Esposito G.; Tresoldi S.; Zingarelli A.;
Rigattieri S.; Palmieri C.; Liso A.; Abate F.; Zimarino M.; Comeglio M.;
Gabrielli G.; Chieffo A.; Brugaletta S.; Mauro C.; Van Mieghem N.M.; Heg
D.; Juni P.; Windecker S.; Valgimigli M.
Institution
(Leonardi, Ferlini) Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Frigoli) EUSTRATEGY Association, Forli', Italy
(Rothenbuhler, Heg) CTU Bern, University of Bern, Switzerland
(Rothenbuhler, Heg) Institute of Social and Preventive Medicine (ISPM),
University of Bern, Switzerland
(Navarese) Policlinico Multimedica IRCSS, University of Milan, Milan,
Italy
(Calabro) Division of Cardiology, Department of Cardiothoracic Sciences,
Second University of Naples, Naples, Italy
(Bellotti) Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa,
Italy
(Briguori) Clinica Mediterranea, Napoli, Italy
(Cortese) Ospedale Fatebene Fratelli, Milano, Italy
(Lupi) University Hospital Maggiore Della Carita, Novara, Italy
(Lerna) Ospedale Sirai-Carbonia, Carbonia, Italy
(Zavallonito-Parenti) Humanitas Research Hospital, IRCCS, Rozzano, Italy
(Esposito) Division of Cardiology-Department of Advanced Biomedical
Sciences, Federico II University of Naples, Italy
(Tresoldi) A O Ospedale di Desio, Lombardia, Italy
(Zingarelli) IRCCS San Martino-IST, Genoa, Italy
(Rigattieri) Interventional Cardiology Sandro Pertini Hospital Rome, Italy
(Palmieri) Ospedale Pasquinucci, Massa, Italy
(Liso) Citta' di Lecce Hospital, Lecce, Italy
(Abate) Ospedale Giovanni Paolo II, Sciacca, Italy
(Zimarino) Universita degli Studi G d'Annunzio Chieti e Pescara, Chieti,
Italy
(Comeglio) Ospedale San Jacopo, Pistoia, Italy
(Gabrielli) Azienda Ospedali Riuniti-Presidio GM Lancisi, Ancona, Italy
(Chieffo) Ospedale San Raffaele IRCCS, Milano, Italy
(Brugaletta) Hospital Clinic, Cardiovascular Institute, IDIBAPS,
Barcelona, Spain
(Mauro) AORN Cardarelli, Napoli, Italy
(Van Mieghem) Erasmus MC, Rotterdam, Netherlands
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute,
St. Michael's Hospital, Department of Medicine, University of Toronto,
Canada
(Windecker, Valgimigli) Swiss Cardiovascular Centre Bern, Bern University
Hospital, Bern CH-3010, Switzerland
Title
Bivalirudin or unfractionated heparin in patients with acute coronary
syndromes managed invasively with and without ST elevation (MATRIX):
Randomised controlled trial.
Source
BMJ (Online). 354 (no pagination), 2016. Article Number: i4935. Date of
Publication: 27 Sep 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
OBJECTIVE: To test the optimal antithrombotic regimen in patients with
acute coronary syndrome. DESIGN: andomised controlled trial. SETTING:
Patients with acute coronary syndrome with and without ST segment
elevation in 78 centres in Italy, the Netherlands, Spain, and Sweden.
PARTICIPANTS: 7213 patients with acute coronary syndrome and planned
percutaneous coronary intervention: 4010 with ST segment elevation and
3203 without ST segment elevation. The primary study results in the
overall population have been reported previously. INTERVENTIONS: Patients
were randomly assigned, in an open label fashion, to one of two regimens:
bivalirudin with glycoprotein IIb/IIIa inhibitors restricted to procedural
complications or heparin with or without glycoprotein IIb/IIIa inhibitors.
MAIN OUTCOME MEASURES: Primary endpoints were the occurrence of major
adverse cardiovascular events, defined as death, myocardial infarction or
stroke; and net adverse clinical events, defined as major bleeding or
major adverse cardiovascular events, both assessed at 30 days. Analyses
were performed by the principle of intention to treat. RESULTS: Use of a
glycoprotein IIb/IIIa inhibitor in patients assigned to heparin was
planned at baseline in 30.7% of patients with ST segment elevation, in
10.9% without ST segment elevation, and in no patients assigned to
bivalirudin. In patients with ST segment elevation, major adverse
cardiovascular events occurred in 118 (5.9%) assigned to bivalirudin and
129 (6.5%) assigned to heparin (rate ratio 0.90, 95% confidence interval
0.70 to 1.16; P=0.43), whereas net adverse clinical events occurred in 139
(7.0%) patients assigned to bivalirudin and 163 (8.2%) assigned to heparin
(0.84, 0.67 to 1.05; P=0.13). In patients without ST segment elevation,
major adverse cardiovascular events occurred in 253 (15.9%) assigned to
bivalirudin and 262 (16.4%) assigned to heparin (0.97, 0.80 to 1.17;
P=0.74), whereas net adverse clinical events occurred in 262 (16.5%)
patients assigned to bivalirudin and 281 (17.6%) assigned to heparin
(0.93, 0.77 to 1.12; P=0.43). CONCLUSIONS: A bivalirudin monotherapy
strategy compared with heparin with or without glycoprotein IIb/IIIa
inhibitors, did not result in reduced major adverse cardiovascular events
or net adverse clinical events in patients with or without ST segment
elevation. TRIAL REGISTRATION: ClinicalTrials.gov NCT01433627. Copyright
&#xa9; BMJ Publishing Group Ltd 2016.

<54>
Accession Number
613475171
Author
Poplawski S.; Johnson M.; Philips P.; Eberhart L.H.J.; Koch T.; Itri L.M.
Institution
(Poplawski) Forest Health Medical Center, Ypsilanti, MI, United States
(Johnson) Indispensable Healthcare, Grass Lake, MI, United States
(Philips) Landmark Medical Center, Woonsocket, RI, United States
(Eberhart, Koch) Department of Anesthesiology and Intensive Care Medicine,
Philipps-University Marburg, Marburg, Germany
(Itri) The Medicines Company, Parsippany, NJ, United States
Title
Use of Fentanyl Iontophoretic Transdermal System (ITS) (IONSYS)
in the Management of Patients with Acute Postoperative Pain: A Case
Series.
Source
Pain and Therapy. 5 (2) (pp 237-248), 2016. Date of Publication: 01 Dec
2016.
Publisher
Springer Healthcare
Abstract
Fentanyl iontophoretic transdermal system (ITS) [IONSYS, The
Medicines Company, Parsippany, NJ, USA] is a needle-free,
patient-controlled, postoperative opioid pain management treatment. It is
indicated for the short-term management of acute postoperative pain in
adults requiring opioid analgesia in the hospital. The safety and
effectiveness of fentanyl ITS for acute postoperative pain management has
been demonstrated in a range of surgery and patient types studied in seven
phase 3 trials (three placebo-controlled trials and four active-comparator
trials). The majority of the patients in the phase 3 trials had undergone
either abdominal/pelvic, orthopedic, or thoracic surgery. Consistent with
the prescribing information, physicians in clinical practice may treat
patients with this system following any type of surgery including those
that may not have been included in the phase 3 trials. The purpose of this
case series is to illustrate how fentanyl ITS is being utilized for
postoperative pain management in real-world clinical practice following a
variety of surgeries and in current pain management protocols that may
have evolved since the completion of the phase 3 program. There are seven
cases from three clinical centers described within this case series, each
using fentanyl ITS according to the prescribing information. The surgery
types included are bariatric (N = 3), prostate (N = 2), colorectal (N =
1), and perirectal abscess drainage (N = 1). A systematic review of each
patient chart was conducted via a standardized retrospective assessment by
the clinicians who managed each patient. Additionally, each healthcare
professional was interviewed regarding their overall experience and key
learnings using fentanyl ITS. Overall, fentanyl ITS was effective and well
tolerated in these case reports in current-day clinical practice settings.
These case studies are informative about fentanyl ITS use shortly after
product approval and set the stage for additional clinical research.
Copyright &#xa9; 2016, The Author(s).

<55>
Accession Number
613438639
Author
Morche J.; Mathes T.; Pieper D.
Institution
(Morche) The University Hospital of Cologne (AoR), Institute of Health
Economics and Clinical Epidemiology, Gleueler Str. 176-178, Cologne 50935,
Germany
(Mathes, Pieper) Witten/Herdecke University, Faculty of Health, School of
Medicine, Institute for Research in Operative Medicine, Ostmerheimer Str.
200, Building 38, Cologne 51109, Germany
Title
Relationship between surgeon volume and outcomes: A systematic review of
systematic reviews.
Source
Systematic Reviews. 5 (1) (no pagination), 2016. Article Number: 204. Date
of Publication: 29 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The surgeon volume-outcome relationship has been discussed for
many years and its existence or nonexistence is of importance for various
reasons. A lot of empirical work has been published on it. We aimed to
summarize systematic reviews in order to present current evidence.
Methods: Medline, Embase, Cochrane database of systematic reviews (CDSR),
and health technology assessment websites were searched up to October 2015
for systematic reviews on the surgeon volume-outcome relationship. Reviews
were critically appraised, and results were extracted and synthesized by
type of surgical procedure/condition. Results: Thirty-two reviews
reporting on 15 surgical procedures/conditions were included.
Methodological quality of included systematic reviews assessed with the
assessment of multiple systematic reviews (AMSTAR) was generally moderate
to high albeit included literature partly neglected considering
methodological issues specific to volume-outcome relationship. Most
reviews tend to support the presence of a surgeon volume-outcome
relationship. This is most clear-cut in colorectal cancer, bariatric
surgery, and breast cancer where reviews of high quality show large
effects. Conclusions: When taking into account its limitations, this
overview can serve as an informational basis for decision makers. Our
results seem to support a positive volume-outcome relationship for most
procedures/conditions. However, forthcoming reviews should pay more
attention to methodology specific to volume-outcome relationship. Due to
the lack of information, any numerical recommendations for minimum volume
thresholds are not possible. Further research is needed for this issue.
Copyright &#xa9; 2016 The Author(s).

<56>
Accession Number
613239389
Author
Herrmann J.L.; Goldberg L.A.; Khan A.M.; Partington S.L.; Brothers J.A.;
Mascio C.E.; Spray T.L.; Kim Y.Y.; Fuller S.
Institution
(Herrmann) Division of Cardiac Surgery, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Herrmann, Goldberg, Mascio, Spray, Fuller) Division of Cardiothoracic
Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, United
States
(Khan, Partington, Kim) Division of Cardiovascular Medicine, Hospital of
the University of Pennsylvania, Philadelphia, PA, United States
(Brothers) Division of Cardiology, The Children's Hospital of
Philadelphia, Philadelphia, PA, United States
Title
A Comparison of Perioperative Management of Anomalous Aortic Origin of a
Coronary Artery Between an Adult and Pediatric Cardiac Center.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 7 (6) (pp
721-726), 2016. Date of Publication: 01 Nov 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Anomalous aortic origin of a coronary artery (AAOCA) presents
in varying age-groups. Assuming management algorithms differ between
pediatric and adult institutions, we compared the perioperative management
of patients with AAOCA at two such centers. Methods: A retrospective
review was conducted at a pediatric and an adult institution of patients
14 years or older who underwent surgical repair of AAOCA between January
2000 and May 2014. Results: Twenty patients from the pediatric center
(median age: 16.5 years, range: 14-18 years) and nine patients from the
adult center (median age: 40 years, range: 37-52 years) were included. An
anomalous aortic origin of a right coronary artery was the most frequent
pathology at each institution. Chest pain was the most common presenting
symptom at both institutions. Preoperative echocardiography was performed
in 95% patients at the pediatric center and in 100% of patients at the
adult center. Cardiac catheterization was utilized more frequently at the
adult center, and cardiac magnetic resonance imaging more commonly
employed at the pediatric center. Isolated coronary unroofing was
performed in 19 of 20 cases at the pediatric center and in only 2 (22%)
cases at the adult institution, both by congenitally trained cardiac
surgeons. More concomitant cardiac procedures were performed at the adult
center with associated longer operative times and hospital stays.
Conclusion: Management strategies for AAOCA vary depending on both
patient-specific factors and expertise of the managing team. Further
studies are needed to optimally standardize diagnostic and treatment
pathways regardless of location venue. Copyright &#xa9; 2016, &#xa9; The
Author(s) 2016.

<57>
Accession Number
613120301
Author
Wallentin L.; Lindhagen L.; Arnstrom E.; Husted S.; Janzon M.; Johnsen
S.P.; Kontny F.; Kempf T.; Levin L.-A.; Lindahl B.; Stridsberg M.; Stahle
E.; Venge P.; Wollert K.C.; Swahn E.; Lagerqvist B.
Institution
(Wallentin, Lindahl, Lagerqvist) Department of Medical Sciences, Uppsala
University, Uppsala, Sweden
(Wallentin, Lindhagen, Arnstrom, Lindahl, Lagerqvist) Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Stridsberg, Venge) Department of Medical Sciences, Clinical Chemistry,
Uppsala University, Uppsala, Sweden
(Stahle) Department of Surgical Sciences, Thoracic Surgery, Uppsala
University, Uppsala, Sweden
(Husted) Medical Department, Hospital Unit West, Herning/Holstebro,
Denmark
(Janzon, Levin, Swahn) Department of Cardiology and Department of Medical
and Health Sciences, Linkoping University, Linkoping, Sweden
(Janzon, Levin) Division of Health Care Analysis, Department of Medical
and Health Sciences, Center for Medical Technology Assessment, Linkoping
University, Linkoping, Sweden
(Johnsen) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
(Kontny) Stavanger University Hospital, Department of Cardiology,
Stavanger, Norway
(Kontny) Drammen Heart Center, Drammen, Norway
(Kempf, Wollert) Department of Cardiology and Angiology, Hannover Medical
School, Hannover, Germany
Title
Early invasive versus non-invasive treatment in patients with
non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of
a prospective, randomised, multicentre study.
Source
The Lancet. 388 (10054) (pp 1903-1911), 2016. Date of Publication: 15 Oct
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The FRISC-II trial was the first randomised trial to show a
reduction in death or myocardial infarction with an early invasive versus
a non-invasive treatment strategy in patients with non-ST-elevation acute
coronary syndrome. Here we provide a remaining lifetime perspective on the
effects on all cardiovascular events during 15 years' follow-up. Methods
The FRISC-II prospective, randomised, multicentre trial was done at 58
Scandinavian centres in Sweden, Denmark, and Norway. Between June 17,
1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with
non-ST-elevation acute coronary syndrome to an early invasive treatment
strategy, aiming for revascularisation within 7 days, or a non-invasive
strategy, with invasive procedures at recurrent symptoms or severe
exercise-induced ischaemia. Plasma for biomarker analyses was obtained at
randomisation. For long-term outcomes, we linked data with national
health-care registers. The primary endpoint was a composite of death or
myocardial infarction. Outcomes were compared as the average postponement
of the next event, including recurrent events, calculated as the area
between mean cumulative count-of-events curves. Analyses were done by
intention to treat. Findings At a minimum of 15 years' follow-up on Dec
31, 2014, data for survival status and death were available for 2421 (99%)
of the initially recruited 2457 patients, and for other events after 2
years for 2182 (89%) patients. During follow-up, the invasive strategy
postponed death or next myocardial infarction by a mean of 549 days (95%
CI 204-888; p=0.0020) compared with the non-invasive strategy. This effect
was larger in non-smokers (mean gain 809 days, 95% CI 402-1175;
p<inf>interaction</inf>=0.0182), patients with elevated troponin T (778
days, 357-1165; p<inf>interaction</inf>=0.0241), and patients with high
concentrations of growth differentiation factor-15 (1356 days, 507-1650;
p<inf>interaction</inf>=0.0210). The difference was mainly driven by
postponement of new myocardial infarction, whereas the early difference in
mortality alone was not sustained over time. The invasive strategy led to
a mean of 1128 days (95% CI 830-1366) postponement of death or next
readmission to hospital for ischaemic heart disease, which was consistent
in all subgroups (p<0.0001). Interpretation During 15 years of follow-up,
an early invasive treatment strategy postponed the occurrence of death or
next myocardial infarction by an average of 18 months, and the next
readmission to hospital for ischaemic heart disease by 37 months, compared
with a non-invasive strategy in patients with non-ST-elevation acute
coronary syndrome. This remaining lifetime perspective supports that an
early invasive treatment strategy should be the preferred option in most
patients with non-ST-elevation acute coronary syndrome. Funding Swedish
Heart-Lung Foundation, Swedish Foundation for Strategic Research, and
Uppsala Clinical Research Center. Copyright &#xa9; 2016 Elsevier Ltd

<58>
Accession Number
602988924
Author
Linni K.; Aspalter M.; Butturini E.; Dabernig W.; Guggenbichler S.; Hitzl
W.; Holzenbein T.
Institution
(Linni, Aspalter, Butturini, Dabernig, Guggenbichler, Holzenbein)
Department of Vascular and Endovascular Surgery, PMU Salzburg, Mullner
Hauptstrasse 48, Salzburg A-5020, Austria
(Hitzl) Department of Biostatistics, PMU, Salzburg, Austria
Title
Arm veins versus contralateral greater saphenous veins for lower extremity
bypass reconstruction: Preliminary data of a randomized study.
Source
Annals of Vascular Surgery. 29 (3) (pp 551-559), 2015. Date of
Publication: 01 Apr 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The aim of this randomized study was to determine whether arm
vein (AV) or contralateral greater saphenous vein (CGSV) is the better
alternative vein source for lower extremity bypass reconstruction. Methods
Consecutive patients with absent ipsilateral greater saphenous vein
undergoing lower extremity revascularization were allocated to group A (AV
bypass) or B (CGSV bypass). Results From 6, 2010, to 11, 2013, 64 patients
(32 each group) were randomized. In all, 29 of 93 patients had to be
excluded for various reasons. Median age was 76 years vs. 71 years (P =
0.01) for group A and B patients. There were no statistically significant
differences regarding gender, cardiovascular risk factors, redo bypass
procedures (P = 0.77), below-knee bypass procedures (P = 0.61), median
bypass length (P = 0.6), and median length of incision on ipsilateral leg
to perform anastomoses (P = 0.2) between group A and B patients,
respectively. Incisions for vein harvest were longer in group A (P =
0.003). Overall surgical site infections (SSIs, P = 1.0) and SSI from vein
harvest (P = 1.0) were equally distributed. No patient was lost to
follow-up (17 vs. 18 months, P = 0.74). There was no statistically
significant difference regarding primary (P = 0.77) and secondary (P =
0.25) patency rates at 1 year (group A: 52% vs. group B: 54% and group A:
72% vs. group B: 61%) and at 2 years (52% vs. 48% and 64% vs. 61%),
respectively. There were 4 vs. 6 major amputations (P = 0.23) and 5 vs. 2
deaths (P = 0.1) in groups A and B during follow-up. Conclusions
Preliminary results suggest that both AV and CGSV may serve as a secondary
vein bypass graft equally well. Copyright &#xa9; 2015 Elsevier Inc.

<59>
[Use Link to view the full text]
Accession Number
605282918
Author
Bangalore S.; Toklu B.; Wetterslev J.
Institution
(Bangalore, Toklu) Division of Cardiology, New York University, School of
Medicine, New York, NY, United States
(Wetterslev) Division of Cardiology, Copenhagen Trial Unit, Centre for
Clinical Intervention Research, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
Title
Complete Versus Culprit-Only Revascularization for ST-Segment-Elevation
Myocardial Infarction and Multivessel Disease.
Source
Circulation: Cardiovascular Interventions. 8 (4) (no pagination), 2015.
Article Number: e002142. Date of Publication: 21 Apr 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
Background - The 2013 American College of Cardiology Foundation/American
Heart Association guidelines for patients with ST-segment-elevation
myocardial infarction gives a class III indication for nonculprit artery
percutaneous coronary intervention at the time of primary percutaneous
coronary intervention, driven by data from observational studies. However,
more recent trials suggest otherwise. Methods and Results - We conducted
PUBMED, EMBASE, and CENTRAL searches for randomized trials comparing
complete versus culprit-only revascularization in patients with
ST-segment-elevation myocardial infarction. Efficacy outcomes were major
adverse cardiovascular events, as well as death, cardiovascular death,
myocardial infarction, and repeat revascularization. Safety outcomes were
contrast-induced nephropathy, contrast volume used, and procedure time.
Five trials with 1165 patients fulfilled the inclusion criteria. Complete
revascularization (68% during index percutaneous coronary intervention)
was associated with significant reduction in major adverse cardiovascular
events (rate ratio =0.48; 95% confidence interval =0.37-0.61), death (rate
ratio =0.60; 95% confidence interval =0.38-0.97), cardiovascular death
(rate ratio =0.38, 95% confidence interval =0.20-0.73), and repeat
revascularization (rate ratio =0.42; 95% confidence interval =0.31-0.57)
when compared with culprit-only revascularization. However, trial
sequential analyses (similar to interim analysis of a randomized trial)
powered for a 25% relative reduction showed firm evidence (cumulative
z-curve crossed the monitoring boundary) only for major adverse
cardiovascular events driven by a decrease in repeat revascularization
with no firm evidence for reduction in death and myocardial infarction.
Moreover, there was a significant increase in contrast volume use (mean
difference 85.12 [70.41-83.00] ml) and procedure time (mean difference
16.42 [13.22-19.63] mins) with complete revascularization without increase
in contrast-induced nephropathy. Conclusions - In patients with
ST-segment-elevation myocardial infarction, immediate or staged complete
revascularization results in significant reduction in major adverse
cardiovascular events driven largely by reduction in repeat
revascularization with no firm evidence for the reduction in death or
myocardial infarction when compared with culprit-only revascularization.
Copyright &#xa9; &#xa9; 2015 American Heart Association, Inc.

<60>
Accession Number
605282883
Author
Nikolsky E.; Mehran R.; Dangas G.D.; Xu K.; Parvataneni R.; Witzenbichler
B.; Guagliumi G.; Kornowski R.; Genereux P.; Brener S.J.; Stone G.W.
Institution
(Nikolsky) Cardiology Department, Rambam Health Care Campus,
Technion-Israel Institute of Technology, Intermediate Cardiac Care Unit,
Cardiovascular Research Unit, 8 Ha'Aliyah St., Haifa 35254, Israel
(Mehran, Dangas, Xu, Parvataneni, Genereux, Brener, Stone) Cardiovascular
Research Foundation, New York, NY, United States
(Mehran, Dangas) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Witzenbichler) Helios Amper-Klinikum, Dachau, Germany
(Guagliumi) Ospedale Papa Giovanni XXIII, Bergamo, Italy
(Kornowski) Rabin Medical Center, Petach-Tikva, Israel
(Genereux) Hopital du Sacre-Coeur de Montreal, QC, Canada
(Genereux, Stone) Columbia University, Medical Center, New York, NY,
United States
(Brener) New York Methodist Hospital, Brooklyn, United States
Title
Cerebrovascular Events after a Primary Percutaneous Coronary Intervention
Strategy for Acute ST-Segment- Elevation Myocardial Infarction.
Source
Circulation: Cardiovascular Interventions. 8 (4) (no pagination), 2015.
Article Number: e002283. Date of Publication: 21 Apr 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
Background - Patients with ST-segment-elevation myocardial infarction are
at increased risk of cerebrovascular events. We assessed the incidence,
predictors, and implications of cerebrovascular events in patients with
ST-segment-elevation myocardial infarction managed with a primary
percutaneous coronary intervention strategy. Methods and Results - In the
Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial
Infarction (HORIZONS-AMI) trial, 72 of 3602 patients (2.0%) experienced at
least 1 cerebrovascular event (stroke: 63 patients; transient ischemic
attack: 12 patients) during the 3-year follow-up (40.3% within 30 days,
20.8% between 30 days and 1 year, and 38.9% between 1 and 3 years). Stroke
was ischemic in 58 (92.1%) patients and hemorrhagic in 5 (7.9%) patients.
More than half of all strokes (52.3%) were disabling. By principal
management strategy, cerebrovascular events developed in 2.0%, 14.9%, and
1.9% of patients triaged to primary percutaneous coronary intervention,
coronary artery bypass grafting, and medical therapy, respectively
(P<0.0001). Cerebrovascular events were independently predicted by older
age, creatinine clearance <60 mL/min, treatment with coronary artery
bypass grafting, anemia, and diabetes mellitus. Cerebrovascular events
were associated with significantly increased rates of 3-year mortality
(20.5% versus 6.5%; P<0.0001), as well as reinfarction (14.3% versus 3.8%;
P=0.0007), ischemia-driven target vessel revascularization (22.8% versus
13.0%; P=0.006), and major bleeding (23.5% versus 8.4%; P<0.0001).
Conclusions - In HORIZONS-AMI, cerebrovascular events within 3 years after
ST-segment-elevation myocardial infarction in patients undergoing a
primary percutaneous coronary intervention management strategy occurred in
2.0% of patients and were most frequent after coronary artery bypass
grafting. Cerebrovascular events were often disabling and were strongly
associated with high rates of death, reinfarction, recurrent ischemia, and
major bleeding. Clinical Trial Registration - URL:
http://www.clinicaltrials.gov. Unique identifier: NCT00433966. Copyright
&#xa9; &#xa9; 2015 American Heart Association, Inc.

<61>
[Use Link to view the full text]
Accession Number
605282819
Author
Piccolo R.; Stefanini G.G.; Franzone A.; Spitzer E.; Blochlinger S.; Heg
D.; Juni P.; Windecker S.
Institution
(Piccolo, Stefanini, Franzone, Spitzer, Blochlinger, Windecker) Department
of Cardiology, Bern University Hospital, Bern 3010, Switzerland
(Heg, Juni, Windecker) Clinical Trials Unit, University of Bern, Bern,
Switzerland
(Heg) Institute of Social and Preventive Medicine, University of Bern,
Bern, Switzerland
(Juni) Institute of Primary Health Care (BIHAM), University of Bern, Bern,
Switzerland
Title
Safety and Efficacy of Resolute Zotarolimus-Eluting Stents Compared with
Everolimus-Eluting Stents.
Source
Circulation: Cardiovascular Interventions. 8 (4) (no pagination), 2015.
Article Number: e002223. Date of Publication: 21 Apr 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
Background - Although new-generation drug-eluting stents represent the
standard of care among patients undergoing percutaneous coronary
intervention, there remains debate about differences in efficacy and the
risk of stent thrombosis between the Resolute zotarolimus-eluting stent
(R-ZES) and the everolimus-eluting stent (EES). The aim of this study was
to evaluate the safety and efficacy of the R-ZES compared with EES in
patients undergoing percutaneous coronary intervention. Methods and
Results - A systematic literature search of electronic resources was
performed using specific search terms until September 2014. Random-effects
meta-analysis was performed comparing clinical outcomes between patients
treated with R-ZES and EES up to maximum available follow-up. The primary
efficacy end point was target-vessel revascularization. The primary safety
end point was definite or probable stent thrombosis. Secondary safety end
points were cardiac death and target-vessel myocardial infarction. Five
trials were identified, including a total of 9899 patients. Compared with
EES, R-ZES had similar risks of target-vessel revascularization (risk
ratio [RR], 1.06; 95% confidence interval [CI], 0.90-1.24; P=0.50),
definite or probable stent thrombosis (RR, 1.26; 95% CI, 0.86-1.85;
P=0.24), cardiac death (RR, 1.01; 95% CI, 0.79-1.30; P=0.91), and
target-vessel myocardial infarction (RR, 1.10; 95% CI, 0.89-1.36; P=0.39).
Moreover, R-ZES and EES had similar risks of late definite or probable
very late stent thrombosis (RR, 1.06; 95% CI, 0.53-2.11; P=0.87). No
evidence of significant heterogeneity was observed across trials.
Conclusions - R-ZES and EES provide similar safety and efficacy among
patients undergoing percutaneous coronary intervention. Copyright &#xa9;
&#xa9; 2015 American Heart Association, Inc.

<62>
Accession Number
603692071
Author
Naraghi L.; Mejaddam A.Y.; Birkhan O.A.; Chang Y.; Cropano C.M.; Mesar T.;
Larentzakis A.; Peev M.; Sideris A.C.; Van der Wilden G.M.; Imam A.M.;
Hwabejire J.O.; Velmahos G.C.; Fagenholz P.J.; Yeh D.; de Moya M.A.; King
D.R.
Institution
(Naraghi, Mejaddam, Birkhan, Chang, Cropano, Mesar, Larentzakis, Peev,
Sideris, Van der Wilden, Imam, Hwabejire, Velmahos, Fagenholz, Yeh, de
Moya, King) Division of Trauma, Emergency Surgery and Surgical Critical
Care, Massachusetts General Hospital and Harvard Medical School, Boston,
MA, United States
Title
Sample entropy predicts lifesaving interventions in trauma patients with
normal vital signs.
Source
Journal of Critical Care. 30 (4) (pp 705-710), 2015. Date of Publication:
01 Aug 2015.
Publisher
W.B. Saunders
Abstract
Introduction: Heart rate complexity, commonly described as a "new vital
sign," has shown promise in predicting injury severity, but its use in
clinical practice is not yet widely adopted. We previously demonstrated
the ability of this noninvasive technology to predict lifesaving
interventions (LSIs) in trauma patients. This study was conducted to
prospectively evaluate the utility of real-time, automated, noninvasive,
instantaneous sample entropy (SampEn) analysis to predict the need for an
LSI in a trauma alert population presenting with normal vital signs.
Methods: Prospective enrollment of patients who met criteria for trauma
team activation and presented with normal vital signs was conducted at a
level I trauma center. High-fidelity electrocardiogram recording was used
to calculate SampEn and SD of the normal-to-normal R-R interval (SDNN)
continuously in real time for 2 hours with a portable, handheld device.
Patients who received an LSI were compared to patients without any
intervention (non-LSI). Multivariable analysis was performed to control
for differences between the groups. Treating clinicians were blinded to
results. Results: Of 129 patients enrolled, 38 (29%) received 136 LSIs
within 24 hours of hospital arrival. Initial systolic blood pressure was
similar in both groups. Lifesaving intervention patients had a lower
Glasgow Coma Scale. The mean SampEn on presentation was 0.7 (0.4-1.2) in
the LSI group compared to 1.5 (1.1-2.0) in the non-LSI group (. P <
.0001). The area under the curve with initial SampEn alone was 0.73 (95%
confidence interval [CI], 0.64-0.81) and increased to 0.93 (95% CI,
0.89-0.98) after adding sedation to the model. Sample entropy of less than
0.8 yields sensitivity, specificity, negative predictive value, and
positive predictive value of 58%, 86%, 82%, and 65%, respectively, with an
overall accuracy of 76% for predicting an LSI. SD of the normal-to-normal
R-R interval had no predictive value. Conclusions: In trauma patients with
normal presenting vital signs, decreased SampEn is an independent
predictor of the need for LSI. Real-time SampEn analysis may be a useful
adjunct to standard vital signs monitoring. Adoption of real-time,
instantaneous SampEn monitoring for trauma patients, especially in
resource-constrained environments, should be considered. Copyright &#xa9;
2015 Elsevier Inc..

<63>
Accession Number
605504210
Author
Koch K.T.; Grundeken M.J.; Vos N.S.; IJsselmuiden A.J.J.; Van Geuns R.-J.;
Wessely R.; Dengler T.; La Manna A.; Silvain J.; Montalescot G.;
Spaargaren R.; Tijssen J.G.P.; Amoroso G.
Institution
(Koch, Grundeken, Tijssen) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Vos, Amoroso) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(IJsselmuiden) Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands
(Van Geuns) Erasmus Medical Center, Rotterdam, Netherlands
(Wessely) Cologne Cardiovascular and Chest Center, Cologne, Germany
(Dengler) SLK Kliniken, Heilbronn, Germany
(La Manna) Ospedale Ferrarotto, Catania, Italy
(Silvain, Montalescot) CHU la Pitie-Salpetriere (AP-HP), ACTION Study
Group, Univ Paris 06, Paris, France
(Spaargaren) STENTYS S.A, Paris, France
Title
One-year clinical outcomes of the STENTYS Self-Apposing coronary stent in
patients presenting with ST-segment elevation myocardial infarction:
Results from the APPOSITION III registry.
Source
EuroIntervention. 11 (3) (pp 264-271), 2015. Date of Publication: 01 Jul
2015.
Publisher
EuroPCR
Abstract
Aims: The aim of APPOSITION III was to evaluate the feasibility and
performance of the STENTYS Self-Apposing stent (STENTYS S.A., Paris,
France) in the setting of primary percutaneous coronary intervention
(PCI). Methods and results: APPOSITION III was an international,
prospective, multicentre registry. The study population consisted of 965
patients. The rate of the primary endpoint major adverse cardiac events
(MACE), defined as the composite of cardiac death, recurrent target vessel
myocardial infarction (TV-MI), and clinically driven target lesion
revascularisation (CD-TLR), at one year was 9.3%. One-year cardiac death
rate was 2.0%, TV-MI rate was 1.3%, CD-TLR rate was 7.4% and
definite/probable stent thrombosis (ST) rate was 3.5% (definite ST 2.8%).
An interim safety analysis of in-hospital outcomes in the first 400
patients showed higher event rates if post-dilation was not performed, and
post-dilations became highly recommended in the remaining cohort. Patients
undergoing post-dilation eventually showed a numerically lower one-year
MACE rate (8.4% vs. 11.3%, p=0.137). One-year TV-MI (0.8% vs. 2.5%,
p=0.027) and definite ST (1.9% vs. 5.0%, p=0.010) rates were significantly
lower if post-dilation was performed, with the divergence occurring at <30
days. Conclusions: The use of the STENTYS Self-Apposing stent in the
setting of primary PCI was feasible and associated with acceptable
cardiovascular event rates which improved when post-dilation was
performed. Copyright &#xa9; Europa Digital & Publishing 2015. All rights
reserved.

<64>
Accession Number
602095645
Author
Lam C.S.P.; McEntegart M.; Claggett B.; Liu J.; Skali H.; Lewis E.; Kober
L.; Rouleau J.; Velazquez E.; Califf R.; McMurray J.J.; Pfeffer M.;
Solomon S.
Institution
(Lam) National University Health System, Tower Block, 1E Kent Ridge Road
119228, Singapore
(McEntegart, McMurray) Department of Cardiology, Western Infirmary
Scotland, Glasgow, United Kingdom
(Claggett, Liu, Skali, Lewis, Pfeffer, Solomon) Brigham and Women's
Hospital, Boston, MA, United States
(Kober) Rigshospitalet, Copenhagen, Denmark
(Rouleau) Montreal Heart Institute, QC, Canada
(Velazquez, Califf) Duke University Medical Center, Durham, NC, United
States
Title
Sex differences in clinical characteristics and outcomes after myocardial
infarction: Insights from the Valsartan in Acute Myocardial Infarction
Trial (VALIANT).
Source
European Journal of Heart Failure. 17 (3) (pp 301-312), 2015. Date of
Publication: 01 Mar 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background We examined the association of sex with clinical
characteristics and outcomes in patients following myocardial infarction
(MI) in the Valsartan in Acute Myocardial Infarction Trial (VALIANT).
Methods and Results A total of 4570 women and 10 133 men with heart
failure (HF), left ventricular systolic dysfunction or both were enrolled
0.5-10 days after myocardial infarction (MI) and followed for a median of
24.7 months. Compared with men, women were older, had more comorbidities,
and were more likely to present in Killip Class III/IV and experience
post-infarction angina or HF. After adjusting for baseline differences,
both short-term and longer-term mortality were similar in men and women.
However, women were more likely than men to experience the composite
outcome of cardiovascular death, MI, HF, stroke, and resuscitation from
cardiac arrest [adjusted hazard ratio (HR) 1.15; 95% confidence interval
(CI); 1.06-1.24, P = 0.001], mainly owing to an increased risk of
hospitalization for HF (adjusted HR 1.36; 95% CI 1.22-1.52; P < 0.001). In
a subset of patients who underwent echocardiographic study (n = 603),
women had smaller left ventricular volumes indexed by body size than men
but similar ejection fractions and similar changes in ventricular volumes
from baseline to 1 month and 20 months. Conclusions In VALIANT, the risk
of HF following MI was higher in women than men after adjusting for age
and comorbidities, although the risk of other fatal and non-fatal outcomes
were similar. The higher long-term risk of HF in women appears to be
independent of the extent of left ventricular systolic dysfunction or
remodelling compared with men. Copyright &#xa9; 2015 The Authors. European
Journal of Heart Failure &#xa9; 2015 European Society of Cardiology.

<65>
[Use Link to view the full text]
Accession Number
612287125
Author
Medeiros D.N.M.; Ferranti J.F.; Delgado A.F.; De Carvalho W.B.
Institution
(Medeiros, Ferranti) Pediatric Intensive Care Unit, Hospital Municipal Dr.
Moises Deutsch-M Boi Mirim, Av. Albert Einstein, 627/701, Sao Paulo
05652-900, Brazil
(Medeiros) Pediatric Intensive Care Unit, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Delgado, De Carvalho) Pediatric Intensive Care Department, Instituto da
Crianca, Sao Paulo, Brazil
Title
Colloids for the initial management of severe sepsis and septic shock in
pediatric patients a systematic review.
Source
Pediatric Emergency Care. 31 (11) (pp e11-e16), 2015. Date of Publication:
November 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aim: The goal of this study was to perform a systematic review of the
literature assessing the use of colloids for the initial treatment of
severe sepsis and septic shock in pediatric patients. Design: The PICO
[Patient, Intervention, Comparison, Outcome] method was used for the
selection of studies, and the Cochrane Bias Tool was used to analyze the
quality of the selected studies. Data Search: Relevant studies were sought
using the following databases: EMBASE (1980 to March 2014), PubMed (1970
to March 2014), Cochrane (1980 to March 2014), Web of Science, and Scopus.
Searches used the following key words: isotonic solution, crystalloid,
saline solution, colloid, resuscitation, fluid therapy, sepsis and septic
shock, starch, and gelatin. The filters children and clinical trial were
used when possible. Review Method: Study selection was performed by 1
examiner. The selected articles were analyzed by 2 examiners who validated
the articles according to the Cochrane Bias Tool. Discrepancies were
resolved by consensus or by a third examiner. Result: A total of 110
articles were selected based on the key words. Of these, 99 were excluded
because they assessed postoperative follow-up, burn cases, cardiac
surgery, or nutritional therapy or were review articles, guidelines, or
editorials. One study was included after an analysis of previous reviews.
A total of 12 articles were selected for analysis because they were
reports of clinical trials conducted with prospective cohorts and they
analyzed the use of crystalloids and colloids or colloids only in the
initial treatment of severe sepsis or septic shock in children and
adolescents. The total number of patients was 4375, and they ranged in age
from 2 months to 15 years, with most patients between 5 and 15 years. Five
studies assessed patients diagnosed with malaria, 5 assessed patients with
dengue shock syndrome, 1 studied febrile diseases, and 1 examined the
progression of patients with septic shock caused by various causes.
Conclusions: The studies analyzed did not find evidence to suggest that
the use of colloids is superior to crystalloids. In some studies, the
fluid volume needed to achieve initial stabilization was smaller in the
group given colloids. Crystalloids are the preferred therapeutic option
because of their effectiveness, low cost, and wide availability. Colloids
may be the first choice in cases of malaria when the central nervous
system is affected. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc. All
rights reserved.

<66>
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.

<67>
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.

<68>
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.

<69>
Accession Number
613367508
Author
Guan Z.; Lv Y.; Liu J.; Liu L.; Yuan H.; Shen X.
Institution
(Guan, Liu, Yuan, Shen) Departments of Anesthesiology and, China
(Lv) Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong
University, Xi'an, Shaanxi, China
(Liu) Department of Neurology, Second Affiliated Hospital of Xi'an
Jiaotong University, Xi'an, Shaanxi, China
Title
Smoking Cessation Can Reduce the Incidence of Postoperative Hypoxemia
After On-Pump Coronary Artery Bypass Grafting Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1545-1549),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives To determine whether smoking cessation can reduce the incidence
of postoperative hypoxemia (POH) after on-pump coronary artery bypass
grafting (CABG) surgery. Design Prospective, single-center, observational
study. Setting Single-center university teaching hospital. Participants
The study comprised 300 patients undergoing on-pump CABG surgery who met
the inclusion criteria. Patients were divided into the following 3 groups
according to smoking status: sustained quitters (n = 132)-smoking
cessation for more than 1 month and less than 1 year; quitters (n =
95)-smoking cessation for more than 1 week and less than 1 month; and
smokers (n = 73)-smoking at least 1 cigarette per day for at least 1 year.
Interventions None. Measurements and Main Results The primary outcome was
the incidence of POH after on-pump CABG surgery. Secondary outcomes
included length of postoperative mechanical ventilation and intensive care
unit stay between the POH group and non-POH group. There were significant
decreases of POH incidence in the sustained quitters and quitters compared
with the smokers both after intensive care unit (ICU) admission and 24
hours after surgery (18.2%, 18.9%, v 32.9%; p = 0.036 and 9.8%, 10.5%, v
26%; p = 0.003, respectively), and there was no significant difference in
POH incidence between the sustained quitters and quitters. The length of
postoperative mechanical ventilation was longer in smokers than in
sustained quitters and quitters (15.9+/-6.1 h v 11.9+/-5.3 h and
13.0+/-5.8 h, respectively; p<0.05), but there were no significant
differences in the length of ICU stay among the 3 groups (54.2+/-7.5 h v
55.1+/-7.5 h and 53.7+/-6.6 h, respectively; p = 0.333). Conclusions
Smoking cessation can reduce POH after on-pump CABG surgery, and it also
can shorten the length of postoperative mechanical ventilation. Copyright
&#xa9; 2016 Elsevier Inc.

<70>
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.

<71>
Accession Number
613283078
Author
Abreu J.S.; Tsutsui J.M.; Falcao S.N.R.; Feitosa J.A.; Rocha E.A.;
Oliveira I.M.; Diogenes T.C.; Paes J.N.; Sbano J.C.; Dallan L.A.; Filho
R.K.; Mathias W.
Institution
(Abreu) Public Health Department, State University of Ceara, Fortaleza,
Brazil
(Abreu, Feitosa, Rocha, Diogenes, Paes) Prontocardio Hospital, Fortaleza,
Brazil
(Abreu, Tsutsui, Sbano, Dallan, Filho, Mathias) Program in Cardiology,
Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
(Falcao, Oliveira) Messejana's Heart and Lung Hospital, Fortaleza, Brazil
Title
The impact of ligation of proximal side branches on blood flow and
functional status of the internal thoracic artery in coronary anastomosis.
Source
Echocardiography. 33 (11) (pp 1656-1664), 2016. Date of Publication: 01
Nov 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The effect of proximal side branches on the patency of the
internal thoracic artery (ITA) is controversial. We used echocardiography
and Doppler to verify the effect of ligation of branches on the flow and
coronary flow reserve (CFR) of the grafted ITA in patients after coronary
artery bypass grafting (CABG). Methods: We prospectively investigated 53
patients with preserved left ventricular ejection fraction (LVEF >50%) who
underwent CABG of the ITA. In Group I (25 patients), major branches were
ligated during ITA anastomosis to the left anterior descending (LAD)
coronary artery, whereas no ligation was performed in Group II (28
patients). Systolic flow (SF), diastolic flow (DF), and total flow (TF =
SF + DF) were measured by Doppler echocardiography at the proximal level
of the ITA preoperatively, at early postoperative stage, and 6 months
after surgery. Dobutamine stress echocardiography (DSE) was performed at 6
months to determine CFR. Results: The ITA flow was predominantly systolic
before surgery and diastolic in the postoperative period. We found no
differences between the groups in DF. On DSE, SF (19.5+/-9 mL/min vs
32.7+/-19 mL/min; P=.003) and TF (79+/-21 mL/min vs 101+/-47 mL/min;
P=.037) were higher in Group II. There were no differences in CFR
(1.9+/-0.46 vs 2.11+/-0.56; P=.143). Conclusion: In patients with
preserved LVEF, ligation of major side branches during anastomosis to the
LAD does not alter ITA flow or CFR. Copyright &#xa9; 2016, Wiley
Periodicals, Inc.

<72>
Accession Number
613260169
Author
Joo H.J.; Cho S.-A.; Hong S.J.; Hur S.-H.; Bae J.-H.; Choi D.-J.; Ahn
Y.-K.; Park J.-S.; Choi R.-K.; Choi D.; Kim J.-H.; Han K.-R.; Park H.-S.;
Choi S.-Y.; Yoon J.-H.; Kwon H.-C.; Rha S.-W.; Hwang K.-K.; Jung K.-T.; Oh
S.-K.; Lee J.-H.; Shin E.-S.; Kim K.-S.; Kim H.-S.; Lim D.-S.
Institution
(Joo, Cho, Hong, Lim) Division of Cardiology, Korea University Anam
Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul 136-705, South Korea
(Hur) Division of Cardiology, Keimyung University Dongsan Medical Center,
Daegu, South Korea
(Bae) Division of Cardiology, Konyang University Hospital, Daejeon, South
Korea
(Choi) Division of Cardiology, Seoul National University Bundang Hospital,
Seongnam, South Korea
(Ahn) Division of Cardiology, Chonnam National University Hospital,
Gwangju, South Korea
(Park) Division of Cardiology, Yeungnam University Hospital, Daegu, South
Korea
(Choi) Division of Cardiology, Sejong General Hospital, Bucheon, South
Korea
(Choi) Division of Cardiology, Yonsei University Severance Hospital,
Seoul, South Korea
(Kim) Division of Cardiology, Pusan National University Yangsan Hospital,
Yangsan, South Korea
(Han) Division of Cardiology, Hallym University Kangdong Sacred Heart
Hospital, Seoul, South Korea
(Park) Division of Cardiology, Kyungpook National University Hospital,
Daegu, South Korea
(Choi) Division of Cardiology, Ajou University Hospital, Suwon, South
Korea
(Yoon) Division of Cardiology, Wonju Severance Christian Hospital, Wonju,
South Korea
(Kwon) Division of Cardiology, Samsung Medical Center, Seoul, South Korea
(Rha) Division of Cardiology, Korea University Guro Hospital, Seoul, South
Korea
(Hwang) Division of Cardiology, Chungbuk National University Hospital,
Cheongju, South Korea
(Jung) Division of Cardiology, Eulji University Hospital, Daejeon, South
Korea
(Oh) Division of Cardiology, Wonkwang University Hospital, Iksan, South
Korea
(Lee) Division of Cardiology, Chungnam National University Hospital,
Daejeon, South Korea
(Shin) Division of Cardiology, Ulsan University Hospital, Ulsan, South
Korea
(Kim) Division of Cardiology, Daegu Catholic University Medical Center,
Daegu, South Korea
(Kim) Division of Cardiology, Seoul National University Hospital, 101,
DaeHak-ro, JongRo-gu, Seoul 110-744, South Korea
Title
Impact of low high-density lipoprotein-cholesterol level on 2-year
clinical outcomes after acute myocardial infarction in patients with
diabetes mellitus.
Source
Lipids in Health and Disease. 15 (1) (pp 1-8), 2016. Date of Publication:
18 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: It is still unclear whether low high-density lipoprotein
cholesterol (HDL-C) affects cardiovascular outcomes after acute myocardial
infarction (AMI), especially in patients with diabetes mellitus. Methods:
A total of 984 AMI patients with diabetes mellitus from the DIabetic Acute
Myocardial InfarctiON Disease (DIAMOND) Korean multicenter registry were
divided into two groups based on HDL-C level on admission: normal HDL-C
group (HDL-C > 40 mg/dL, n = 519) and low HDL-C group (HDL-C < 40 mg/dL, n
= 465). The primary endpoint was 2-year major adverse cardiovascular
events (MACE), defined as a composite of cardiac death, non-fatal
myocardial infarction (MI), and target vessel revascularization (TVR).
Results: The median follow-up duration was 730 days. The 2-year MACE rates
were significantly higher in the low HDL-C group than in the normal HDL-C
group (MACE, 7.44% vs. 3.49%, p = 0.006; cardiac death, 3.72% vs. 0.97%, p
= 0.004; non-fatal MI, 1.75% vs. 1.55%, p = 0.806; TVR, 3.50% vs. 0.97%, p
= 0.007). Kaplan-Meier analysis revealed that the low HDL-C group had a
significantly higher incidence of MACE compared to the normal HDL-C group
(log-rank p = 0.013). After adjusting for conventional risk factors, Cox
proportional hazards analysis suggested that low HDL-C was an independent
risk predictor for MACE (hazard ratio [HR] 3.075, 95% confidence interval
[CI] 1.034-9.144, p = 0.043). Conclusions: In patients with diabetes
mellitus, low HDL-C remained an independent risk predictor for MACE after
adjusting for multiple risk factors during 2-year follow-up of AMI. Trial
registration: This study was the sub-analysis of the prospective
multi-center registry of DIAMOND (Diabetic acute myocardial infarction
Disease) in Korea. This is the observational study supported by Bayer
HealthCare, Korea. Study number is 15614. First patient first visit was 02
April 2010 and last patient last visit was 09 December 2013. Copyright
&#xa9; 2016 The Author(s).

<73>
Accession Number
613244267
Author
Villablanca P.A.; Mathew V.; Thourani V.H.; Rodes-Cabau J.; Bangalore S.;
Makkiya M.; Vlismas P.; Briceno D.F.; Slovut D.P.; Taub C.C.; McCarthy
P.M.; Augoustides J.G.; Ramakrishna H.
Institution
(Villablanca, Briceno, Slovut, Taub) Division of Cardiovascular Diseases,
Montefiore Medical Center/Albert Einstein College of Medicine, New York,
NY, United States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(Thourani) Emory University School of Medicine, Division of Cardiothoracic
Surgery, Atlanta, GA, United States
(Rodes-Cabau) Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
(Bangalore) New York University School of Medicine, New York, NY, United
States
(Makkiya, Vlismas) Department of Internal Medicine, Montefiore Medical
Center/Albert Einstein College of Medicine, New York, NY, United States
(Slovut) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, New York, NY, United
States
(McCarthy) Division of Cardiac Surgery, Bluhm Cardiovascular Institute,
Northwestern University Feinberg School of Medicine, Chicago, Ill, United
States
(Augoustides) Department of Anesthesiology and Critical Care, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic College of Medicine, Scottsdale, AZ, United States
Title
A meta-analysis and meta-regression of long-term outcomes of transcatheter
versus surgical aortic valve replacement for severe aortic stenosis.
Source
International Journal of Cardiology. 225 (pp 234-243), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve replacement (TAVR) has emerged as an
alternative to surgical aortic-valve replacement (SAVR) for patients with
severe symptomatic aortic stenosis (AS) who are at high operative risk. We
sought to determine the long-term (> 1 year follow-up) safety and efficacy
TAVR compared with SAVR in patients with severe AS. Methods A
comprehensive search of PubMed, EMBASE, Cochrane Central Register of
Controlled Trials, conference proceedings, and relevant Web sites from
inception through 10 April 2016. Results Fifty studies enrolling 44,247
patients met the inclusion criteria. The mean duration follow-up was 21.4
months. No difference was found in long-term all-cause mortality (risk
ratios (RR), 1.06; 95% confidence interval (CI) 0.91-1.22). There was a
significant difference favoring TAVR in the incidence of stroke (RR, 0.82;
95% CI 0.71-0.94), atrial fibrillation (RR, 0.43; 95% CI 0.33-0.54), acute
kidney injury (RR, 0.70; 95% CI 0.53-0.92), and major bleeding (RR, 0.57;
95% CI 0.40-0.81). TAVR had significant higher incidence of vascular
complications (RR, 2.90; 95% CI 1.87-4.49), aortic regurgitation (RR,
7.00; 95% CI 5.27-9.30), and pacemaker implantation (PPM) (RR, 2.02; 95%
CI 1.51-2.68). TAVR demonstrated significantly lower stroke risk compared
to SAVR in high-risk patients (RR, 1.49; 95% CI 1.06-2.10); no differences
in PPM implantation were observed in intermediate-risk patients (RR, 1.68;
95% CI 0.94-3.00). In a meta-regression analysis, the effect of TAVR
baseline clinical features did not affect the long-term all-cause
mortality outcome. Conclusion TAVR and SAVR showed similar long-term
survival in patients with severe AS; with important differences in
treatment-associated morbidity. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<74>
Accession Number
613253848
Author
El-Boghdadly K.; Madjdpour C.; Chin K.J.
Institution
(El-Boghdadly, Chin) Department of Anesthesia, Toronto Western Hospital,
University of Toronto, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
(Madjdpour) Anaesthetics Department, Northumbria Healthcare NHS Foundation
Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and
Wear NE29 8NH, United Kingdom
Title
Thoracic paravertebral blocks in abdominal surgery - A systematic review
of randomized controlled trials.
Source
British Journal of Anaesthesia. 117 (3) (pp 297-308), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Thoracic paravertebral blocks (TPVBs) have an extensive evidence base as
part of a multimodal analgesic strategy for thoracic and breast surgery
and have gained popularity with the advent of ultrasound guidance.
However, this role is poorly defined in the context of abdominal surgery.
We performed a systematic review of randomized controlled trials, to
clarify the impact of TPVB on perioperative analgesic outcomes in adult
abdominal surgery. We identified 20 published trials involving a total of
1044 patients that met inclusion criteria; however there was significant
heterogeneity in terms of type of surgery, TPVB technique, comparator
groups and study quality. Pain scores and opioid requirements in the early
postoperative period were generally improved when compared with systemic
analgesia, but there was insufficient evidence for any definitive
conclusions regarding comparison with epidural analgesia or other
peripheral block techniques, or the benefit of continuous TPVB techniques.
The reported primary block failure rate was 2.8% and the incidence of
complications was 1.2% (6/504); there were no instances of pneumothorax.
TPVB therefore appears to be a promising analgesic technique for abdominal
surgery in terms of efficacy and safety. But further well-designed and
adequately powered studies are needed to confirm its utility, particularly
with respect to other regional anaesthesia techniques. Copyright &#xa9;
The Author 2016. Published by Oxford University Press on behalf of the
British Journal of Anaesthesia.

<75>
Accession Number
613161678
Author
Carrabba N.; Parodi G.; Marcucci R.; Valenti R.; Gori A.M.; Migliorini A.;
Comito V.; Bellandi B.; Abbate R.; Gensini G.F.; Antoniucci D.
Institution
(Carrabba, Parodi, Valenti, Migliorini, Comito, Bellandi, Antoniucci)
Department of Cardiology, Careggi Hospital, Florence, Italy
(Marcucci, Gori, Abbate, Gensini) Department of Experimental and Clinical
Medicine, University of Florence, Florence, Italy
(Gori, Gensini) Don Gnocchi Foundation, Florence, Italy
Title
Bleeding events and maintenance dose of prasugrel: BLESS pilot study.
Source
Open Heart. 3 (2) (no pagination), 2016. Article Number: e000460. Date of
Publication: 01 Oct 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate changes in residual platelet reactivity (RPR) over
time, and bleeding and ischaemic events rate using 5 vs 10 mg maintenance
dose (MD) regimens of prasugrel 1 month after acute coronary syndrome
(ACS). Background The optimal level of RPR with prasugrel may change over
time after an ACS. Methods After 60 mg loading dose of prasugrel (T0)
followed by 10 mg/day for 1 month, patients were randomised to receive
prasugrel 10 mg/day (n=95, group A) or 5 mg/day MD (n=98, group B) up to 1
year. RPR was assessed at T0, 37 (T1) and 180 days (T2). The primary end
point was Bleeding Academic Research Consortium (BARC) bleeding events >2
between 1 and 12 months, and the secondary composite end point was cardiac
death, myocardial infarction, stroke and definite/probable stent
thrombosis. Results From T0 to T1, RPR significantly increased in both
groups A and B and the increase was higher for group B (? ADP 10 mumol:
13.8%+/-14.7% vs 23.5%+/-19.2%, p=0.001). At T2 a lower rate of high RPR
patients were found in group A (2.6% vs13.3%; p=0.014). The BARC type >2
bleeding occurred in 12.6% of group A versus 4.1% of group B (OR 0.29, 95%
CI 0.09 to 0.94) and secondary end point in 2.1% vs 1.0% (p=0.542),
respectively, without stent thrombosis. Conclusions RPR increases shifting
from 60 mg loading dose to 10 mg/day prasugrel MD with a further increase
of RPR reducing prasugrel MD to 5 mg 1 month after ACS. Clinical value of
these pharmacodynamic findings should be proved in larger clinical trials.
Trial registration number NCT01790854. Copyright &#xa9; 2016 Published by
the BMJ Publishing Group Limited.

<76>
Accession Number
613300045
Author
Vives M.; Callejas R.; Duque P.; Echarri G.; Wijeysundera D.N.; Hernandez
A.; Sabate A.; Bes-Rastrollo M.; Monedero P.
Institution
(Vives) Anaesthesia and Intensive Care, Hospital Universitari Bellvitge,
Universitat de Barcelona, C/ Feixa Llarga, s/n. Hospitalet, Barcelona
08907, Spain
(Callejas, Duque, Echarri, Monedero) Anesthesiology and Critical Care,
Clinica Universidad de Navarra, Avenida Pio 12, 36, Pamplona 31008, Spain
(Wijeysundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
(Wijeysundera) Department of Anesthesia and Institute of Health Policy
Management and Evaluation, University of Toronto, Toronto, Canada
(Wijeysundera) Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Toronto, Canada
(Hernandez) Department of Anesthesiology and Critical Care, University
Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester M23
9LT, United Kingdom
(Sabate) Department of Anesthesiology and Critical Care, Bellvitge
University Hospital, C/ Feixa Llarga, s/n. Hospitalet, Barcelona 08907,
Spain
(Bes-Rastrollo) Department Preventive Medicine and Public Health,
University of Navarra, Av. Pio XII, 36, Pamplona 31008, Spain
(Bes-Rastrollo) CIBERobn, Instituto de Salud Carlos III, Spain
(Bes-Rastrollo) IDISNA, Navarra's Health Research Institute, Spain
Title
Modern hydroxyethyl starch and acute kidney injury after cardiac surgery:
A prospective multicentre cohort.
Source
British Journal of Anaesthesia. 117 (4) (pp 458-463), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Recent trials have shown hydroxyethyl starch (HES) solutions
increase the risk of acute kidney injury (AKI) in critically ill patients.
It is uncertain whether these adverse effects also affect surgical
patients. We sought to determine the renal safety of modern tetrastarch
(6% HES 130/0.4) use in cardiac surgical patients. Methods In this
multicentre prospective cohort study, 1058 consecutive patients who
underwent cardiac surgery from 15th September 2012 to 15th December 2012
were recruited in 23 Spanish hospitals. Results We identified 350 patients
(33%) administered 6% HES 130/0.4 intraoperatively and postoperatively,
and 377 (36%) experienced postoperative AKI (AKI Network criteria).
In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES
group had higher Euroscore and more comorbidities including unstable
angina, preoperative cardiogenic shock, preoperative intra-aortic balloon
pump use, peripheral arterial disease, and pulmonary hypertension. The
non-HES group received more intraoperative vasopressors and had longer
cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES
130/0.4 use was not associated with significantly increased risks of AKI
(adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were
confirmed by propensity score-matched pairs analyses. Conclusions The
intraoperative and postoperative use of modern hydroxyethyl starch 6% HES
130/0.4 was not associated with increased risks of AKI and dialysis after
cardiac surgery in our multicentre cohort. Copyright &#xa9; 2016 The
Author 2016. Published by Oxford University Press on behalf of the British
Journal of Anaesthesia. All rights reserved. For Permissions, please
email: journals.permissions@oup.com.

<77>
Accession Number
613300025
Author
Soh S.; Song J.W.; Shim J.K.; Kim J.H.; Kwak Y.L.
Institution
(Soh, Song, Shim, Kwak) Department of Anaesthesiology and Pain Medicine,
South Korea
(Song, Shim, Kwak) Anaesthesia and Pain Research Institute, Yonsei
Cardiovascular Hospital, Yonsei University College of Medicine, 50
Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
(Kim) Department of Anaesthesiology and Pain Medicine, National Health
Insurance Service Ilsan Hospital, Goyang City, Gyeonggi-do 410-719, South
Korea
Title
Sodium bicarbonate does not prevent postoperative acute kidney injury
after off-pump coronary revascularization: A double-blinded randomized
controlled trial.
Source
British Journal of Anaesthesia. 117 (4) (pp 450-457), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Acute kidney injury (AKI) is a common morbidity after off-pump
coronary revascularization. We investigated whether perioperative
administration of sodium bicarbonate, which might reduce renal injury by
alleviating oxidative stress in renal tubules, prevents postoperative AKI
in off-pump coronary revascularization patients having renal risk factors.
Methods Patients (n=162) having at least one of the following AKI risk
factors were enrolled: (i) age >70 yr; (ii) diabetes mellitus; (iii)
chronic renal disease; (iv) congestive heart failure or left ventricular
ejection fraction <35%; and (v) reoperation or emergency. Patients were
evenly randomized to receive either sodium bicarbonate (0.5 mmol
kg^-1 for 1 h upon induction of anaesthesia followed by 0.15
mmol kg^-1 h^-1 for 23 h) or 0.9% saline. Acute kidney
injury within 48 h after surgery was assessed using the Acute Kidney
Injury Network criteria. Results The incidences of AKI were 21 and 26% in
the bicarbonate and control groups, respectively (P=0.458). Serially
measured serum creatinine concentrations and perioperative fluid balance
were also comparable between the groups. The length of postoperative
hospitalization and incidence of morbidity end points were similar between
the groups, whereas significantly more patients in the bicarbonate group
required prolonged mechanical ventilation (>24 h) relative to the control
group (20 vs 6, P=0.003). Conclusions Perioperative sodium bicarbonate
administration did not decrease the incidence of AKI after off-pump
coronary revascularization in high-risk patients and might even be
associated with a need for prolonged ventilatory care. Clinical trial
registration NCT01840241. Copyright &#xa9; 2016 The Author 2016. Published
by Oxford University Press on behalf of the British Journal of
Anaesthesia. All rights reserved. For Permissions, please email:
journals.permissions@oup.com.

<78>
Accession Number
613300007
Author
Joosten A.; Tircoveanu R.; Arend S.; Wauthy P.; Gottignies P.; Van Der
Linden P.
Institution
(Joosten) Department of Anesthesiology and Perioperative Care, Erasme
University Hospital, Universit Libre de Bruxelles, Brussels, Belgium
(Tircoveanu, Arend, Van Der Linden) Department of Anesthesiology and
Perioperative Care, CHU Brugmann, Universit Libre de Bruxelles, Brussels,
Belgium
(Wauthy) Department of Cardiac Surgery, CHU Brugmann, Universit Libre de
Bruxelles, Brussels, Belgium
(Gottignies) Department of Intensive Care, CHU Brugmann, Universit Libre
de Bruxelles, Brussels, Belgium
Title
Impact of balanced tetrastarch raw material on perioperative blood loss: A
randomized double blind controlled trial.
Source
British Journal of Anaesthesia. 117 (4) (pp 442-449), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background As 6% hydroxyethyl starch (HES) 130/0.40 or 130/0.42 can
originate from different vegetable sources, they might have different
clinical effects. The purpose of this prospective, randomized,
double-blind controlled trial was to compare two balanced tetrastarch
solutions, one maize-derived and one potato-derived, on perioperative
blood loss in patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB). Methods We randomly assigned 118 patients undergoing
elective cardiac surgery into two groups, to receive either a maize- or a
potato-derived HES solution. Study fluids were administered
perioperatively (including priming of CPB) until the second postoperative
day (POD#2) using a goal directed algorithm. The primary outcome was
calculated postoperative blood loss up to POD#2. Secondary outcomes
included short-term incidence of acute kidney injury (AKI), and long-term
effect (up to one yr) on renal function. Results Preoperative and
intraoperative characteristics of the subjects were similar between
groups. Similar volumes of HES were administered (1950 ml [1250-2325] for
maize-HES and 2000 ml [1500-2700] for potato-HES; P=0.204). Calculated
blood loss (504 ml [413-672] for maize-HES vs 530 ml [468-705] for
potato-HES; P=0.107) and the need for blood components were not different
between groups. The incidence of AKI was similar in both groups (P=0.111).
Plasma creatinine concentration and glomerular filtration rates did vary
over time, although changes were minimal. Conclusions Under our study
conditions, HES 130/0.4 or 130/0.42 raw material did not have a
significant influence on perioperative blood loss. Moreover, we did not
find any effect of tetrastarch raw material composition on short and
long-term renal function. Clinical trial registration EudraCT number:
2011-005920-16. Copyright &#xa9; 2016 The Author 2016. Published by Oxford
University Press on behalf of the British Journal of Anaesthesia. All
rights reserved. For Permissions, please email:
journals.permissions@oup.com.

<79>
Accession Number
607452999
Author
Khot U.N.; Johnson-Wood M.L.; VanLeeuwen R.; Ramsey C.; Khot M.B.
Institution
(Khot, Khot) Cleveland Clinic Department of Cardiovascular Medicine,
Cleveland, OH, United States
(Johnson-Wood) Society of Cardiovascular Patient Care, Columbus, OH,
United States
(VanLeeuwen) Franciscan St. Francis Health Indianapolis, Indianapolis, IN,
United States
(Ramsey) Curtis Ramsey & Associates, Indianapolis, IN, United States
Title
A hospital-wide system to ensure rapid treatment time across the entire
spectrum of emergency percutaneous intervention.
Source
Catheterization and Cardiovascular Interventions. 88 (5) (pp 678-689),
2016. Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study's aim was to describe a hospital-wide system to
deliver rapid door-to-balloon time across the entire spectrum of emergency
percutaneous intervention. Background: Many patients needing emergency PCI
are excluded from door-to-balloon public reporting metric; these groups do
not achieve door-to-balloon times <90 min and have increased mortality
rates. Methods: We prospectively implemented a protocol for patients with
STEMI or other emergency indication for catheterization mandating (1)
emergency department physician or cardiologist activation of the
catheterization lab and (2) immediate patient transfer to an immediately
available catheterization lab by an in-house nursing transfer team.
Results: From September 1, 2005 to December 31, 2008, 526 consecutive
patients underwent emergency PCI. Median door-to-balloon time was 68 min
with 85.7% <90 min overall. Important subgroups included primary emergency
department (62.5 min), cardiorespiratory arrest (71 min), cardiogenic
shock (68 min), need for temporary pacemaker or balloon pump (67 min),
initial ECG without ST-elevation (66.5 min), transfer from another ED (84
min), in-hospital (70 min), and activation indications other than STEMI
(68 min). Patients presenting to primary ED and in transfer were compared
to historical controls. Treatment <90 min increased (28%-85%, P < 0.0001).
Mean infarct size decreased, as did hospital length-of-stay and admission
total hospital costs. Acute myocardial infarction all-cause 30-day
unadjusted mortality and risk-standardized mortality ratios were
substantially lower than national averages. Conclusion: A hospital-wide
systems approach applied across the entire spectrum of emergency PCI leads
to rapid door-to-balloon time, reduced infarct size and hospitals costs,
and low myocardial infarction 30-day all-cause mortality. &#xa9; 2015
Wiley Periodicals, Inc. Copyright &#xa9; 2015 The Authors. Catheterization
and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

<80>
Accession Number
611872944
Author
Badings E.A.; Remkes W.S.; The S.H.K.; Dambrink J.-H.E.; Tjeerdsma G.;
Rasoul S.; Timmer J.R.; van der Wielen M.L.J.; Lok D.J.A.; Hermanides R.;
van Wijngaarden J.; Suryapranata H.; van 't Hof A.W.J.
Institution
(Badings, Lok, van Wijngaarden) Deventer Ziekenhuis, Deventer, Netherlands
(Remkes, Dambrink, Timmer, Hermanides, Suryapranata, van 't Hof) Isala
Klinieken, Zwolle, Netherlands
(The, van der Wielen) Treant Zorggroep, Locatie Ziekenhuis Bethesda,
Hoogeveen, Netherlands
(Tjeerdsma) Ziekenhuis De Tjongerschans, Heerenveen, Netherlands
(Rasoul) Atrium Medisch Centrum, Heerlen, Netherlands
(Rasoul) Maastricht UMC, Netherlands
(Suryapranata) Radboudumc, Nijmegen, Netherlands
Title
Early or late intervention in patients with transient ST-segment elevation
acute coronary syndrome: Subgroup analysis of the ELISA-3 trial.
Source
Catheterization and Cardiovascular Interventions. 88 (5) (pp 755-764),
2016. Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To investigate incidence and patient characteristics of
transient ST-segment elevation (TSTE) ACS and to compare outcome of early
versus late invasive treatment. Background: Optimal timing of treatment in
TSTE-ACS patients is not outlined in current guidelines and no prospective
randomized trials have been done so far. Methods: Post hoc subgroup
analysis of patients with TSTE randomized in the ELISA 3 trial. This study
compared early (<12 h) versus late (>48 h) angiography and
revascularization in 542 patients with high-risk NSTE-ACS. Primary
endpoint was incidence of death, reinfarction, or recurrent ischemia at 30
days follow-up. Results: TSTE was present in 129 patients (24.2%) and
associated with male gender, smoking and younger age. The primary endpoint
occurred in 8.9% of patients with and 13.0% of patients without TSTE (RR =
0.681, P = 0.214). Incidence of death or MI after 2 year follow-up was 5.7
and 14.6% respectively (RR = 0.384, P = 0.008). Within the group of
patients with TSTE, incidence of the primary endpoint was 5.8% in the
early and 12.7% in the late treatment group (RR = 0.455, P = 0.213),
driven by reduction in recurrent ischemia. Enzymatic infarct size,
bleeding and incidence of death or recurrent MI at 2 years follow-up was
comparable between the treatment groups. Conclusions: In high-risk
patients with NSTE-ACS, TSTE is frequently seen. Similar to findings in
patients with high-risk NSTE-ACS, immediate angiography and
revascularization in these patients is feasible but not superior to later
treatment. Prospective randomized trials are needed to provide more
evidence in the optimal timing of treatment in patients with TSTE-ACS.
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<81>
Accession Number
613277924
Author
Gelsomino S.; La Meir M.; Van Breugel H.N.A.M.; Renzulli A.; Rostagno C.;
Lorusso R.; Parise O.; Lozekoot P.W.J.; Klop I.D.G.; Kumar N.; Luca F.;
Matteucci F.; Serraino F.; Sante P.; Caciolli S.; Vizzardi E.; De Jong M.;
Crijns H.J.G.M.; Gensini G.F.; Maessen J.G.
Institution
(Gelsomino, La Meir, Van Breugel, Parise, Lozekoot, Klop, Kumar, Luca,
Matteucci, De Jong, Crijns, Maessen) University Hospital Maastricht,
Maastricht, Netherlands
(Gelsomino, Rostagno, Luca, Matteucci, Caciolli, Gensini) Careggi
University Hospital, Florence, Italy
(Renzulli, Serraino, Sante) University of Magna Graecia, Catanzaro, Italy
(Lorusso, Vizzardi) Ospedali Riuniti Brescia, Brescia, Italy
Title
Surgical ablation in patients undergoing mitral valve surgery: Impact of
lesion set and surgical techniques on long-term success.
Source
Europace. 18 (10) (pp 1528-1537), 2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To assess the results and impact of lesion set and surgical technique
on long-term success of surgical ablation during mitral surgery. Methods
and results The patient population consisted of 685 subjects with
persistent and long-standing persistent atrial fibrillation (AF)
undergoing cardiac surgery for mitral valve disease as the primary
indication and concomitant ablation between January 2003 and January 2012
at three institutions. One hundred and sixty-six underwent unipolar
(24.2%), 371 (54.2%) bipolar, and 148 (21.6%) had combined ablation.
Median follow-up was 58.4 months (interquartile range 43.3-67.9). To
appropriately account for death, a competing risk model was employed to
identify predictors of cumulative incidence of recurrent AF among lesion
set and surgical techniques. Eight-year freedom from recurrent arrhythmia
without antiarrhythmic drugs was 0.60 +/- 0.02. Success rate was higher
using bipolar radiofrequency (RF) (P < 0.001), after performing mitral
isthmus line (P = 0.003) and following the biatrial technique (P < 0.001).
Competing risk regression revealed that use of unipolar RF [sub-hazard
ratio (SHR) 2.41 (1.52-3.43), P < 0.001], combined unipolar/bipolar
ablation [SHR 1.93 (0.89-2.57), P = 0.003] and the absence of right atrial
ablation [SHR 2.79 (1.27-3.48), P < 0.001] were predictors of cumulative
incidence of long-term recurrence. Conclusions Our experience suggests
that the use of bipolar clamp improves long-term results in surgical
treatment of AF and that right-sided ablation should be routinely added.
Randomized studies are necessary to confirm our findings. Copyright &#xa9;
2015 Published on behalf of the European Society of Cardiology. All rights
reserved. &#xa9; The Author 2015. For permissions please email:
journals.permissions@oup.com.

<82>
Accession Number
613277917
Author
Saravanan P.; West A.L.; Bridgewater B.; Davidson N.C.; Calder P.C.;
Dobrzynsky H.; Trafford A.; O'Neill S.C.
Institution
(Saravanan, Dobrzynsky, Trafford, O'Neill) Institute of Cardiovascular
Sciences, University of Manchester, Manchester, United Kingdom
(West, Calder) Faculty of Medicine, University of Southampton, Southampton
General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom
(Bridgewater, Davidson) Department of Cardiology, University Hospital of
South Manchester, Manchester, United Kingdom
Title
Omega-3 fatty acids do not alter P-wave parameters in electrocardiogram or
expression of atrial connexins in patients undergoing coronary artery
bypass surgery.
Source
Europace. 18 (10) (pp 1521-1527), 2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims We previously reported omega-3 polyunsaturated fatty acids (n-3PUFAs)
supplementation does not reduce atrial fibrillation (AF) following
coronary artery bypass graft (CABG) surgery. The aim of the present study
is to evaluate the impact of n-3 PUFAs on electrocardiogram (ECG) atrial
arrhythmic markers and compare with expression of gap-junction proteins,
Connexins. Methods and results Subset of clinical trial subjects with
right atrial sampling during CABG surgery included. Twelve-lead ECG
performed at recruitment and at surgery [after supplementation with n-3
PUFA (~1.8 g/day) or matched placebo] for ~14 days. Electrocardiograms
analysed for maximum P-wave duration (P-max) and difference between P-max
and minimum P-wave duration, P-wave dispersion (PWD). Right atrial
specimens analysed for expression of Connexins 40 and 43 using real-time
quantitative polymerase chain reaction (qPCR) and western blot. Serum
levels of n-3 PUFA at baseline, at surgery, and atrial tissue levels at
surgery collated from file. Postoperative AF was quantified by analysing
data from stored continuous electrograms. A total of 61 patients (n-3 PUFA
34, Placebo 27) had ECG analysis and AF burden, of which 52 patients (26
in each group) had qPCR and 16 (8 in each group) had western blot analyses
for Connexins 40 and 43. No difference between the two groups in ECG
parameters or expression of Connexin 40 or 43. P-wave dispersion in the
preoperative ECG independently predicted occurrence of AF following CABG
surgery. Conclusions Omega-3 polyunsaturated fatty acids supplementation
does not alter pro-arrhythmic P-wave parameters in ECG or connexin
expression in human atrium with no effect on the incidence of AF following
CABG surgery. Copyright &#xa9; 2016 Published on behalf of the European
Society of Cardiology. All rights reserved. &#xa9; The Author 2016. For
permissions please email: journals.permissions@oup.com.

<83>
Accession Number
613239044
Author
Shivanna S.; Priye S.; Singh D.; Jagannath S.; Mudassar S.; Reddy D.P.
Institution
(Shivanna, Priye, Singh, Jagannath, Mudassar, Reddy) Department of Cardiac
Anaesthesiology, Vydehi Institute of Medical Sciences and Research Centre,
Bengaluru, Karnataka, India
Title
Efficacy of methylprednisolone and lignocaine on propofol injection pain:
A randomised, double-blind, prospective study in adult cardiac surgical
patients.
Source
Indian Journal of Anaesthesia. 60 (11) (pp 848-851), 2016. Date of
Publication: November 2016.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aims: Propofol (2, 6-di-isopropylphenol) used for the
induction of anaesthesia often causes mild to severe pain or discomfort on
injection. We designed this double-blind study to compare the efficacy of
methylprednisolone and lignocaine in reducing the pain of propofol
injection in patients scheduled for cardiac surgery. Methods: A total of
165 adult patients, scheduled for elective cardiac surgery, were divided
into three groups: saline (group S, n = 55), lignocaine 20 mg (Group L, n
= 55) and methylprednisolone 125 mg diluted into 2 ml of distilled water
(Group MP, n = 55). Drugs were administered after tourniquet application
and occlusion was released after 1 min and 1/4^th of the total
dose of propofol (2 mg/kg) was administered at the rate of 0.5 ml/s. Pain
on propofol injection was evaluated by four-point verbal rating scale.
Statistical methods used included Student's t-test and Chi-square
test/Fisher's exact test. Results: The overall incidence of pain was 70.9%
in the saline group, 30.9% in the lignocaine group and 36.4% in the
methylprednisolone group. The intensity of pain was significantly less in
patients receiving methylprednisolone and lignocaine than those receiving
saline (P < 0.012). Conclusion: Pre-treatment with intravenous
methylprednisolone was found to be as effective as lignocaine in reducing
propofol injection-induced pain. Copyright &#xa9; 2016 Indian Journal of
Anaesthesia.

<84>
Accession Number
613147849
Author
Elgendy I.Y.; Kumbhani D.J.; Mahmoud A.N.; Wen X.; Bhatt D.L.; Bavry A.A.
Institution
(Elgendy, Mahmoud, Wen, Bavry) Department of Medicine, University of
Florida, Gainesville, FL, United States
(Kumbhani) Department of Medicine, University of Texas Southwestern
Medical Center, Dallas, TX, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
(Bavry) North Florida/South Georgia Veterans Health System, Gainesville,
FL, United States
Title
Routine invasive versus selective invasive strategies for Non-ST-elevation
acute coronary syndromes: An Updated meta-analysis of randomized trials.
Source
Catheterization and Cardiovascular Interventions. 88 (5) (pp 765-774),
2016. Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To perform an updated systematic review comparing a routine
invasive strategy with a selective invasive strategy for patients with
non-ST-elevation acute coronary syndromes (NSTE-ACS) in the era of stents
and antiplatelet therapy. Background: Recent meta-analyses comparing both
strategies have shown conflicting results. Methods: Electronic databases
were searched for randomized trials that compared a routine invasive
strategy (i.e., routine coronary angiography +/- revascularization) versus
a selective invasive strategy (i.e., medical stabilization and coronary
angiography +/- revascularization if objective evidence of ischemia or
refractory ischemia) in patients with NSTE-ACS. Summary odds ratios (OR)
were primarily constructed using Peto's model. Results: Twelve trials with
9,650 patients were included. Compared with a selective invasive strategy,
a routine invasive strategy was associated with a reduction in the
composite of all-cause mortality or myocardial infarction (MI) [OR: 0.86,
95% confidence interval (CI) 0.77-0.96] at a mean follow-up of 39 months,
primarily due to a reduction in the risk of MI (OR: 0.78, 95% CI:
0.68-0.88). The risk of all-cause mortality was non-significantly reduced
with a routine invasive strategy (OR: 0.88, 95% CI: 0.77-1.01). The risk
of recurrent angina was reduced with a routine invasive strategy (OR:
0.55, 95% CI: 0.49-0.62), as well as the risk of future revascularization
procedures (OR: 0.35, 95% CI: 0.30-0.39). Conclusion: In patients with
NSTE-ACS, a routine invasive strategy reduced the risk of ischemic events,
including the risk of mortality or MI. Routine invasive therapy reduced
the risk of recurrent angina and future revascularization procedures.
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<85>
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.

<86>
Accession Number
607673594
Author
Rajesh G.N.; Sreekumar P.; Haridasan V.; Sajeev C.G.; Bastian C.;
Vinayakumar D.; Kadermuneer P.; Mathew D.; George B.; Krishnan M.N.
Institution
(Rajesh, Bastian, Vinayakumar, Kadermuneer) Additional Professor,
Department of Cardiology, Government Medical College, Kozhikode, Kerala,
India
(Sreekumar) Senior Resident, Department of Cardiology, Government Medical
College, Kozhikode, Kerala, India
(Haridasan, Mathew) Assistant Professor, Department of Cardiology,
Government Medical College, Kozhikode, Kerala, India
(Sajeev) Professor, Department of Cardiology, Government Medical College,
Kozhikode, Kerala, India
(George) Assistant Professor, Department of Community Medicine, Government
Medical College, Kozhikode, Kerala, India
(Krishnan) Professor and Head, Department of Cardiology, Government
Medical College, Kozhikode, Kerala, India
Title
Effect of balloon mitral valvotomy on left ventricular function in
rheumatic mitral stenosis.
Source
Indian Heart Journal. 68 (5) (pp 612-617), 2016. Date of Publication: 01
Sep 2016.
Publisher
Elsevier B.V.
Abstract
Aim Mitral stenosis (MS) is found to produce left ventricular (LV)
dysfunction in some studies. We sought to study the left ventricular
function in patients with rheumatic MS undergoing balloon mitral valvotomy
(BMV). Ours is the first study to analyze effect of BMV on mitral annular
plane systolic excursion (MAPSE), and to quantify prevalence of
longitudinal left ventricular dysfunction in rheumatic MS. Methods In this
prospective cohort study, we included 43 patients with severe rheumatic
mitral stenosis undergoing BMV. They were compared to twenty controls
whose distribution of age and gender were similar to that of patients. The
parameters compared were LV ejection fraction (EF) by modified Simpson's
method, mitral annular systolic velocity (MASV), MAPSE, mitral annular
early diastolic velocity (E'), and myocardial performance index (MPI).
These parameters were reassessed immediately following BMV and after 3
months of procedure. Results MASV, MAPSE, E', and EF were significantly
lower and MPI was higher in mitral stenosis group compared to controls.
Impaired longitudinal LV function was present in 77% of study group. MAPSE
and EF did not show significant change after BMV while MPI, MASV, and E'
improved significantly. MASV and E' showed improvement immediately after
BMV, while MPI decreased only at 3 months follow-up. Conclusions There
were significantly lower mitral annular motion parameters including MAPSE
in patients with rheumatic mitral stenosis. Those with atrial fibrillation
had higher MPI. Immediately after BMV, there was improvement in LV long
axis function with a gradual improvement in global LV function. There was
no significant change of MAPSE after BMV. Copyright &#xa9; 2015
Cardiological Society of India

<87>
Accession Number
613231151
Author
Yoon S.-H.; Lefevre T.; Ahn J.-M.; Perlman G.Y.; Dvir D.; Latib A.;
Barbanti M.; Deuschl F.; De Backer O.; Blanke P.; Modine T.; Pache G.;
Neumann F.-J.; Ruile P.; Arai T.; Ohno Y.; Kaneko H.; Tay E.; Schofer N.;
Holy E.W.; Luk N.H.V.; Yong G.; Lu Q.; Kong W.K.F.; Hon J.; Kao H.-L.; Lee
M.; Yin W.-H.; Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Lee C.W.;
Park S.-W.; Kim H.-S.; Butter C.; Khalique O.K.; Schaefer U.; Nietlispach
F.; Kodali S.K.; Leon M.B.; Ye J.; Chevalier B.; Leipsic J.; Delgado V.;
Bax J.J.; Tamburino C.; Colombo A.; Sondergaard L.; Webb J.G.; Park S.-J.
Institution
(Yoon, Ahn, Park, Kang, Lee, Kim, Lee, Park, Park) Division of Cardiology,
University of Ulsan, Asan Medical Center, Seoul, Korea, United States
(Lefevre, Arai, Chevalier) Generale de Sante, Institut Cardiovasculaire
Paris Sud, Hopital Prive Jacques Cartier, Massy, France
(Perlman, Dvir, Blanke, Ye, Leipsic, Webb) Department of Cardiology, St
Paul's Hospital, University of British Columbia, Vancouver, British
Columbia, Canada
(Latib, Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, San Raffaele Scientific Institute, Italy San Raffaele Hospital,
Milan, Italy
(Barbanti, Ohno, Tamburino) Division of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Deuschl, Schofer, Schaefer) Department for General and Interventional
Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf
(UKE), Hamburg, Germany
(De Backer, Luk, Sondergaard) The Heart Centre, Rigshospitalet University
Hospital, Copenhagen, Denmark
(Modine) Department of Cardiovascular Surgery, Hospital Cardiologique,
Lille, France
(Pache) Department of Radiology, Section of Cardiovascular Radiology,
University of Freiburg, Bad Krozingen, Germany
(Neumann, Ruile) Department of Cardiology & Angiology II, University Heart
Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Kaneko, Butter) Heart Center Brandenburg in Bernau, Bernau, Germany
(Tay, Kong, Hon) Department of Cardiology, National University Heart
Centre, Singapore
(Holy, Nietlispach) University Heart Center, Cardiology and Cardiovascular
Surgery, University Hospital Zurich, Zurich, Switzerland
(Yong) Division of Cardiology, Royal Perth Hospital, Perth, Western
Australia, Australia
(Lu) Division of Vascular Surgery, Changhai Hospital, Shanghai, China
(Kong) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Kao, Delgado, Bax) Department of Internal Medicine, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
(Lee) Division of Cardiology, Queen Elizabeth Hospital, Kowloon, Hong Kong
(Yin) Division of Cardiology, Heart Center, Cheng Hsin General Hospital,
Taipei, Taiwan (Republic of China)
(Kim) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Khalique, Kodali, Leon) Columbia University Medical Center/New York
Presbyterian Hospital, New York, New York, United States
Title
Transcatheter Aortic Valve Replacement With Early- and New-Generation
Devices in Bicuspid Aortic Valve Stenosis.
Source
Journal of the American College of Cardiology. 68 (11) (pp 1195-1205),
2016. Date of Publication: 13 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Few studies have evaluated the clinical outcomes of
transcatheter aortic valve replacement (TAVR) in patients with bicuspid
aortic valve stenosis (AS). Particularly, limited data exist comparing the
results of TAVR with new-generation devices versus early-generation
devices. Objectives This study sought to evaluate the clinical outcomes of
TAVR for bicuspid AS with early- and new-generation devices. Methods The
Bicuspid TAVR Registry is an international multicenter study enrolling
consecutive patients with bicuspid AS undergoing TAVR between April 2005
and May 2015. Results Of 301 patients, 199 patients (71.1%) were treated
with early-generation devices (Sapien XT [Edwards Lifesciences
Corporation, Irvine, California]: n = 87; CoreValve [Medtronic,
Minneapolis, Minnesota]: n = 112) and 102 with new-generation devices
(Sapien 3 [Edwards Lifesciences Corporation]: n = 91; Lotus [Boston
Scientific Corporation, Marlborough, Massachusetts]: n = 11). The mean
Society of Thoracic Surgeons score was 4.7 +/- 5.2 without significant
differences between groups (4.6 +/- 5.1 vs. 4.9 +/- 5.4; p = 0.57).
Overall, all-cause mortality rates were 4.3% at 30 days and 14.4% at 1
year. Moderate or severe paravalvular leak was absent and significantly
less frequent with new-generation compared to early-generation devices
(0.0% vs. 8.5%; p = 0.002), which resulted in a higher device success rate
(92.2% vs. 80.9%; p = 0.01). There were no differences between early- and
new-generation devices in stroke (2.5% vs. 2.0%; p > 0.99),
life-threatening bleeding (3.5% vs. 2.9%; p > 0.99), major vascular
complication (4.5% vs. 2.9%; p = 0.76), stage 2 to 3 acute kidney injury
(2.5% vs. 2.9%; p > 0.99), early safety endpoints (15.1% vs. 10.8%; p =
0.30), and 30-day all-cause mortality (4.5% vs. 3.9%; p > 0.99).
Conclusions The clinical outcomes of TAVR in patients with bicuspid AS
were favorable. New-generation devices were associated with less
paravalvular leak and, hence, a higher device success rate than
early-generation devices. (The Bicuspid Aortic Stenosis Following
Transcatheter Aortic Valve Replacement Registry [Bicuspid TAVR];
NCT02394184) Copyright &#xa9; 2016 American College of Cardiology
Foundation

<88>
Accession Number
610047471
Author
Vilvanathan V.K.; Srinivas Prabhavathi Bhat B.C.; Nanjappa M.C.; Pandian
B.; Bagi V.; Kasturi S.; Bandimida S.K.
Institution
(Vilvanathan, Srinivas Prabhavathi Bhat, Nanjappa, Pandian, Bagi)
Department of Cardiology, Sri Jayadeva Institute of Cardiovascular
Sciences & Research, Bangalore, India
(Kasturi) Interventional Cardiologist, Sunshine Heart Institute,
Hyderabad, India
(Bandimida) Researcher, Sunshine Heart Institute, Hyderabad, India
Title
A randomized placebo-controlled trial with amiodarone for persistent
atrial fibrillation in rheumatic mitral stenosis after successful balloon
mitral valvuloplasty.
Source
Indian Heart Journal. 68 (5) (pp 671-677), 2016. Date of Publication: 01
Sep 2016.
Publisher
Elsevier B.V.
Abstract
Objective Atrial fibrillation is the most common sustained arrhythmia in
patients with rheumatic heart disease (RHD). This study was conducted to
determine the maintenance of sinus rhythm with amiodarone therapy
following DC cardioversion (DCCV), early after successful balloon mitral
valvuloplasty (BMV). Methods Patients were randomized to amiodarone group
and placebo group and their baseline characteristics were recorded. DCCV
was done 48 h after BMV. After cardioversion, oral amiodarone was started
initially 200 mg three times a day for 2 weeks, then 200 mg twice daily
for two weeks followed by 200 mg once daily for 12 months. Patients in
placebo group received DCCV alone without preloading amiodarone. After
DCCV, they were given placebo for 12 months. Results The 3 months
follow-up period was completed by 77 patients (95%). Of them, 31 (77.5%)
patients in amiodarone group and 14 (34.1%) in placebo group remained in
sinus rhythm (SR). The 12 months follow-up period was completed by 73
patients (90.1%). Of them, 22 (55%) patients in amiodarone group and 7
(17.1%) in placebo group remained in SR. Conclusion We conclude that
amiodarone is more effective than placebo in maintenance of SR at the end
of 3 months following successful cardioversion and more patients continued
to remain in SR even at the end of 12 months without major serious adverse
effects. Copyright &#xa9; 2016

<89>
Accession Number
613451300
Author
Chow D.; Shikuma C.; Ritchings C.; Guo M.; Rosenblatt L.
Institution
(Chow, Shikuma) Hawaii Center for AIDS, John A. Burns School of Medicine,
University of Hawaii Manoa, Honolulu, HI, United States
(Ritchings, Guo, Rosenblatt) Bristol-Myers Squibb, Plainsboro, NJ, United
States
Title
Atazanavir and Cardiovascular Risk Among Human Immunodeficiency
Virus-Infected Patients: A Systematic Review.
Source
Infectious Diseases and Therapy. 5 (4) (pp 473-489), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Springer Healthcare
Abstract
Introduction: Patients with human immunodeficiency virus (HIV) infection
have an increased risk of cardiovascular disease (CVD). While viral
suppression with antiretroviral therapy decreases CVD risk overall,
several studies have suggested that certain antiretrovirals, particularly
certain protease inhibitors, may be associated with an increased relative
risk of CVD. In AIDS Clinical Trials Group 5260 s, ritonavir-boosted
atazanavir (ATV) was associated with slower atherosclerosis progression
compared to ritonavir-boosted darunavir and raltegravir, potentially due
to hyperbilirubinemia. Although hyperbilirubinemia may lead to increased
rates of treatment discontinuation, it may also contribute to a favorable
cardiovascular (CV) profile for ATV. To fully elucidate the effect of ATV
on CVD risk among HIV-infected patients, a systematic review of the
literature was performed. Methods: A systematic search of the PubMed and
Embase databases was conducted on August 26, 2015, using terms to identify
papers that discuss ATV, HIV, and CVD. Articles were limited to
English-language publications of randomized-controlled or observational
studies investigating adult humans. The primary outcome was the incidence
of CVD. Articles describing surrogate markers of CVD were also included.
Results: Ten studies were included in this qualitative analysis: six
reported CVD outcomes, two reported data on atherosclerosis as assessed by
carotid intima-media thickness (cIMT), and two reported outcomes related
to endothelial function. The studies reporting the incidence of myocardial
infarction (MI) among HIV-infected patients showed that ATV (boosted and
unboosted) was not associated with an increased risk of acute MI. Other CV
endpoints were similarly unaffected by treatment with ATV. Compared with
non-ATV-based regimens, ATV had beneficial effects on cIMT progression in
the publications identified, with no apparent impact on endothelial
function. Conclusions: This analysis showed that there was no increased
risk or occurrence of adverse CV events among HIV-infected patients
receiving ATV. Markers of atherosclerosis were improved, suggesting a
possible antioxidant effect of ATV, and endothelial function was not
affected. Funding: Bristol-Myers Squibb (article processing charges and
medical writing support). Copyright &#xa9; 2016, The Author(s).

<90>
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.

<91>
Accession Number
613616161
Author
Tang M.; Feng M.; Chen L.; Zhang J.; Ji P.; Luo S.
Institution
(Tang) Menglin Tang is a nurse in the pediatric intensive care unit at
West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei
Feng is a nurse in the pediatric intensive care unit at West China
Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric
intensive care unit at West China Hospital of Sichuan University.Jinmei
Zhang is a nurse in the pediatric intensive care unit at West China
Hospital of Sichuan University.Peng Ji is a resident physician, Department
of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is
an attending physician, Department of Cardiac Surgery, West China Hospital
of Sichuan University.
(Feng) Menglin Tang is a nurse in the pediatric intensive care unit at
West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei
Feng is a nurse in the pediatric intensive care unit at West China
Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric
intensive care unit at West China Hospital of Sichuan University.Jinmei
Zhang is a nurse in the pediatric intensive care unit at West China
Hospital of Sichuan University.Peng Ji is a resident physician, Department
of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is
an attending physician, Department of Cardiac Surgery, West China Hospital
of Sichuan University
(Chen) Menglin Tang is a nurse in the pediatric intensive care unit at
West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei
Feng is a nurse in the pediatric intensive care unit at West China
Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric
intensive care unit at West China Hospital of Sichuan University.Jinmei
Zhang is a nurse in the pediatric intensive care unit at West China
Hospital of Sichuan University.Peng Ji is a resident physician, Department
of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is
an attending physician, Department of Cardiac Surgery, West China Hospital
of Sichuan University
(Zhang) Menglin Tang is a nurse in the pediatric intensive care unit at
West China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei
Feng is a nurse in the pediatric intensive care unit at West China
Hospital of Sichuan University.Lijun Chen is a nurse in the pediatric
intensive care unit at West China Hospital of Sichuan University.Jinmei
Zhang is a nurse in the pediatric intensive care unit at West China
Hospital of Sichuan University.Peng Ji is a resident physician, Department
of Anesthesiology, West China Hospital of Sichuan University.Shuhua Luo is
an attending physician, Department of Cardiac Surgery, West China Hospital
of Sichuan University
(Ji) Menglin Tang is a nurse in the pediatric intensive care unit at West
China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei Feng is
a nurse in the pediatric intensive care unit at West China Hospital of
Sichuan University.Lijun Chen is a nurse in the pediatric intensive care
unit at West China Hospital of Sichuan University.Jinmei Zhang is a nurse
in the pediatric intensive care unit at West China Hospital of Sichuan
University.Peng Ji is a resident physician, Department of Anesthesiology,
West China Hospital of Sichuan University.Shuhua Luo is an attending
physician, Department of Cardiac Surgery, West China Hospital of Sichuan
University
(Luo) Menglin Tang is a nurse in the pediatric intensive care unit at West
China Hospital of Sichuan University, Chengdu, Sichuan, China.Mei Feng is
a nurse in the pediatric intensive care unit at West China Hospital of
Sichuan University.Lijun Chen is a nurse in the pediatric intensive care
unit at West China Hospital of Sichuan University.Jinmei Zhang is a nurse
in the pediatric intensive care unit at West China Hospital of Sichuan
University.Peng Ji is a resident physician, Department of Anesthesiology,
West China Hospital of Sichuan University.Shuhua Luo is an attending
physician, Department of Cardiac Surgery, West China Hospital of Sichuan
University
Title
Closed blood conservation device for reducing catheter-related infections
in children after cardiac surgery.
Source
Critical care nurse. 34 (5) (pp 53-61), 2014. Date of Publication: 01 Oct
2014.
Abstract
BACKGROUND: Arterial catheters are potential sources of nosocomial
infection.
OBJECTIVE: To investigate use of a closed blood conservation device in
preventing catheter-related bloodstream infections in children after
cardiac surgery.
METHODS: Children with an indwelling arterial catheter after cardiac
surgery were randomly assigned to 2 groups: a control group with a
conventional 3-way stopcock in the catheter system and an interventional
group with the conservation device in the catheter system. Catheter tips,
catheter intraluminal fluid, and blood samples obtained from the catheter
and peripherally were cultured for microbiological analysis. RESULTS
Intraluminal fluid contamination was significantly lower (P = .03) in the
interventional group (3 of 147 catheters) than in the control group (10 of
137 catheters). The 2 groups did not differ significantly in the rate of
tip colonization (9 of 147 vs 12 of 137; P = .40) or in the number of
catheter-related bloodstream infections (0 of 147 vs 2 of 137; P = .21).
CONCLUSION: Use of a closed blood conservation device could decrease the
incidence of catheter-related contamination of intraluminal fluid.
Copyright &#xa9;2014 American Association of Critical-Care Nurses.

<92>
Accession Number
613524995
Author
Miozzo A.P.; Stein C.; Bozzetto C.B.; Plentz R.D.M.
Institution
(Miozzo, Stein, Bozzetto, Plentz) Universidade Federal de Ciencias da
Saude de Porto Alegre, Porto Alegre, RS, Brazil
(Miozzo, Stein) Instituto de Cardiologia do Rio Grande do Sul, Fundacao
Universitaria de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil
Title
Massage therapy reduces pain and anxiety after cardiac surgery: A
systematic review and meta-analysis of randomized clinical trials.
Source
Clinical Trials and Regulatory Science in Cardiology. 23-24 (pp 1-8),
2016. Date of Publication: 01 Nov 2016.
Publisher
Elsevier B.V.
Abstract
Background Cardiac surgery is one of the most frequently performed
surgeries worldwide and its postoperative period is associated with
complications. Studies show that massage therapy alone or accompanied by
other complementary treatments is beneficial in reducing pain and
psychological symptoms. Objective The aim of this study was to review the
effects of treatment with massage therapy on the symptoms of pain and
anxiety reported by patients who underwent heart surgery. Methods The
electronic databases searched were (from inception to March 2016):
MEDLINE, PEDro, Cochrane CENTRAL and EMBASE. In addition, a manual search
of the references on the published papers used in the study was performed.
These included randomized clinical trials with patients who underwent
heart surgery, comparing the postoperative treatment with massage and the
usual treatment. Studies that did not provide necessary information were
excluded from the meta-analysis. The primary outcome extracted was pain
measured by the visual analog scale. The other outcome was anxiety.
Results A number of 962 records was identified in the database search; 10
randomized clinical trials were included in the systematic review,
providing data on 888 individuals. Massage therapy was associated with
decreased pain (- 1.52 [95% CI, - 2.2, - 0.84; I2 91%], p < 0.0001) and
with lower anxiety in the postoperative period when compared to the
control group (- 1.48 [95% CI, - 1.93, - 1.04; I2 0%], p < 0.0001).
Conclusion Massage therapy might be a useful method to reduce pain and
anxiety in patients undergoing cardiac surgery. Copyright &#xa9; 2016

<93>
Accession Number
613473570
Author
Zhang Y.; Yang S.; Liu J.; Wang Y.; Gao B.; Cui W.; Cao S.; Zhang W.
Institution
(Zhang, Zhang) Department of Anesthesiology, The First Affiliated of
Zhenzhou University, Zhengzhou, China
(Zhang, Yang, Liu, Wang, Cao) Department of Anesthesiology, The First
Affiliated Hospital of Xinxiang Medical University, China
(Gao) Department of General Surgery, The First Affiliated Hospital of
Xinxiang Medical University, Weihui, China
(Cui) Department of Anesthesiology, Zhengzhou Children's Hospital,
Zhengzhou, China
Title
Narcotrend and bispectral index for monitoring intraoperative anesthetic
depth in patients with severe burns.
Source
International Journal of Clinical and Experimental Medicine. 9 (11) (pp
22020-22026), 2016. Article Number: IJCEM0029578. Date of Publication: 20
Dec 2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Patients with severe burns has a high risk of cardiovascular accidents in
surgery and their surgery requires an accurate monitoring of anesthesia
depth. The values of Narcotrend and bispectral index (BIS) for
intraopera-tive monitoring of anestheis depth in severely burned patients
have not been fully evaluated. Aiming to study their values, 108 cases of
severely burned patients who needed early surgery (escharotomy +
dermatoplasty, <7 days) were randomly divided into group A, B, and C, in
which the intraoperative anesthesia depth was controlled by the Narcotrend
level (D2 to E0), BIS level (40 to 65), and systolic blood pressure (90 to
140 mmHg), respectively. Main observation indexes included intraoperative
maximum differential mean arterial pressure (Max-Min MAP), maxi-mum
differential heart rate (Max-Min HR), narcotic drug dosage, and
postoperative recovery quality. Compared with group C, intraoperative
Max-Min MAPs in group A and B were significantly decreased (P<0.0001);
intraoperative Max-Min HRs were obviously declined (P<0.0001); Propofol
and remifentanil dosages were markedly reduced; and postoperative
spontaneous breathing recovery time was significantly shortened
(P<0.0001). Moreover, the direc-tional force recovery time in group B was
significantly shorter than that in group C (P<0.05), whereas the
extubation time in group A was much shorter than that in group C (P<0.05).
No significant differences in all tested indexes were observed between
group A and B. In summary, Narcotrend- and BIS-controlled anesthesia depth
are important for the surgery in severely burned patient by maintaining
stable hemodynamics, decreasing anesthetic drugs dosage, and improving
postoperative recovery quality. Copyright &#xa9; 2016, E-Century
Publishing Corporation. All rights reserved.

<94>
Accession Number
613566794
Author
Baker W.L.; Coleman C.I.
Institution
(Baker, Coleman) Department of Pharmacy Practice, School of Pharmacy,
University of Connecticut, Storrs, CT, United States
Title
Meta-analysis of ascorbic acid for prevention of postoperative atrial
fibrillation after cardiac surgery.
Source
American Journal of Health-System Pharmacy. 73 (24) (pp 2056-2066), 2016.
Date of Publication: 15 Dec 2016.
Publisher
American Society of Health-Systems Pharmacy
Abstract
Purpose. Results of a systematic review and meta-analysis of published
data on use of ascorbic acid to prevent postoperative atrial fibrillation
(POAF) after cardiac surgery are presented. Methods. MEDLINE and other
sources were searched for reports on trials evaluating the effects of
preoperative and/or postoperative use of ascorbic acid in patients
undergoing cardiac surgery. For each study selected for meta-analysis, an
assessment for risks of methodological bias was performed. Data on POAF
frequency and length of stay (LOS) outcomes were pooled and analyzed via
random-effects modeling. Results. The 11 identified studies involved
patients receiving coronary artery bypass grafts with or without valve
replacement; both i.v. and oral ascorbic acid formulations were used.
Analysis of pooled outcomes data on treatment and control groups indicated
that ascorbic acid prophylaxis was associated with reductions in POAF
frequency (odds ratio, 0.44; 95% confidence interval [CI], 0.32 to 0.61),
intensive care unit (ICU) LOS (difference in means, -0.24 day; 95% CI,
-0.45 to -0.03 day), and total hospital LOS (difference in means, -0.94
day; 95% CI, -1.65 to -0.23 day). Significant statistical, methodological,
and clinical heterogeneity were observed. Conclusion. A meta-analysis
revealed that, compared with use of a placebo or a nonplacebo control,
perioperative administration of ascorbic acid to patients undergoing
cardiac surgery was associated with a reduced frequency of POAF and a
shorter ICU LOS and total hospital LOS. &#xa9; Copyright 2016, American
Society of Health-System Pharmacists, Inc. All rights.

<95>
Accession Number
613511320
Author
Putzu A.; Capelli B.; Belletti A.; Cassina T.; Ferrari E.; Gallo M.; Casso
G.; Landoni G.
Institution
(Putzu, Capelli, Cassina, Casso) Cardiocentro Ticino, Department of
Cardiovascular Anesthesia and Intensive Care, Via Tesserete 48, Lugano,
Switzerland
(Belletti, Landoni) IRCCS San Raffaele Scientific Institute, Department of
Anesthesia and Intensive Care, Via Olgettina 60, Milano, Italy
(Ferrari, Gallo) Cardiocentro Ticino, Department of Cardiac Surgery, Via
Tesserete 48, Lugano, Switzerland
(Landoni) Vita-Salute San Raffaele University, Via Olgettina 58, Milano,
Italy
Title
Perioperative statin therapy in cardiac surgery: A meta-analysis of
randomized controlled trials.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 395. Date of
Publication: 05 Dec 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Several studies suggest beneficial effects of perioperative
statin therapy on postoperative outcome after cardiac surgery. However,
recent randomized controlled trials (RCTs) show potential detrimental
effects. The objective of this systematic review is to examine the
association between perioperative statin therapy and clinical outcomes in
cardiac surgery patients. Methods: Electronic databases were searched up
to 1 November 2016 for RCTs of preoperative statin therapy versus placebo
or no treatment in adult cardiac surgery. Postoperative outcomes were
acute kidney injury, atrial fibrillation, myocardial infarction, stroke,
infections, and mortality. We calculated odds ratios (ORs) and 95%
confidence intervals (CIs) using fixed-effects meta-analyses. Primary
analysis was restricted to trials with low risk of bias according to
Cochrane methodology, and sensitivity analyses examined whether the risk
of bias of included studies was associated with different results. We
performed trial sequential analysis (TSA) to test the strength of the
results. Results: We included data from 23 RCTs involving 5102 patients.
Meta-analysis of trials with low risk of bias showed that statin therapy
was associated with an increase in acute kidney injury (314 of 1318
(23.82%) with statins versus 262 of 1319 (19.86%) with placebo; OR 1.26
(95%CI 1.05 to 1.52); p = 0.01); these results were supported by TSA. No
difference in postoperative atrial fibrillation, myocardial infarction,
stroke, infections, or mortality was present. On sensitivity analysis,
statin therapy was associated with a slight increase in hospital
mortality. Meta-analysis including also trials with high or unclear risk
of bias showed no beneficial effects of statin therapy on any
postoperative outcomes. Conclusions: There is no evidence that statin
therapy in the days prior to cardiac surgery is beneficial for patients'
outcomes. Particularly, statins are not protective against postoperative
atrial fibrillation, myocardial infarction, stroke, or infections. Statins
are associated with a possible increased risk of acute kidney injury and a
detrimental effect on hospital survival could not be excluded. Future RCTs
should further evaluate the safety profile of this therapy in relation to
patients' outcomes and assess the more appropriate time point for
discontinuation of statins before cardiac surgery. Copyright &#xa9; 2016
The Author(s).

<96>
Accession Number
613593348
Author
Winkler B.; Heinisch P.P.; Gahl B.; Aghlmandi S.; Jenni H.J.; Carrel T.P.
Institution
(Winkler, Heinisch, Gahl, Jenni, Carrel) Department of Cardiovascular
Surgery, Inselspital, University of Bern, Bern, Switzerland
(Aghlmandi) Institute of Social and Preventive Medicine, University of
Bern, Bern, Switzerland
Title
Minimally Invasive Extracorporeal Circulation Circuit Is Not Inferior to
Off-Pump Coronary Artery Bypass Grafting: Meta-Analysis Using the Bayesian
Method.
Source
Annals of Thoracic Surgery. (no pagination), 2016. Date of Publication:
2016.
Publisher
Elsevier USA
Abstract
The pathophysiologic side effects of cardiopulmonary bypass have already
been identified. Minimally invasive extracorporeal circulation
technologies (MiECT) and off-pump coronary artery bypass graft surgery
(OPCABG) aim to reduce these problems. This metaanalysis provides a
comparison of MiECT and OPCABG in randomized and observational studies. A
fully probabilistic, Bayesian approach of primary and secondary endpoints
was conducted. MiECT does not give inferior results when compared with
OPCABG. However, there is a trend to borderline significantly higher blood
loss in this group in randomized controlled trials. The question whether
MiECT is equivalent to OPCABG can be answered with the affirmative, but
long-term follow-up data are needed to detect any advantage over time.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<97>
Accession Number
613591573
Author
Goncalves A.; Nyman C.; Okada D.R.; Singh A.; Swanson J.; Cheezum M.;
Steigner M.; Di Carli M.; Solomon S.; Shah P.B.; Bhatt D.L.; Shook D.;
Blankstein R.
Institution
(Goncalves, Nyman, Okada, Singh, Swanson, Cheezum, Steigner, Di Carli,
Solomon, Shah, Bhatt, Shook, Blankstein) aCardiovascular Division,
bAnesthesiology Division and cDepartment of Radiology, Brigham and Women's
Hospital, Boston, MA, USA; dUniversity of Porto Medical School, Porto,
Portugal
Title
Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR:
A Comparison with Periprocedural Transesophageal Echocardiography.
Source
Cardiology (Switzerland). (pp 1-8), 2016. Date of Publication: 08 Dec
2016.
Publisher
S. Karger AG
Abstract
Background: We aimed to compare periprocedural transesophageal
echocardiography (TEE) with postprocedural transthoracic echocardiography
(TTE) for the diagnosis of aortic regurgitation (AR). Methods and Results:
TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR)
patients (mean age 81 +/- 8 years; 56% men) were reviewed separately and
blinded to each other as well as to all clinical data. The median time
between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days).
After TAVR, 48% of the patients had at least trace AR by TEE, 56% by
angiography and 67% by TTE. The majority of AR was paravalvular (78%).
More patients were classified with mild-to-moderate AR by TTE than by TEE
(44 vs. 22%, p < 0.01). When examining the 46 patients with AR by TTE
which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP
and DBP) were significantly higher during TTE than during TEE (mean
DELTASBP = 9 +/- 4 mm Hg and mean DELTADBP = 6 +/- 2 mm Hg, p < 0.01 for
both). No differences in BP between TEE and TTE were found among patients
with no AR or among those who had AR in both studies. At a median
follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%,
but this was not associated with the presence of AR on TTE or TEE.
Conclusions: Patients' hemodynamic conditions may result in underdiagnosis
of paravalvular regurgitation in periprocedural TEE. Our findings suggest
that a postprocedural evaluation for AR by TTE could serve as a reasonable
alternative to TEE for the evaluation of AR. Copyright &#xa9; 2016 S.
Karger AG, Basel

<98>
Accession Number
613571777
Author
Parthiban A.; Levine J.C.; Nathan M.; Marshall J.A.; Shirali G.S.; Simon
S.D.; Colan S.D.; Newburger J.W.; Raghuveer G.
Institution
(Parthiban, Marshall, Shirali, Raghuveer) Children's Mercy Hospital,
University of Missouri Kansas City School of Medicine, Kansas City,
Missouri
(Simon) Children's Mercy Hospital, and the Department of Biostatistics,
University of Missouri Kansas City School of Medicine, Kansas City,
Missouri
(Levine, Colan, Newburger) Department of Cardiology, Boston Children's
Hospital, Boston, Massachusetts
(Levine, Colan, Newburger) Department of Pediatrics, Harvard Medical
School, Boston, Massachusetts
(Nathan) Department of Cardiac Surgery, Boston Children's Hospital,
Boston, Massachusetts
(Nathan) Department of Surgery, Harvard Medical School, Boston,
Massachusetts
Title
Implementation of a Quality Improvement Bundle Improves Echocardiographic
Imaging after Congenital Heart Surgery in Children.
Source
Journal of the American Society of Echocardiography. (no pagination),
2016. Date of Publication: 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Postoperative echocardiography after congenital heart disease
surgery is of prognostic importance, but variable image quality is
problematic. We implemented a quality improvement bundle comprising of
focused imaging protocols, procedural sedation, and sonographer education
to improve the rate of optimal imaging (OI). Methods: Predischarge
echocardiograms were evaluated in 116 children (median age, 0.51 years;
range, 0.01-5.6 years) from two centers after tetralogy of Fallot repair,
arterial switch operation, and bidirectional Glenn and Fontan procedures.
OI rates were compared between the centers before and after the
implementation of a quality improvement bundle at center 1, with center 2
serving as the comparator. Echocardiographic images were independently
scored by a single reader from each center, blinded to center and time
period. For each echocardiographic variable, quality score was assigned as
0 (not imaged or suboptimally imaged) or 1 (optimally imaged); structures
were classified as intra- or extracardiac. The rate of OI was calculated
for each variable as the percentage of patients assigned a score of 1.
Results: Intracardiac structures had higher OI than extracardiac
structures (81% vs 57%; adjusted odds ratio [OR], 3.47; . P < .01). Center
1 improved overall OI from 48% to 73% (OR, 4.44; . P < .01), intracardiac
OI from 69% to 85% (OR, 3.53; . P = .01), and extracardiac OI from 35% to
67% (OR, 5.16; . P < .01). There was no temporal difference for center 2.
Conclusions: After congenital heart disease surgery in children,
intracardiac structures are imaged more optimally than extracardiac
structures. Focused imaging protocols, patient sedation, and sonographer
education can improve OI rates. Copyright &#xa9; 2016 American Society of
Echocardiography.

<99>
Accession Number
613549637
Author
Sunaga H.; Blasberg J.D.; Heerdt P.M.
Institution
(Sunaga) aDepartment of Anesthesiology, Jikei University School of
Medicine, Tokyo, Japan bDepartment of Surgery cDepartment of
Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
Title
Anesthesia for nonintubated video-assisted thoracic surgery.
Source
Current Opinion in Anaesthesiology. (no pagination), 2016. Date of
Publication: 30 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
PURPOSE OF REVIEW: This review focuses primarily on nonintubated
video-assisted thoracic surgery (NIVATS), and discusses advantages,
indications, anesthetic techniques, and approaches to intraoperative
crisis management. RECENT FINDINGS: Advancements in endoscopic,
endovascular, and robotic techniques have expanded the range of surgical
procedures that can be performed in a minimally invasive fashion. For
thoracic operations in particular, video-assisted thoracic surgery (VATS)
has largely replaced traditional thoracotomy, and continued technical
development has made surgical access into the pleural space even less
disruptive. As a consequence, the need for general anesthesia and
endotracheal intubation has been re-examined, such that regional or
epidural analgesia may be sufficient for cases where lung collapse can be
accomplished with spontaneous ventilation and an open hemithorax. This
concept of NIVATS has gained popularity, and in some centers has now
expanded to include procedures involving placement of multiple ports.
Although still relatively uncommon at present, a small number of
randomized trials and meta-analyses have indicated some advantages,
suggesting that NIVATS may be a desirable alternative to general
anesthesia with endotracheal intubation for specific indications. SUMMARY:
Although anesthesia for NIVATS is associated with some of the same risks
as general anesthesia with endotracheal intubation, NIVATS can be
successfully performed in carefully selected patients. Copyright &#xa9;
2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

<100>
Accession Number
613545299
Author
Hallgren O.; Svenmarker S.; Appelblad M.
Institution
(Hallgren, Svenmarker, Appelblad) Department of Public Health and Clinical
Medicine, Heart Centre, Umea University, Umea, Sweden
Title
Implementing a Statistical Model for Protamine Titration: Effects on
Coagulation in Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objectives: To implement a statistical model for protamine titration.
Design: Prospective randomized trial. Setting: University hospital.
Participants: Sixty (n = 30+30) patients scheduled for elective coronary
artery bypass surgery were randomly assigned to 2 groups. Interventions:
Protamine dose calculated according to an algorithm established from a
statistical model or to a fixed protamine-heparin dose ratio (1:1).
Measurements and Main Results: Both groups demonstrated comparable patient
demographics and intraoperative data. Coagulation effects were evaluated
using rotational thromboelastometry. Using the statistical model reduced
(p<0.01) the protamine dose from 426+/-43 mg to 251+/-66 mg, followed by
significantly (p<0.01) shorter intrinsic clotting time (208+/-29 seconds
versus 244+/-52 seconds) and stronger clot firmness (p = 0.01), and
effects on indices of extrinsic or fibrinogen coagulation pathways were
insignificant. Test of residual heparin was negative in all patients after
protamine administration, aligned with insignificant (p = 0.27) intergroup
heparinase-verified clotting time differences. Conclusions: The
statistical model for protamine titration is clinically feasible and
protects the patient from exposure to excessive doses of protamine, with
advantageous effects on coagulation as measured using rotational
thromboelastometry. Significance regarding clinical outcome is yet to be
defined. Copyright &#xa9; 2016 Elsevier Inc.