EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 84

Results Generated From:
Embase <1980 to 2017 Week 02>
Embase (updates since 2016-12-30)

<1>
[Use Link to view the full text]
Accession Number
608904244
Author
Rea F.; Potena L.; Yonan N.; Wagner F.; Calabrese F.
Institution
(Rea) Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular
Sciences, University of Padua, Via Giustiniani 2, Padua 35100, Italy
(Potena) Heart and Lung Transplant Program, Cardiovascular Department,
Academic Hospital Sant Orsola Malpighi Bologna, Bologna, Italy
(Yonan) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Manchester, United Kingdom
(Wagner) Department of Cardiovascular Surgery, Hamburg University, Heart
Center, Hamburg, Germany
(Calabrese) Thoracic Pathology Unit, Department of Cardiac, Thoracic and
Vascular Sciences, University of Padua, Italy
Title
Cytomegalovirus hyper immunoglobulin for CMV prophylaxis in thoracic
transplantation.
Source
Transplantation. 100 (pp S19-S26), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Cytomegalovirus (CMV) infection negatively influences both short- and
long-term outcomes after cardiothoracic transplantation. In heart
transplantation, registry analyses have shown that CMV immunoglobulin
(CMVIG) with or without virostatic prophylaxis is associated with a
significant reduction in mortality and graft loss versus no prophylaxis,
particularly in high-risk donor (D)+/recipient (R)-transplants. Randomized
comparative trials are lacking but retrospective data suggest that
addition of CMVIG to antiviral prophylaxis may reduce rates of CMV-related
events after heart transplantation, including the incidence of acute
rejection or chronic allograft vasculopathy. However, available data
consistently indicate that when CMVIG is used, it should be administered
with concomitant antiviral therapy, and that evidence concerning
preemptive management with CMVIG is limited, but promising. In lung
transplantation, CMVIG should again only be used with concomitant
antiviral therapy. Retrospective studies have shown convincing evidence
that addition of CMVIG to antiviral prophylaxis lowers CMV endpoints and
mortality. The current balance of evidence suggests that CMVIG prophylaxis
reduces the risk of bronchiolitis obliterans syndrome, but a controlled
trial is awaited. Overall, the relatively limited current data set
suggests that prophylaxis with CMVIG in combination with antiviral therapy
appears effective in D+/R-heart transplant patients, whereas in lung
transplantation, addition of CMVIG in recipients of a CMV-positive graft
may offer an advantage in terms of CMV infection and disease. Copyright
&#xa9; 2016 Wolters Kluwer Health, Inc. All rights reserved.

<2>
[Use Link to view the full text]
Accession Number
611547041
Author
Duerinckx N.; Burkhalter H.; Engberg S.J.; Kirsch M.; Klem M.-L.; Sereika
S.M.; De Simone P.; De Geest S.; Dobbels F.
Institution
(Duerinckx, De Geest, Dobbels) Academic Centre for Nursing and Midwifery,
Department of Public Health and Primary Care, KU Leuven, University of
Leuven, Belgium
(Duerinckx) Heart Transplantation Program, University Hospitals of Leuven,
Belgium
(Burkhalter) Centre of Sleep Medicine, Hirslanden Group Zurich,
Switzerland
(Engberg, Sereika) School of Nursing, University of Pittsburgh,
Pittsburgh, PA, United States
(Kirsch) Department of Anesthesiology, University Hospital of Basel,
Switzerland
(Klem) Health Sciences Library System, University of Pittsburgh,
Pittsburgh, PA, United States
(De Simone) Hepatobiliary Surgery and Liver Transplantation, University of
Pisa Medical School Hospital, Pisa, Italy
(De Geest, Dobbels) Institute of Nursing Science, University of Basel,
Faculty of Medicine, Bernoullistrasse 28, Basel 4056, Switzerland
Title
Correlates and Outcomes of Posttransplant Smoking in Solid Organ
Transplant Recipients: A Systematic Literature Review and Meta-Analysis.
Source
Transplantation. 100 (11) (pp 2252-2263), 2016. Date of Publication: 01
Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Despite smoking being an absolute or relative contraindication
for transplantation, about 11% to 40% of all patients continue or resume
smoking posttransplant. This systematic review with meta-analysis
investigated the correlates and outcomes associated with smoking after
solid organ transplantation. Methods We searched PubMed, EMBASE, CINAHL,
and PsycINFO from inception until January 2016, using state-of-the art
methodology. Pooled odds ratios (ORs) with 95% confidence intervals (CIs)
were computed for correlates/outcomes investigated 5 times or more.
Results Seventy-three studies (43 in kidney, 17 in heart, 12 in liver, 1
in lung transplantation) investigated 95 correlates and 24 outcomes, of
which 6 correlates and 4 outcomes could be included in the meta-analysis.
The odds of smoking posttransplant were 1.33 times higher in men (95% CI,
1.12-1.57). Older individuals were significantly less likely to smoke (OR,
0.48; 95% CI, 0.38-0.62), as were patients with a higher body mass index
(OR, 0.68; 95% CI, 0.52-0.89). Hypertension (OR, 1.16; 95% CI, 0.77-1.75),
diabetes mellitus (OR, 0.52; 95% CI, 0.15-1.78), and having a history of
cardiovascular disease (OR, 0.92; 95% CI, 0.77-1.09) were not significant
correlates. Posttransplant smokers had higher odds of newly developed
posttransplant cardiovascular disease (OR, 1.41; 95% CI, 1.02-1.95),
nonskin malignancies (OR, 2.58; 95% CI, 1.26-5.29), a shorter patient
survival time (OR, 0.59; 95% CI, 0.44-0.79), and higher odds of mortality
(OR, 1.74; 95% CI, 1.21-2.48). Conclusions Posttransplant smoking is
associated with poor outcomes. Our results might help clinicians to
understand which patients are more likely to smoke posttransplant, guide
interventional approaches, and provide recommendations for future
research. Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All rights
reserved.

<3>
[Use Link to view the full text]
Accession Number
606901254
Author
Bode L.G.M.; Rijen M.M.L.V.; Wertheim H.F.L.; Vandenbroucke-Grauls
C.M.J.E.; Troelstra A.; Voss A.; Verbrugh H.A.; Vos M.C.; Kluytmans
J.A.J.W.
Institution
(Bode, Wertheim, Verbrugh, Vos) Erasmus University, Department of Medical
Microbiology and Infectious Diseases, Rotterdam, Netherlands
(Rijen, Kluytmans) Amphia Hospital, Laboratory for Microbiology and
Infection Control, Breda, Netherlands
(Vandenbroucke-Grauls, Kluytmans) VU Medical Center, Department of Medical
Microbiology and Infection Control, Amsterdam, Netherlands
(Troelstra) University Medical Center, Department of Medical Microbiology,
Utrecht, Netherlands
(Voss) Can-Canisius Wilhelmina Hospital, Department of Medical
Microbiology and Infectious Diseases, Nijmegen, Netherlands
(Bode) Department of Medical Microbiology, Heidelberglaan 100, Utrecht
3584, Netherlands
Title
Long-term mortality after rapid screening and decolonization of
staphylococcus aureus carriers : Observational follow-up study of a
randomized, placebo-controlled trial.
Source
Annals of Surgery. 263 (3) (pp 511-515), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
To identify patients who benefit most from Staphylococcus aureus screening
and decolonization treatment upon admission. Background: S. aureus
carriers are at increased risk of developing surgicalsite infections with
S. aureus. Previously, we demonstrated in a randomized, placebo-controlled
trial (RCT) that these infections can largely be prevented by detection of
carriage and decolonization treatment upon admission. In this study, we
analyzed 1-and 3-year mortality rates in both treatment arms of the RCT to
identify patient groups that should be targeted when implementing the
screen-and-treat strategy. Methods: Three years after enrolment in the
RCT, mortality dates of all surgical patients were checked. One-and 3-year
mortality rates were calculated for all patients and for various
subgroups. Results: After 3 years, 44 of 431 (10.2%) and 43 of 362 (11.9%)
patients had died in the mupirocin/chlorhexidine and placebo groups,
respectively. No significant differences in mortality rates were observed
between the treatment groups or the subgroups according to type of
surgery. In the subgroup of patients with clean procedures (382
cardiothoracic, 167 orthopedic, 61 vascular, and 56 other),
mupirocin/chlorhexidine reduced 1-year mortality: 11 of 365 (3.0%) died in
the mupirocin/chlorhexidine versus 21 of 301 (7.0%) in the placebo group
[hazard ratio=0.38 (95% CI: 0.18-0.81)]. Conclusions: Detection and
decolonization of S. aureus carriage not only prevents S. aureus
surgical-site infections but also reduces 1-year mortality in surgical
patients undergoing clean procedures. Such patients with a high risk of
developing S. aureus infections should therefore be the primary target
when implementing the screen-and-treat strategy in clinical practice.
Copyright &#xa9; 2015 Wolters Kluwer Health, Inc.

<4>
[Use Link to view the full text]
Accession Number
609695296
Author
Thomas D.M.; Branch K.R.; Cury R.C.
Institution
(Thomas, Branch, Cury) Cardiology Division, Brooke Army Medical Center,
San Antonio, Texas, the Cardiology Division, University of Washington,
Seattle, and the Miami Cardiac and Vascular Institute, Baptist Health of
South Florida, Miami
Title
PROMISE of coronary CT angiography: Precise and accurate diagnosis and
prognosis in coronary artery disease.
Source
Southern Medical Journal. 109 (4) (pp 242-247), 2016. Date of Publication:
01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Coronary computed tomography angiography (CCTA) is a rapidly growing and
powerful diagnostic test that offers a great deal of precision with
respect to diagnosing coronary artery disease (CAD). Guideline statements
for patients with stable ischemic heart disease have recommended CCTA for
only a limited portion of intermediate-risk patients who have relative or
absolute contraindications for exercise or vasodilator stress testing. The
publication of two large, prospective randomized clinical trials, the
Prospective Multicenter Imaging Study for Evaluation of Chest Pain and the
Scottish Computed Tomography of the Heart Trial are likely to expand these
indications. These new data from large trials, in addition to other
studies, show that CCTA is highly sensitive for the detection of CAD,
identifies high-risk patients for cardiac events based on extent or plaque
morphology of CAD that would not be identified by other noninvasive means,
and provides significantly greater diagnostic certainty for proper
treatment, including referral for invasive coronary angiography with
revascularization more appropriately. Superior diagnostic accuracy and
prognostic data with CCTA, when compared with other functional stress
tests, may result in a reduction in unnecessary downstream testing and
cost savings. In addition, newer CCTA applications hold the promise of
providing a complete evaluation of a patient's coronary anatomy as well as
a per-vessel ischemic evaluation. This review focuses on the interval
knowledge obtained from newer data on CCTA in patients with stable
ischemic heart disease, primarily focusing on the contributions of the
Prospective Multicenter Imaging Study for Evaluation of Chest Pain and the
Scottish Computed Tomography of the Heart Trial. Copyright &#xa9; 2016 by
The Southern Medical Association.

<5>
Accession Number
606579913
Author
Amanda Dew M.; Rosenberger E.M.; Myaskovsky L.; DiMartini A.F.; DeVito
Dabbs A.J.; Posluszny D.M.; Steel J.; Switzer G.E.; Shellmer D.A.;
Greenhouse J.B.
Institution
(Amanda Dew, DiMartini) University of Pittsburgh School of Medicine and
Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
(Amanda Dew) Department of Psychology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Biostatistics, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew, Rosenberger) Clinical and Translational Science Institute,
University of Pittsburgh, Pittsburgh, PA, United States
(Rosenberger, Myaskovsky, Posluszny, Switzer) Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Myaskovsky, Switzer) Center for Health Equity Research and Promotion,
Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA,
United States
(DiMartini, Steel, Shellmer) Department of Surgery, University of
Pittsburgh, Pittsburgh, PA, United States
(DeVito Dabbs) Department of Acute and Tertiary Care, University of
Pittsburgh School of Nursing, Pittsburgh, PA, United States
(Greenhouse) Department of Statistics, Carnegie Mellon University,
Pittsburgh, PA, United States
Title
Depression and anxiety as risk factors for morbidity and mortality after
organ transplantation: A systematic review and meta-analysis.
Source
Transplantation. 100 (5) (pp 988-1003), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background. Depression and anxiety are common mental health problems in
transplant populations. There is mixed evidence concerning whether they
increase morbidity and mortality risks after transplantation. If such
associations exist, additional risk reduction strategiesmay be
needed.Methods. Four bibliographic databases were searched from1981
through September 2014 for studies prospectively examining whether
depression or anxiety (determined with diagnostic evaluations or
standardized symptomscales) affected risk for posttransplant mortality,
graft loss, acute graft rejection, chronic rejection, cancer, infection,
and rehospitalization. Results. Twenty-seven studies (10 heart, total n =
1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas,
n = 80; 1 mixed recipient sample, n = 205) were identified. In each,
depression and/or anxiety were typically measured before or early after
transplantation. Follow-up for outcomes was a median of 5.8 years (range,
0.50-18.0). Depression increased the relative risk (RR) of mortality by
65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies).
Meta-regression indicated that risk was stronger in studies that did (vs
did not) control for potential confounders (P = .032). Risk was unaffected
by type of transplant or other study characteristics. Depression increased
death-censored graft loss risk (RR, 1.65; 95% CI, 1.21- 2.26, 3 studies).
Depression was not associated with other morbidities (each morbidity was
assessed in 1-4 studies). Anxiety did not significantly increase mortality
risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed
in single studies). Conclusions. Depression increases risk for
posttransplant mortality. Few studies considered morbidities; the
depression-graft loss association suggests that linkages with morbidities
deserve greater attention. Depression screening and treatment may be
warranted, although whether these activities would reduce posttransplant
mortality requires study. Copyright &#xa9; 2016 Wolters Kluwer Health,
Inc. All rights reserved.

<6>
[Use Link to view the full text]
Accession Number
606627138
Author
Ziegler T.R.; May A.K.; Hebbar G.; Easley K.A.; Griffith D.P.; Dave N.;
Collier B.R.; Cotsonis G.A.; Hao L.; Leong T.; Manatunga A.K.; Rosenberg
E.S.; Jones D.P.; Martin G.S.; Jensen G.L.; Sax H.C.; Kudsk K.A.; Galloway
J.R.; Blumberg H.M.; Evans M.E.; Wischmeyer P.E.
Institution
(Ziegler, Hebbar, Hao) Division of Endocrinology, Metabolism and Lipids,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Ziegler, Galloway) Center for Clinical and Molecular Nutrition, Emory
University, School of Medicine, Atlanta, GA, United States
(Ziegler, Hebbar, Griffith, Dave, Galloway) Emory University Hospital,
Nutrition and Metabolic Support Service, Atlanta Clinical and
Translational Science Institute, 1364 Clifton Rd, Atlanta, GA 30322,
United States
(May, Collier) Department of Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Easley, Cotsonis, Leong, Manatunga) Department of Biostatistics and
Bioinformatics, Rollins School of Public Health, Emory University,
Atlanta, GA, United States
(Collier) Department of Surgery, Virginia Technical Institute Carilion,
School of Medicine, Roanoke, VA, United States
(Rosenberg) Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, United States
(Jones) Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Martin) Department of Nutritional Sciences, Pennsylvania State
University, University Park, PA, United States
(Jensen, Blumberg) Department of Surgery, Miriam Hospital, Providence, RI,
United States
(Sax) Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA,
United States
(Sax) Department of Surgery, University of Wisconsin, Schools of Medicine
and Public Health, Madison, WI, United States
(Kudsk) Department of Surgery, Emory University, School of Medicine,
Atlanta, GA, United States
(Galloway) Division of Infectious Diseases, Department of Medicine, Emory
University, School of Medicine, Atlanta, GA, United States
(Evans) Hubert Department of Global Health Rollins, School of Public
Health, Emory University, Atlanta, GA, United States
(Wischmeyer) National Institutes of Health, National Institute of Diabetes
and Digestive and Kidney Diseases, Bethesda, MD, United States
(Wischmeyer) Department of Anesthesiology, University of Colorado, School
of Medicine, Aurora, CO, United States
Title
Efficacy and safety of glutamine-supplemented parenteral nutrition in
surgical ICU patients: An American mul ticenter rand omized controlled
trial.
Source
Annals of Surgery. 263 (4) (pp 646-655), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To determine whether glutamine (GLN)-supplemented parenteral
nutrition (PN) improves clinical outcomes in surgical intensive care unit
(SICU) patients. Summary Background Data: GLN requirements may increase
with critical illness. GLN-supplemented PN may improve clinical outcomes
in SICU patients. Methods: A parallel-group, multicenter, double-blind,
randomized, controlled clinical trial in 150 adults after
gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care.
Patients were without significant renal or hepatic failure or shock at
entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids
(AAs) and energy at 1.3x estimated basal energy expenditure]. Controls (n
= 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75)
received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally
replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN
weaned as indicated. Hospital mortality and infections were primary
endpoints. Results: Baseline characteristics, days on study PN and daily
macronutrient intakes via PN and EN, were similar between groups. There
were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the
STD-PN group (17.3%; difference,-2.6%; 95% confidence interval,-14.6% to
9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN
group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream
infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and
STD-PN groups, respectively (P = 0.73). Other clinical outcomes and
adverse events were similar. Conclusions: PN supplemented with GLN
dipeptide was safe, but did not alter clinical outcomes among SICU
patients. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc. All rights
reserved.

<7>
Accession Number
601114425
Author
Tregay J.; Wray J.; Bull C.; Franklin R.C.; Daubeney P.; Barron D.J.;
Brown K.; Knowles R.L.
Institution
(Tregay, Wray, Bull, Brown) Cardiorespiratory Unit, Great Ormond Street
Hospital NHS Foundation Trust, London, United Kingdom
(Franklin, Daubeney) Department of Paediatric Cardiology, Royal Brompton
and Harefield NHS Trust, London, United Kingdom
(Barron) Cardiac Unit, Birmingham Children's Hospital NHS Foundation
Trust, Birmingham, United Kingdom
(Knowles) Population, Policy and Practice Programme, Institute of Child
Health, University College London, 30 Guilford St, London WC1N 1EH, United
Kingdom
Title
Unexpected deaths and unplanned re-admissions in infants discharged home
after cardiac surgery: A systematic review of potential risk factors.
Source
Cardiology in the Young. 25 (5) (pp 839-852), 2015. Date of Publication:
10 Jun 2015.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background Babies with CHDs are a particularly vulnerable population with
significant mortality in their 1st year. Although most deaths occur in the
hospital within the early postoperative period, around one-fifth of
postoperative deaths in the 1st year of life may occur after hospital
discharge in infants who have undergone apparently successful cardiac
surgery. Aim To systematically review the published literature and
identify risk factors for adverse outcomes, specifically deaths and
unplanned re-admissions, following hospital discharge after infant surgery
for life-threatening CHDs. Methods A systematic search was conducted in
MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO
electronic databases, supplemented by manual searching of conference
abstracts. Results A total of 15 studies were eligible for inclusion.
Almost exclusively, studies were conducted in single US centres and
focussed on children with complex single ventricle diagnoses. A wide range
of risk factors were evaluated, and those more frequently identified as
having a significant association with higher mortality or unplanned
re-admission risk were non-Caucasian ethnicity, lower socio-economic
status, co-morbid conditions, age at surgery, operative complexity and
procedure type, and post-operative feeding difficulties. Conclusions
Studies investigating risk factors for adverse outcomes post-discharge
following diverse congenital heart operations in infants are lacking.
Further research is needed to systematically identify higher risk groups,
and to develop interventions targeted at supporting the most vulnerable
infants within an integrated primary and secondary care pathway. Copyright
&#xa9; Cambridge University Press 2014.

<8>
[Use Link to view the full text]
Accession Number
612817756
Author
Reek S.
Institution
(Reek) Electrophysiology Service, Hirslanden Klinik Aarau, Rhythmologie
Aargau, Rain 34, Aarau CH-5000, Switzerland
Title
The wearable defibrillator: Current technology, indications and future
directions.
Source
Current Opinion in Cardiology. 32 (1) (pp 39-46), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review The wearable cardioverter-defibrillator has been
available for over a decade. In recent years, the device has been
prescribed increasingly for a wide range of indications. The purpose of
this review is to describe the technical and clinical aspects of the
wearable cardioverter-defibrillator. The available literature on safety,
efficacy and cost-effectiveness is reviewed, and indications for use will
be discussed. Recent findings The wearable cardioverter-defibrillator has
been used successfully in more than 100 000 patients for a variety of
indications. These include high-risk patients after myocardial infarction
or revascularization or with heart failure and newly diagnosed
cardiomyopathy. It has also been used to bridge the time period of
postponed implantable cardioverter-defibrillator implantation or
reimplantation, or until heart transplantation. It has been shown that the
device safely and effectively terminates ventricular tachycardia and
fibrillation with high first shock success. Patient compliance has been
high. Although no randomized trial has been published yet, several
guidelines recommend wearable cardioverter-defibrillator use in different
patient populations and clinical scenarios. Summary The wearable
cardioverter-defibrillator effectively bridges a limited time period in
patients with a real or perceived high risk for sudden cardiac arrest and
may become a helpful tool for risk stratification to better select
patients for primary prevention implantable cardioverter-defibrillator
placement. Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All rights
reserved.

<9>
Accession Number
613337945
Author
Mishra B.; Gupta A.; Sagar S.; Singhal M.; Kumar S.
Institution
(Mishra, Gupta, Sagar, Singhal, Kumar) Division of Trauma Surgery &
Critical Care, JPN Apex Trauma Centre, All India Institute of Medical
Sciences, New Delhi, India
Title
Traumatic cardiac injury: Experience from a level-1 trauma centre.
Source
Chinese Journal of Traumatology - English Edition. 19 (6) (pp 333-336),
2016. Date of Publication: 01 Dec 2016.
Publisher
Elsevier B.V.
Abstract
Purpose Traumatic cardiac injury (TCI) is a challenge for trauma surgeons
as it provides a short therapeutic window and the management is often
dictated by the underlying mechanism and hemodynamic status. The current
study is to evaluate the factors influencing the outcome of TCI. Methods
Prospectively maintained database of TCI cases admitted at a Level-1
trauma center from July 2008 to June 2013 was retrospectively analyzed.
Hospital records were reviewed and statistical analysis was performed
using the SPSS version 15. Results Out of 21 cases of TCI, 6 (28.6%) had
isolated and 15 (71.4%) had associated injuries. Ratio between blunt and
penetrating injuries was 2:1 with male preponderance. Mean ISS was 31.95.
Thirteen patients (62%) presented with features suggestive of shock.
Cardiac tamponade was present in 12 (57%) cases and pericardiocentesis was
done in only 6 cases of them. Overall 19 patients underwent surgery.
Perioperatively 8 (38.1%) patients developed cardiac arrest and 7
developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality
was related to cardiac arrest (p = 0.014), arrhythmia (p = 0.014), and
hemorrhagic shock (p = 0.04). The diagnostic accuracy of focused
assessment by sonography in trauma (FAST) was 95.24%. Conclusion High
index of clinical suspicion based on the mechanism of injury, meticulous
examination by FAST and early intervention could improve the overall
outcome. Copyright &#xa9; 2016 Daping Hospital and the Research Institute
of Surgery of the Third Military Medical University

<10>
Accession Number
613762011
Author
Sannino A.; Schiattarella G.G.; Toscano E.; Gargiulo G.; Giugliano G.;
Galderisi M.; Losi M.-A.; Stabile E.; Cirillo P.; Imbriaco M.; Grayburn
P.A.; Trimarco B.; Esposito G.
Institution
(Sannino, Schiattarella, Toscano, Gargiulo, Giugliano, Galderisi, Losi,
Stabile, Cirillo, Imbriaco, Trimarco, Esposito) Division of Cardiology,
Department of Advanced Biomedical Sciences, Federico II University,
Naples, Italy
(Sannino, Grayburn) Division of Cardiology, Baylor University Medical
Center, Dallas, Texas, United States
(Schiattarella) Department of Internal Medicine (Cardiology), University
of Texas Southwestern Medical Center, Dallas, Texas, United States
Title
Meta-Analysis of Effect of Body Mass Index on Outcomes After Transcatheter
Aortic Valve Implantation.
Source
American Journal of Cardiology. 119 (2) (pp 308-316), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Controversial data exist regarding the impact of body mass index (BMI) on
TAVI outcomes. Thirteen TAVI studies were included and analyzed for the
incidence of procedural complications, 30-day, and long-term all-cause
mortality. Three comparisons were executed: (1) underweight versus normal
weight, (2) overweight versus normal weight, and (3) obese versus normal
weight patients. Underweight patients (BMI <20 kg/m²) had
similar 30-day all-cause mortality compared with the normal, although they
displayed a significant worse survival at long-term follow-up (hazard
ratio 1.68, 95% confidence interval (CI) 1.09 to 2.59, p = 0.02).
Underweight patients showed a higher incidence of major and
life-threatening bleedings (2,566 patients, odds ratio 1.64, 95% CI 1.10
to 2.45, p = 0.02) and of major vascular complications (2,566 patients,
odds ratio 1.86, 95% CI 1.16 to 2.98, p = 0.01), compared with normal
weight patients. Overweight patients (BMI >25 and <30 kg/m²)
display similar 30-day and long-term all-cause mortality, as well as
similar procedural complication rate compared with normal weight patients.
Obese patients (BMI >30 kg/m²) had similar 30-day all-cause
mortality rates compared with the normal weight category, whereas they
displayed a significant better survival at long-term (hazard ratio 0.79,
95% CI 0.67 to 0.93, p = 0.004). Procedural complications did not differ
between obese and normal body weight patients. In conclusion, a low BMI is
linked to a significantly worse prognosis after TAVI. Therefore, BMI
represents an important and handily tool that might be used in the risk
prediction of patients to be addressed for TAVI. Copyright &#xa9; 2016
Elsevier Inc.

<11>
Accession Number
611570779
Author
Sibilitz K.L.; Berg S.K.; Rasmussen T.B.; Risom S.S.; Thygesen L.C.; Tang
L.; Hansen T.B.; Johansen P.P.; Gluud C.; Lindschou J.; Schmid J.P.;
Hassager C.; KOber L.; Taylor R.S.; Zwisler A.-D.
Institution
(Sibilitz, Berg, Rasmussen, Risom, Tang, Hansen, Johansen, Hassager,
KOber, Zwisler) Department of Cardiology, Rigshospitalet, Copenhagen
University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
(Sibilitz, Thygesen, Taylor, Zwisler) National Institute of Public Health,
University of Southern Denmark, Copenhagen, Denmark
(Berg, Rasmussen) Department of Cardiology, Gentofte Hospital, Gentofte,
Denmark
(Risom) Bachelor's Degree Programme in Nursing, Metropolitan University
College, Copenhagen, Denmark
(Tang) Bachelor's Degree Programme in Physiotherapy, Department of
Rehabilitation and Nutrition, Metropolitan University College, Copenhagen,
Denmark
(Tang) Section of Social Medicine, Department of Public Health, University
of Copenhagen, Copenhagen, Denmark
(Hansen) Zealand University Hospital, Department of Cardiology, KOgevej
7-13, Roskilde 4000, Denmark
(Johansen) Department of Cardiology, Bispebjerg Hospital, Copenhagen,
Denmark
(Gluud, Lindschou) Department 7812, Centre for Clinical Intervention
Research, Copenhagen University Hospital, Copenhagen, Denmark
(Schmid) Cardiology Clinic, Tiefenau Hospital, University of Bern, Bern,
Switzerland
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, United Kingdom
(Zwisler) Department of Cardiology, Holbaek Sygehus, Holbaek, Denmark
(Zwisler) National Centre of Rehabilitation and Palliation, University of
Southern Denmark, University Hospital of Odense, Odense, Denmark
Title
Cardiac rehabilitation increases physical capacity but not mental health
after heart valve surgery: A randomised clinical trial.
Source
Heart. 102 (24) (pp 1995-2003), 2016. Date of Publication: 15 Dec 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The evidence for cardiac rehabilitation after valve surgery
remains sparse. Current recommendations are therefore based on patients
with ischaemic heart disease. The aim of this randomised clinical trial
was to assess the effects of cardiac rehabilitation versus usual care
after heart valve surgery. Methods The trial was an
investigator-initiated, randomised superiority trial (The CopenHeartVR
trial, VR; valve replacement or repair). We randomised 147 patients after
heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting
of physical exercise and monthly psycho-educational consultations
(intervention) versus usual care without structured physical exercise or
psycho-educational consultations (control). Primary outcome was physical
capacity measured by VO<inf>2</inf> peak and secondary outcome was
self-reported mental health measured by Short Form-36. Results 76% were
men, mean age 62 years, with aortic (62%), mitral (36%) or
tricuspid/pulmonary valve surgery (2%). Cardiac rehabilitation compared
with control had a beneficial effect on VO<inf>2</inf> peak at 4 months
(24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short
Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40)
or the exploratory physical and mental outcomes. Cardiac rehabilitation
increased the occurrence of self-reported non-serious adverse events
(11/72 vs 3/75, p=0.02). Conclusions Cardiac rehabilitation after heart
valve surgery significantly improves VO<inf>2</inf> peak at 4 months but
has no effect on mental health and other measures of exercise capacity and
self-reported outcomes. Further research is needed to justify cardiac
rehabilitation in this patient group.

<12>
Accession Number
613933197
Author
Andres Navarro O.; Thebault S.; Wierzgon M.; Kralj I.; Paetzel C.; Kaduk
M.
Institution
(Andres Navarro) Vascular Surgery, Hospital Universitari Dr.Josep Trueta
De Girona, Girona, Spain
(Thebault) Surgery, Clinique Ormeau-Pyrenees, Tarbes, France
(Wierzgon) Radiodiagnostic, Trinec-Podlesi a.s, Trinec, Czech Republic
(Kralj) Interventional Radiology, Diakonissenkrankenhaus
Karlsruhe-Ruppurr, Karlsruhe, Germany
(Paetzel) Radiology, Klinikum Weiden, Weiden, Germany
(Kaduk) Radiology/ Angiology, Dr. Drogula KH Dobeln, Dobeln, Germany
Title
The impact of Misago Rx nitinol stenting on clinical outcomes for the
treatment in the bypass grafts from the e-MISAGO registry.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2016. Spain.
Conference Start: 20160911. Conference End: 20160914. 39 (3 Supplement 1)
(pp S306-S307), 2016. Date of Publication: 2016.
Publisher
Springer New York LLC
Abstract
Purpose: To date, there is a lack of data on clinical outcomes following
percutaneous peripheral revascularisation of a bypass graft in the lower
extremities. We investigated the safety and efficacy of Misago stent
implantation in the bypass grafts at the 12-month follow-up. Material and
methods: E-MISAGO is a prospective, non-randomised, multi-centre registry.
Primary safety and efficacy endpoint match VIVA group's criteria. Of the
3331 patients enrolled in the registry, only 33 patients (mean age
72.4+/-10.3 years; 66.7% male) at 15 sites underwent Misago Rx nitinol
stenting in the bypass grafts. Results: Among this group, 74.3% had
lesions in the femoro-popliteal bypass graft and 17.1% in the
femoro-distal bypass graft. Participants had a high prevalence of diabetes
(51.5%), hypertension (84.9%), hyperlipidaemia (42.4%) or previous
coronary revascularisation (39.4%). Critical limb ischaemia was present in
48.5% of the patients with treated lesions, including new lesions,
in-stent restenosis (ISR), restenosis post-angioplasty and
thrombus-occluded artery. Massive and moderate calcifications were
observed in less than 20% of the patients. The mean lesion length was
65.8+/-80.8mm, and the mean reference vessel diameter was 5.7+/-1.2mm. The
composite rate of death, amputation or TLR was 15.2% at 1 year with the
primary patency rate of 87.9%. Conclusion: Despite the fact that bypass
lesions are not frequently observed, the results demonstrate that
placement of the Misago stent in the bypass graft is safe and effective in
the lower extremities.

<13>
Accession Number
613932957
Author
Izaaryene J.; Bartoli J.-M.; Vidal V.; Jacquier A.; Gaubert J.-Y.
Institution
(Izaaryene) Radiology, Hopital De La Timone, Marseille, France
(Bartoli, Jacquier) Radiologie Adulte, APHM CHU La Timone, Marseille,
France
(Vidal) Service De Radiologie, Hopital Timone Adultes, Marseille, France
(Gaubert) Department of Adult Radiology, CHU Timone 2, Marseille, France
Title
Embolizing lung radiofrequency ablation tracks.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2016. Spain.
Conference Start: 20160911. Conference End: 20160914. 39 (3 Supplement 1)
(pp S290), 2016. Date of Publication: 2016.
Publisher
Springer New York LLC
Abstract
Purpose: Pneumothorax is the most common complication after percutaneous
radiofrequency lung ablation. The chest tube is the most frequent cause of
lengthening the hospital stay. Material and methods: We included
prospectively 54 patients and randomly divided them into 2 groups: 27
patients "without embolization" and 27 patients "with embolization"; in
these patients, we embolized the RFA tracks with gelatin torpedoes. The 2
groups were comparable for different risk factors of pneumothorax (age,
sex, history of ipsilateral thoracic surgery, and the distance between the
pleura and lesion). Results: The number of pneumothorax was significantly
(p = 0.008) lower in the group "with embolization," which included 14
pneumothoraces (51.9%), than in the group "without embolization," which
included 23 pneumothoraces (85.2%). The volume of pneumothorax was
significantly less abundant (p = 0.019) in the group "with embolization"
(average of 15.1%, standard deviation 13.8%) than in the group "without
embolization" (average of 28.7%, standard deviation 17.4%). The drainage
was significantly lower (p = 0.011) in the group "with embolization" (2
drainages or 14.3%) than in the group without embolization (13 drainages
or 56.5%). Conclusion: Embolization lung radiofrequency tracks with
absorbable gelatin torpedoes significantly decreases the number and
abundance of pneumothorax and the number of chest tubes. This method is
simple and inexpensive; it is not intended to revolutionize the practice
of pulmonary RFA, but it can improve the patient comfort during
hospitalization.

<14>
Accession Number
613918668
Author
Agarwal M.; Bomb R.; Oliphant C.S.; Khouzam R.N.
Institution
(Agarwal) Department of Internal Medicine, University of Tennessee Health
Science Center, Memphis, TN, United States
(Bomb, Khouzam) Division of Cardiovascular diseases, Department of
Medicine, University of Tennessee Health Science Center, Memphis, TN,
United States
(Oliphant) Department of Pharmacy, Methodist University Hospital, Memphis,
TN, United States
(Oliphant) Department of Clinical Pharmacy, University of Tennessee,
College of Pharmacy, Memphis, TN, United States
Title
Dual antiplatelet therapy after coronary artery bypass grafting in the
setting of acute coronary syndrome.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
21st World Congress on Heart Disease Annual Scientific Sessions 2016.
United States. Conference Start: 20160730. Conference End: 20160801. 134
(pp 52), 2016. Date of Publication: July 2016.
Publisher
S. Karger AG
Abstract
Objective: To review available clinical data regarding Dual Antiplatelet
therapy (DAPT) in post coronary artery bypass grafting (pCABG) patients.
Background: CABG is the best recommended intervention for post acute
coronary syndrome (ACS) patients with severe multi-vessel coronary artery
disease. Among the most common and worrisome complications in pCABG
patients are recurrent ACS, venous graft thrombosis and death. Unlike post
ACS medical management guidelines where DAPT use is a standard, no clear
guidelines exist for pCABG patients. Hence we performed literature review
to study pCABG DAPT use. Methods: An extensive literature search was
conducted using the terms aspirin, clopidogrel, DAPT and coronary artery
bypass surgery. In addition, studies were discovered during bibliographic
reviews. The studies with clear efficacy end points were included and
divided into 2 groups:- significant positive results (sP) and neutral
results (nR). A separate search for meta analyses was also performed.
Results: 12 clinical studies and 3 meta analyses were identified, and
reviewed. Among 12 clinical studies, 5 sP and 7 nR were found (Table 1).
Conclusion: Although in the absence of contraindications, 9-12 months post
operative DAPT use is reasonable, but no clear consensus exist for pCABG
DAPT use. Hence large, multicenter, randomized clinical trials are
indicated. (Table Presented).

<15>
Accession Number
613918314
Author
Arabia F.; Gregoric I.; Kasirajan V.; Moriguchi J.D.; Naftel D.C.; Myers
S.L.; Kirklin J.K.
Institution
(Arabia, Moriguchi) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Gregoric) University of Texas, Health Science Center Houston, Houston,
TX, United States
(Kasirajan) Virginia Commonwealth University Medical Center, Richmond, VA,
United States
(Naftel, Myers, Kirklin) University of Alabama at Birmingham, Birmingham,
AL, United States
Title
Total artificial heart (TAH): Survival outcomes, risk factors, adverse
events in intermacs.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
21st World Congress on Heart Disease Annual Scientific Sessions 2016.
United States. Conference Start: 20160730. Conference End: 20160801. 134
(pp 283), 2016. Date of Publication: July 2016.
Publisher
S. Karger AG
Abstract
Purpose: We aim to better understand the pt population with biventricular
failure receiving TAH as a BTT, determine outcomes in 3 eras, effect of
implanting ctr on outcomes, and adverse events related to this therapy.
Methods: Between 2006 and 2015 359 pts received TAH implants as BTT in 44
hospitals in the registry. Mean age 50 yrs, 85% males. Common primary
diagnoses: 34% Dilated CM, 30% ischemic CM, and 26% other. 210 pts
received a heart transplant and 114 pts died while on the device. Mean
follow up 5 mths. Outcomes were analyzed with competing outcomes methods.
Results: Outcomes were separated, Era 1 (2006-09), Era 2 (2010-12), and
Era 3 (2013-15); ctrs that implanted 1-5, 6-10, and =11 implants/year.
Intermacs profile (IP) 1+2 accounted for 88% of pts in Era 1, 74% in Era
2, & 70% in Era 3. Competing outcome survival at 6 mths were: Era 1, 80%;
Era 2, 76%; and Era 3, 67% (Era 1 vs. Era 2, p=.86; Era 1 vs Era 3, p=.24;
Era 2 vs Era 3, p=.13). Ctrs that performed = 11 implants experienced
survival at 85% 6 mths post implant for pts IP 1 + 2 (1-5 vs 6-10, p=.70;
1-5 vs 11+, p=.0003; 6-10 vs 11+, p=.0009). Baseline characteristic (p <
0.05) TAH vs. LVAD populations were respectively: CVP 17.3 vs. 12.9, IP1
38.7% vs 15.8%, ECMO 12.4% vs. 2.3%, ventilator 19.1% vs. 6.8%. Common
AEs: bleeding 47%, resp failure 36%, renal dysf 33.7%, neuro dysf 24.9%,
hepatic dysf 13.5%. Hazard function analysis revealed the following risk
factors for death: older age, elevated bilirubin, lower albumin, prior
history of cancer, valve surgery. Conclusion: Centers with the largest
experience have the best outcomes secondary to better pt selection, timing
and mgmt. AE rates are similar when compared to those of LVAD's.

<16>
Accession Number
613918238
Author
Kreidieh O.; Kabach M.; El Dassouki S.; Martinez J.; Rosenstein R.; Chait
R.
Institution
(Kreidieh, Kabach, El Dassouki, Chait) University of Miami Miller, Palm
Beach Regional Campus, Atlantis, FL, United States
(Martinez) Einstein Medical Center, Philadelphia, PA, United States
(Rosenstein) West Palm Beach Veterans Affairs Medical Center, West Palm
Beach, FL, United States
Title
Colchicine versus placebo for prevention of post-procedural atrial
fibrillation: A systematic review and meta-analysis.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
21st World Congress on Heart Disease Annual Scientific Sessions 2016.
United States. Conference Start: 20160730. Conference End: 20160801. 134
(pp 227), 2016. Date of Publication: July 2016.
Publisher
S. Karger AG
Abstract
Introduction: Inflammation has been implicated in post-cardiothoracic
surgery and post-catheter ablation atrial fibrillation (AF). Hypothesis:
Colchicine, an anti-inflammatory drug, decreases the incidence of
post-procedural atrial fibrillation. Methods: We searched PUBMED, EMBASE
and the Cochrane Library for randomized controlled trials comparing
Colchicine to placebo for the prevention of peri-procedural AF. The
primary outcomes were incidence of AF and total mortality. Secondary
outcomes were stroke, total adverse events, gastrointestinal complaints,
myelotoxicity, and length of stay (LOS). All endpoints were studied within
3 months of the procedure. Included articles underwent analysis via a
random effects model. Results: Of 96 retrieved entries, 7 papers from 5
studies were selected for inclusion. There was a total of 1160 patients
with 806 males, and a mean age of 64.5. There were 113 recurrences of AF
in 574 patients randomized to receive Colchicine and 184 recurrences in
586 patients from the placebo group (RR = 0.62 [0.48-0.8]). The finding
remained significant on subgroup analysis of patients having
cardiothoracic surgery and those having catheter ablation for preexisting
AF. Similarly in 552 patients from 2 studies, the Colchicine treatment
group had a shorter LOS (mean difference = -1.31 days [-1.86, -0.77]).
There was however an increased incidence of total adverse events (52/349
vs. 29/347 HR=1.95 [1.2,3.17]), and GI side-effects (49/430 VS 20/427 HR =
2.56 [1.48,4.42]) with Colchicine therapy. Two studies reported that the
incidence of death and stroke were similar amongst groups and two studies
reported on myelotoxicity without events. Conclusion: Colchicine
significantly reduced post-procedural AF and in-hospital LOS in patients
undergoing cardiothoracic surgery or AF ablation. The drug is also
associated with an increased incidence of gastrointestinal side-effects.
(Figure Presented).

<17>
Accession Number
613918196
Author
Agarwal M.; Botta V.; Gardner J.; Khouzam R.
Institution
(Agarwal, Botta, Gardner, Khouzam) University of Tennessee, Health Science
Center, Memphis, TN, United States
Title
Wearable cardioverter-defibrillator -where are the clinical guidelines?.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
21st World Congress on Heart Disease Annual Scientific Sessions 2016.
United States. Conference Start: 20160730. Conference End: 20160801. 134
(pp 277), 2016. Date of Publication: July 2016.
Publisher
S. Karger AG
Abstract
Objective: To propose a set of guidelines based on literature review on
wearable cardioverter defibrillator (WCD) use for the management of
patients with/or at risk for ventricular arrhythmias (VA) and/or sudden
cardiac death (SCD). Background: Implantable cardiac defibrillator (ICD)
is an invasive, device based management option for patients with VA and at
risk for SCD. In 2002, a non invasive alternative, WCD was FDA approved
for potential use in such patient population. Since then, it has been used
in a wide variety of challenging clinical settings like post myocardial
infarction, post-coronary artery bypass grafting or percutaneous coronary
intervention, and those with severe left ventricular dysfunction (LVd)
secondary to different cardiac non-ischemic pathologies. Despite this, no
clear consensus or guidelines exist to date. Although indications for
intervention are continually evolving and further research is certainly
warranted, this review aims at summarizing the clinical data and possible
indications in a more robust manner. Discussion: Currently extensive
clinical data exist highlighting WCD indications in scenarios like post
myocardial infarction (MI), awaiting heart transplantation or ICD
placement, conditions requiring ICD explantation (infections, cardiac
thrombi), newly diagnosed cardiomyopathies resulting in severe LVd (non-
ischemic, inherited, congenital) etc. Potential hurdles for more effective
use are inappropriate shocks, practical cosmetic/comfort issues, high cost
and compliance. Formal clinical guidelines have yet to be presented and
importantly no large-scale clinical trial has shown mortality benefit with
WCD. Therefore, our detailed literature review will help build guidelines
with a cohesive set of indications. Conclusion:- WCD use should be
considered in 1) early-post acute MI or early post-CABG/PCI, 2)
preclusions to ICD placement, 3) ICD explantation, and 4) prolonged
clinical workup of disorders (non-ischemic cardiomyopathies) predisposing
high-risk VA. Adverse events, practical and financial issues need to be
properly addressed. Multicenter randomized clinical trials are indicated.

<18>
Accession Number
613918137
Author
Bhatt D.L.
Institution
(Bhatt) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
Title
Controversies in antiplatelet and anticoagulant therapy.
Source
Cardiology (Switzerland). Conference: International Academy of Cardiology
21st World Congress on Heart Disease Annual Scientific Sessions 2016.
United States. Conference Start: 20160730. Conference End: 20160801. 134
(pp 376), 2016. Date of Publication: July 2016.
Publisher
S. Karger AG
Abstract
Antiplatelet therapy is critical for patients with acute coronary
syndromes, those undergoing coronary stenting, and especially for patients
with both indications. Aspirin continues to be the backbone of
antiplatelet strategies in cardiovascular secondary prevention. The
concept of dual antiplatelet therapy - that is, aspirin plus an adenosine
diphosphate receptor antagonist - has been a major advance in secondary
prevention. Specifically, dual antiplatelet therapy is indicated for a
year after an acute coronary syndrome. The most recent data support use of
dual antiplatelet therapy even beyond a year in high risk patients with a
history of prior myocardial infarction, assuming that they are at low
bleeding risk. In patients without acute coronary syndromes who have
received stents, the optimal duration of dual antiplatelet therapy remains
a controversial point. Studies are ongoing to determine if second
generation drug eluting stents may require a shorter mandated duration of
dual antiplatelet therapy. Beyond the controversies of duration of dual
antiplatelet therapy, physicians remain uncertain about which patients
benefit most from intensification of the antiplatelet regimen, either with
oral or intravenous agents. The major challenge remains balancing
reductions in ischemic events with increases in bleeding. No antiplatelet
agent has yet succeeded in uncoupling anti-thrombotic benefit from
bleeding hazards. Perhaps no area is as challenging in this regard as the
management of patients with acute coronary syndromes and atrial
fibrillation. Major randomized clinical trials are underway to determine
the best combinations and durations of antiplatelet and anticoagulant
therapies in this cohort of patients.

<19>
Accession Number
613917976
Author
Kulkarni R.; Cymerman J.; Gilbert K.; Kreis I.; Mcmahon J.; Mccaul J.
Institution
(Kulkarni, Cymerman, Gilbert, Kreis, Mcmahon, Mccaul) Royal Marsden
Hospital NHSFT, United Kingdom
Title
Enhanced Recovery After Surgery (ERAS) In Major Head and Neck Cancer
Surgery; A Systematic Review.
Source
British Journal of Oral and Maxillofacial Surgery. Conference: Annual
Scientific Meeting of the British Association of Oral and Maxillofacial
Surgery 2016. United Kingdom. Conference Start: 20160608. Conference End:
20160610. 54 (10) (pp e85), 2016. Date of Publication: December 2016.
Publisher
Churchill Livingstone
Abstract
Introduction: ERAS Programs are implemented in multiple specialties such
as colorectal, vascular and thoracic surgery with the principle aim of
reducing morbidity and mortality. These are delivered using protocols
before, during and after surgery and have been successful in reducing
morbidity and mortality by omitting harmful practice. This systematic
review evaluates the existing body of evidence regarding ERAS in major
Head and Neck cancer surgery.Methods: A literature search on MEDLINE,
Ovid, PubMed and Cochrane library Database on ERAS in head and neck cancer
surgery published in English language between 1980 to 2014 was performed.
We searched for any paper describing an intervention aiming to reduce
morbidity and mortality. A title and abstract search was then performed
and inclusion criteria implemented to ensure studies of relevance were
analysed. The PRISMA statement methodology was used to provide transparent
reporting.Results: Our systematic review produced 1024 papers for abstract
review. This reduced to 119 after title and abstract search. A further
search of references in these papers yielded 100 further papers for
appraisal. Critical appraisal of all of these showed only seven
appropriate for inclusion. We present information from these studies aimed
to reduce morbidity and mortality. There are no large randomised control
trials assessing ERAS in Head and Neck cancer surgery and most studies are
based on case series.Conclusion: ERAS protocols have produced improvement
in surgical morbidity. It is critical that this is now explored in head
and neck cancer surgery to optimize outcomes for our patients.

<20>
Accession Number
613911523
Author
Debieuvre D.; Asselain B.; Braud M.L.; Fouret C.; Larive S.; Falchero L.;
Duval Y.; Lemaire B.; Farny M.; Brun P.; Dujon C.; Nocent C.; Dumont P.;
Le Lann P.; Kassem G-J.; Grivaux M.
Institution
(Debieuvre) Pneumologie, Hopital Emile Muller, Mulhouse, France
(Asselain) Epidemiology, Freelance, Paris, France
(Braud) Pneumologie, Centre Hospitalier De Bourg-en-Bresse (Fleyriat), CH
De Fleyriat, Bourg En Bresse, France
(Fouret) Pneumologie, Centre Hospitalier Intercommunal, Villeneuve
Saint-Georges, France
(Larive) Pneumologie, Centre Hospitalier, Macon, France
(Falchero) Pneumologie, Hopital Nord Ouest, Villefranche Sur Saone, France
(Duval) Pneumologie, Centre Hospitalier De Cannes, Cannes, France
(Lemaire) Pneumologie, C.H.R. Orleans - La Source, Orleans, France
(Farny) Pneumologie, Centre Hospitalier, Cahors, France
(Brun) Pneumologie, CH De Valence, Valence, France
(Dujon) Pneumologie, Centre Hospitalier De Versailles Andre Mignot, Le
Chesnay, France
(Nocent) Pneumologie, Centre Hospitalier De La Cote Basque, Bayonne,
France
(Dumont) Pneumologie, CH DE Chauny, Chauny, France
(Le Lann) Pneumologie, Groupe Hospitalier Public Du Sud De l'Oise, Creil,
France
(Kassem) Pneumologie, Centre Hospitalier, Sedan, France
(Grivaux) Pneumologie, Centre Hospitalier General Meaux, Meaux, France
Title
Good news for French NSCLC patients: Distance between chest and surgical
departments did not impair outcome.
Source
Annals of Oncology. Conference: 41st European Society for Medical Oncology
Congress, ESMO 2016. Denmark. Conference Start: 20161007. Conference End:
20161011. 27 (no pagination), 2016. Date of Publication: 2016.
Publisher
Oxford University Press
Abstract
Background: Surgery remains a major treatment option in lung cancer in
particular at early stages. Recent Australian and UK studies have shown
that patients with NSCLC were less likely to have surgery and more likely
to die if they were first seen at a non-specialized surgical centre, or
with increasing distance to the nearest specialist hospital. In France,
not all general hospitals have a thoracic surgery department. We assessed
the impact on patient outcome of the distance between the chest and
thoracic surgery Departments. Methods: KBP-2010-CPHG is a prospective
multicentre epidemiological study promoted by the French College of
General Hospital Respiratory Physicians (CPHG), including 7,051 patients
followed for primary lung cancer diagnosed in 2010 in the chest department
of 104 general hospitals. The distance from the usual thoracic surgery
department in 2010 was collected for each chest department in 2015.
Univariate and multivariate analyses were performed to identify
independent factors for surgery and mortality. Distance was included in
the model as a 4-class variable: 0 (same hospital), 1-34, 35-79, and >80
km. Results: 23% of hospitals had a thoracic surgery department;
otherwise, mean distance between the hospital and the surgical centre was
65 km. 6,083 patients had a NSCLC; 1157 (19%) were operated on.
Independent factors for surgery were: young age, early disease, good
performance status, and cancer histological type. Distance was not an
independent factor for surgery: OR [95% CI] was 0.971 [0.74-1.274] (p =
0.833), 0.883 [0.662-1.178] (p = 0.399), and 1.015 [0.783-1.317] (p =
0.91) for 1-34, 35-79, and >80 km vs. 0 km. 1,939 patients had stage I to
IIIA NSCLC; 1070 (55%) were operated on. Independent risk factors for
mortality were old age, male gender, advanced disease, and poor
performance status. Distance was not an independent risk factor for
mortality: OR [95% CI] was 1.016 [0.83-1.244] (p = 0.878), 1.089
[0.882-1.344] (p = 0.427), and 1.011 [0.829-1.233] (p = 0.915) for 1-34,
35-79, and >80 km vs. 0 km. Conclusions: In France, in 2010, the absence
of an on-site thoracic surgery department did not impair outcome in NSCLC
patients managed in the chest department of general hospitals.

<21>
Accession Number
613889662
Author
Al-Araimi T.; Bookman A.
Institution
(Al-Araimi) Department of Medicine, Toronto, ON, Canada
(Bookman) Division of Rheumatology, University Health Network, University
of Toronto, Toronto, ON, Canada
Title
Inflammation as an under-recognized cause of ascending aortic aneurysms: A
single-center clinical and pathological study of 53 cases over 6 years.
Source
Arthritis and Rheumatology. Conference: American College of
Rheumatology/Association of Rheumatology Health Professionals Annual
Scientific Meeting, ACR/ARHP 2016. United States. Conference Start:
20161111. Conference End: 20161116. 68 (pp 3972-3973), 2016. Date of
Publication: October 2016.
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose: This study is aimed at estimating the prevalence of
inflammatory ascending aneurysms, describing clinical and
histopathological findings, and assessing whether appropriate follow-up
was arranged post discharge Methods: Data from Enterprise Data Warehouse
was retrieved for all cases of ascending aortic aneurysms from Jan
2009-Dec 2015 requiring surgery at the University Health Network for the
following diagnostic codes: thoracic aortic aneurysm, ruptured (I71.1) or
without mention of rupture (I71.2); aortic aneurysm of unspecified site,
ruptured (I71.8) or without mention of rupture (I71.9). After eliminating
duplicate retrievals, 743 had their ascending aorta resected. Of these,
730 had aneurysmal dilatation, defined as maximum diameter >40mm measured
by pre-operative echo or cardiac CT/MRI. All cases with ascending
non-infectious inflammatory aneurysms were identified and reviewed for
clinical presentation, imaging, histopathological and management method.
Results: Among the 730 cases studied, 53 (7.3%) were of a
non-atherosclerotic, non-infectious inflammatory pathogenesis. Mean age
was 67 years (18-68), with 50.9% women. Asymptomatic presentation occurred
in 52.9%, 7.8% had constitutional symptoms and 43.1% had symptoms that
could be attributed to an aneurysm. Isolated aortitis with no other
evidence of arterial involvement presented in 41 (77.3%), and 12 had
underlying rheumatic disease: Rheumatoid Arthritis (4), Polymyalgia
Rheumatica (3), Giant Cell Artertitis (3), Systemic Lupus Erythematosus
(1) and Cogan's Syndrome (1). Echocardiographic findings demonstrated a
maximum mean aneurysm diameter of 54.7+/- 6.8mm, aortic insufficiency (AI)
in 73.5%, stenosis (AS) in 9.4% and mixed AS & AI in 3.8%. A bicuspid
aortic valve was found in 15.1%. Twenty-five (47.1%) had the aortic
aneurysm distal to the ascending aorta and changes of calcification or
atherosclerosis seen on CT (10) or intraoperatively (12). Histopathology
revealed Giant Cell Aortitis in 35.8% (19), Takayasu's Arteritis in 5.7%
(3), Lymphoplasmacytic Aortitis in 22.6% (12), Mixed Lymphoplasmacytic
with Giant Cells in 15.1% (8) and unclassified in 20.8% (11). No
lymphoplasmacytic cases were stained for IgG4. Four patients received
perioperative steroids. Only 1 had aortitis mentioned in the discharge
summary. Of the 53, 24 had a follow-up visit, 8 of which had aortitis
diagnosis in the follow-up notes. Two were referred to a rheumatologist, 4
had their family MD notified, and 2 already had a rheumatologist.
Rheumatologist referrals status for the remaining 45 (84.9%) patients
after discharge is unknown. Conclusion: Ascending Aortitis is
under-recognized as a cause of ascending aortic aneurysms. Diagnosis is
often incidental as most patients are asymptomatic. The presence of an
aortic bicuspid valve or aortic stenosis and changes of atherosclerosis on
imaging or in the intraoperative period do not rule out an inflammatory
aortic aneurysm. IgG4 staining should be routine practice for all patients
with lymphoplasmacytic aortitis. Cardiovascular surgeons, Pathologists and
rheumatologists need to develop protocols for appropriate care of this
patient subset. Further multi-center studies are needed.

<22>
Accession Number
613889534
Author
Bannuru R.R.; Vaysbrot E.; Osani M.; Buckley L.; Fink H.; McAlindon T.E.
Institution
(Bannuru) Rheumatology, Tufts Med Ctr, Boston, MA, United States
(Vaysbrot, Osani) Rheumatology, Tufts Medical Center, Boston, MA, United
States
(Buckley) Rheumatology, Yale University, North Haven, CT, United States
(Fink) Minneapolis VA Health Care System, Washington, DC, United States
(McAlindon) Division of Rheumatology, Tufts Medical Center, Boston, MA,
United States
Title
Fracture incidence rates in solid organ transplant recipients: A
systematic review and meta-analysis.
Source
Arthritis and Rheumatology. Conference: American College of
Rheumatology/Association of Rheumatology Health Professionals Annual
Scientific Meeting, ACR/ARHP 2016. United States. Conference Start:
20161111. Conference End: 20161116. 68 (pp 450-456), 2016. Date of
Publication: October 2016.
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose: Transplants increase risk of bone loss and fractures
and reduce quality of life. Information on fracture incidence is important
when making clinical decisions about initiating anti-osteoporotic
treatment and when assessing treatment success. No existing fracture
assessment tool accounts for the additional risk transplant patients may
experience over time. With this study, we aimed to estimate fracture
incidence rates in transplant patients and present them in a uniform way,
which could aid clinicians in making personalized patient care decisions.
Methods: We searched MEDLINE and PubMed from inception to May 2016 for all
observational studies and randomized controlled trials (RCTs) involving
solid organ transplant recipients and reporting on osteoporotic fractures.
We included RCT data from groups which received no anti-osteoporotic
treatment or were treated with calcium and vitamin D. Studies involving
>50% bisphosphonate users were excluded. Two independent reviewers
extracted data on hip, vertebral (morphometric /clinical), non-vertebral,
and total fractures. We calculated fracture incidence rates per 1000
patient-years (PY) for each study and combined them using a random effects
meta-analysis model. Results: We included 42 studies (N=280,066, 99% were
kidney transplant) (Table 1). Time since transplantation varied across
studies (3 months-11.5 years; median 1 year). A majority of transplant
recipients were started on pulse IV steroids, followed by high dose oral
corticosteroids, which were tapered within 3-6 months. Most incident
fractures were reported within one year post-transplant across all
studies. Kidney transplant recipients experienced high risk of hip
fracture (4 per 1000 PY) (Table 2). We also found a very high risk of
vertebral (morphometric/clinical) fracture (81 per 1000 PY) in heart
transplant recipients. Liver transplant recipients experienced high risks
of vertebral and non-vertebral fractures (86 and 31 per 1000 PY,
respectively). Conclusion: This study found a high fracture risk in
transplant recipients, especially within the first post-transplant year.
Our results will support informed decision-making regarding
anti-osteoporotic treatment and will aid policy makers in formulating
standards of care. Current evidence is heterogeneous in terms of variables
such as patient characteristics and follow-up. Researchers studying
post-transplant care should aim for a homogeneous study design, which will
enable precise estimation of fracture rates and treatment effects, as well
as investigation of factors relating to variability in fracture risk among
transplant recipients.

<23>
Accession Number
613885923
Author
Tume L.; Baines P.; Guerrero R.; Hurely M.; Johnson R.; Kalantre A.;
Ramaraj R.; Ritson P.; Scott E.; Walsh L.; Arnold P.
Institution
(Tume) LiverpoolUnited Kingdom
(Baines, Walsh) AlderHey Children's Hospital, PICU, Liverpool, United
Kingdom
(Guerrero) AlderHey Children's Hospital, Cardiac Surgery, Liverpool,
United Kingdom
(Hurely) University of Central Lancashire, School of Health, Preston,
United Kingdom
(Johnson, Kalantre, Ramaraj) AlderHey Children's Hospital, Dept
Cardiology, Liverpool, United Kingdom
(Ritson) AlderHey Children'sHospital, Dept. Physiotherapy, Liverpool,
United Kingdom
(Scott) AlderHey Children's Hospital, PICU and R and D, Liverpool, United
Kingdom
(Arnold) AlderHey Children's Hospital, Dept. Anaesthesia, Liverpool,
United Kingdom
Title
Open or closed endotracheal suctioning in reducing instability in high
risk cardiac infants-is one better?.
Source
European Journal of Pediatrics. Conference: 6th Congress of the European
Academy of Paediatric Societies. Switzerland. Conference Start: 20161021.
Conference End: 20161025. 175 (11) (pp 1532-1533), 2016. Date of
Publication: 2016.
Publisher
Springer Verlag
Abstract
Background and aims Endotracheal suctioning is a high risk procedure in in
single ventricle infants, especially in the early post-operative period.
We aimed to determine the effect of endotracheal suction in the first 36
hours after high risk infant heart surgery on the ICU and to compare open
(OS) and closed suctioning (CS) techniques in these infants. Methods A
randomised crossover study of open versus closed suctioning. Detailed
physiological data and echocardiography (for flow velocity) were measured
at baseline, during and 2 minutes after the procedure. Treatment means and
standard errors at baseline, during and post procedure were computed using
Excel and ANOVA used formeasurement change during the procedure. Results
22 infants were recruited: 6 infants after Norwood-Sano, 10 modified
Blalock-taussig shunt (MBTS) and 6 after Pulmonary Artery Banding (PAB).
Themedian age was 15 days (IQR5-53) mean weight (3.4Kg SD 0.76). All
infants were sedated and muscle-relaxed for measurements. There was more
change in physiological variables with OS, but these were not clinically
significant (Graph 1). We observed a reduction in flow velocity (on
echocardiogram) from 2.1 m/sec to 1.67 m/sec during suctioning, but
recovery to baseline values was rapid. Conclusions There was no clinically
significant change in key physiological parameters between open and closed
suction methods. Closed suctioning did not appear to confer any
haemodynamic benefit over open suctioning when undertaken by experienced
staff in a controlled manner in high risk cardiac infants.(Figure
Presented).

<24>
Accession Number
613885430
Author
Caglar S.; Buyukyilmaz F.; Cosansu G.; Caglayan S.
Institution
(Caglar) Istanbul University, Florence Nightingale Faculty of Nursing,
Paediatric Nursing Department, Istanbul, Turkey
(Buyukyilmaz) Istanbul University, Florence Nightingale Faculty of
Nursing, Fundamental Nursing Department, Istanbul, Turkey
(Cosansu) Istanbul University, Florence Nightingale Faculty of Nursing,
Public Health Nursing Department, Istanbul, Turkey
(Caglayan) Medipol University Hospital, Directorate of Nursing Services
Nursing Training and Development, Istanbul, Turkey
Title
The effect of shotblocker on immunization pain in term neonates:
Randomized controlled clinicaltrial.
Source
European Journal of Pediatrics. Conference: 6th Congress of the European
Academy of Paediatric Societies. Switzerland. Conference Start: 20161021.
Conference End: 20161025. 175 (11) (pp 1445), 2016. Date of Publication:
2016.
Publisher
Springer Verlag
Abstract
Background and aims Vaccinations are often implemented via intramuscular
(IM) route injections, which are common painful procedure. Use of
non-pharmacological interventions are of great importance because
providing especially newborn safety in IM injections. The aim of the study
was to examine the effects of a new non-pharmacological device as
ShotBlocker on injection pain associated with the first dose hepatitis B
vaccine in term neonates. Methods Randomised prospective study was
conducted on nursery room in one private university hospital in Istanbul,
Turkey. A hundred healthy term neonates were randomly assigned to either
the ShotBlocker group (n=50) or the control group (n=50). The Neonatal
Infant Pain Scale (NIPS) scores of the term neonates in the ShotBlocker
and control groups were compared before, during, and after procedure.
Also, the term neonates physiological parameters were compared before and
after the procedure. Descriptive statistics, a chi-square test, student's
t test, and a repeated-measure analyses of variance (RMANOVA) were used to
assess the data. Results Pain score of the term neonates during
(ShotBlocker Group: 1.64 +/-0.80; Control Group: 2.96+/-0.73) and after
(ShotBlocker group: 0.74+/- 0.66; Control Group: 1.42+/- 0.76) the
procedure was lower compared to the control group than ShotBlocker group
(p= 0.000). Post-procedure heart rate in infants in ShotBlocker group
(145.02 +/-13.50) was found to be lower than those for whom ShotBlocker
was not used (150.24+/-13.36) (p=0.05). Conclusions The use of ShotBlocker
during the first dose of Hepatitis B vaccine in term neonates is efficient
in reducing acute pain related to IM injection.

<25>
Accession Number
613219109
Author
Davari Dolatabadi A.; Khadem S.E.Z.; Asl B.M.
Institution
(Davari Dolatabadi, Khadem, Asl) Mechanical Engineering Department,
Tarbiat Modares University, Tehran, Iran, Islamic Republic of
Title
Automated diagnosis of coronary artery disease (CAD) patients using
optimized SVM.
Source
Computer Methods and Programs in Biomedicine. 138 (pp 117-126), 2017. Date
of Publication: 01 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background and objective Currently Coronary Artery Disease (CAD) is one of
the most prevalent diseases, and also can lead to death, disability and
economic loss in patients who suffer from cardiovascular disease.
Diagnostic procedures of this disease by medical teams are typically
invasive, although they do not satisfy the required accuracy. Methods In
this study, we have proposed a methodology for the automatic diagnosis of
normal and Coronary Artery Disease conditions using Heart Rate Variability
(HRV) signal extracted from electrocardiogram (ECG). The features are
extracted from HRV signal in time, frequency and nonlinear domains. The
Principal Component Analysis (PCA) is applied to reduce the dimension of
the extracted features in order to reduce computational complexity and to
reveal the hidden information underlaid in the data. Finally, Support
Vector Machine (SVM) classifier has been utilized to classify two classes
of data using the extracted distinguishing features. In this paper,
parameters of the SVM have been optimized in order to improve the
accuracy. Results Provided reports in this paper indicate that the
detection of CAD class from normal class using the proposed algorithm was
performed with accuracy of 99.2%, sensitivity of 98.43%, and specificity
of 100%. Conclusions This study has shown that methods which are based on
the feature extraction of the biomedical signals are an appropriate
approach to predict the health situation of the patients. Copyright &#xa9;
2016 Elsevier Ireland Ltd

<26>
Accession Number
613772248
Author
Ederoth P.; Grins E.; Dardashti A.; Bronden B.; Metzsch C.; Erdling A.;
Nozohoor S.; Mokhtari A.; Hansson M.J.; Elmer E.; Algotsson L.; Jovinge
S.; Bjursten H.
Institution
(Ederoth, Grins, Dardashti, Bronden, Metzsch, Erdling, Algotsson)
Department of Anesthesiology and Intensive Care, Lund University, Skane
University Hospital, Lund, Sweden
(Nozohoor, Mokhtari, Bjursten) Department of Cardiothoracic Surgery, Lund
University, Skane University Hospital, Lund, Sweden
(Hansson, Elmer) Department of Mitochondrial Medicine, Clinical Sciences,
Lund University, Lund, Sweden
(Jovinge) Fredrik Meijer Heart and Vascular Institute Spectrum Health, MI
US Van Andel Institute, Grand Rapids, MI, United States
(Jovinge) Cardiovascular Institute, Stanford University, Stanford, CA,
United States
Title
Ciclosporin to Protect Renal function In Cardiac Surgery (CiPRICS): A
study protocol for a double-blind, randomised, placebo-controlled,
proof-of-concept study.
Source
BMJ Open. 6 (12) (no pagination), 2016. Article Number:
bmjopen-2016-012299. Date of Publication: 01 Dec 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Acute kidney injury (AKI) after cardiac surgery is common
and results in increased morbidity and mortality. One possible mechanism
for AKI is ischaemia-reperfusion injury caused by the extracorporeal
circulation (ECC), resulting in an opening of the mitochondrial
permeability transition pore (mPTP) in the kidneys, which can lead to cell
injury or cell death. Ciclosporin may block the opening of mPTP if
administered before the ischaemia- reperfusion injury. We hypothesised
that ciclosporin given before the start of ECC in cardiac surgery can
decrease the degree of AKI. Methods and analysis: Ciclosporin to Protect
Renal function In Cardiac Surgery (CiPRICS) study is an
investigator-initiated double-blind, randomised, placebo-controlled,
parallel design, single-centre study performed at a tertiary university
hospital. The primary objective is to assess the safety and efficacy of
ciclosporin to limit the degree of AKI in patients undergoing coronary
artery bypass grafting surgery. We aim to evaluate 150 patients with a
preoperative estimated glomerular filtration rate of 15-90 mL/min/ 1.73
m2. Study patients are randomised in a 1:1 ratio to receive study drug 2.5
mg/kg ciclosporin or placebo as an intravenous injection after anaesthesia
induction but before start of surgery. The primary end point consists of
relative P-cystatin C changes from the preoperative day to postoperative
day 3. The primary variable will be tested using an analysis of covariance
method. Secondary end points include evaluation of P-creatinine and
biomarkers of kidney, heart and brain injury. Ethics and dissemination:
The trial is conducted in compliance with the current version of the
Declaration of Helsinki and the International Council for Harmonisation
(ICH) Good Clinical Practice guidelines E6 (R1) and was approved by the
Regional Ethical Review Board, Lund and the Swedish Medical Products
Agency (MPA). Written and oral informed consent is obtained before
enrolment into the study.

<27>
Accession Number
613696739
Author
Zhang D.; Lyu S.; Song X.; Yuan F.; Xu F.; Zhang M.
Institution
(Zhang, Lyu, Song, Yuan, Xu, Zhang, Zhang) Department of Cardiology,
Beijing Institute of Heart, Lung and Blood Vessel Disease, Capital Medical
University, Beijing Anzhen Hospital, Anzhenli Avenue, Chao Yang District,
Beijing 100029, China
Title
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
in Patients with Left Ventricular Systolic Dysfunction.
Source
Angiology. 68 (1) (pp 19-28), 2017. Date of Publication: 01 Jan 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The optimal method of coronary revascularization for patients with
coronary artery disease (CAD) and left ventricular (LV) systolic
dysfunction is unclear. The purpose of this meta-analysis was to compare
coronary artery bypass grafting (CABG) and percutaneous coronary
intervention (PCI) in these patients. Two investigators independently
searched PubMed, EMBASE, and the Cochrane Controlled Trials Register
databases for relevant studies. Four prospective and 5 retrospective
studies, published before March 2015, involving 6082 patients were
included. Compared with PCI, CABG was significantly associated with lower
long-term death (odds ratio [OR]: 0.82, 95% confidence interval [CI]:
0.70-0.96, P =.01, I ² = 0%), myocardial infarction (OR: 0.58,
95% CI: 0.36-0.95, P =.03, I ² = 44%), and repeat
revascularization (OR: 0.17, 95% CI: 0.14-0.22, P <.001, I ² =
32%). The short-term death rate was comparable between CABG and PCI (OR:
2.09, 95% CI: 0.80-5.45, P =.13, I ² = 9%). Coronary artery
bypass grafting has long-term benefits compared with PCI in patients with
CAD and LV dysfunction. Copyright &#xa9; The Author(s) 2016.

<28>
Accession Number
606743480
Author
Scalise A.; Calamita R.; Tartaglione C.; Pierangeli M.; Bolletta E.;
Gioacchini M.; Gesuita R.; Benedetto G.D.
Institution
(Scalise, Calamita, Tartaglione, Pierangeli, Bolletta, Gioacchini,
Benedetto) Department of Plastic and Reconstructive Surgery, Universita
Politecnica delle Marche, Ancona, Italy
(Gesuita) Interdepartmental Centre of Epidemiology, Biostatistics and
Medical Informatics (EBI Centre), Universita Politecnica delle Marche,
Ancona, Italy
Title
Improving wound healing and preventing surgical site complications of
closed surgical incisions: A possible role of incisional negative pressure
wound therapy. A systematic review of the literature.
Source
International Wound Journal. 13 (6) (pp 1260-1281), 2016. Date of
Publication: December 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Advances in preoperative care, surgical techniques and technologies have
enabled surgeons to achieve primary closure in a high percentage of
surgical procedures. However, often, underlying patient comorbidities in
addition to surgical-related factors make the management of surgical
wounds primary closure challenging because of the higher risk of
developing complications. To date, extensive evidence exists, which
demonstrate the benefits of negative pressure dressing in the treatment of
open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT)
technology as delivered by PrevenaTM (KCI USA, Inc., San Antonio, TX) and
Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new
investigation on possible prophylactic measures to prevent complications
via application immediately after surgery in high-risk, clean, closed
surgical incisions. A systematic review was performed to evaluate INPWT's
effect on surgical sites healing by primary intention. The primary
outcomes of interest are an understanding of INPWT functioning and
mechanisms of action, extrapolated from animal and biomedical engineering
studies and incidence of complications (infection, dehiscence, seroma,
hematoma, skin and fat necrosis, skin and fascial dehiscence or
blistering) and other variables influenced by applying INPWT (re-operation
and re-hospitalization rates, time to dry wound, cost saving) extrapolated
from human studies. A search was conducted for published articles in
various databases including PubMed, Google Scholar and Scopus Database
from 2006 to March 2014. Supplemental searches were performed using
reference lists and conference proceedings. Studies selection was based on
predetermined inclusion and exclusion criteria and data extraction
regarding study quality, model investigated, epidemiological and clinical
characteristics and type of surgery, and the outcomes were applied to all
the articles included. 1 biomedical engineering study, 2 animal studies,
15 human studies for a total of 6 randomized controlled trials, 5
prospective cohort studies, 7 retrospective analyses, were included. Human
studies investigated the outcomes of 1042 incisions on 1003 patients. The
literature shows a decrease in the incidence of infection, sero-haematoma
formation and on the re-operation rates when using INPWT. Lower level of
evidence was found on dehiscence, decreased in some studies, and was
inconsistent to make a conclusion. Because of limited studies, it is
difficult to make any assertions on the other variables, suggesting a
requirement for further studies for proper recommendations on INPWT.
Copyright &#xa9; 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

<29>
[Use Link to view the full text]
Accession Number
611864380
Author
Lee C.Y.; Wong J.K.; Ross R.E.; Liu D.C.; Khabbaz K.R.; Martellaro A.J.;
Gorea H.R.; Sauer J.S.; Knight P.A.
Institution
(Lee, Wong, Ross, Knight) Division of Cardiac Surgery, University of
Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, United
States
(Liu, Khabbaz) Division of Cardiac Surgery, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Martellaro, Gorea, Sauer) LSI SOLUTIONS, Victor, NY, United States
Title
Prosthetic aortic valve fixation study 48 replacement valves analyzed
using digital pressure mapping.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 11 (5) (pp 327-336), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: Prostheses attachment is critical in aortic valve replacement
surgery, yet reliable prosthetic security remains a challenge. Accurate
techniques to analyze prosthetic fixation pressures may enable the use of
fewer sutures while reducing the risk of paravalvular leaks (PVL).
Methods: Customized digital thin film pressure transducers were sutured
between aortic annulus models and 21-mm bioprosthetic valves with 15 x
4-mm, 12 x 4-mm, or 9 x 6-mm-wide pledgeted mattress sutures. Simulating
open and minimally invasive access, 4 surgeons, blinded to data
acquisition, each secured 12 valves using manual knottying (hand-tied [HT]
or knot-pusher [KP]) or automated titanium fasteners (TFs). Real-time
pressure measurements and times were recorded. Two-dimensional (2D) and 3D
pressure maps were generated for all valves. Pressures less than 80 mm Hg
were considered at risk for PVL. Results: Pressures under each knot
(intrasuture) fell less than 80 mm Hg for 12 of 144 manual knots (5/144
HT, 7/144 KP) versus 0 of 288 TF (P < 0.001). Pressures outside adjacent
sutures (extrasuture) were less than 80 mm Hg in 10 of 60 HT, zero of 60
KP, and zero of 120 TF sites for 15 x 4-mm valves; 17 of 48 HT, 25 of 48
KP, and 12 of 96 TF for 12 x 4-mm valves; and 15 of 36 HT, 17 of 36 KP,
and 9 and 72 TF for 9 x 6-mm valves; P < 0.001 all manual versus TF.
Annular areas with pressures less than 80 mm Hg ranged from 0% of the
sewing-ring area (all open TF) to 31% (12 x 4 mm, KP). The average time
per manual knot, 46 seconds (HT, 31 seconds; KP, 61 seconds), was greater
than TF, 14 seconds (P < 0.005). Conclusions: Reduced operative times and
PVL risk would fortify the advantages of surgical aortic valve
replacement. This research encourages continued exploration of technical
factors in optimizing prosthetic valve security. Copyright &#xa9; 2016 by
the International Society for Minimally Invasive Cardiothoracic Surgery.

<30>
Accession Number
613158074
Author
Krieger E.V.; Lee J.; Branch K.R.; Hamilton-Craig C.
Institution
(Krieger, Lee, Branch, Hamilton-Craig) Division of Cardiology, Department
of Medicine, University of Washington, Seattle, WA, United States
(Krieger) Seattle Adult Congenital Heart Service, University of Washington
School of Medicine, Seattle, WA 98195, United States
(Hamilton-Craig) Department of Cardiology, University of Queensland,
Brisbane, QLD, Australia
(Hamilton-Craig) Department of Cardiology, Heart and Lung Institute,
Prince Charles Hospital, Brisbane, QLD, Australia
Title
Quantitation of mitral regurgitation with cardiac magnetic resonance
imaging: A systematic review.
Source
Heart. 102 (23) (pp 1864-1870), 2016. Date of Publication: 01 Dec 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
In this review discuss the application of cardiac magnetic resonance (CMR)
to the evaluation and quantification of mitral regurgitation and provide a
systematic literature review for comparisons with echocardiography. Using
the 2015 Preferred Reporting Items for Systematic Reviews and
Meta-Analyses methodology, we searched Medline and PubMed for original
research articles published since 2000 that provided data on the
quantification of mitral regurgitation by CMR. We identified 220 articles
of which 33 were included. Four main techniques of mitral regurgitation
quantification were identified. Reproducibility varied substantially
between papers but was high overall for all techniques. However,
quantification differed between the techniques studied. When compared with
two-dimensional echocardiography, mitral regurgitation fraction and
regurgitant volume measured by CMR were comparable but typically lower.
CMR has high reproducibility for the quantification of mitral
regurgitation in experienced centres, but further technological refinement
is needed. An integrated and standardised approach that combines multiple
techniques is recommended for optimal reproducibility and precise mitral
regurgitation quantification. Definitive outcome studies using CMR as a
basis for treatment are lacking but needed.

<31>
Accession Number
613094640
Author
Said S.A.M.
Institution
(Said) Department of Cardiology, Hospital Group Twente, Hengelo,
Netherlands
Title
Characteristics of Congenital Coronary Artery Fistulas Complicated with
Infective Endocarditis: Analysis of 25 Reported Cases.
Source
Congenital Heart Disease. 11 (6) (pp 756-765), 2016. Date of Publication:
01 Nov 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Congenital coronary artery fistulas (CAFs) are infrequent congenital
coronary artery anomalies. Complications such as left-to-right shunt,
congestive heart failure, myocardial infarction, pericardial effusion,
aneurysm formation, rupture, hemopericardium, pulmonary hypertension,
infective endocarditis (IE), syncope, stroke, and sudden death may occur
with a variable low frequency. To describe the clinical characteristics of
patients with CAFs complicated by IE. A search was conducted through
PubMed using the terms "CAFs" and "IE." Papers with a full description of
the fistula characteristics and detailed data regarding bacterial
endocarditis were included for evaluation. In the overall group of
reviewed subjects (n = 25, 9 females), the mean patient age was 42.5 years
(range: 16 and 87). The right coronary artery (RCA) and left coronary
artery (LCA) contributed equally to fistula formation. Terminations into
the right heart side occurred in 19 (76%) fistulas. The majority of the
fistulas (92%) were unilateral. The cultured microorganism was
Streptococcus in 14 (56%) and Staphylococcus in 4 (16%) of the reviewed
subjects. Echocardiographic single or multiple valvular regurgitation was
found in 8 (32%) of the reviewed subjects. Small and large intracardiac
vegetations were detected in 18 patients (72%). Antibiotic therapy was
initiated in 20 (80%) subjects and 16 fistulas were treated surgically.
During surgery, spontaneous closure of the fistula was observed in one
patient. Percutaneous therapeutic embolization (PTE) was successfully
performed in two subjects. CAFs complicated by IE may affect all age
groups with a slight male preponderance. Unilateral fistulas, either
arising from the right or left coronary artery, are predominant, draining
mainly into the right heart side. It is emphasized that antibiotic
prophylaxis is strongly advised for pediatric and adult patients with
congenital CAFs. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<32>
Accession Number
613465654
Author
Yang M.; Guan X.; Wan Z.; Kang Q.
Institution
(Yang, Guan, Wan, Kang) Tianjin Medical University, Tianjin, China
(Yang, Guan, Wan, Kang) Department of Cardiology, Tianjin Medical
University General Hospital, Tianjin, China
Title
Prehospital facilitated intervention as a potential "sally port" for the
rescue of acute ST-segment elevation myocardial infarction: A
meta-analysis.
Source
International Journal of Clinical and Experimental Medicine. 9 (11) (pp
20761-20776), 2016. Article Number: IJCEM0035617. Date of Publication: 20
Dec 2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Background: Early reperfusion in ST-segment elevation myocardial
infarction (STEMI) is associated with improved clinical outcomes. The
purpose of this study was to characterize the benefits and risks of
prehospital fibrinolysis with timely percutaneous coronary intervention
(PCI) as a promising strategy which could reduce the reperfusion delay
especially for the patients in remote areas. Methods: We identified
clinical trials comparing the facilitated PCI versus primary PCI and
divided them into two subgroups (prehospital treatment and in-hospital
treatment). Results: We identified eighteen clinical trials involving
11118 patients. The facilitated PCI had higher rates of initial TIMI grade
3 flow compared with the primary PCI (44.6% vs 18.8%, P<0.01). Facilitated
PCI with prehospital fibrinolysis was associated with lower incidences of
cardiogenic shock (3.8% vs 5.7%, P=0.02), potential lower incidences of
short-term mortality (4.3% vs 4.3%, P=0.94), heart failure (6.9% vs 8.3%,
P=0.20) and major bleeding (2.4% vs 3.6%; P=0.06), and higher rates of
urgent target vessel revascularization (5.2% vs 2.5%, P=0.0002) and total
stroke (1.3% vs 0.4%, P=0.009) compared with primary PCI. Facilitated PCI
with in-hospital fibrinolysis led to increased incidences of non-fatal
reinfarction (3.4% vs 1.8%, P=0.0004) and total stroke (1.2% vs 0.4%,
P=0.002), and potential risks for short-term death (4.5% vs 3.5%, P=0.10),
cardiogenic shock (5.3% vs 4.7%, P=0.61), urgent target vessel
revascularization (4.4% vs 3.5%, P=0.18), and major bleeding (5.8% vs
4.3%, P=0.11) compared with primary PCI. Conclusions: Facilitated PCI with
prehospital fibrinolysis offered potential benefits over primary PCI for
the treatment of STEMI, in spite of a slight increased risk of total
stroke. Copyright &#xa9; 2016, E-Century Publishing Corporation. All
rights reserved.

<33>
Accession Number
606034598
Author
Rodriguez-Caulo E.A.; Otero J.; Mataro M.J.; Sanchez-Espin G.; Porras C.;
Guzon A.; Such M.; Melero J.M.
Institution
(Rodriguez-Caulo, Otero, Mataro, Sanchez-Espin, Porras, Guzon, Such,
Melero) UGC Area del Corazon, Servicio de Cirugia Cardiovascular, Hospital
Clinico Universitario Virgen de la Victoria, Malaga, Spain
Title
Minimally invasive aortic valve surgery.
Source
Cirugia Cardiovascular. 23 (6) (pp 306-311), 2016. Date of Publication: 01
Nov 2016.
Publisher
Elsevier Doyma (E-mail: editorial@elsevier.com)
Abstract
The aging of the population has led to an increase in the number of
surgeries on the aortic valve. During the past 20 years the surgical
technique has progressed to less aggressive techniques, with new types of
minimally invasive aortic valve surgery (MIAVR) emerging. Of these
techniques, the upper hemi-sternotomy (UHS) or mini-sternotomy has become
the most commonly used, followed by the right anterior thoracotomy (RAT).
Compared with conventional surgery, both have shown a faster recovery,
better cosmetic results, shorter hospital and ICU stay, better respiratory
function, reduced blood loss and transfusions, as well as lower early and
late mortality. Despite these advances, their use has not been
definitively extended, due to an increase in the ischaemia and
cardiopulmonary bypass (CPB) times needed in these more complex
procedures. The emergence of new generation sutureless prosthesis can
overcome this setback by reducing the ischemic and CPB by up to 43%, and
allows MIAVR to expand and become a real alternative to the transcatheter
valves (TAVI) in high risk operable patients. Although prospective
randomised controlled trials are required to confirm these data, there is
sufficient available evidence to consider MIAVR (especially UHS) as the
current reference method for isolated aortic valve replacement. Copyright
&#xa9; 2015 Sociedad Espanola de Cirugia Toracica-Cardiovascular

<34>
[Use Link to view the full text]
Accession Number
613856670
Author
Siontis K.C.; Kim H.M.; Stevenson W.G.; Fujii A.; Della Bella P.; Vergara
P.; Shivkumar K.; Tung R.; Do D.H.; Daoud E.G.; Okabe T.; Zeppenfeld K.;
De Riva Silva M.; Hindricks G.; Arya A.; Weber A.; Kuck K.-H.; Metzner A.;
Mathew S.; Riedl J.; Yokokawa M.; Jongnarangsin K.; Latchamsetty R.;
Morady F.; Bogun F.M.
Institution
(Siontis, Kim, Yokokawa, Jongnarangsin, Latchamsetty, Morady, Bogun)
Division of Cardiovascular Medicine, Cardiovascular Center, University of
Michigan, 1500 E Medical Center Dr SPC 5853, Ann Arbor, MI 48109, United
States
(Stevenson, Fujii) Arrhythmia Service, Cardiovascular Division, Brigham
and Women's Hospital, Boston, MA, United States
(Della Bella, Vergara) Arrhythmia Unit, San Raffaele University Hospital,
Milan, Italy
(Shivkumar, Do) Cardiac Arrhythmia Center, University of California, Los
Angeles, United States
(Tung) Center for Heart Rhythm, University of Chicago, IL, United States
(Daoud, Okabe) Electrophysiology Section, Division of Cardiology, Ohio
State University, Columbus, United States
(Zeppenfeld, De Riva Silva) Department of Cardiology, Leiden University
Medical Center, Netherlands
(Hindricks, Arya, Weber) Division of Cardiology, University Hospital,
Leipzig, Germany
(Kuck, Metzner, Mathew, Riedl) Department of Cardiology, Asklepios Klinik
St. Georg, Hamburg, Germany
Title
Prognostic Impact of the Timing of Recurrence of Infarct-Related
Ventricular Tachycardia after Catheter Ablation.
Source
Circulation: Arrhythmia and Electrophysiology. 9 (12) (no pagination),
2016. Article Number: e004432. Date of Publication: 01 Dec 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Recurrence of ventricular tachycardia (VT) after ablation in
patients with previous myocardial infarction is associated with adverse
prognosis. However, the impact of the timing of VT recurrence on outcomes
is unclear. Methods and Results - We analyzed data from a multicenter
collaborative database of patients who underwent catheter ablation for
infarct-related VT. Multivariable Cox regression analyses investigated the
effect of the timing of VT recurrence on the composite outcome of death or
heart transplantation using VT recurrence as a time-varying covariate. A
total of 1412 patients were included (92% men; age: 66.7+/-10.7 years),
and 605 patients (42.8%) had a recurrence after median 116 days (188
[31.1%] within 1 month, 239 [39.5%] between 1 and 12 months, and 178
[29.4%] after 12 months). At median follow-up of 670 days, 375 patients
(26.6%) experienced death or heart transplantation. The median time from
recurrence to death or heart transplantation was 65 and 198.5 days in
patients with recurrence <30 days and >30 days post ablation,
respectively. The adjusted hazard ratio (95% confidence interval) for the
effect of VT recurrence occurring immediately post ablation on death or
heart transplantation was 3.45 (2.33-5.11) in reference to no recurrence.
However, the magnitude of this effect decreased statistically
significantly (P<0.001) as recurrence occurred later in the follow-up
period. The respective risk estimates for VT recurrence at 30 days, 6
months, 1 year, and 2 years were 3.36 (2.29-4.93), 2.94 (2.09-4.14), 2.50
(1.85-3.37), and 1.81 (1.37-2.40). Conclusions - VT recurrence post
ablation is associated with a mortality risk that is highest soon after
the ablation and decreases gradually thereafter. Copyright &#xa9; 2016
American Heart Association, Inc.

<35>
[Use Link to view the full text]
Accession Number
613856650
Author
Disertori M.; Mase M.; Rigoni M.; Nollo G.; Ravelli F.
Institution
(Disertori, Rigoni, Nollo) Healthcare Research and Innovation Program,
PAT-FBK, Via Sommarive no. 18, Trento 38123, Italy
(Disertori) Department of Cardiology, Santa Chiara Hospital, Trento, Italy
(Mase, Ravelli) Department of Physics, University of Trento, Italy
Title
Heart Rate Turbulence is a Powerful Predictor of Cardiac Death and
Ventricular Arrhythmias in Postmyocardial Infarction and Heart Failure
Patients: A Systematic Review and Meta-Analysis.
Source
Circulation: Arrhythmia and Electrophysiology. 9 (12) (no pagination),
2016. Article Number: e004610. Date of Publication: 01 Dec 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Heart rate turbulence (HRT) has been proposed as a candidate
marker of altered autonomic tone, and some studies showed its prognostic
value for both cardiac death (CD) and sudden death. Nevertheless, HRT is
not currently used in the clinical practice. Methods and Results - We
performed a systematic review and meta-analysis of the predictive value of
HRT for the end points of total mortality, CD, and fatal and nonfatal
ventricular arrhythmias in postacute myocardial infarction and heart
failure patients. MEDLINE and The Cochrane Library databases were
systematically searched to identify studies, which analyzed the predictive
value of abnormal HRT for the defined end points. Twenty studies (25
cohorts: 12 832 patients) were identified by the systematic review, and 15
studies (20 cohorts: 11 499 patients) were included in the meta-analyses.
Abnormal HRT was a predictive marker for all the end points in heart
failure patients and more markedly in postacute myocardial infarction
patients, where 9 out of the 10 cohorts had an ejection fraction >30%. In
postacute myocardial infarction patients, HRT had pooled risk ratios of
3.53 (95% confidence interval [CI], 2.54-4.90), 4.82 (95% CI, 3.12-7.45),
and 4.48 (95% CI, 3.04-6.60), and positive likelihood ratios of 3.5 (95%
CI, 2.6-4.8), 4.1 (95% CI, 3.0-5.7), and 2.7 (95% CI, 2.2-3.3) for total
mortality, CD, and arrhythmic events, respectively. The combination of
abnormal HRT and T-wave alternans (5 cohorts: 1516 patients) increased the
predictive power for CD and arrhythmic events. Conclusions - HRT is a
powerful predictor of both CD and arrhythmic events, particularly in
postacute myocardial infarction patients with ejection fraction >30%. HRT
power increases in combination with T-wave alternans analysis. Copyright
&#xa9; 2016 American Heart Association, Inc.

<36>
[Use Link to view the full text]
Accession Number
613856628
Author
Law I.H.; Alam O.; Bove E.L.; Ohye R.G.; Bradley D.J.; Yu S.; Dick M.
Institution
(Law) Division of Pediatric Cardiology, Department of Pediatrics, Carver
College of Medicine, University of Iowa, Iowa City, United States
(Alam, Bradley, Yu, Dick) Division of Pediatric Cardiology, Department of
Pediatrics and Communicable Diseases, United States
(Bove, Ohye, Dick) Department of Cardiac Surgery, University of Michigan
Medical School, 1540 E Hospital Dr, Ann Arbor, MI 48109, United States
Title
Follow-Up of a Prospective Surgical Strategy to Prevent Intra-Atrial
Reentrant Tachycardia after the Fontan Operation.
Source
Circulation: Arrhythmia and Electrophysiology. 9 (12) (no pagination),
2016. Article Number: e004478. Date of Publication: 01 Dec 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Intra-atrial reentrant tachycardia (IART) after the Fontan
operation had an early reported incidence of 10% to 35% during early and
intermediate follow-up and posed substantial management challenges.
Methods and Results - To reduce the incidence of IART after the Fontan
procedure, we performed a randomized, double-blind study to evaluate the
impact of an incision in the right atrium joining the lateral tunnel
suture line and the tricuspid valve annulus. Between March 1998 and
September 2003, 134 subjects (median age: 1.8 years; range: 1.3-5.2 years;
91 men) were randomly assigned to receive the incision. All 134 patients
had a form of single ventricle pathological anatomy. The clinical course,
electrocardiograms, and Holter monitoring were available for review in 114
subjects at a median of 8.2-year follow-up (range: 0.9-11.9 years). There
were 2 late deaths, neither subject had IART. The combined incidence of
sustained IART was 3.5% (4/114). There was no difference in the occurrence
of sustained IART between those subjects receiving the incision and those
who did not (2 in each group) during follow-up. No patients of either
group experienced short-term complications. Conclusions - Despite the fact
that the primary outcome of this trial was not reached, the most
significant finding was that with current management, the incidence of
IART is considerably lower than the early retrospective, observational
studies suggested. Copyright &#xa9; 2016 American Heart Association, Inc.

<37>
Accession Number
613486335
Author
Momeni M.; Gaudin A.
Institution
(Momeni, Gaudin) Department of Anesthesiology, Universite Catholique de
Louvain, Cliniques Universitaires Saint Luc, Avenue Hippocrate 10,
Brussels 1200, Belgium
Title
Intraoperative cerebral hypoperfusion and electroencephalogram suppression
resulting in neurological complications after cardiac surgery: The need
for an in depth investigation.
Source
Acta Anaesthesiologica Belgica. 67 (2) (pp 73-79), 2016. Date of
Publication: 2016.
Publisher
ARSMB-KVBMG (Avenue W. Churchill-laan 11/30, Brussels B-1180, Belgium)
Abstract
Reports on the demographic profile of older populations estimate that, in
2050, 19 countries will have at least 10% of their population aged 80
years or more. Many high risk elderly patients undergo cardiac surgery. In
addition, advanced age has been shown to be a strong predictor of adverse
neurological outcome. Despite significant improvements achieved in the
perioperative care of cardiac surgical patients, neurological
complications remain a global health issue. Recent findings have pointed
out that cerebral hypoperfusion and too deep levels of anesthesia are
major sources of adverse neurological outcomes. Cerebral near-infrared
spectroscopy provides information about cerebral perfusion non-invasively,
and is increasingly used. Depth of anesthesia is evaluated using monitors
that are based on processed electroencephalogram. This non-systematic
review focuses on the results of studies performed with each monitor
separately, and the need for a combined evaluation of their utility and
eventual impact on neurological outcomes. The use of a combined cerebral
monitoring strategy based on the two aforementioned monitors is proposed
in order to optimize cerebral outcomes. Copyright &#xa9; Acta
Anoesthesiologica Belgica, 2016.

<38>
Accession Number
612175899
Author
Briguori C.; Visconti G.; Donahue M.; Di Palma V.; De Micco F.;
Signoriello G.; Focaccio A.
Institution
(Briguori, Visconti, Donahue, Di Palma, De Micco, Focaccio) Interventional
Cardiology, Clinica Mediterranea, Naples, Italy
(Signoriello) Department of Mental Health and Preventive Medicine, Second
University of Naples, Naples, Italy
Title
Performance of the XLIMUS Sirolimus-Eluting Coronary Stent in Very Complex
Lesions.
Source
Journal of Interventional Cardiology. 29 (6) (pp 559-568), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Stent delivery failure may occur especially when treating
complex coronary artery stenosis. XLIMUS (CARDIONOVUM GmbH, Bonn, Germany)
is a new sirolimus-eluting stent (SES) with the following features: 1)
cobalt chromium stent platform, with low (73 mum) strut thickness, (2)
biodegradable polymer, and 3) potent antiproliferative drug (Sirolimus).
Preliminary data suggest that XLIMUS SES may be ideal for the treatment of
complex lesions. Methods: In this registry, we assessed the
deliverability, safety, and efficacy of percutaneous coronary
interventions (PCI) using the XLIMUS SES in patients undergoing elective
PCI in native coronary vessels for complex de novo lesions, including
severe calcification, severe tortuosity, and chronic total occlusion. The
primary objective of the study is the delivery success of the XLIMUS SES.
The secondary objective is the 1-year rate of major adverse cardiac events
(MACE; including all-cause death, nonfatal myocardial infarction, and
repeat revascularization). Results: A total of 200 consecutive patients
with 255 lesions were included. Delivery success was obtained in 196 (98%)
patients and in 251 (98.4%) lesions. The XLIMUS SES was successfully
implanted on the first attempt with a single guidewire in 176 (88%)
patients and in 208 (81.6%) lesions. Additional techniques to facilitate
stent delivery (i.e., buddy wire, anchoring-balloon, or GuideLiner
catheter) were necessary in 47 (18.4%) lesions. Failure in XLIMUS SES
implantation occurred in 4 (1.6%) lesions. MACE rate at 1 year was 9%.
Conclusions: This registry supports the positive performance of the XLIMUS
SES in the treatment of complex coronary artery lesions. Copyright &#xa9;
2016, Wiley Periodicals, Inc.

<39>
Accession Number
610353211
Author
Sanchez-Espin G.; Otero J.J.; Rodriguez E.A.; Mataro M.J.; Melero J.M.;
Porras C.; Guzon A.; Such M.
Institution
(Sanchez-Espin, Otero, Rodriguez, Mataro, Melero, Porras, Guzon, Such)
Unidad de Gestion Clinica del Corazon y Patologia Cardiovascular, Servicio
de Cirugia Cardiaca, Hospital Universitario Virgen de la Victoria, Malaga,
Spain
Title
Minimally invasive mitral valve surgery.
Source
Cirugia Cardiovascular. 23 (6) (pp 276-281), 2016. Date of Publication: 01
Nov 2016.
Publisher
Elsevier Doyma (E-mail: editorial@elsevier.com)
Abstract
During the last two decades cardiac surgery has evolved into less-invasive
procedures, looking for a lesser body aggression and faster patient
recovery, these procedures becoming more attractive to patients and
clinical cardiologists. Currently, minimally invasive mitral valve surgery
(MIMVS) has established itself as an alternative for patients with mitral
valve pathology. Compared with conventional mitral surgery (full
sternotomy approach) and after overcoming initial learning curve, it turns
out to be a safe and effective technique, with equivalent short- and
long-term follow-up results. Despite involving an increase in operative
times (ischemic and cardiopulmonary bypass time), the MIMVS is associated
with shorter in-hospital and intensive care unit stay, reduced blood loss
and transfusions, earlier extubation and fewer arrhythmias and allows a
faster patient recovery with better cosmetic result. Therefore, MIMVS is a
steadily growing technique in different centers, being recommended
prospective randomized studies that allow a better assessment of clinical
outcomes and in terms of cost-efficiency. Copyright &#xa9; 2016 Sociedad
Espanola de Cirugia Toracica-Cardiovascular

<40>
Accession Number
613415426
Author
Wang C.-H.; Zhang S.-Y.; Jin X.-F.
Institution
(Wang, Zhang, Jin) Department of Cardiology, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences & Peking Union Medical
College, Beijing 100730, China
Title
Complete revascularization versus culprit-only revascularization in
ST-segment elevation myocardial infarction and multivessel disease
patients undergoing primary percutaneous coronary intervention: A
meta-analysis and trial sequential analysis.
Source
International Journal of Cardiology. 228 (pp 844-852), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
The present study compared the outcomes of complete revascularization (CR)
and culprit-only revascularization (COR) performed during primary
percutaneous coronary intervention (PCI) in patients with ST-segment
elevation myocardial infarction (STEMI) and multivessel disease through a
meta-analysis in order to determine which strategy is more appropriate.
Published randomized controlled trials (RCTs) were retrieved from the
PubMed, EMBASE, and CENTRAL databases. Eight RCTs with 2060 patients were
selected (1080 patients underwent CR [immediate (ICR) or staged (SCR)] and
980 patients underwent COR). The follow-up was 6-38 months. In the overall
population, CR reduced major adverse cardiac events (MACE) and repeat
revascularization when compared to those with COR (RR 0.60, 95% CI
0.50-0.72; RR 0.49, 95% CI 0.33-0.73). In the subgroups analysis, ICR
reduced MACE, all-cause death and/or MI, non-fatal MI, and repeat
revascularization compared to COR (RR 0.44, 95% CI 0.32-0.60; RR 0.55, 95%
CI 0.36-0.85; RR 0.35, 95% CI 0.17-0.71; RR 0.35, 95% CI 0.24-0.52; SCR
reduced only MACE when compared with those in COR (RR 0.71, 95% CI
0.56-0.89). However, trial sequential analysis powered for a 25% relative
reduction indicated firm evidence (cumulative z-curve crossed the
monitoring boundary) for only MACE and revascularization in the overall
population and ICR subgroup. Contrast-induced nephropathy, major
hemorrhage, and stroke incidences were not different between CR and COR.
Based on these findings, we believe that CR is preferable to COR in STEMI
and multivessel disease patients undergoing primary PCI. Copyright &#xa9;
2016 Elsevier Ireland Ltd

<41>
Accession Number
613466701
Author
Ali Z.A.; Maehara A.; Genereux P.; Shlofmitz R.A.; Fabbiocchi F.; Nazif
T.M.; Guagliumi G.; Meraj P.M.; Alfonso F.; Samady H.; Akasaka T.; Carlson
E.B.; Leesar M.A.; Matsumura M.; Ozan M.O.; Mintz G.S.; Ben-Yehuda O.;
Stone G.W.
Institution
(Ali, Maehara, Nazif, Ben-Yehuda, Stone) New York Presbyterian Hospital
and Columbia University, New York, NY, United States
(Ali, Maehara, Genereux, Nazif, Matsumura, Ozan, Mintz, Ben-Yehuda, Stone)
Cardiovascular Research Foundation, New York, NY, United States
(Shlofmitz) St Francis Hospital, Roslyn, New York, NY, United States
(Fabbiocchi) Centro Cardiologico Monzino Istituto di Ricovero e Cura a
Carattere Scientifico, Milan, Italy
(Guagliumi) Ospedale Papa Giovanni XXIII, Bergamo, Italy
(Meraj) Northwell Health, Manhasset, New York, NY, United States
(Alfonso) Hospital Universitario de La Princesa, Madrid, Spain
(Samady) Emory University Hospital, Atlanta, GA, United States
(Akasaka) Wakayama Medical University, Wakayama, Japan
(Carlson) Eastern Cardiology, Greenville, NC, United States
(Leesar) University of Alabama, Birmingham, AB, United States
Title
Optical coherence tomography compared with intravascular ultrasound and
with angiography to guide coronary stent implantation (ILUMIEN III:
OPTIMIZE PCI): a randomised controlled trial.
Source
The Lancet. 388 (10060) (pp 2618-2628), 2016. Date of Publication: 26 Nov
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Percutaneous coronary intervention (PCI) is most commonly
guided by angiography alone. Intravascular ultrasound (IVUS) guidance has
been shown to reduce major adverse cardiovascular events (MACE) after PCI,
principally by resulting in a larger postprocedure lumen than with
angiographic guidance. Optical coherence tomography (OCT) provides higher
resolution imaging than does IVUS, although findings from some studies
suggest that it might lead to smaller luminal diameters after stent
implantation. We sought to establish whether or not a novel OCT-based
stent sizing strategy would result in a minimum stent area similar to or
better than that achieved with IVUS guidance and better than that achieved
with angiography guidance alone. Methods In this randomised controlled
trial, we recruited patients aged 18 years or older undergoing PCI from 29
hospitals in eight countries. Eligible patients had one or more target
lesions located in a native coronary artery with a visually estimated
reference vessel diameter of 2.25-3.50 mm and a length of less than 40 mm.
We excluded patients with left main or ostial right coronary artery
stenoses, bypass graft stenoses, chronic total occlusions, planned
two-stent bifurcations, and in-stent restenosis. Participants were
randomly assigned (1:1:1; with use of an interactive web-based system in
block sizes of three, stratified by site) to OCT guidance, IVUS guidance,
or angiography-guided stent implantation. We did OCT-guided PCI using a
specific protocol to establish stent length, diameter, and expansion
according to reference segment external elastic lamina measurements. All
patients underwent final OCT imaging (operators in the IVUS and
angiography groups were masked to the OCT images). The primary efficacy
endpoint was post-PCI minimum stent area, measured by OCT at a masked
independent core laboratory at completion of enrolment, in all randomly
allocated participants who had primary outcome data. The primary safety
endpoint was procedural MACE. We tested non-inferiority of OCT guidance to
IVUS guidance (with a non-inferiority margin of 1.0 mm²),
superiority of OCT guidance to angiography guidance, and superiority of
OCT guidance to IVUS guidance, in a hierarchical manner. This trial is
registered with ClinicalTrials.gov, number NCT02471586. Findings Between
May 13, 2015, and April 5, 2016, we randomly allocated 450 patients (158
[35%] to OCT, 146 [32%] to IVUS, and 146 [32%] to angiography), with 415
final OCT acquisitions analysed for the primary endpoint (140 [34%] in the
OCT group, 135 [33%] in the IVUS group, and 140 [34%] in the angiography
group). The final median minimum stent area was 5.79 mm² (IQR
4.54-7.34) with OCT guidance, 5.89 mm² (4.67-7.80) with IVUS
guidance, and 5.49 mm² (4.39-6.59) with angiography guidance.
OCT guidance was non-inferior to IVUS guidance (one-sided 97.5% lower CI
-0.70 mm²; p=0.001), but not superior (p=0.42). OCT guidance
was also not superior to angiography guidance (p=0.12). We noted
procedural MACE in four (3%) of 158 patients in the OCT group, one (1%) of
146 in the IVUS group, and one (1%) of 146 in the angiography group (OCT
vs IVUS p=0.37; OCT vs angiography p=0.37). Interpretation OCT-guided PCI
using a specific reference segment external elastic lamina-based stent
optimisation strategy was safe and resulted in similar minimum stent area
to that of IVUS-guided PCI. These data warrant a large-scale randomised
trial to establish whether or not OCT guidance results in superior
clinical outcomes to angiography guidance. Funding St Jude Medical.
Copyright &#xa9; 2016 Elsevier Ltd

<42>
Accession Number
613254306
Author
Oster M.E.; Kelleman M.; McCracken C.; Ohye R.G.; Mahle W.T.
Institution
(Oster, Mahle) Children's Healthcare of Atlanta, GA, United States
(Oster, Kelleman, McCracken, Mahle) University School of Medicine,
Atlanta, GA, United States
(Ohye) University of Michigan Medical School, Ann Arbor, MI, United States
Title
Association of digoxin with interstage mortality: Results from the
pediatric heart network single ventricle reconstruction trial public use
dataset.
Source
Journal of the American Heart Association. 5 (1) (pp 1-7), 2016. Date of
Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Mortality for infants with single ventricle congenital heart
disease remains as high as 8% to 12% during the interstage period, the
time between discharge after the Norwood procedure and before the stage II
palliation. The objective of our study was to determine the association
between digoxin use and interstage mortality in these infants. Methods and
Results-We conducted a retrospective cohort study using the Pediatric
Heart Network Single Ventricle Reconstruction Trial public use dataset,
which includes data on infants with single right ventricle congenital
heart disease randomized to receive either a Blalock-Taussig shunt or
right ventricle-to-pulmonary artery shunt during the Norwood procedure at
15 institutions in North America from 2005 to 2008. Parametric survival
models were used to compare the risk of interstage mortality between those
discharged to home on digoxin versus those discharged to home not on
digoxin, adjusting for center volume, ascending aorta diameter, shunt
type, and socioeconomic status. Of the 330 infants eligible for this
study, 102 (31%) were discharged home on digoxin. Interstage mortality for
those not on digoxin was 12.3%, compared to 2.9% among those on digoxin,
with an adjusted hazard ratio of 3.5 (95% CI, 1.1-11.7; P=0.04). The
number needed to treat to prevent 1 death was 11 patients. There were no
differences in complications between the 2 groups during the interstage
period. Conclusions-Digoxin use in infants with single ventricle
congenital heart disease is associated with significantly reduced
interstage mortality. (J Am Heart Assoc. 2016;5:e002566 doi:
10.1161/JAHA.115.002566). Copyright &#xa9; 2016 The Authors.

<43>
[Use Link to view the full text]
Accession Number
613375878
Author
Zong Z.J.; Shen Q.Y.; Lu Y.; Li Y.H.
Institution
(Zong, Shen, Lu, Li) Department of Anesthesiology, First Affiliated
Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
Title
A simple blind placement of the left-sided double-lumen tubes.
Source
Medicine (United States). 95 (45) (no pagination), 2016. Article Number:
e5376. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
One-lung ventilation (OLV) has been commonly provided by using a
double-lumen tube (DLT). Previous reports have indicated the high
incidence of inappropriate DLT positioning in conventional maneuvers.
After obtaining approval from the medical ethics committee of First
Affiliated Hospital of Anhui Medical University and written consent from
patients, 88 adult patients belonging to American society of
anesthesiologists (ASA) physical status grade I or II, and undergoing
elective thoracic surgery requiring a left-side DLT for OLV were enrolled
in this prospective, single-blind, randomized controlled study. Patients
were randomly allocated to 1 of 2 groups: simple maneuver group or
conventional maneuver group. The simple maneuver is a method that relies
on partially inflating the bronchial balloon and recreating the effect of
a carinal hook on the DLTs to give an idea of orientation and depth. After
the induction of anesthesia the patients were intubated with a left-sided
Robertshaw DLT using one of the 2 intubation techniques. After intubation
of each DLT, an anesthesiologist used flexible bronchoscopy to evaluate
the patient while the patient lay in a supine position. The number of
optimal position and the time required to place DLT in correct position
were recorded. Time for the intubation of DLT took 100+/-16.2seconds
(mean+/-SD) in simple maneuver group and 95.1+/-20.8seconds in
conventional maneuver group. The difference was not statistically
significant (P=0.221). Time for fiberoptic bronchoscope (FOB) took
22+/-4.8seconds in simple maneuver group and was statistically faster than
that in conventional maneuver group (43.6+/-23.7seconds, P<0.001). Nearly
98% of the 44 intubations in simple maneuver group were considered as in
optimal position while only 52% of the 44 intubations in conventional
maneuver group were in optimal position, and the difference was
statistically significant (P<0.001). This simple maneuver is more rapid
and more accurate to position left-sided DLTs, it may be substituted for
FOB during positioning of a left-sided DLT in condition that FOB is
unavailable or inapplicable. Copyright &#xa9; 2016 the Author(s).
Published by Wolters Kluwer Health, Inc. All rights reserved.

<44>
Accession Number
613800718
Author
Mokhles S.; Takkenberg J.J.; Treasure T.
Institution
(Mokhles, Takkenberg) Department of Cardio-Thoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Treasure) Clinical Operational Research Unit, University College London,
London, United Kingdom
Title
Evidence-Based and Personalized Medicine. It's [AND] not [OR].
Source
Annals of Thoracic Surgery. 103 (1) (pp 351-360), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier USA
Abstract
Good clinical practice is an amalgamation of personalized medicine with
evidence-based medicine in the best interests of patient. Hence, our title
uses Boolean operators to indicate that it is [AND] not [OR]. This is the
syntax of formal searching for systematic reviews, ensuring that all the
evidence is found. Comprehensive evidence-based guidance can thus be
formulated. Many residents and fellows around the world, and their chiefs,
are now exposed to consensus documents, white papers, levels of
appropriateness, and guidelines and are in many jurisdictions expected to
comply with them. However, they are the summation of many forms of
evidence, each of which has its place, and we consider them in turn in
this article. Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<45>
Accession Number
613800714
Author
Gong M.; Zhang Z.; Fragakis N.; Korantzopoulos P.; Letsas K.P.; Li G.; Yan
G.-X.; Liu T.
Institution
(Gong, Zhang, Li, Liu) Tianjin Key Laboratory of Ionic-Molecular Function
of Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Fragakis) Third Cardiology Department, Hippokrateion Hospital, Aristotle
University, Medical School, Thessaloniki, Greece
(Korantzopoulos) First Department of Cardiology, University of Ioannina
Medical School, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, "Evangelismos" General Hospital of Athens, Athens,
Greece
(Yan) Lankenau Institute for Medical Research and Lankenau Medical Center,
Wynnewood, Pennsylvania, United States
(Yan) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Title
Role of ranolazine in the prevention and treatment of atrial fibrillation:
A meta-analysis of randomized clinical trials.
Source
Heart Rhythm. 14 (1) (pp 3-11), 2017. Date of Publication: 01 Jan 2017.
Publisher
Elsevier B.V.
Abstract
Background Randomized controlled trials (RCTs) on the use of ranolazine
(RN) for prevention and cardioversion of atrial fibrillation (AF) have
yielded conflicting results. Objective The purpose of this study was to
conduct a meta-analysis of RCTs to examine the potential role of RN in the
prevention and cardioversion of AF. Methods PubMed and EMBASE were
searched until June 2016. Of 484 initially identified studies, 8 RCTs were
finally analyzed. Results The analysis of RCTs showed that RN
significantly reduced the incidence of AF compared to the control group in
various clinical settings, such as after cardiac surgery, in acute
coronary syndromes, and post-electrical cardioversion of AF (relative risk
[RR] 0.67, 95% confidence interval [CI] 0.52-0.87, Z = 3.06, P =.002).
Furthermore, a higher conversion rate of AF from the combined use of RN
and amiodarone compared to amiodarone alone (RR 1.23, 95% CI 1.08-1.40, Z
= 3.07, P =.002) was clear, with conversion time significantly shorter in
RN plus amiodarone compared to the amiodarone group (weighted mean
difference [WMD] = -10.38 hours, 95% CI -18.18 to -2.57, Z = 2.61, P
=.009). Conclusion Our meta-analysis suggests that RN may be effective in
AF prevention, whereas it potentiates and accelerates the conversion
effect of amiodarone of recent-onset AF. Larger RCTs with long-term
follow-up in diverse clinical settings are needed to further clarify the
impact of RN on AF therapy. Copyright &#xa9; 2016 Heart Rhythm Society

<46>
Accession Number
613800628
Author
Patel R.B.; Moorthy M.V.; Chiuve S.E.; Pradhan A.D.; Cook N.R.; Albert
C.M.
Institution
(Patel, Moorthy, Chiuve, Pradhan, Cook, Albert) Department of Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(Moorthy, Albert) Center for Arrhythmia Prevention, Brigham and Women's
Hospital, Boston, Massachusetts, United States
(Moorthy, Chiuve, Pradhan, Cook, Albert) Division of Preventive Medicine,
Brigham and Women's Hospital, Boston, Massachusetts, United States
(Albert) Cardiovascular Division, Brigham and Women's Hospital, Boston,
Massachusetts, United States
Title
Hemoglobin A<inf>1c</inf> levels and risk of sudden cardiac death: A
nested case-control study.
Source
Heart Rhythm. 14 (1) (pp 72-78), 2017. Date of Publication: 01 Jan 2017.
Publisher
Elsevier B.V.
Abstract
Background Sudden cardiac death (SCD) is often the first manifestation of
cardiovascular disease (CVD), and preventive strategies within this broad
population are lacking. Patients with diabetes represent a high-risk
subgroup, but few data exist regarding whether measures of glycemia
mediate risk and/or add to SCD risk stratification. Objective The purpose
of this study was to examine the association between hemoglobin
A<inf>1c</inf> (HbA<inf>1c</inf>) and SCD. Methods We performed a
case-control analysis among individuals enrolled in 6 prospective cohort
studies. HbA<inf>1c</inf> levels were determined for 482 cases of SCD and
914 matched controls. Conditional logistic regression with fixed effects
meta-analysis was used for analysis. Results In multivariable models,
HbA<inf>1c</inf> levels were linearly associated with SCD risk over
follow-up of 11.3 years (P <.001). Each 1% increment in HbA<inf>1c</inf>
was associated with a hazard ratio (HR) of 1.32 (95% confidence interval
[CI] 1.16-1.50). The magnitude of the association was greater in subjects
without vs those with known CVD [HR per 1% increment 1.64 (95% CI
1.31-2.06) vs 1.15 (95% CI 0.99-1.33), P interaction =.009]. In models
simultaneously controlling for diabetes status and HbA<inf>1c</inf>, the
association between HbA<inf>1c</inf> and SCD remained significant (HR
1.29, 95% CI 1.07-1.55, P =.01), whereas the association between diabetes
and SCD was attenuated (relative risk 1.21, 95% CI 0.64-2.27, P =.56).
Conclusion In these prospective cohorts, HbA<inf>1c</inf> levels
associated with SCD risk, particularly among those without known CVD, even
after controlling for diabetes status. These data support the hypothesis
that hyperglycemia mediates SCD risk among patients with diabetes.
Copyright &#xa9; 2016

<47>
Accession Number
613811038
Author
Ongkasuwan J.; Ocampo E.; Tran B.
Institution
(Ongkasuwan) Department of Otolaryngology Head and Neck Surgery, Baylor
College of Medicine/Texas Children's Hospital, Texas, United States
(Ocampo) Department of Pediatric Cardiology, Texas Children's Hospital,
Houston, TX, United States
(Tran) Department of Pediatric Radiology, Texas Children's Hospital,
Houston, TX, United States
Title
Laryngeal ultrasound and vocal fold movement in the pediatric
cardiovascular intensive care unit.
Source
Laryngoscope. 127 (1) (pp 167-172), 2017. Date of Publication: 01 Jan
2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives/Hypothesis: Vocal fold motion impairment (VFMI) is a known
sequela of cardiovascular surgery. The gold standard for the evaluation of
vocal fold movement is flexible nasolaryngoscopy (FNL). Although safe, FNL
does cause measurable physiologic changes. Noxious stimuli in
cardiovascular intensive care unit (CVICU) neonates may cause imbalance
between the pulmonary and systemic circulations and potentially
circulatory collapse. The goals of this project were to determine the
accuracy of laryngeal ultrasound (LUS) compared to FNL to identify VFMI in
CVICU neonates and compare their physiologic impact. Study Type: Case
control. Design: Prospective case-control study. Methods: Forty-six
consecutive infants from the CVICU were recruited, 23 with VFMI and 23
without based on FNL findings. They then underwent LUS, which was
subsequently reviewed by two pediatric radiologists blinded to the FNL
results. Physiologic parameters were recorded before and after the
procedures. Data analysis was performed with Cohen's kappa and Wilcoxon
signed-rank test. Results: Agreement between LUS and FNL was substantial
(kappa = 0.78). Laryngeal ultrasound had a sensitivity of 0.84 and
specificity of 0.95 for identifying VFMI. In terms of physiologic impact,
LUS caused statistically significantly less change in diastolic blood
pressure (P = 0.01), pulse (P = 0.001), and O<inf>2</inf> saturation (P =
0.004) compared to FNL. Arytenoid rotation could be seen clearly, and the
vocal fold-arytenoid angle in abduction was most predictive of symmetry
and movement (P = 0.17). However, it was difficult to determine vocal fold
closure patterns with LUS. Conclusion: Laryngeal ultrasound is a
comparable to FNL for evaluating vocal fold mobility with less physiologic
impact. Level of Evidence: 3b. Laryngoscope, 127:167-172, 2017. Copyright
&#xa9; 2016 The American Laryngological, Rhinological and Otological
Society, Inc.

<48>
Accession Number
613800486
Author
Badhwar V.; Rankin J.S.; Damiano R.J.; Gillinov A.M.; Bakaeen F.G.;
Edgerton J.R.; Philpott J.M.; McCarthy P.M.; Bolling S.F.; Roberts H.G.;
Thourani V.H.; Suri R.M.; Shemin R.J.; Firestone S.; Ad N.
Institution
(Badhwar, Rankin, Ad) Division of Cardiothoracic Surgery, West Virginia
University, Morgantown, West Virginia, United States
(Damiano) Division of Cardiothoracic Surgery, Washington University, St.
Louis, Missouri, United States
(Gillinov, Bakaeen, Suri) Division of Thoracic and Cardiovascular Surgery,
Cleveland Clinic, Cleveland, Ohio, United States
(Edgerton) Department of Cardiothoracic Surgery, Baylor Plano Heart
Hospital, Plano, Texas, United States
(Philpott) Department of Cardiothoracic Surgery, Sentara Heart Hospital,
Norfolk, Virginia, United States
(McCarthy) Division of Cardiac Surgery, Northwestern University Feinberg
School of Medicine, Chicago, Illinois, United States
(Bolling) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, Michigan, United States
(Roberts) Department of Cardiovascular Services, Florida Heart and
Vascular Care at Aventura, Aventura, Florida, United States
(Thourani) Division of Cardiothoracic Surgery, Emory University, Atlanta,
Georgia
(Shemin) Division of Cardiothoracic Surgery, University of California Los
Angeles David Geffen School of Medicine, Los Angeles, California, United
States
(Firestone) The Society of Thoracic Surgeons, Chicago, Illinois, United
States
Title
The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the
Surgical Treatment of Atrial Fibrillation.
Source
Annals of Thoracic Surgery. 103 (1) (pp 329-341), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier USA
Abstract
Executive Summary Surgical ablation for atrial fibrillation (AF) can be
performed without additional risk of operative mortality or major
morbidity, and is recommended at the time of concomitant mitral operations
to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can
be performed without additional operative risk of mortality or major
morbidity, and is recommended at the time of concomitant isolated aortic
valve replacement, isolated coronary artery bypass graft surgery, and
aortic valve replacement plus coronary artery bypass graft operations to
restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation
for symptomatic AF in the absence of structural heart disease that is
refractory to class I/III antiarrhythmic drugs or catheter-based therapy
or both is reasonable as a primary stand-alone procedure, to restore sinus
rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic
persistent or longstanding persistent AF in the absence of structural
heart disease is reasonable, as a stand-alone procedure using the Cox-Maze
III/IV lesion set compared with pulmonary vein isolation alone. (Class
IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the
setting of left atrial enlargement (>4.5 cm) or more than moderate mitral
regurgitation by pulmonary vein isolation alone is not recommended. (Class
III no benefit, Level C expert opinion) It is reasonable to perform left
atrial appendage excision or exclusion in conjunction with surgical
ablation for AF for longitudinal thromboembolic morbidity prevention.
(Class IIA, Level C limited data) At the time of concomitant cardiac
operations in patients with AF, it is reasonable to surgically manage the
left atrial appendage for longitudinal thromboembolic morbidity
prevention. (Class IIA, Level C expert opinion) In the treatment of AF,
multidisciplinary heart team assessment, treatment planning, and long-term
follow-up can be useful and beneficial to optimize patient outcomes.
(Class I, Level C expert opinion) Copyright &#xa9; 2017 The Society of
Thoracic Surgeons

<49>
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.

<50>
[Use Link to view the full text]
Accession Number
613344592
Author
Filardo G.; Ailawadi G.; Pollock B.D.; Da Graca B.; Sass D.M.; Phan T.K.;
Montenegro D.E.; Thourani V.; Damiano R.
Institution
(Filardo, Pollock, Da Graca, Sass, Phan, Montenegro) Office of the Chief
Quality Officer, Baylor Scott and White Health, 8080 N Central Expressway,
Dallas, TX 75206, United States
(Filardo) Heart Hospital Baylor Plano, TX, United States
(Ailawadi) Division of Thoracic and Cardiovascular Surgery, University of
Virginia, Charlottesville, United States
(Thourani) Division of Cardiothoracic Surgery, Emory University, Atlanta,
GA, United States
(Damiano) Department of Cardiac Surgery, Washington University School of
Medicine, Barnes-Jewish Hospital, St Louis, MO, United States
Title
Sex Differences in the Epidemiology of New-Onset In-Hospital Post-Coronary
Artery Bypass Graft Surgery Atrial Fibrillation: A Large Multicenter
Study.
Source
Circulation: Cardiovascular Quality and Outcomes. 9 (6) (pp 723-730),
2016. Date of Publication: 01 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - New-onset atrial fibrillation (AF) after coronary artery
bypass graft surgery (CABG) is associated with increased morbidity and
poorer long-term survival. Although many studies show differences in
outcome in women versus men after CABG, little is known about the
sex-specific incidence and characteristics of post-CABG AF. Methods and
Results - Overall, 11 236 consecutive patients without preoperative AF
underwent isolated CABG from 2002 to 2010 at 4 US academic medical centers
and 1 high-volume specialty cardiac hospital. Data routinely collected for
the Society of Thoracic Surgeons database were augmented with details on
new-onset post-CABG AF events detected via continuous in-hospital
ECG/telemetry monitoring. Unadjusted incidence of post-CABG AF was 29.5%
(3312/11 236) overall, 30.2% (2485/8214) in men, and 27.4% (827/3022) in
women. After adjustment for Society of Thoracic Surgeons-recognized risk
factors, women had significantly lower risk for post-CABG AF (odds ratio
[95% confidence interval]=0.75 [0.64-0.89]), shorter first, longest, and
total duration of AF episodes (mean difference [95% confidence
interval]=-2.7 [-4.7 to -0.8] hours; -4.1 [-6.9 to -1.2] hours; -2.4 [-2.5
to -2.3] hours, respectively). At 48 hours, AF-free probabilities were 77%
for women and 72% for men (P<0.001). Number of episodes (P=0.18),
operative mortality (P=0.048), stroke (P=0.126), and discharge in AF
(P=0.234) did not differ significantly by sex. Conclusions - These novel
data on sex-specific characteristics of new-onset AF after isolated CABG
show that women had lower adjusted risk for post-CABG AF and experienced
shorter episodes. Investigation of sex-specific impacts on outcomes is
needed to identify optimal strategies for prevention and management to
ensure all patients achieve the best possible outcomes. Copyright &#xa9;
2016 American Heart Association, Inc.

<51>
Accession Number
613110662
Author
van Houwelingen K.G.; Lam M.K.; Lowik M.M.; Danse P.W.; Tjon Joe Gin R.M.;
Jessurun G.A.; Anthonio R.L.; Sen H.; Linssen G.C.M.; IJzerman M.J.;
Doggen C.J.M.; von Birgelen C.
Institution
(van Houwelingen, Lam, Lowik, Sen, von Birgelen) Cardiology Department,
Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
(Danse, Tjon Joe Gin) Cardiology Department, Rijnstate Hospital, Arnhem,
Netherlands
(Jessurun, Anthonio) Cardiology Department, Treant Zorggroep Location
Scheper, Emmen, Netherlands
(Linssen) Cardiology Department, Ziekenhuisgroep Twente, Almelo y Hengelo,
Netherlands
(IJzerman, Doggen, von Birgelen) Department Health Technology and Services
Research, MIRA - Institute for Biomedical Technology and Technical
Medicine, University of Twente, Enschede, Netherlands
Title
Outcome After Myocardial Infarction Treated With Resolute Integrity and
Promus Element Stents: Insights From the DUTCH PEERS (TWENTE II)
Randomized Trial.
Source
Revista Espanola de Cardiologia. 69 (12) (pp 1152-1159), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Ediciones Doyma, S.L. (E-mail: suscripciones@doyma.es)
Abstract
Introduction and objectives In acute myocardial infarction (MI), novel
highly deliverable drug-eluting stents (DES) may be particularly valuable
as their flexible stent designs might reduce device-induced traumas to
culprit lesions. The aim of the study was to assess the safety and
efficacy of percutaneous coronary interventions with 2 novel durable
polymer-coated DES in patients with acute MI. Methods The prospective,
randomized DUTCH PEERS (TWENTE II) multicenter trial compares Resolute
Integrity and Promus Element stents in 1811 all-comer patients, of whom
817 (45.1%) were treated for ST-segment elevation MI or non-ST-segment
elevation MI and the 2-year outcome is available in 99.9%. The primary
clinical endpoint is target vessel failure (TVF), a composite of cardiac
death, target vessel related MI, or target vessel revascularization.
Results Of all 817 patients treated for acute MI, 421 (51.5%) were treated
with Resolute Integrity and 396 (48.5%) with Promus Element stents. At the
2-year follow-up, the rates of TVF (7.4% vs 6.1%; P =.45), target lesion
revascularization (3.1% vs 2.8%; P =.79), and definite stent thrombosis
(1.0% vs 0.5%; P =.69) were low for both stent groups. Consistent with
these findings in all patients with acute MI, outcomes for the 2 DES were
favorable and similar in both, with 370 patients with ST-segment elevation
MI (TVF: 5.1% vs 4.9%; P =.81) and 447 patients with non-ST-segment
elevation MI (TVF: 9.0% vs 7.5%; P =.56). Conclusions Resolute Integrity
and Promus Element stents were both safe and efficacious in treating
patients with acute MI. The present 2-year follow-up data underline the
safety of using these devices in this particular clinical setting. Full
English text available from: www.revespcardiol.org/en Copyright &#xa9;
2016 Sociedad Espanola de Cardiologia

<52>
[Use Link to view the full text]
Accession Number
613845446
Author
Batra J.; Toyoda N.; Goldstone A.B.; Itagaki S.; Egorova N.N.; Chikwe J.
Institution
(Batra, Toyoda, Itagaki, Chikwe) Department of Cardiovascular Surgery,
Mount Sinai Hospital, 1190 Fifth Ave, New York, NY 10029, United States
(Egorova) Department of Population Health Science and Policy, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
(Goldstone) Department of Cardiothoracic Surgery, Stanford University
School of Medicine, CA, United States
Title
Extracorporeal Membrane Oxygenation in New York State: Trends, Outcomes,
and Implications for Patient Selection.
Source
Circulation: Heart Failure. 9 (12) (no pagination), 2016. Article Number:
e003179. Date of Publication: 01 Dec 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Utilization of extracorporeal membrane oxygenation (ECMO) is
expanding despite limited outcome data defining appropriate use. Methods
and Results - To quantify determinants of early and 1-year survival after
ECMO in adult patients, we conducted a retrospective cohort analysis of
1286 patients aged >18 years who underwent ECMO in New York State from
2003 to 2014. Median follow-up time was 4.9 months (range, 0-12 months).
ECMO utilization increased from 13 patients in 8 hospitals in 2003 to 330
patients in 30 hospitals in 2014. Compared with patients undergoing ECMO
before 2009, later patients were older (54.4 versus 52.3 years; P=0.013)
and more likely to have major comorbidity including chronic kidney disease
(25.2% versus 13.2%; P=0.02) and liver disease (20.0% versus 10.7%;
P=0.001). In the overall cohort, 30-day mortality was 52.2% (95%
confidence interval, 49.5-54.9). Mortality at 30 days was 65.2% for
patients aged >75 years (n=73/112) and 74.6% in patients who required
cardiopulmonary resuscitation (n=91/122). Survival at 1 year was 38.4%
(95% confidence interval, 35.7-41.0). The 30-day mortality and 1-year
survival improved across the study period. In multivariable analysis,
earlier year of ECMO, lower hospital volume, indication for ECMO after a
cardiac procedure, cardiopulmonary resuscitation before ECMO placement,
and age >65 years were independent predictors of worse survival.
Conclusions - Outcomes of ECMO have improved despite increasing
comorbidity. Extreme mortality after ECMO in elderly patients and patients
requiring cardiopulmonary resuscitation indicates that less invasive
therapeutic or palliative modalities may be more appropriate in this
end-of-life setting. Copyright &#xa9; 2016 American Heart Association,
Inc.

<53>
Accession Number
613497700
Author
Bundhun P.K.; Yanamala C.M.; Huang F.
Institution
(Bundhun, Huang) The First Affiliated Hospital of Guangxi Medical
University, Institute of Cardiovascular Diseases, Nanning, Guangxi 530027,
China
(Yanamala) EALING Hospital, University of Buckingham, Department of
Internal Medicine, Uxbridge road, Southall, London UB1 3HW, United Kingdom
Title
Comparing the adverse clinical outcomes associated with fraction flow
reserve-guided versus angiography-guided percutaneous coronary
intervention: A systematic review and meta-analysis of randomized
controlled trials.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 249. Date of Publication: 03 Dec 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recently published randomized controlled trials have shown
different results compared to the Fraction Flow Reserve Versus Angiography
for Multi-vessel Evaluation (FAME) study. Therefore, this current analysis
aimed to compare the adverse clinical outcomes associated with Fraction
Flow Reserve (FFR)-guided versus standard angiography-guided Percutaneous
Coronary Intervention (PCI) using a large number of randomized patients.
Methods: PubMed/Medline, EMBASE and the Cochrane library were searched for
studies comparing FFR-guided with angiography-guided PCI. Mortality,
Myocardial Infarction (MI), repeated revascularization and Major Adverse
Cardiac Events (MACEs) at any follow up period following PCI were
considered as the clinical endpoints in this analysis. Odds Ratios (OR)
with 95% Confidence Intervals (CIs) were calculated and the analyses were
carried out by the RevMan 5.3 software. Ethical approval was not necessary
for this type of study. Results: A total number of 2138 patients (1080
patients with FFR-guided versus 1058 patients with angiography-guided PCI)
were included. Results of this analysis showed mortality not to be
significantly different between FFR-guided and angiography-guided PCI with
OR: 0.70, 95% CI: 0.39 - 1.25; P = 0.22, I² = 0%. Total
repeated revascularization and Target Lesion Revascularization were also
similarly manifested with OR: 0.82, 95% CI: 0.60 - 1.13; P = 0.22,
I² = 0% and OR: 0.88, 95% CI: 0.43 - 1.80; P = 0.73,
I² = 0% respectively. In addition, MACEs were also not
significantly lower in the FFR-guided PCI group with OR: 0.82, 95% CI:
0.64 - 1.06; P = 0.13, I² = 0%. However, FFR-guided PCI was
associated with a significantly lower rate of re-infarction with OR: 0.67,
95% CI: 0.47 - 0.96; P = 0.03, I² = 0%. Conclusion: FFR-guided
PCI was not associated with significantly higher adverse clinical outcomes
when compared to angiography-guided PCI. A significantly lower rate of
re-infarction associated with FFR-guided PCI could show an important
benefit. However, due to the limited number of patients analyzed, this
hypothesis should further be confirmed in future trials. Copyright &#xa9;
2016 The Author(s).

<54>
Accession Number
613627202
Author
investigators B.S.
Title
Twelve-month follow-up of complex patients treated with the Xience
V^TM everolimus drug-eluting stents in daily practice - results
of the BRAVO Brazilian Registry.
Source
Revista Brasileira de Cardiologia Invasiva. 23 (1) (pp 22-27), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Sociedade Brasileira de Cardiologia
Abstract
Background The Xience V^TM everolimus-eluting stent is a new
generation drug-eluting stent (DES) that incorporates a low profile
cobalt-chromium platform (81 mum) and a highly biocompatible polymer
(fluoropolymer), which carries and controls the release of everolimus.
Recent studies have demonstrated sustained safety and efficacy of the
Xience V^TM in the treatment of real-world populations. Our aim
was to report the clinical results of 12 months of the BRAVO Brazilian
protocol. Methods The BRAVO Registry was a prospective, non-randomized,
single-arm, multicenter (25 centers) study that evaluated the late
clinical results of 535 minimally selected patients treated with the drug-
eluting stent Xience V^TM in Brazilian daily practice. Results
Overall, 40% of patients had diabetes, 25% prior myocardial infarction,
and 42% presented with acute coronary artery syndrome. The majority of
lesions (69%) was highly complex (ACC/AHA type B2 or C). The mean length
and the nominal stent diameter were 19.9 +/- 5.3 mm and 3.0 +/- 0.4 mm,
respectively. The angiographic and procedural successes were 99.7 and 98%,
respectively. At 12 months, the cumulative rate of major adverse cardiac
events, available in 100% of patients, was 5.6% (cardiac death: 1.3%;
acute myocardial infarction: 3.0%; revascularization of the target lesion:
2.2%). Stent thrombosis occurred in 5 patients (0,9%), and only 1 case was
reported between 6 and 12 months. Conclusions The drug-eluting stent
Xience V^TM demonstrated sustained safety and efficacy up to 12
months in the treatment of complex coronary lesions in patients from daily
practice. Copyright &#xa9; 2015

<55>
Accession Number
613755577
Author
Morrison L.J.; Devlin S.M.; Kontos M.C.; Cheskes S.; Aufderheide T.P.;
Christenson J.; Ornato J.P.; Stiell I.G.; Rac V.E.; Thomas A.J.; Wigginton
J.G.; Dorian P.
Institution
(Morrison) Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital,
Division of Emergency Medicine, Department of Medicine, University of
Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
(Devlin) Department of Epidemiology and Biostatistics, Memorial
Sloan-Kettering Cancer Center, 307 East 63rd Street, 3rd Floor, New York,
NY, United States
(Kontos) Pauley Heart Center, Division of Cardiology, Virginia
Commonwealth University, Richmond, VA, United States
(Cheskes) Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital,
Sunnybrook Centre for Prehospital Medicine, Division of Emergency
Medicine, Department of Family and Community Medicine University of
Toronto, 77 Browns Line, Suite 100, Toronto, Ontario M8W 3S2, Canada
(Aufderheide) Medical College of Wisconsin, Department of Emergency
Medicine, 9200W. Wisconsin Avenue, Pavilion 1P, Milwaukee, WI 53226,
United States
(Christenson) University of British Columbia, Department of Emergency
Medicine, Room 3300 3rd Floor, 910 West 10th Avenue, Vancouver, British
Columbia V5Z 1M9, Canada
(Ornato) Department of Emergency Medicine, Virginia Commonwealth
University, Richmond, VA, United States
(Stiell) Department of Emergency Medicine, Ottawa Hospital Research
Institute, University of Ottawa, Clinical Epidemiology Unit, F6 1053
Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
(Rac) THETA (Toronto Health Economics and Technology Assessment)
Collaborative, Toronto General Research Institute, University Health
Network and Leslie Dan Pharmacy Building, 6th Floor, Room 651, 144 College
Street, Toronto, Ontario M5S 3M2, Canada
(Thomas) School of Medicine, Oregon Health & Science University, 3181 SW
Sam Jackson Park Rd, Portland, OR 97239-3098, United States
(Wigginton) University of Texas Southwestern Medical Center, 5323 Harry
Hines Boulevard, Dallas, TX 75390, United States
(Dorian) Division of Cardiology, Department of Medicine, St Michael's
Hospital and University of Toronto, Toronto, Ontario, Canada
Title
The association of maximum Troponin values post out-of-hospital cardiac
arrest with electrocardiographic findings, cardiac reperfusion procedures
and survival to discharge: A sub-study of ROC PRIMED.
Source
Resuscitation. 111 (pp 82-89), 2017. Date of Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The role of Troponin (Tn) levels in the management of patients
post out-of-hospital cardiac arrest (OHCA) is unclear. Methods All OHCA
patients enrolled in the Resuscitation Outcomes Consortium Prehospital
Resuscitation using an IMpedance valve and Early versus Delayed analysis
trial and admitted to hospital with a Tn level and a 12-lead
electrocardiogram were stratified by ST elevation (STE) or no STE in a
regression model for survival to discharge adjusted for Utstein predictors
and site. Results Of the 15,617 enrolled OHCA patients, 4118 (26%)
survived to admission to hospital; 17% (693) were STE and 77% (3188) were
no STE with 6% unknown; 83% (3460) had at least one Tn level. Reperfusion
rates were higher when Tn level >2 ng/ml (p > 0.1 ng/ml) improved with a
diagnostic cardiac catheterization (p < 0.001). Conclusions Elevated Tn
levels >2 ng/ml were associated with improved survival to discharge in
patients post OHCA with STE. Survival in patients with no STE and Tn
values >0.1 ng/ml was higher when associated with diagnostic cardiac
catheterization or treated with reperfusion or revascularization.
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<56>
Accession Number
613791534
Author
Bjornnes A.K.; Parry M.; Lie I.; Fagerland M.W.; Watt-Watson J.; Rustoen
T.; Stubhaug A.; Leegaard M.
Institution
(Bjornnes, Rustoen) Department of Research and Development, Division of
Emergencies and Critical Care, Oslo University Hospital, Norway and
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo,
Norway
(Parry, Watt-Watson) Lawrence S. Bloomberg Faculty of Nursing, University
of Toronto, Canada
(Lie) Department of Cardiothoracic Surgery, Oslo University Hospital,
Ulleval/Center for Patient Centered Heart and Lung Research, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Norway
(Fagerland) Oslo Centre for Biostatistics and Epidemiology, Research
Support Services, Oslo University Hospital, Norway
(Stubhaug) Department of Pain Management and Research, Oslo University
Hospital, Institute of Clinical Medicine, Faculty of Medicine, University
of Oslo, Norway
(Leegaard) Oslo and Akershus University, College of Applied Sciences,
Faculty of Health Sciences, Institute of Nursing, Norway
Title
The impact of an educational pain management booklet intervention on
postoperative pain control after cardiac surgery.
Source
European Journal of Cardiovascular Nursing. 16 (1) (no pagination), 2017.
Date of Publication: 01 Jan 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Relevant discharge information about the use of analgesic
medication and other strategies may help patients to manage their pain
more effectively and prevent postoperative persistent pain. Aims: To
examine patients' pain characteristics, analgesic intake and the impact of
an educational pain management booklet intervention on postoperative pain
control after cardiac surgery. Concerns about pain and pain medication
prior to surgery will also be described. Methods: From March 2012 to
September 2013, 416 participants (23% women) were consecutively enrolled
in a randomized controlled trial. The intervention group received usual
care plus an educational booklet at discharge with supportive telephone
follow-up on postoperative day 10, and the control group received only
usual care. The primary outcome was worst pain intensity (The Brief Pain
Inventory - Short Form). Data about pain characteristics and analgesic use
were collected at 2 weeks and at 1, 3, 6 and 12 months post-surgery.
General linear mixed models were used to determine between-group
differences over time. Results: Twenty-nine percent of participants
reported surgically related pain at rest and 9% reported moderate to
severe pain at 12 months post-surgery. Many participants had concerns
about pain and pain medication, and analgesic intake was insufficient
post-discharge. No statistically significant differences between the
groups were observed in terms of the outcome measures following surgery.
Conclusion: Postoperative pain and inadequate analgesic use were problems
for many participants regardless of group allocation, and the current
intervention did not reduce worst pain intensity compared with control.
Further examination of supportive follow-up monitoring and/or
self-management strategies post-discharge is required. Copyright &#xa9;
European Society of Cardiology.

<57>
[Use Link to view the full text]
Accession Number
613342594
Author
Zhou B.; Cen X.-J.; Qian L.-Y.; Pang J.; Zou H.; Ding Y.-H.
Institution
(Zhou) Department of Cardiac Surgery, Zhejiang Provincial People's
Hospital, Hangzhou, China
(Cen, Qian, Pang, Zou, Ding) Department of Cardiology, Zhejiang Provincial
People's Hospital, Hangzhou 310000, China
Title
Treatment strategy for treating atrial-esophageal fistula: Esophageal
stenting or surgical repair?: A case report and literature review.
Source
Medicine (United States). 95 (43) (no pagination), 2016. Article Number:
e5134. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction: Atrial-esophageal fistula (AEF) is a rare severe disease,
which may be associated with radiofrequency catheter ablation (RFCA) of
atrial fibrillation (AF) or intraoperative radiofrequency ablation of
atrial fibrillation (IRAAF). Clinical Findings:We reported a case of a
67-year-old man with AEF following RFCA of AF, who treated with esophageal
stenting and surgical repair. Outcomes: He was attacked by out-of-control
sepsis and infectious shock after surgery and died. Literature review: We
analyzed57 relevant articles about AEF from 2003 to 2015 by searching
PubMed database. According literatures, the most common symptoms were
fever, rigor, sepsis, and neurologic symptoms. Chest computer tomography
(CT) and contrast enhanced CT may be the reliable noninvasive diagnosis
methods because of high sensitive for AEF. Conclusion: Make a definition
diagnosis in time with early primary surgical repair may save their lives.
Conservative treatment or esophageal stenting alone may not be a better
choice for AEF patients. &#xa9; Copyright 2016 the Author(s). Published by
Wolters Kluwer Health, Inc. All rights reserved.

<58>
Accession Number
613790758
Author
Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Suwannasom P.;
Tenekecioglu E.; Yun S.-C.; Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.;
Park S.-W.; Serruys P.W.; Park S.-J.
Institution
(Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Heart Institute, University
of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
(Cavalcante, Onuma, Suwannasom, Tenekecioglu, Serruys) Erasmus University
Medical Center, Amsterdam, Netherlands
(Sotomi) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Yun) Division of Biostatistics, Center for Medical Research and
Information, University of Ulsan College of Medicine, Asan Medical Center,
Seoul, South Korea
(Serruys) International Center for Circulatory Health, Imperial College
London, London, United Kingdom
Title
Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for
Left Main or Multivessel Coronary Artery Disease: A Meta-Analysis of
Individual Patient Data.
Source
JACC: Cardiovascular Interventions. 9 (24) (pp 2481-2489), 2016. Date of
Publication: 26 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors undertook a patient-level meta-analysis to compare
long-term outcomes after coronary artery bypass grafting (CABG) versus
percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in
3,280 patients with left main or multivessel coronary artery disease
(CAD). Background The relative efficacy and safety of CABG versus PCI with
DES for left main or multivessel CAD remain controversial. Methods Data
were pooled from the BEST (Randomized Comparison of Coronary Artery Bypass
Surgery and Everolimus Eluting Stent Implantation in the Treatment of
Patients With Multivessel Coronary Artery Disease), PRECOMBAT (Premier of
Randomized Comparison of Bypass Surgery vs. Angioplasty Using
Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery
Disease), and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery)
trials. The primary outcome was a composite of all-cause death, myocardial
infarction, or stroke. Results The median follow-up was 60 months, and
follow-up was completed for 96.2% of patients. The rate of primary outcome
was significantly lower with CABG than with PCI (13.0% vs. 16.0%; hazard
ratio [HR]: 0.83; 95% confidence interval [CI]: 0.69 to 1.00; p = 0.046).
The difference was mainly driven by reduction in myocardial infarction
(HR: 0.46; 95% CI: 0.33 to 0.64; p < 0.001). There was significant
interaction between treatment effect and types of CAD, showing CABG to be
superior compared with PCI with DES in patients with multivessel CAD (p =
0.001), but no between-group difference in those with left main CAD (p =
0.427). The rates for all-cause death and stroke were similar between the
2 groups. By contrast, the need for repeat revascularization was
significantly lower in the CABG group compared with the PCI group.
Conclusions CABG, as compared with PCI with DES, reduced long-term rates
of the composite of all-cause death, myocardial infarction, or stroke in
patients with left main or multivessel CAD. The advantage of CABG over PCI
with DES was particularly pronounced in those with multivessel CAD.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<59>
Accession Number
613790708
Author
Rojas P.; Amat-Santos I.J.; Cortes C.; Castrodeza J.; Tobar J.; Puri R.;
Sevilla T.; Vera S.; Varela-Falcon L.H.; Zunzunegui J.L.; Gomez I.;
Rodes-Cabau J.; San Roman J.A.
Institution
(Rojas, Amat-Santos, Cortes, Castrodeza, Tobar, Sevilla, Vera,
Varela-Falcon, Gomez, San Roman) Institute of Heart Sciences, Hospital
Clinico Universitario, Valladolid, Spain
(Puri, Rodes-Cabau) Quebec Heart & Lung Institute, Quebec, Quebec, Canada
(Zunzunegui) Hospital General Universitario Gregorio Maranon, Madrid,
Spain
Title
Acquired Aseptic Intracardiac Shunts Following Transcatheter Aortic Valve
Replacement: A Systematic Review.
Source
JACC: Cardiovascular Interventions. 9 (24) (pp 2527-2538), 2016. Date of
Publication: 26 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to describe the incidence,
mechanisms, features, and management of aseptic intracardiac shunts
(AICS). Background AICS following transcatheter aortic valve replacement
(TAVR) are an uncommon and barely described complication. Methods A
systematic review was performed of all published cases of AICS following
TAVR, and the incidence, predictors, main features, management, and
related outcomes were analyzed. Results A total of 31 post-TAVR AICS were
gathered. After excluding transapical fistulas, the 28 remaining cases
corresponded with an incidence of about 0.5%. Mean age and mean logistic
European System for Cardiac Operative Risk Evaluation score were 80 +/- 11
years and 19.2 +/- 8.3%, respectively. Prior radiation therapy for cancer
was present in 14.3%, and 42.8% had severe calcification of the aortic
valve. TAVR was undertaken using balloon-expandable prostheses in the
majority of cases (85.7%), via the transapical approach in one-third.
Median time from TAVR to diagnosis was 21 days (interquartile range: 7 to
30 days), with intraprocedural suspicion in 12 cases (42.9%) and a mean
Q<inf>p</inf>/Q<inf>s</inf> ratio of 1.8 +/- 0.6. The most common location
for AICS was the interventricular septum (60.7%). Heart failure was
frequent (46.4%), but 14 patients (50%) remained asymptomatic. Medical
treatment (71.4%) was associated with poor outcomes (30-day mortality rate
25%), especially in symptomatic patients (35% vs. 0%; p = 0.020) and in
those with higher Q<inf>p</inf>/Q<inf>s</inf> ratios (1.9 +/- 0.6 vs. 1.4
+/- 0.1), while cardiac surgery (3.6%), and percutaneous closure (25%) led
to good outcomes after a median follow-up period of 3 months
(interquartile range: 1 to 9 months). Conclusions Post-TAVR AICS are
uncommon but have high 30-day mortality if left untreated, especially in
symptomatic patients. Percutaneous closure was feasible and safe in
symptomatic patients but remains controversial in asymptomatic subjects.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<60>
Accession Number
613769716
Author
Nesterov M.A.; Afonnikov D.A.; Sergeeva E.M.; Miroshnichenko L.A.; Bragina
M.K.; Bragin A.O.; Vasiliev G.V.; Salina E.A.
Institution
(Nesterov, Afonnikov, Sergeeva, Bragina, Bragin, Vasiliev, Salina)
Institute of Cytology and Genetics, Siberian Branch, Russian Academy of
Sciences, Novosibirsk 630090, Russian Federation
(Miroshnichenko) Sobolev Institute of Mathematics, Siberian Branch,
Russian Academy of Sciences, Novosibirsk 630090, Russian Federation
Title
Identification of microsatellite loci based on BAC sequencing data and
their physical mapping into the soft wheat 5B chromosome.
Source
Russian Journal of Genetics: Applied Research. 6 (8) (pp 825-837), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Maik Nauka Publishing / Springer SBM (E-mail: compmg@maik.ru)
Abstract
The shortage of polymorphic markers for the regions of the wheat
chromosomes that encode commercially valuable traits determines the need
for studying the wheat microsatellite SSR loci. In this work, SSR markers
for individual regions of the short arm of soft wheat chromosome 5B (5BS)
were designed based on the sequence data obtained from BAC clones, and
regions of the corresponding chromosome were saturated with these markers.
Totally, 130 randomly selected BAC clones from 5BS library were sequenced
using the IonTorrent platform and assembled in contigs using MIRA
software. The assembly characteristics (N50 = 4136 bp) are comparable to
the recently obtained data for wheat and related species and are
acceptable for the identification of the microsatellite loci. The
algorithm utilizing the properties of complex decompositions in the
sliding-window mode was used to detect DNA sequences with a repeat unit of
2-4 bp. Analysis of 17770 contigs with a total length of 25879921 bp
allowed for the design of 113, 79, and 67 microsatellite SSR loci with a
repeat unit of 2, 3, and 4 bp, respectively. SSR markers with a motif of 3
bp were tested using nullitetrasomic lines of Chinese Spring wheat
homoeologous group 5. In total, 21 markers specific for chromosome 5B were
identified. Eight of these markers were mapped into the distal region of
this chromosome (bin 5BS6) using a set of Chinese Spring deletion lines
for 5BS. Eight and four markers were mapped to the interstitial region
(bins 5BS5 and 5BS4, respectively). One marker was mapped to a
pericentromeric bin. Comparative analysis of the distribution of
trinucleotide microsatellites over wheat chromosome 5B, and in different
cereal species, suggests that the (AAG)<inf>n</inf> repeat proliferates
and is conserved during the evolution of cereals. Copyright &#xa9; 2016,
Pleiades Publishing, Ltd.

<61>
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.

<62>
Accession Number
613864946
Author
De Oliveira A.P.A.; De Souza E.N.; Pellanda L.C.
Institution
(De Oliveira, De Souza, Pellanda) Universidade Federal de Ciencias da
Saude de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
(Pellanda) Instituto de Cardiologia do Rio Grande do Sul / Fundacao
Universitaria de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil
Title
Effectiveness of video resources in nursing orientation before cardiac
heart surgery.
Source
Revista da Associacao Medica Brasileira. 62 (8) (pp 762-767), 2016. Date
of Publication: November 2016.
Publisher
Associacao Medica Brasileira
Abstract
Objective: To evaluate the effectiveness of video resources in increasing
patient knowledge during preoperative orientation for cardiac surgery
compared to standard orientation. Method: Randomized clinical trial.
Patients in the intervention group (IG) received bedside orientation with
the aid of a short video and a slide presentation on the day prior to
surgery. Patients in the control group (CG) received standard orientation.
Allocation and analysis of knowledge were blinded. Analysis was performed
according to the intention to treat principle. Results: We included 90
patients, 45 in each group; 27.8% had incomplete primary education. There
were no differences between groups in the baseline. After orientation, IG
scored 7.20 (+/-1.56) and scored CG 2.71 (+/-1.96, p<0,001). The topic
"surgical room" had the lowest proportion of correct answers in CG (6.7%),
compared to IG (68.9%). The question about "postoperative unit" was the
one with the highest proportion of correct answers in IG (93.3%), while in
CG the proportion was 22.2%. "Ventilatory support" had a low proportion of
correct answers in IG (60%), but still much higher than the correct
answers in CG (17.8%). Conclusion: Orientation performed with the aid of
video resources is more effective for knowledge retention in preoperative
patients, compared to verbal orientation alone. Copyright &#xa9; 2016,
Associacao Medica Brasileira. All rights reserved.

<63>
Accession Number
613864913
Author
Likosky D.S.; Dickinson T.A.; Paugh T.A.
Institution
(Likosky, Paugh) Section of Health Services Research and Quality,
Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI,
United States
(Dickinson) Specialty Care, Nashville, Tennessee for the Michigan Society
of Thoracic and Cardiovascular Surgeons, Perfusion Measures and Outcomes
(PERForm) Registry, United States
Title
Blood conservation-a team sport.
Source
Journal of Extra-Corporeal Technology. 48 (3) (pp 99-104), 2016. Date of
Publication: 2016.
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
Cardiac surgery accounts for between 15% and 20% of all blood product
utilization in the United States. A body of literature suggests that
patients who are exposed to even small quantities of blood have an
increased risk of morbidity and mortality, even after adjusting for
pre-operative risk. Despite this body of literature supporting a
restrictive blood management strategy, wide variability in transfusion
rates exist across institutions. Recent blood management guidelines have
shed light on a number of potentially promising blood management
strategies, including acute normovolemic hemodilution (ANH) and retrograde
autologous priming (RAP).We evaluated the literature concerning ANH and
RAP, and the use of both techniques among centers participating in the
Perfusion Measures and outcomes (PERForm) registry. We leveraged data
concerning ANH and RAP among 10,203 patients undergoing isolated coronary
artery bypass grafting (CABG) procedures from 2010 to 2014 at 27 medical
centers. Meta-analyses have focused on the topic of ANH, with few studies
focusing specifically on cardiac surgery. Two meta-analyses have been
conducted to date on RAP, with many reporting higher intra-operative
hematocrits and reduced transfusions. The rate of red blood cell
transfusions in the setting of CABG surgery is 34.2%, although varied
across institutions from 16.8% to 57.6%. Overall use of ANH was 11.6%,
although the utilization varied from .0% to 75.7% across institutions. RAP
use was 71.4%, although varied from .0% to 99.0% across institutions. A
number of blood conservation strategies have been proposed, with varying
levels of evidence from meta-analyses. This uncertainty has likely
contributed to center-level differences in the utilization of these
practices as evidenced by our multi-institutional database. Perfusion
databases, including the PERForm registry, serve as a vehicle for
perfusionist's to track their practice, and contribute to
multidisciplinary team efforts aimed at assessing and improving the value
of cardiac surgical care.

<64>
Accession Number
613749226
Author
Knezevic I.; Poglajen G.; Hrovat E.; Oman A.; Pintar T.; Wu J.C.; Vrtovec
B.; Haddad F.
Institution
(Knezevic, Poglajen, Hrovat, Oman, Pintar, Vrtovec) Advanced Heart Failure
and Transplantation Center, UMC, Ljubljana, Slovenia
(Wu, Vrtovec, Haddad) Department of Medicine, Division of Cardiology,
Stanford University School of Medicine, Stanford, CA, United States
(Wu, Haddad) Stanford Cardiovascular Institute, Stanford University School
of Medicine, Stanford, CA, United States
Title
The effects of levosimendan on renal function early after heart
transplantation: results from a pilot randomized trial.
Source
Clinical Transplantation. 28 (10) (pp 1105-1111), 2014. Date of
Publication: 01 Oct 2014.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: We evaluated the effects of a levosimendan (LS)-based strategy
compared with standard inotropic therapy on renal function in heart
transplantation. Methods and results: Using a randomized study design, 94
patients were assigned to LS-based therapy or standard inotropic support.
At the time of transplantation, the groups did not differ in age, gender,
heart failure etiology, hemodynamic profile, LVEF, or comorbidities. While
there were no differences in serum creatinine (sCr) or eGFR between groups
at baseline, patients in the LS group had a greater increase in their
relative eGFR (62% vs. 12%, p = 0.002) and a lower incidence of acute
kidney injury (AKI) (28% vs. 6%, p = 0.01) during the first
post-transplant week. On logistic regression analysis, correlates of AKI
were randomization to LS therapy (OR = 0.21 [0.09-0.62], p = 0.01),
baseline renal dysfunction (OR = 3.9 [1.1-13.6], p = 0.032), and diabetes
mellitus (OR = 4.2 [1.1-16.5], p = 0.038). However, LS was associated with
a greater need for additional norepinephrine therapy (40 [85%] vs. 15
[31%], p < 0.001) and a trend toward longer intensive care unit stay (9.5
+/- 9.0 d vs. 7.0 +/- 6.0 d, p = 0.13). Conclusions: In patients
undergoing heart transplantation, levosimendan-based strategy may be
associated with better renal function when compared to standard therapy.
Copyright &#xa9; 2014 John Wiley & Sons A/S. Published by John Wiley &
Sons Ltd

<65>
Accession Number
613925866
Author
Parra M.C.; Washburn K.; Brown J.R.; Beach M.L.; Yeager M.P.; Barr P.;
Bonham K.; Lamb K.; Loftus R.W.
Institution
(Parra, Loftus) Department of Anesthesiology, University of Iowa Hospitals
and Clinics, 200 Hawkins Rd, Iowa City, IA 52240, United States
(Washburn) Department of Anesthesiology, Providence Anesthesiology Assoc.,
P.A., Charlotte, NC, United States
(Brown) Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth, Hanover, NH, United States
(Beach, Yeager, Barr, Bonham, Lamb) Department of Anesthesiology,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
Title
Fluoroscopic guidance increases the incidence of thoracic epidural
catheter placement within the epidural space: A randomized trial.
Source
Regional Anesthesia and Pain Medicine. 42 (1) (pp 17-24), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Objectives: Thoracic epidural analgesia can reduce
postoperative pain and cardiopulmonarymorbidity, but it is associatedwith
a high rate of clinical failure. Up to 50% of clinical failure is thought
to be related to technical insertion. In this study, patients undergoing
thoracic surgery were randomized to one of two catheter insertion
techniques: fluoroscopically guided or conventional loss of resistance
with saline/air. Our primary aim was to examinewhether fluoroscopic
guidance could increase the incidence of correct catheter placement and
improve postoperative analgesia. Our secondary aim was to assess the
potential impact of correct epidural catheter positioning on length of
stay in the postanesthesia care unit and total hospital length of stay.
Methods: This randomized clinical trial was conducted at
Dartmouth-Hitchcock Medical Center over 25 months (January 2012 to
February 2014). Patients (N = 100) undergoing thoracic surgery were
randomized to fluoroscopic guidance (n = 47) or to loss of resistance with
saline/air (n = 53). Patients were followed for the primary outcomes of
24-hour morphine use, 24-hour numeric pain scores, and the incidence of
epidural catheter positioningwithin the epidural space. Postanesthesia
care unit and total hospital lengths of stay were evaluated as secondary
outcome measurements and compared for patients with correct epidural
catheter positioning and those without correct epidural catheter
positioning. Results: One hundred patients were included in an
intention-to-treat analysis. Numeric pain scores and 24-hour morphine
consumption were no different between groups. Fluoroscopic guidance was
associated with an increased incidence of epidural catheter placement
within the epidural space compared with loss of resistance with air/saline
[fluoroscopic guidance, epidural in 98% (46/47) versus loss of resistance
with saline/air, epidural in 74% (39/53)]. There was a significant
increase in correct catheter positioning with (odds ratio, 21.07; 95%
confidence interval, 2.07-214.38; P = 0.010) or without (odds ratio,
16.15; 95% confidence interval, 2.03-128.47; P = 0.009) adjustment for
potentially confounding variables. In an adjusted analysis, correctly
positioned thoracic epidural catheters were associated with shorter
postanesthesia care unit (5.87 +/- 5.39 hours vs 4.30 +/- 1.171 hours; P =
0.044) and total hospital length of stay (5.77 +/- 4.94 days vs 4.93 +/-
2.79 days; P = 0.031). Conclusions: Fluoroscopic guidance increases the
incidence of epidural catheter positioning within the epidural space and
may reduce postanesthesia care unit and hospital lengths of stay. Future
work should validate the effectiveness of this approach. Copyright &#xa9;
2016 by American Society of Regional Anesthesia and Pain Medicine.

<66>
Accession Number
613927676
Author
Sedighinejad A.; Imantalab V.; Mirmansouri A.; Nabi B.N.; Tarbiat M.;
Sadeghi A.M.; Sheikhani N.N.; Haghighi M.; Varag Z.S.
Institution
(Sedighinejad, Imantalab, Mirmansouri, Tarbiat) Anesthesiology Research
Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran, Islamic
Republic of
(Nabi) Anesthesiology Department, Anesthesiology Research Center, Guilan
University of Medical Sciences, Rasht, Iran, Islamic Republic of
(Sadeghi, Sheikhani) Department of Cardiology, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
(Haghighi) Anesthesiology Research Center, Guilan University of Medical
Sciences (GUMS), Rasht, Iran, Islamic Republic of
(Varag) Department of Anesthesiology, Anesthesiology Research Center,
Guilan University of Medical Sciences, Rasht, Iran, Islamic Republic of
Title
Comparing the effects of isoflurane-sufentanil anesthesia and
propofol-sufentanil anesthesia on serum cortisol levels in open heart
surgery with cardiopulmonary bypass.
Source
Anesthesiology and Pain Medicine. 6 (6) (no pagination), 2016. Article
Number: e42066. Date of Publication: December 2016.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Major surgeries such as open-heart surgery with
cardiopulmonary bypass are associated with a complexity of stress response
leading to post-operative complications. Studies have confirmed that
anesthesia can mitigate the surgically induced stress response.
Objectives: The aim of this study was to compare the effects of propofol
and isoflurane, both supplemented with Sufentanil, on the stress response
in coronary artery bypass graft surgery with cardiopulmonary bypass, using
cortisol as a biochemical marker. Methods: This double-blind randomized
clinical trial was conducted on 72 patients who underwent coronary artery
bypass grafting (CABG) with cardiopulmonary bypass meeting the inclusion
criteria. The subjects were randomly divided into two groups of isoflurane
(n = 36) and propofol (n = 36) both supplemented with sufentanil. Serum
cortisol levels were measured and compared between the groups; 30 minutes
before the surgery (T0), at the end of the cardiopulmonary bypass (T1),
and 24 hours after the surgery (T2). Results: Compared to the baseline
(T0), at the end of cardiopulmonary bypass (T1), both groups demonstrated
a decrease in plasma cortisol levels with no statistical significant
difference (P = 0.4). At T2 measuring time point, the level of plasma
cortisol significantly increased in both groups (P = 0.02), however this
increase was less in the Isoflurane group. Conclusions: In CABG with
cardiopulmonary bypass, using plasma cortisol level as a measure,
Isoflurane-Sufentanil significantly reduces the stress response to the
surgery, when compared to propofol-Sufentanil. Copyright &#xa9; 2016,
Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM).

<67>
Accession Number
613927661
Author
Fard A.J.; Farzanegan B.; Khalili A.; Ahmadabad N.E.; Kakhaki A.D.; Parsa
T.; Mahjoobifard M.; Khabiri M.; Eraghi M.G.
Institution
(Fard, Kakhaki) Lung Transplantation Research Center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Farzanegan) Tracheal Diseases Research Center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Khalili, Ahmadabad, Parsa) Anesthesiology Research Center, Masih
Daneshvari Hospital, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Mahjoobifard) Children and Adolescent Health Research Center,
Ali-Ebne-Abitaleb Hospital, Zahedan University of Medical Sciences,
Zahedan, Iran, Islamic Republic of
(Khabiri) Anesthesiology Research Center, Taleghani Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Eraghi) Chronic Respiratory Diseases Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Paracetamol instead of ketorolac in post-video-assisted thoracic surgery
pain management: A randomized trial.
Source
Anesthesiology and Pain Medicine. 6 (6) (no pagination), 2016. Date of
Publication: December 2016.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Video-assisted thoracic surgery (VATS) is a minimally invasive
procedure that is growing more common around the world. Despite causing
less pain compared open thoracic surgery, postoperative pain management is
still important. Objectives: The aim of the present study was to compare
the analgesic effects of paracetamol and ketorolac in VATS patients.
Methods: This was a double-blinded randomized clinical trial conducted on
70 patients undergoing lobectomy or segmentectomy due to lung masses,
using video-assisted methods. The patients were randomly divided into two
groups (each n = 35): the ketorolac (K) group and the paracetamol (P)
group. The K group received ketorolac 30 mg IV stat at the end of surgery
and then a 90 mg/24 h infusion. The P group received paracetamol 1 g IV
stat at the end of surgery and then a 3 g/24 h infusion. Pain scores were
recorded during recovery and 2, 4, 8, 12, and 24 hours after drug
administration. Pain scores, total doses of rescue analgesics, and patient
satisfaction levels were compared between the groups. Results: There was
no significant difference between the K and P groups in pain scores in any
of the evaluations. Seventeen (48.6%) and 9 (25.7%) patients in the K and
P groups, respectively, did not require any rescue analgesia (P = 0.047).
The mean doses of rescue analgesia in the K and P groups were 3.129+/-4.27
mg and 4.38+/-3.69 mg, respectively, which were similar (P = 0.144). There
was no significant difference between the groups in satisfaction scores (P
= 0.175). Conclusions: Paracetamol 1 g stat + 3 g/24 h infusion is as
effective as ketorolac 30 mg stat + 90 mg/24 h infusion in post-VATS pain
management, with good tolerability and a low incidence of adverse effects.
Copyright &#xa9; 2016, Iranian Society of Regional Anesthesia and Pain
Medicine (ISRAPM).

<68>
[Use Link to view the full text]
Accession Number
613905145
Author
Samanta A.; Dawn B.
Institution
(Samanta, Dawn) Division of Cardiovascular Diseases, Cardiovascular
Research Institute, Midwest Stem Cell Therapy Center, University of Kansas
Medical Center and Hospital, 3901 Rainbow Blvd, 1001 Eaton, MS 3006,
Kansas City, KS 66160, United States
Title
Remote Ischemic Preconditioning for Cardiac Surgery: Reflections on
Evidence of Efficacy.
Source
Circulation Research. 118 (7) (pp 1055-1058), 2016. Date of Publication:
01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Ever since its discovery more than 2 decades ago, remote ischemic
preconditioning (RIPC) has generated tremendous interest among scientists
and clinicians alike. However, two recent large, well-conducted,
randomized controlled trials (RCTs) have failed to identify any
significant benefit of RIPC during cardiac surgery. A reconciliatory yet
objective review of cumulative evidence with regard to cardiac surgery
reveals that RIPC in preclinical studies reduced infarct size after
experimental myocardial infarction (MI), which is different from cardiac
surgery; improved release of biomarkers, but not hard clinical end points,
in proof-of-concept clinical trials with discordant results; and failed to
produce significant improvement in outcomes in meta-analyses. This
difficult journey of RIPC across the valley of death underscores the
importance of scientific rigor and exercise of caution in interpreting
data at every step of the way until efficacy of a purported therapy is
proven conclusively in large RCTs. Copyright &#xa9; 2016 American Heart
Association, Inc.

<69>
[Use Link to view the full text]
Accession Number
613905052
Author
Garratt K.N.; Whittaker P.; Przyklenk K.
Institution
(Garratt) Center for Heart and Vascular Health, Christiana Care Health
System, Wilmington, DE, United States
(Whittaker, Przyklenk) Cardiovascular Research Institute, Wayne State
University School of Medicine, Elliman Bldg, Room 1107, 421 E Canfield,
Detroit, MI 48201, United States
(Whittaker, Przyklenk) Department of Emergency Medicine, Wayne State
University School of Medicine, Detroit, MI, United States
(Przyklenk) Department of Physiology, Wayne State University School of
Medicine, Detroit, MI, United States
Title
Remote Ischemic Conditioning and the Long Road to Clinical Translation:
Lessons Learned from ERICCA and RIPHeart.
Source
Circulation Research. 118 (7) (pp 1052-1054), 2016. Date of Publication:
01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Remote ischemic conditioning (RIC) is the phenomenon whereby brief
episodes of peripheral ischemia-reperfusion, typically applied to >1 limbs
by inflation-deflation of a standard blood pressure cuff, increase the
tolerance of the myocardium to a sustained ischemic episode. Compelling
preclinical evidence of infarct size reduction with RIC, together with
promising results from small, proof-of-concept phase II trials, has
yielded cautious optimism that RIC may be the long sought-after
cardioprotective strategy capable of attenuating morbidity and mortality
in patients having a spontaneous or planned period of prolonged cardiac
ischemia. Progress toward clinical translation may, however, be hindered
by the recent release of 2 eagerly anticipated phase III trials. ERICCA
(Effect of Remote Ischemic Preconditioning on Clinical Outcomes in
Patients Undergoing Coronary Artery Bypass Graft Surgery) and RIPHeart
(Remote Ischaemic Preconditioning for Heart Surgery), both published in
the New England Journal of Medicine and both designed to assess major
adverse cardiac and cerebrovascular events after cardiac surgery in
RIC-treated cohorts versus sham controls, concluded that RIC had no
benefit on clinical outcomes. Copyright &#xa9; 2016 American Heart
Association, Inc.

<70>
Accession Number
613835786
Author
Zhang H.; Lei C.; Zhang T.; Hou L.; Wang Q.; Dong H.; Han J.; Xiong L.
Institution
(Zhang, Lei, Zhang, Hou, Wang, Dong, Xiong) Department of Anesthesiology,
Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi
Province 710032, China
(Han) Department of Anesthesiology, Tianjin Chest Hospital, Tianjin
300051, China
Title
Randomized controlled trial of TEAS with different acupoints combination
on opioids consumption in patients undergoing off-pump coronary artery
bypass grafting.
Source
International Journal of Clinical and Experimental Medicine. 9 (12) (pp
23060-23071), 2016. Article Number: IJCEM0031552. Date of Publication:
2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
We conducted this prospective, double-blinded, randomized controlled trial
to compare the opioid sparing effect of transcutaneous electric acupoint
stimulation (TEAS) on the distal-proximal acupoints combination and
regional acupoints combination. 186 adults scheduled for elective off-pump
coronary artery bypass grafting (OP-CABG) surgery were randomized to TEAS
with distal-proximal acupoints combination (LI4 and CV17), regional
acupoints combination (CV17 and CV14) and control (non-acupoints) groups.
The primary endpoint was intraoperative sufentanil consumption. Secondary
endpoints included perioperative hemodynamics, duration of mechanic
ventilation, length of cardiac care unit (CCU) and postoperative hospital
stay, incidence and the duration of re-intubation, re-admission to CCU,
placement of intra-aortic balloon counter pulsation (IABP) or ventricular
assisted device (VAD), postoperative cardiac function, incidence of
postoperative complications, and all cause mortality by day 30. The
cumulative consumption of sufentanil was significantly reduced in the
distal-proximal acupoints combination group when compared with those in
the regional acupoints combination and control groups (255.0 +/- 106.1
micro&#32;g vs 300.4 +/- 106.9 micro&#32;g and 305.9 +/- 119.1
micro&#32;g, P = 0.027). No significant differences among the three groups
were found as refer to all of the secondary endpoints. TEAS with
distal-proximal acupoints combination has better efficacy in reducing
intraoperative opioid consumption in patients undergoing OP-CABG surgery.
Copyright &#xa9; 2016, E-Century Publishing Corporation. All rights
reserved.

<71>
Accession Number
613835762
Author
Yang L.; He L.; Tang Y.; Lai G.; Guo Y.; Cao G.; Ni J.
Institution
(Yang, He, Tang, Lai, Guo, Cao, Ni) Department of Pain Management, Xuanwu
Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng
District, Beijing 100053, China
Title
Efficacy of coblation nucleoplasty under CT-guidance in lumber paracentral
disc herniation: Parasagittal interlaminar vs posterolateral
extrapedicular approach.
Source
International Journal of Clinical and Experimental Medicine. 9 (12) (pp
23267-23275), 2016. Article Number: IJCEM0022864. Date of Publication:
2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To compare the efficacy of coblation nucleoplasty under
computed tomography (CT) guidancein treating radicular pain related to
lumbar disc herniation using the parasagittal interlaminar versus the
posterolateral extrapedicular approach. Methods: This randomized,
prospective, observational study included fifty-six patients with
radicular pain who received coblation annuloplasty under CT guidance.
Patients were randomized into two groups according to the approach used:
the parasagittal interlaminar group (PIL group) or the posterolateral
extrapedicular group (PEL group). The primary clinical outcome was pain
assessed using the Visual Analog Scale (VAS). Secondary clinical outcomes
were functional status according to modified MacNab criteria, and numbers
of patients with significant pain relief (>50%) and significant reduction
(>50%) in anesthetic intake. All outcome assessments were recorded for 12
months postoperatively. Results: The VAS had significantly decreased to
2.0+/-1.1 in the PIL group and 2.0+/-1.4 in the PEL group at postoperative
12 months. There was no significant difference between the two groups in
VAS, modified MacNab criteria, or numbers of patients with significant
pain relief (>50%) or significant reduction (=50%) in anesthetic intake.
Five patients in the PIL group experienced cerebrospinal fluid leakage,
but there was no significant difference in complication rate between
groups. Conclusion: Under CTguidance, coblation nucleoplasty using either
the parasagittal interlaminar or the posterolateral extrapedicular
approach decreased pain intensity and improved modified MacNabcriteria in
patients with radicular pain related to lumbar disc herniation. Both
approaches were effective, safe, minimally invasive, and caused minimal
discomfort. Copyright &#xa9; 2016, E-Century Publishing Corporation. All
rights reserved.

<72>
Accession Number
613867077
Author
Byrne N.; Velasco Forte M.; Tandon A.; Valverde I.; Hussain T.
Institution
(Byrne) Department of Medical Physics, Guy's and St. Thomas' NHS
Foundation Trust, London, United Kingdom
(Byrne, Velasco Forte, Valverde) Paediatric Cardiology, Evelina London
Children's Hospital at Guy's and St. Thomas' NHS Foundation Trust, London,
United Kingdom
(Byrne, Velasco Forte, Valverde, Hussain) Division of Imaging Sciences and
Biomedical Engineering, King's College London, London, United Kingdom
(Tandon, Hussain) Departments of Paediatrics, University of Texas,
Southwestern Medical Center, Dallas, TX, United States
(Valverde) Department of Paediatric Cardiology, Hospital Virgen del Rocio,
Seville, Spain
(Valverde) Institute of Biomedicine of Seville, Seville, Spain
Title
A systematic review of image segmentation methodology, used in the
additive manufacture of patient-specific 3D printed models of the
cardiovascular system.
Source
JRSM Cardiovascular Disease. 5 (no pagination), 2016. Date of Publication:
26 Apr 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Shortcomings in existing methods of image segmentation
preclude the widespread adoption of patient-specific 3D printing as a
routine decision-making tool in the care of those with congenital heart
disease. We sought to determine the range of cardiovascular segmentation
methods and how long each of these methods takes. Methods: A systematic
review of literature was undertaken. Medical imaging modality,
segmentation methods, segmentation time, segmentation descriptive quality
(SDQ) and segmentation software were recorded. Results: Totally 136
studies met the inclusion criteria (1 clinical trial; 80 journal articles;
55 conference, technical and case reports). The most frequently used image
segmentation methods were brightness thresholding, region growing and
manual editing, as supported by the most popular piece of proprietary
software: Mimics (Materialise NV, Leuven, Belgium, 1992-2015). The use of
bespoke software developed by individual authors was not uncommon. SDQ
indicated that reporting of image segmentation methods was generally poor
with only one in three accounts providing sufficient detail for their
procedure to be reproduced. Conclusions and implication of key findings:
Predominantly anecdotal and case reporting precluded rigorous assessment
of risk of bias and strength of evidence. This review finds a reliance on
manual and semi-automated segmentation methods which demand a high level
of expertise and a significant time commitment on the part of the
operator. In light of the findings, we have made recommendations regarding
reporting of 3D printing studies. We anticipate that these findings will
encourage the development of advanced image segmentation methods.
Copyright &#xa9; 2016, &#xa9; The European Society of Cardiology 2016.

<73>
Accession Number
613890543
Author
Naber C.K.; Pyxaras S.A.; Ince H.; Frambach P.; Colombo A.; Butter C.;
Gatto F.; Hink U.; Nickenig G.; Bruschi G.; Brueren G.; Tchetche D.; Den
Heijer P.; Schillinger W.; Scholtz S.; Van Der Heyden J.; Lefevre T.;
Gilard M.; Kuck K.-H.; Schofer J.; Divchev D.; Baumgartner H.; Asch F.;
Wagner D.; Latib A.; De Marco F.; Kische S.
Institution
(Naber, Pyxaras) Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus
Essen, Klara-Kopp-Weg 1, Essen 45138, Germany
(Ince, Kische) Vivantes Klinikum im Friedrichshain und Am Urban, Berlin,
Germany
(Ince, Divchev, Kische) Universitatsklinikum Rostock, Rostock, Germany
(Frambach, Wagner) Institut de Chirurgie Cardiaque et de Cardiologie
Interventionnelle, Luxembourg
(Colombo, Latib) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Butter) Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
(Gatto) Herzzentrum Saar, Volklingen, Germany
(Hink) Universitatsklinikum Mainz, Mainz, Germany
(Nickenig) Universitatsklinikum Bonn, Bonn, Germany
(Bruschi, De Marco) Ospedale Niguarda Ca' Granda, Milan, Italy
(Brueren) Catharina Ziekenhuis, Eindhoven, Netherlands
(Tchetche) Clinique Pasteur, Toulouse, France
(Den Heijer) Amphia Ziekenhuis Hartcentrum - Cardiologie, Breda,
Netherlands
(Schillinger) Universitatsklinikum Gottingen, Gottingen, Germany
(Scholtz) Klinik fur Kardiologie Herz, Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Van Der Heyden) St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Lefevre) Hopital Prive Jacques Cartier, Massy, France
(Gilard) CHU Brest, Brest, France
(Kuck) Asklepios Klinik St. Georg, Hamburg, Germany
(Schofer) Albertinen Herzzentrum, Hamburg, Germany
(Baumgartner) Universitatsklinikum Munster, Munster, Germany
(Asch) MedStar Health Research Institute, Washington, DC, United States
Title
A multicentre European registry to evaluate the Direct Flow Medical
transcatheter aortic valve system for the treatment of patients with
severe aortic stenosis.
Source
EuroIntervention. 12 (11) (pp e1413-e1419), 2016. Date of Publication:
December 2016.
Publisher
EuroPCR
Abstract
Aims: Our aim was to assess the clinical outcomes of the Direct Flow
Medical Transcatheter Aortic Valve System (DFM-TAVS), when used in routine
clinical practice. Methods and results: This is a prospective, open-label,
multicentre, post-market registry of patients treated with DFM-TAVS
according to approved commercial indications. Echocardiographic and
angiographic data were evaluated by an independent core laboratory and
adverse events were adjudicated and classified according to VARC-2
criteria by an independent clinical events committee. The primary endpoint
was freedom from all-cause mortality at 30 days post procedure. Secondary
endpoints included procedural, early safety and efficacy endpoints at 30
days. Two hundred and fifty patients with severe aortic stenosis
undergoing transcatheter aortic valve implantation (TAVI) with the
DFM-TAVS were enrolled in 21 European centres. The primary endpoint,
freedom from all-cause mortality at 30 days, was met in 98% (245/250) of
patients. Device success was 83.8%. Moderate or severe aortic
regurgitation was reported in 3% of patients, and none/trace regurgitation
in 73% of patients. Post-procedural permanent pacemaker implantation was
performed in 30 patients (12.0%). Conclusions: The DFM-TAVS was associated
with good short-term outcomes in this real-world registry. The low
pacemaker and aortic regurgitation rates confirm the advantages of this
next-generation transcatheter heart valve (THV). Copyright &#xa9; Europa
Digital & Publishing 2016. All rights reserved.

<74>
Accession Number
613890402
Author
Pilgrim T.; Piccolo R.; Heg D.; Roffi M.; Tuller D.; Vuilliomenet A.;
Muller O.; Cook S.; Weilenmann D.; Kaiser C.; Jamshidi P.; Khattab A.A.;
Taniwaki M.; Rigamonti F.; Nietlispach F.; Blochlinger S.; Wenaweser P.;
Juni P.; Windecker S.
Institution
(Pilgrim, Piccolo, Khattab, Taniwaki, Nietlispach, Blochlinger, Wenaweser,
Windecker) Department of Cardiology, Bern University Hospital, Bern 3010,
Switzerland
(Heg) Institute of Social and Preventive Medicine, Clinical Trials Unit,
Bern University Hospital, Bern, Switzerland
(Roffi, Rigamonti) Department of Cardiology, University Hospital, Geneva,
Geneva, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Vuilliomenet) Department of Cardiology, Kantonsspital, Aarau, Switzerland
(Muller) Department of Cardiology, University Hospital, Lausanne,
Switzerland
(Cook) Department of Cardiology, University Hospital, Fribourg,
Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital, St. Gallen,
Switzerland
(Kaiser) Department of Cardiology, University Hospital, Basel, Switzerland
(Jamshidi) Department of Cardiology, Kantonsspital, Luzern, Switzerland
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute of St. Michael's Hospital, University of Toronto, Department of
Medicine, Toronto, Canada
(Juni) Institute of Primary Health Care, University of Bern, Bern,
Switzerland
Title
Biodegradable polymer sirolimus-eluting stents versus durable polymer
everolimus-eluting stents for primary percutaneous coronary
revascularisation of acute myocardial infarction.
Source
EuroIntervention. 12 (11) (pp e1343-e1354), 2016. Date of Publication:
December 2016.
Publisher
EuroPCR
Abstract
Aims: Our aim was to compare the safety and efficacy of a novel, ultrathin
strut, biodegradable polymer sirolimus-eluting stent (BP-SES) with a thin
strut, durable polymer everolimus-eluting stent (DP-EES) in a
pre-specified subgroup of patients with acute ST-segment elevation
myocardial infarction (STEMI) enrolled in the BIOSCIENCE trial. Methods
and results: The BIOSCIENCE trial is an investigator-initiated,
single-blind, multicentre, randomised non-inferiority trial (NCT01443104).
Randomisation was stratified according to the presence or absence of
STEMI. The primary endpoint, target lesion failure (TLF), is a composite
of cardiac death, target vessel myocardial infarction, and clinically
indicated target lesion revascularisation within 12 months. Between
February 2012 and May 2013, 407 STEMI patients were randomly assigned to
treatment with BP-SES or DP-EES. At one year, TLF occurred in seven (3.4%)
patients treated with BP-SES and 17 (8.8%) patients treated with DP-EES
(RR 0.38, 95% CI: 0.16-0.91, p=0.024). Rates of cardiac death were 1.5% in
the BP-SES group and 4.7% in the DP-EES group (RR 0.31, 95% CI: 0.08-1.14,
p=0.062); rates of target vessel myocardial infarction were 0.5% and 2.6%
(RR 0.18, 95% CI: 0.02-1.57, p=0.082), respectively, and rates of
clinically indicated target lesion revascularisation were 1.5% in the
BP-SES group versus 2.1% in the DP-EES group (RR 0.69, 95% CI: 0.16-3.10,
p=0.631). There was no difference in the risk of definite stent
thrombosis. Conclusions: In this pre-specified subgroup analysis, BP-SES
was associated with a lower rate of target lesion failure at one year
compared to DP-EES in STEMI patients. These findings require confirmation
in a dedicated STEMI trial. Copyright &#xa9; Europa Digital & Publishing
2016. All rights reserved.

<75>
Accession Number
613879052
Author
Joss J.D.; Hernan J.; Collier R.; Cardenas A.
Institution
(Joss, Collier) Good Samaritan Regional Medical Center, Corvallis, OR,
United States
(Hernan) CarePro Home Infusion and Ambulatory Care, Cedar Rapids, IA,
United States
(Cardenas) Harvard T. H. Chan School of Public Health, Boston, MA, United
States
Title
Perioperative supplementation of polyunsaturated omega-3 fatty acid for
the prevention of atrial fibrillation after cardiothoracic surgery.
Source
American Journal of Health-System Pharmacy. 74 (1) (pp e17-e23), 2017.
Date of Publication: 01 Jan 2017.
Publisher
American Society of Health-Systems Pharmacy
Abstract
Purpose. The effect of perioperative supplementation of polyunsaturated
omega-3 fatty acid (PUFA) on the frequency of atrial fibrillation (AF) in
patients without a history of AF was evaluated. Methods. A total of 561
patients were randomized to receive either 1 g of PUFA or placebo twice
daily. Treatment was started up to five days before surgery or within 24
hours after surgery, depending on when consent was received. Treatment was
continued until the patient's follow-up visit with the cardiologist up to
four weeks after surgery. The primary endpoint of the study was AF before
hospital discharge. Secondary endpoints included AF within one week after
surgery, AF within one month after surgery, length of hospital stay,
postoperative bleeding complications, and readmission within one month
after surgery. Results. No significant reduction in the risk of AF was
observed at hospital discharge (relative risk [RR], 0.98; p = 0.922) or at
three weeks after surgery (RR, 0.98; p = 0.844). After restricting the
analysis to treatmentadherent patients, the association remained
nonsignificant at hospital discharge (RR, 0.90; p = 0.374) and at three
weeks after surgery (RR, 0.90; p = 0.330). No significant differences were
observed between treatments for rates of readmission, death, and bleeding
complications or the length of hospital stay. Conclusion. Perioperative
supplementation with PUFA did not decrease the risk of AF in the immediate
postoperative period. PUFA also had no effect on the length of hospital
stay, postoperative bleeding complications, and readmissions within one
month after surgery.

<76>
[Use Link to view the full text]
Accession Number
613879067
Author
Nerlekar N.; Ha F.J.; Verma K.P.; Bennett M.R.; Cameron J.D.; Meredith
I.T.; Brown A.J.
Institution
(Nerlekar, Ha, Verma, Cameron, Meredith, Brown) Monash Cardiovascular
Research Centre, Monash University, Clayton, VIC, Australia
(Nerlekar, Ha, Verma, Cameron, Meredith, Brown) MonashHeart, Clayton, VIC,
Australia
(Nerlekar, Ha, Verma, Cameron, Meredith, Brown) Monash Health, Clayton,
VIC, Australia
(Bennett, Brown) Division of Cardiovascular Medicine, University of
Cambridge, Cambridge, United Kingdom
Title
Percutaneous coronary intervention using drug-eluting stents versus
coronary artery bypass grafting for unprotected left main coronary artery
stenosis.
Source
Circulation: Cardiovascular Interventions. 9 (12) (no pagination), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Current guidelines suggest that coronary artery bypass
grafting (CABG) should be the preferred revascularization method for
unprotected left main coronary artery stenosis. In light of evidence from
recent randomized trials, we assessed whether percutaneous coronary
intervention (PCI) using drug-eluting stents is as safe and effective as
CABG for the treatment of unprotected left main coronary artery disease.
Methods and Results - Digital databases and manual searches were performed
for randomized trials comparing PCI and CABG for unprotected left main
coronary artery stenosis. Among 3887 potentially relevant studies, 5 met
inclusion criteria. The primary safety end point was defined as the
composite of all-cause death, myocardial infarction, or stroke. Secondary
end points included a clinical effectiveness composite, which was defined
as all-cause death, myocardial infarction, stroke, or repeat
revascularization. Summary estimates were obtained using random-effects
modeling. In total, 4594 patients were included in the analysis. There was
no significant difference in the primary safety end point between the
revascularization strategies (odds ratio [OR], 0.97; 95% confidence
interval [CI], 0.79-1.17; P=0.73). However, when compared with CABG, PCI
was less effective (OR, 1.36; 95% CI, 1.18-1.58; P<0.001) because of
significantly higher rates of repeat revascularization (OR, 1.85; 95% CI,
1.53-2.23; P<0.001). The incidence of all-cause death (OR, 1.03; 95% CI,
0.78-1.35; P=0.61), myocardial infarction (OR, 1.46; 95% CI, 0.88-2.45;
P=0.08), and stroke (OR, 0.88; 95% CI, 0.39-1.97; P=0.53) did not differ
between PCI and CABG. Conclusions - PCI using drug-eluting stents and CABG
are equally safe methods of revascularization for patients at low surgical
risk with significant unprotected left main coronary artery stenosis.
However, CABG is associated with significantly lower rates of repeat
revascularization. Copyright &#xa9; 2016 American Heart Association, Inc.

<77>
Accession Number
613928599
Author
Rafiq S.; Steinbruchel D.A.; Lilleor N.B.; Moller C.H.; Lund J.T.; Thiis
J.J.; Kober L.; Olsen P.S.
Institution
(Rafiq, Steinbruchel, Lilleor, Moller, Lund, Thiis, Olsen) Department of
Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen
University Hospital, Blegdamsvej 9, 2100 Copenhagen O, Denmark
(Kober) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen O, Denmark
Title
Antithrombotic therapy after bioprosthetic aortic valve implantation:
Warfarin versus aspirin, a randomized controlled trial.
Source
Thrombosis Research. (no pagination), 2016. Date of Publication: August
07, 2016.
Publisher
Elsevier Ltd
Abstract
Background: The optimal medical strategy for prevention of thromboembolic
events after surgical bioprosthetic aortic valve replacement (BAVR) is
still debated. The objective of this study was to compare warfarin therapy
(target INR of 2.0 to 3.0) with aspirin 150. mg daily as antithrombotic
therapy for the first three months after BAVR with or without concomitant
coronary artery bypass grafting (CABG). The aim was to evaluate
thromboembolic complications, major bleeding complications and death.
Materials and methods: Prospective, single-centre, open-label, randomized
controlled trial. 370 patients were enrolled, 328 were available for data
analysis. Results: At baseline the warfarin and aspirin groups were
comparable. Thromboembolic events were comparable between groups 11 (6.6%)
vs. 12 (7.5%), p. =0.83. Major bleeding events occurred numerically more
often in warfarin patients 9 (5.4%) vs. 3 (1.9%), p. =0.14. Warfarin was
in multivariate analysis significantly associated with major bleeding OR
5.18 (CI 1.06-25.43), p. =0.043. 90-day mortality was comparable between
groups 8 (4.7%) vs. 6 (3.7%), p. =0.79. Conclusions: Our results suggest
that aspirin might be equally effective as warfarin in preventing
thromboembolic events after BAVR, but with less major bleedings. Although
this is numerically the largest trial testing this hypothesis in a
prospective randomized trial, further adequately powered studies are
warranted. Copyright &#xa9; 2016 Elsevier Ltd.

<78>
Accession Number
613926582
Author
Iyengar S.S.; Gupta R.; Ravi S.; Thangam S.; Alexander T.; Manjunath C.N.;
Keshava R.; Patil C.B.; Sheela A.; Sawhney J.P.S.
Institution
(Iyengar) Manipal Hospital, Bangalore, India
(Gupta) Eterna Heart Care Centre and Research Institute, Jaipur, India
(Ravi) Lotus Clinical Research Academy, Bangalore, India
(Thangam) Norwich Clinical Services, Bangalore, India
(Alexander) Kovai Medical Center and Hospital, Coimbatore, India
(Manjunath) Sri Jaideva Institute of Cardiovascular Sciences and Research,
Bangalore, India
(Keshava) Fortis Hospital, Bangalore, India
(Patil) St Philomena Hospital, Bangalore, India
(Sheela) PS Mission Hospital, Ernakulam, India
(Sawhney) Sir Gangaram Hospital, New Delhi, India
Title
Premature coronary artery disease in India: Coronary artery disease in the
young (CADY) registry.
Source
Indian Heart Journal. (no pagination), 2016. Date of Publication: November
03, 2015.
Publisher
Elsevier B.V.
Abstract
Background: Coronary artery disease (CAD) occurs at younger age in India
but only a limited number of studies have evaluated risk factors and
management status. This is a multisite observational registry to assess
risk factors and treatment patterns in young patients presenting with
acute coronary syndrome (ACS) and stable ischemic heart disease (IHD).
Methods: We recruited 997 young patients (men <55, women <65. y)
presenting with ACS or stable IHD successively at 22 centers across India.
Details of baseline risk factors and management status were obtained.
Descriptive statistics are reported. Results: Mean age of participants was
49.1. +/-. 8y, 72% were men and 68% had ACS. Family history of CAD was in
50%, diabetes 44%, hypertension 49%, history of dyslipidemia 11%,
smoking/tobacco use 39%, and sedentary habits in 20%. 1.3% had "possible
familial hypercholesterolemia". Metabolic risk factors (high BMI, diabetes
and hypertension) were significantly greater in women (p < 0.01). Women
were older at diagnosis of CAD and presented more often with non-ST
elevation ACS. In the study cohort antiplatelet use was in 85%,
beta-blockers 38%, statins 63% and ACE inhibitors/ARBs in 41% while in ACS
patients it was 80.5%, 54.6%, 80.8% and 40.8%, respectively. 35.9%
patients underwent percutaneous coronary intervention while coronary
bypass surgery was performed in 10.4%. Conclusions: Conventional risk
factors including family history continue to play a pivotal role in
premature CAD in Indians. Women have more of metabolic risk factors,
present at a later age and have non-ST elevation ACS more often. There is
a need to focus on improving use of evidence-based drug therapies and
interventions. Copyright &#xa9; 2016.

<79>
Accession Number
613880897
Author
Sundermann S.H.; Czesla M.; Kempfert J.; Walther T.; Nataf P.; Raanani E.;
Jacobs S.; Alfieri O.; Maisano F.; Falk V.
Institution
(Sundermann, Kempfert, Jacobs, Falk) Department of Cardiothoracic and
Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1,
Berlin 13353, Germany
(Sundermann, Jacobs, Falk) DZHK (German Centre for Cardiovascular
Research), Partner Site Berlin, Berlin, Germany
(Czesla) Klinikum Passau, Department of Cardiac Surgery. Innstrasse 76,
Passau 94032, Germany
(Walther) Department of Cardiac Surgery, Kerckhoff-Klinik, Benekestr. 2-8,
Bad Nauheim 61231, Germany
(Nataf) Department of Cardiac Surgery, Assistance Publique-Hopitaux de
Paris, Bichat Hospital, Paris, France
(Raanani) Department of Cardiac Surgery, Sheba Medical Center,
Tel-Hashomer, Israel
(Alfieri) Department of Cardiovascular Surgery, San Raffaele Hospital,
Milan, Italy
(Maisano) University Hospital of Zurich, Heart Center, Zurich, Switzerland
(Falk) Charite, Universitatsmedizin Berlin, Berlin, Germany
Title
Results of mitral valve repair with an adjustable annuloplasty ring 2
years after implantation.
Source
Heart and Vessels. (pp 1-7), 2016. Date of Publication: 23 Dec 2016.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Abstract: We aimed to investigate the safety and medium-term durability of
an adjustable mitral annuloplasty ring in patients undergoing surgery for
mitral valve regurgitation. Forty-five patients requiring mitral valve
repair were enrolled into this prospective, multicentre study between May
2012 and May 2013 in six hospitals in Europe and Israel. Study endpoints
evaluated the performance and safety of the device assessed using
inter-individual comparisons. Implantation was performed through a
sternotomy in ten patients and mini-thoracotomy in 35 patients. The ring
was adjusted after declamping and weaning from cardio-pulmonary bypass
under echocardiographic guidance if the coaptation surface was not
optimal, or in cases of residual mitral regurgitation. Follow-up was
performed up to 2 years post-procedure. Mean age was 61 +/- 12 years. Ring
adjustment was performed in 71% of patients to optimise the results of
mitral valve repair. Following the procedure, 11/45 patients (24%) who had
had mild residual mitral regurgitation had no mitral regurgitation
following ring adjustment. Two patients with severe mitral regurgitation
post-procedure had mild regurgitation following ring adjustment.
Coaptation length increased significantly after adjustment. One patient
died before hospital discharge due to complications unrelated to the
adjustable ring. One patient had to undergo re-operation at 39 days
post-procedure due to endocarditis. At 2 years of follow-up, 78% of
patients had no residual mitral regurgitation and 22% had mild residual
mitral regurgitation. Adjustable mitral annuloplasty ring implantation was
safe in all patients. Mitral valve repair with the adjustable ring was
durable in all patients who reached 2 years follow-up. Clinical Trial
Registration: NCT01617720. Copyright &#xa9; 2016 Springer Japan

<80>
Accession Number
613877561
Author
Boeder N.F.; Dorr O.; Rixe J.; Weipert K.; Bauer T.; Bayer M.; Hamm C.W.;
Nef H.M.
Institution
(Boeder, Dorr, Rixe, Weipert, Bauer, Bayer, Hamm, Nef) Department of
Cardiology, University Hospital of Giessen, Giessen, Germany
Title
Endocarditis after interventional repair of the mitral valve: Review of a
dilemma.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2016. Date of
Publication: September 27, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The MitraClip procedure can be an alternative treatment option
for patients with high surgical risk for whom surgical treatment is
contraindicated. Patients with prosthetic material have an increased risk
for infective endocarditis. Hypothesis: Incidence, treatment and outcome
of patients with endocarditis after interventional mitral valve repair are
not known. Methods: We searched for articles using PubMed using the terms
interventional mitral valve repair, mitraclip and endocarditis. We have
also searched for case reports in major congresses. Furthermore, we report
two cases. Results: Four cases of IE after MitraClip were found in
addition to our cases. The leading cause is a bacterial infection,
typically with staphylococcal bacteria. Approximately two thirds of these
patients underwent surgery. Short-term outcome seems to be reasonable for
these patients. During the early postoperative period and if .
Staphylococcus aureus can be cultivated mortality seems to be
significantly elevated. Conclusion: IE after MitraClip procedure is a
dilemma. While surgical bail-out seems to be the favorable treatment
option, patients were rejected conventional surgery in first place due to
their high operative risk. Best treatment recommendation must be made on
an individual basis. Predisposing factors should be conscientiously
addressed prior to the procedure. Copyright &#xa9; 2016 Elsevier Inc.

<81>
Accession Number
613867714
Author
Lazam S.; Vanoverschelde J.-L.; Tribouilloy C.; Grigioni F.; Suri R.M.;
Avierinos J.-F.; de Meester C.; Barbieri A.; Rusinaru D.; Russo A.;
Pasquet A.; Michelena H.I.; Huebner M.; Maalouf J.; Clavel M.-A.;
Szymanski C.; Enrziquez-Sarano M.
Institution
(Lazam) 1Universite Catholique de Louvain, Brussels, Belgium; 2Mayo Clinic
College of Medicine, Rochester, MN; 3University of Bologna, Bologna,
Italy; 4Inserm, ERI-12, University Hospital, Amiens, France;
5Aix-Marseille Universite, Marseille, France; 6University of Modena,
Modena, Italy; 7Cleveland Clinic, Department of Thoracic and Cardiac
Surgery, Cleveland, OH
Title
Twenty-Year Outcome after Mitral Repair Versus Replacement for Severe
Degenerative Mitral Regurgitation: Analysis of a Large, Prospective,
Multicenter International Registry.
Source
Circulation. (no pagination), 2016. Date of Publication: 21 Dec 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: Mitral valve (MV) repair is preferred over replacement in
clinical guidelines and is an important determinant of the indication for
surgery in degenerative mitral regurgitation (MR). Yet, the level of
evidence supporting current recommendations is low, and recent data cast
doubts on its validity in the current era. Accordingly, the aim of the
present study was to analyze very long-term outcome after MV repair and
replacement for degenerative MR with a flail leaflet. METHODS-: MIDA is a
multicenter registry enrolling patients with degenerative MR with a flail
leaflet in 6 tertiary European and US centers. We analyzed the outcome
after MV repair (n=1,709) and replacement (n= 213), overall, by propensity
score matching and by inverse probability-of-treatment weighting.
RESULTS-: At baseline, patients undergoing MV repair were younger, had
more comorbidities and were more likely to present with a posterior
leaflet prolapse than those undergoing MV replacement. After propensity
score matching as well as after inverse probability-of-treatment
weighting, the 2 treatments groups were balanced and absolute standardized
differences were usually below 10%, indicating adequate match. Operative
mortality (defined as a death occurring within 30 days from surgery or
during the same hospitalization) was lower after MV repair than after
replacement, both in the entire (1.3 vs 4.7%; p<0.001) and in
propensity-matched population (0.2% vs 4.4%; p<0.001). During a mean
follow-up of 9.2 years, 552 deaths were observed, of which 207 were of
cardiovascular origin. Twenty-year survival was better after MV repair
than after MV replacement, both in the entire (46% vs 23%, p<0.001) and in
matched population (41% vs 24%, p<0.001). Similar superiority of MV repair
were obtained in patients' subsets based on age, sex or any stratification
criteria (all p<0.001). MV repair was also associated with reduced
incidence of reoperations and valve-related complications. CONCLUSIONS-:
Among patients with degenerative MR with a flail leaflet, referred to
mitral surgery, MV repair was associated with lower operative mortality,
better long-term survival and fewer valve-related complications compared
to MV replacement. Copyright &#xa9; 2016 by the American College of
Cardiology Foundation and the American Heart Association, Inc.

<82>
Accession Number
613864823
Author
Maniotis C.; Andreou C.; Karalis I.; Koutouzi G.; Agelaki M.; Koutouzis M.
Institution
(Maniotis, Agelaki, Koutouzis) 2nd Cardiology Department, Hellenic Red
Cross Hospital of Athens, Athens, Greece
(Andreou, Karalis) Interventional Cardiology Department, University
Hospital of Leiden, Leiden, The Netherlands
(Koutouzi) Interventional Radiology Department, Sahlgrenska University
Hospital, Gothenburg, Sweden
Title
A systematic review on the safety of Prostar XL versus ProGlide after TAVR
and EVAR.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2016. Date of
Publication: October 17, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Endovascular aortic aneurysm repair (EVAR) and transfemoral
transcatheter aortic valve replacement (TAVR) are widely spreading
minimally invasive procedures performed mainly through the femoral artery.
Prostar XL and ProGlide vascular closure devices are used in clinical
practice for the hemostasis in these procedures and they have been shown
to be safe and effective. Purpose: The aim of our systematic review is to
compare the safety of these two devices for percutaneous closure of large
arteriotomies in patients undergoing TAVR and EVAR. Methods: We searched
PubMed, EMBASE, Google Scholar and the Cochrane Central Register of
Controlled Trials for all randomized and observational published studies
that compared Prostar XL vs. ProGlide. Relative risk was calculated by
random-effects model. Review Manager 5.1 was used for statistical
analysis. Results: A total number of 2909 patients were included in our
analysis. The rate of overall vascular complications did not differ
between Prostar XL and ProGlide (RR 1.35 (0.80-2.29), p. =0.27). In
contrary, the risk ratio of all bleeding complications with Prostar XL
compared to ProGlide was 1.82 (1.47-2.24, p. <. 0.001) and for major and
life-threatening bleeding complications was 2.48 (1.65-3.73, p. <. 0001,
suggesting a lower bleeding risk with ProGlide). No statistical difference
was found between groups for end-stage acute kidney injury (AKI), with a
risk ratio of 2.14 (0.81-5.66), p. =0.05. Finally, there were no
differences in in-hospital and 30-days mortality rate between the two
groups (1.41, 0.56-3.54, p. =0.46 and 1.43, 0.55-3.73, p. =0.47,
respectively). Conclusions: Prostar XL is associated with greater risk of
any bleeding as well as life threatening bleeding compared to the ProGlide
device. However, no significant differences were observed in the rate of
overall vascular complications, end stage AKI and in-hospital and 30-days
mortality. Copyright &#xa9; 2016 Elsevier Inc.

<83>
Accession Number
613864102
Author
Ohya M.; Kadota K.; Toyofuku M.; Morimoto T.; Higami H.; Fuku Y.; Yamaji
K.; Muranishi H.; Yamaji Y.; Nishida K.; Furukawa D.; Tada T.; Ko E.; Ando
K.; Sakamoto H.; Tamura T.; Kawai K.; Kimura T.
Institution
(Ohya, Kadota, Fuku) Department of Cardiology, Kurashiki Central Hospital,
Kurashiki, Japan
(Toyofuku, Ko, Tamura) Department of Cardiology, Japanese Red Cross
Society Wakayama Medical Center, Wakayama, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
(Higami, Kimura) Department of Cardiovascular Medicine, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
(Yamaji, Muranishi, Yamaji, Ando) Department of Cardiology, Kokura
Memorial Hospital, Kokura, Japan
(Nishida, Furukawa, Kawai) Department of Cardiology, Chikamori Hospital,
Kochi, Japan
(Tada, Sakamoto) Department of Cardiology, Shizuoka General Hospital,
Shizuoka, Japan
Title
Long-Term Outcomes After Stent Implantation for Left Main Coronary Artery
(from the Multicenter Assessing Optimal Percutaneous Coronary Intervention
for Left Main Coronary Artery Stenting Registry).
Source
American Journal of Cardiology. (no pagination), 2016. Date of
Publication: August 10, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We assessed long-term outcomes after left main coronary artery (LMCA)
stenting based on lesion types and stenting strategies. In the Assessing
Optimal percutaneous coronary Intervention for Left Main Coronary Artery
stenting registry, we evaluated 1,607 consecutive patients undergoing
stent implantation for unprotected LMCA lesions (bifurcation lesions: n =
1318 and nonbifurcation lesions: n = 289). Among the bifurcation lesions,
1,281 lesions were treated with stenting across the bifurcation
(bifurcation 1-stent strategy: n = 999 or bifurcation 2-stent strategy: n
= 282). Among the nonbifurcation lesions, 219 lesions were treated with
nonbifurcation stenting. The median follow-up duration was 4.6 (95% CI 4.5
to 4.8) years. The 5-year risk of bifurcation lesions relative to
nonbifurcation lesions was neutral for target lesion revascularization
(TLR) (adjusted hazard ratio [HR] 0.82, 95% CI 0.55 to 1.23, p = 0.34) and
all-cause death (adjusted HR 1.22, 95% CI 0.87 to 1.71, p = 0.26). The
risk of the bifurcation 1-stent strategy relative to nonbifurcation
stenting in nonbifurcation lesions was also neutral for TLR (adjusted HR
1.19, 95% CI 0.74 to 1.90, p = 0.47) and all-cause death (adjusted HR
0.81, 95% CI 0.56 to 1.18, p = 0.27). However, the bifurcation 2-stent
strategy was associated with worse clinical outcomes than the bifurcation
1-stent strategy in TLR (adjusted HR 1.76, 95% CI 1.23 to 2.52, p = 0.002)
and definite or probable stent thrombosis (crude HR 3.50, 95% CI 1.32 to
9.33, p = 0.01), despite neutral risk for all-cause death (adjusted HR
1.00, 95% CI 0.74 to 1.36, p = 0.99). There was no definite or probable
very late stent thrombosis up to 5 years. In conclusion, long-term
outcomes after stent implantation for unprotected LMCA lesions were not
dependent on the bifurcation lesion types but related to the bifurcation
stenting strategies with worse outcomes for the bifurcation 2-stent
strategy. Copyright &#xa9; 2016 Elsevier Inc.

<84>
Accession Number
613853263
Author
Lin C.-Y.; Yaseri M.; Pakpour A.H.; Malm D.; Brostrom A.; Fridlund B.;
Burri A.; Webb T.L.
Institution
(Lin) Department of Rehabilitation Sciences, Faculty of Health and Social
Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
(Yaseri) Department of Epidemiology and Biostatistics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Pakpour) Social Determinants of Health Research Center, Qazvin University
of Medical Sciences, Shahid Bahounar BLV, Qazvin 3419759811, Iran, Islamic
Republic of
(Pakpour, Malm, Brostrom) Department of Nursing, School of Health and
Welfare, Jonkoping University, Jonkoping, Sweden
(Malm) Department of Internal Medicine, Country Hospital Ryhov, Jonkoping,
Sweden
(Fridlund) School of Health and Welfare, Jonkoping University, Jonkoping,
Sweden
(Burri) Health and Rehabilitation Research Institute, Auckland University
of Technology, Auckland, New Zealand
(Burri) Department of Anaesthesia and Perioperative Medicine, Waitemata
Pain Service, North Shore Hospital, Auckland, New Zealand
(Webb) Department of Psychology, The University of Sheffield, Sheffield,
United Kingdom
Title
Can a Multifaceted Intervention Including Motivational Interviewing
Improve Medication Adherence, Quality of Life, and Mortality Rates in
Older Patients Undergoing Coronary Artery Bypass Surgery? A Multicenter,
Randomized Controlled Trial with 18-Month Follow-Up.
Source
Drugs and Aging. (pp 1-14), 2016. Date of Publication: 21 Dec 2016.
Publisher
Springer International Publishing
Abstract
Background: Patients undergoing coronary artery bypass graft (CABG)
surgery are required to take a complex regimen of medications for extended
periods, and they may have negative outcomes because they struggle to
adhere to this regimen. Designing effective interventions to promote
medication adherence in this patient group is therefore important.
Objective: The present study aimed to evaluate the long-term effects of a
multifaceted intervention (psycho-education, motivational interviewing,
and short message services) on medication adherence, quality of life
(QoL), and mortality rates in older patients undergoing CABG surgery.
Methods: Patients aged over 65 years from 12 centers were assigned to the
intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups
using cluster randomization at center level. Medication adherence was
evaluated using the Medication Adherence Rating Scale (MARS), pharmacy
refill rate, and lipid profile; QoL was evaluated using Short Form-36.
Data were collected at baseline; 3, 6, and 18 months after intervention.
Survival status was followed up at 18 months. Multi-level regressions and
survival analyses for hazard ratio (HR) were used for analyses. Results:
Compared with patients who received TAU, the MARS, pharmacy refill rate,
and lipid profile of patients in the EXP group improved 6 months after
surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL
also increased among patients in the EXP group as compared with those who
received TAU at 18 months post-surgery (physical component summary score p
= 0.02; mental component summary score p = 0.04). HR in the EXP group
compared with the TAU group was 0.38 (p = 0.04). Conclusion: The findings
suggest that a multifaceted intervention can improve medication adherence
in older patients undergoing CABG surgery, with these improvements being
maintained after 18 months. QoL and survival rates increased as a function
of better medication adherence. ClinicalTrials.gov NCT02109523. Copyright
&#xa9; 2016 Springer International Publishing Switzerland