EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
610439704
Author
Neupane I.; Arora R.C.; Rudolph J.L.
Institution
(Neupane, Rudolph) Center of Innovation in Long Term Services and Support,
Providence VA Medical Center, Providence, RI, United States
(Arora) University of Manitoba, College of Medicine, Department of
Surgery, Winnipeg, Manitoba, Canada
(Neupane, Rudolph) Warren Alpert School of Medicine at Brown University,
Providence, RI, United States
Title
Cardiac surgery as a stressor and the response of the vulnerable older
adult.
Source
Experimental Gerontology. Part B. 87 (pp 168-174), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
In an aging population, recovery and restoration of function are critical
to maintaining independence. Over the past 50 years, there have been
dramatic improvements made in cardiac surgery processes and outcomes that
allow for procedures to be performed on an increasingly older population
with the goal of improving function. Although improved function is
possible, major surgical procedures are associated with substantial
stress, which can severely impact outcomes. Past literature has identified
that frail patients, who are vulnerable to the stress of surgery, are more
likely to have postoperative major adverse cardiac and cerebrovascular
events (OR 4.9, 95% confidence interval 1.6, 14.6). The objective of this
manuscript is to examine preoperative frailty in biological,
psychological, and social domains using cardiac surgery to induce stress.
We systematically searched PubMed for keywords including "cardiac surgery,
frailty, and aged" in addition to the biological, psychological, and
social keywords. In the biological domain, we examine the association of
physiological and physical vulnerabilities, as well as, the impact of
comorbidities and inflammation on negative surgical outcomes. In the
psychological domain, the impact of cognitive impairment, depression, and
anxiety as vulnerabilities were examined. In the social domain, social
structure, coping, disparities, and addiction as vulnerabilities are
described. Importantly, there is substantial overlap in the domains of
vulnerability. While frailty research has largely focused on discrete
physical vulnerability criteria, a broader definition of frailty
demonstrates that vulnerabilities in biological, psychological, and social
domains can limit recovery after the stress of cardiac surgery.
Identification of vulnerability in these domains can allow better
understanding of the risks of cardiac surgery and tailoring of
interventions to improve outcomes. Copyright &#xa9; 2016

<2>
Accession Number
610546434
Author
Martin S.S.; Albrecht M.H.; Wichmann J.L.; Husers K.; Scholtz J.-E.; Booz
C.; Bodelle B.; Bauer R.W.; Metzger S.C.; Vogl T.J.; Lehnert T.
Institution
(Martin, Albrecht, Wichmann, Husers, Scholtz, Booz, Bodelle, Bauer,
Metzger, Vogl, Lehnert) Department of Diagnostic and Interventional
Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt
60590, Germany
Title
Value of a noise-optimized virtual monoenergetic reconstruction technique
in dual-energy CT for planning of transcatheter aortic valve replacement.
Source
European Radiology. 27 (2) (pp 705-714), 2017. Date of Publication: 01 Feb
2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objectives: To evaluate objective and subjective image quality of a
noise-optimized virtual monoenergetic imaging (VMI+) reconstruction
technique in dual-energy computed tomography (DECT) angiography prior to
transcatheter aortic valve replacement (TAVR). Methods: Datasets of 47
patients (35 men; 64.1 +/- 10.9 years) who underwent DECT angiography of
heart and vascular access prior to TAVR were reconstructed with standard
linear blending (F_0.5), VMI+, and traditional monoenergetic (VMI)
algorithms in 10-keV intervals from 40-100 keV. Signal-to-noise ratio
(SNR) and contrast-to-noise ratio (CNR) of 564 arterial segments were
evaluated. Subjective analysis was rated by three blinded observers using
a Likert scale. Results: Mean SNR and CNR were highest in 40 keV VMI+
series (SNR, 27.8 +/- 13.0; CNR, 26.3 +/- 12.7), significantly (all p <
0.001) superior to all VMI series, which showed highest values at 70 keV
(SNR, 18.5 +/- 7.6; CNR, 16.0 +/- 7.4), as well as linearly-blended F_0.5
series (SNR, 16.8 +/- 7.3; CNR, 13.6 +/- 6.9). Highest subjective image
quality scores were observed for 40, 50, and 60 keV VMI+ reconstructions
(all p > 0.05), significantly superior to all VMI and standard
linearly-blended images (all p < 0.01). Conclusions: Low-keV VMI+
reconstructions significantly increase CNR and SNR compared to VMI and
standard linear-blending image reconstruction and improve subjective image
quality in preprocedural DECT angiography in the context of TAVR planning.
Key Points: * VMI+ combines increased contrast with reduced image noise. *
VMI+ shows substantially less image noise than traditional VMI. * 40-keV
reconstructions show highest SNR/CNR of the aortic and iliofemoral access
route. * Observers overall prefer 60 keV VMI+ images. * VMI+ DECT imaging
helps improve image quality for TAVR planning. Copyright &#xa9; 2016,
European Society of Radiology.

<3>
Accession Number
612978344
Author
Ando T.; Takagi H.
Institution
(Ando) Department of Internal Medicine, Mount Sinai Beth Israel Medical
Center, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Title
The Prognostic Impact of New-Onset Persistent Left Bundle Branch Block
Following Transcatheter Aortic Valve Implantation: A Meta-analysis.
Source
Clinical Cardiology. 39 (9) (pp 544-550), 2016. Date of Publication: 01
Sep 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
New-onset persistent left bundle branch block (NOP-LBBB) is one of the
most common conduction disturbances after transcatheter aortic valve
implantation (TAVI). We hypothesized that NOP-LBBB may have a clinically
negative impact after TAVI. To find out, we conducted a systematic
literature search of the MEDLINE/PubMed and Embase databases.
Observational studies that reported clinical outcomes of NOP-LBBB patients
after TAVI were included. The random-effects model was used to combine
odds ratios, risk ratios, or hazard ratios (HRs) with 95% confidence
intervals. Adjusted HRs were utilized over unadjusted HRs or risk ratios
when available. A total of 4049 patients (807 and 3242 patients with and
without NOP-LBBB, respectively) were included. Perioperative (in-hospital
or 30-day) and midterm all-cause mortality and midterm cardiovascular
mortality were comparable between the groups. The NOP-LBBB patients
experienced a higher rate of permanent pacemaker implantation (HR: 2.09,
95% confidence interval: 1.12-3.90, P = 0.021, I² = 83%) during
midterm follow-up. We found that NOP-LBBB after TAVI resulted in higher
permanent pacemaker implantation but did not negatively affect the midterm
prognosis. Therefore, careful observation during the follow-up is
required. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<4>
Accession Number
612732470
Author
Gueret P.; Combe S.; Krezel C.; Fuseau E.; van Giersbergen P.L.M.; Petitou
M.; Neuhart E.
Institution
(Gueret) Haemostasis Department, University Hospital Pontchaillou, 2 rue
Henri Le Guilloux, Rennes Cedex 35033, France
(Combe) University Hospital Cochin, Paris, France
(Krezel, Petitou, Neuhart) Endotis Pharma, Romainville, Paris, France
(Fuseau) EMF Consulting, Aix en Provence, France
(van Giersbergen) Van Giersbergen Consulting, Wuenheim, France
(Gueret) GETBO EA 3878, Brest, France
Title
Neutralization of EP217609, a new dual-action FIIa/FXa anticoagulant, by
its specific antidote avidin: a phase I study.
Source
European Journal of Clinical Pharmacology. 73 (1) (pp 15-28), 2017. Date
of Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Introduction: EP217609 is a representative of a new class of synthetic
parenteral anticoagulants with a dual mechanism of action. It combines in
a single molecule a direct thrombin inhibitor and an indirect factor Xa
inhibitor. EP217609 can be neutralized by a specific antidote avidin,
which binds to the biotin moiety of EP217609. Purpose: The primary
objective was to assess the neutralization of EP217609 by avidin in
healthy subjects. Secondary objectives were to define the optimal avidin
monomer/EP217609 molar ratio to achieve an adequate neutralization of
EP217609 and to assess the safety and tolerability of EP217609 and avidin.
Methods: Healthy subjects (n = 36) were randomized to a 3 by 3 replicated
Latin square design between 3 EP217609 doses (4, 8, 12 mg) and 3 avidin
monomer/EP217609 molar ratios (1:1; 2:1; 3:1). EP217609 was administered
as a single intravenous bolus, and avidin as a 30-min intravenous
infusion, starting 90 min after EP217609 administration. Results: Overall,
EP217609 and avidin were well tolerated. One subject experienced a benign
and transient typical pseudo-allergic reaction. The administration of
EP217609 resulted in dose-dependent increases in pharmacodynamic markers.
Avidin triggered a rapid and irreversible neutralization of EP217609
without rebound effect. Adequate neutralization of the anticoagulant
activity was achieved with both 2:1 and 3:1 avidin monomer/EP217609 molar
ratios. All safety parameters did not show any treatment-emergent
clinically relevant changes or abnormalities in any dose group.
Conclusions: These results will allow further investigation in patients
requiring a neutralizable anticoagulant as those undergoing cardiac
surgery. Study registration: EudraCT number 2010-020216-10. Copyright
&#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<5>
Accession Number
607683846
Author
Horton J.D.; Kolbel T.; Haulon S.; Khoynezhad A.; Green R.M.; Borger M.A.;
Mussa F.F.
Institution
(Horton) Department of Surgery, New York University School of Medicine,
New York, New York, United States
(Kolbel) University Heart Center Hamburg, Hamburg, Germany
(Haulon) Aortic Center, Universite Lille Nord de France, Lille, France
(Khoynezhad) Department of Cardio-thoracic Surgery, Cedars-Sinai Heart
Institute, Los Angeles, California, United States
(Green, Borger, Mussa) Department of Surgery, Columbia University Medical
Center Surgery, New York, New York, United States
Title
Endovascular Repair of Type A Aortic Dissection: Current Experience and
Technical Considerations.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (2) (pp 312-317),
2016. Date of Publication: 02 Feb 2016.
Publisher
W.B. Saunders
Abstract
Dissection of the ascending aorta, type A aortic dissection (TAAD),
represents a surgical emergency with high morbidity and mortality. Current
open surgical techniques, although state-of-the-art procedures and having
improved outcomes for patients with TAAD over the last decades, confer
significant risk of complications and death. Recently, endovascular
techniques for repair of both the abdominal and thoracic aorta have gained
acceptance within the vascular and cardiovascular surgical communities as
a useful tool in select pathologies and patient populations. As
development of endovascular technology proceeds ever closer to the aortic
valve, thoracic endovascular repair for TAAD deserves special
investigation. A comprehensive literature search for studies reporting
outcomes of endovascular repair in the ascending aorta was performed. In
this review, we compile the worldwide experience of thoracic endovascular
repair for TAAD as well as imaging studies for patient selection and the
use of hybrid (open plus endovascular) techniques. The authors discuss the
remaining challenges that preclude its broader adoption in this role,
namely patient selection and device specificity. Copyright &#xa9; 2016
Elsevier Inc.

<6>
Accession Number
611440414
Author
Weaver F.A.; Abraham W.T.; Little W.C.; Butter C.; Ducharme A.; Halbach
M.; Klug D.; Lovett E.G.; Madershahian N.; Muller-Ehmsen J.; Schafer J.E.;
Senni M.; Swarup V.; Wachter R.; Zile M.R.
Institution
(Weaver) Division of Vascular Surgery and Endovascular Therapy, Keck
School of Medicine, University of Southern California, Los Angeles,
California, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, Ohio, United States
(Little) Division of Cardiology, University of Mississippi Medical Center,
Jackson, Mississippi, United States
(Butter) Department of Cardiology, Immanuel Heart Center Bernau-Medical
School, Brandenburg, Bernau, Germany
(Ducharme) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Halbach) Department of Internal Medicine III, University Hospital of
Cologne, Cologne, Germany
(Klug) Department of Cardiology, University HospitalLilleFrance
(Lovett) Department of Research, CVRx, Inc.%, Minneapolis, Minnesota,
United States
(Madershahian) Department of Cardiothoracic Surgery, Cologne University
Heart Centre, Cologne, Germany
(Muller-Ehmsen) Department of Medicine, Asklepios Klinik Altona, Hamburg,
Germany
(Schafer) Department of Statistics, NAMSA, Inc.%, Minneapolis, Minnesota,
United States
(Senni) Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo,
Italy
(Swarup) Department of Electrophysiology, Arizona Heart Hospital, Phoenix,
Arizona, United States
(Wachter) Clinic for Cardiology and Pneumology, German Cardiovascular
Research Center (DZHK), University Medicine Gottingen, Gottingen, Germany
(Zile) Medical University of South Carolina, Charleston, South Carolina,
United States
(Zile) Ralph H. Johnson Department of Veterans Affairs Medical Center,
Charleston, South Carolina, United States
Title
Surgical Experience and Long-term Results of Baroreflex Activation Therapy
for Heart Failure With Reduced Ejection Fraction.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (2) (pp 320-328),
2016. Date of Publication: 02 Feb 2016.
Publisher
W.B. Saunders
Abstract
The purpose of this publication is to describe the intraoperative
experience along with long-term safety and efficacy of the
second-generation baroreflex activation therapy (BAT) system in patients
with heart failure (HF) and reduced ejection fraction HF (HFrEF). In a
randomized trial of New York Heart Association Class III HFrEF, 140
patients were assigned 1:1 to receive BAT plus medical therapy or medical
therapy alone. Procedural information along with safety and efficacy data
were collected and analyzed over 12 months. Within the cohort of 71
patients randomized to BAT, implant procedure time decreased with
experience, from 106 +/- 37 minutes on the first case to 83 +/- 32 minutes
on the third case. The rate of freedom from system- and procedure-related
complications was 86% through 12 months, with the percentage of days alive
without a complication related to system, procedure, or underlying
cardiovascular condition identical to the control group. The complications
that did occur were generally mild and short-lived. Overall, 12 months
therapeutic benefit from BAT was consistent with previously reported
efficacy through 6 months: there was a significant and sustained
beneficial treatment effect on New York Heart Association functional
Class, quality of life, 6-minute hall walk distance, plasma N-terminal
pro-brain natriuretic peptide, and systolic blood pressure. This was true
for the full trial cohort and a predefined subset not receiving cardiac
resynchronization therapy. There is a rapid learning curve for the
specialized procedures entailed in a BAT system implant. BAT system
implantation is safe with the therapeutic benefits of BAT in patients with
HFrEF being substantial and maintained for at least 1 year. Copyright
&#xa9; 2016 The Authors

<7>
Accession Number
610936945
Author
Chowdhury S.M.; Graham E.M.; Atz A.M.; Bradley S.M.; Kavarana M.N.; Butts
R.J.
Institution
(Chowdhury, Graham, Atz, Butts) Department of Pediatrics, Medical
University of South Carolina, Charleston, South Carolina, United States
(Bradley, Kavarana) Division of Pediatric Cardiothoracic Surgery,
Department of Surgery, Medical University of South Carolina, Charleston,
South Carolina, United States
Title
Validation of a Simple Score to Determine Risk of Hospital Mortality After
the Norwood Procedure.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (2) (pp 425-433),
2016. Date of Publication: 02 Feb 2016.
Publisher
W.B. Saunders
Abstract
The ability to quantify patient-specific hospital mortality risk before
the Norwood procedure remains elusive. This study aimed to develop an
accurate and clinically feasible score to assess the risk of hospital
mortality in neonates undergoing the Norwood procedure. All patients (n =
549) in the publically available Pediatric Heart Network Single Ventricle
Reconstruction trial database were included in the analysis. Patients were
randomly divided into a derivation (75%) and validation (25%) cohort.
Preoperative factors found to be associated with mortality upon
univariable analysis (P < 0.2) were included in the logistic regression
model. The score was derived by including variables independently
associated with mortality (P < 0.05). A 20-point score using 6 variables
(birth weight, clinical syndrome or abnormal karyotype, surgeon Norwood
volume or year, anatomic subtype, ascending aorta size, and obstructed
pulmonary venous return) was developed using relative magnitudes of the
covariates' odds ratio. The score was then tested in the validation
cohort. In weighted regression analysis, model predicted risk of mortality
correlated closely with actual rates of mortality in the derivation
(R² = 0.87, P < 0.01) and validation cohorts (R² =
0.82, P < 0.01). Patients were classified as low (score: 0-5), medium
(6-10), or high risk (>10). Mortality differed significantly between risk
groups in both the derivation (6% vs 22% vs 77%, P < 0.01) and validation
(4% vs 30% vs 53%, P < 0.01) cohorts. This mortality score is accurate in
determining risk of hospital mortality in neonates undergoing planned
Norwood operations. The score has the potential to be used in clinical
practice to aid in risk assessment before surgery. Clinical trial
registration URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00115934. Copyright &#xa9; 2016 Elsevier Inc.

<8>
Accession Number
613630408
Author
Davis E.; Gorog D.A.; Rihal C.; Prasad A.; Srinivasan M.
Institution
(Davis) Department of Cardiology, Papworth Hospital, Papworth Everard,
United Kingdom
(Gorog, Srinivasan) Hertfordshire Cardiology Centre, Lister Hospital,
Stevenage, United Kingdom
(Gorog) Imperial College, London, United Kingdom
(Gorog) University of Hertfordshire, Herts, United Kingdom
(Rihal, Prasad) The Division of Cardiovascular Diseases and Department of
Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, United
States
Title
"Mind the gap" acute coronary syndrome in women: A contemporary review of
current clinical evidence.
Source
International Journal of Cardiology. 227 (pp 840-849), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
The incidence and prevalence of coronary artery disease in women has
exceeded that in men over the past four decades, and although a
significant decline in mortality has occurred in the past two decades,
there is a growing body of evidence suggesting that there are gender
differences between the clinical manifestations and course of coronary
artery disease, as well as differences in treatment and treatment
response. This review article considers the current literature regarding
the gender-specific manifestation of acute coronary syndromes. Through the
review of basic science articles, subsets of trial data, and
meta-analyses, the gender-specific differences in within acute coronary
syndromes are considered in terms of diagnostic dilemmas, pathophysiology,
and treatment options (including pharmacological, percutaneous and
surgical methods). Finally, acute coronary syndromes and their management
in the special circumstance of pregnancy are also reviewed. Copyright
&#xa9; 2016 Elsevier Ireland Ltd

<9>
Accession Number
613630461
Author
Kim T.K.; Min J.J.; Cho Y.J.; Hausenloy D.J.; Ahn H.; Kim K.-H.; Hwang
H.Y.; Hong D.M.; Jeon Y.
Institution
(Kim, Cho, Hong, Jeon) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Min) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Seoul, South Korea
(Hausenloy) The Hatter Cardiovascular Institute, University College
London, London, United Kingdom
(Hausenloy) The National Institute of Health Research, University College
London Hospitals Biomedical Research Center, London, United Kingdom
(Hausenloy) National Heart Research Institute Singapore, National Heart
Center Singapore, Singapore, Singapore
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore, Singapore
(Ahn, Kim, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul, South Korea
Title
Effects of delayed remote ischemic preconditioning on peri-operative
myocardial injury in patients undergoing cardiac surgery - A randomized
controlled trial.
Source
International Journal of Cardiology. 227 (pp 511-515), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic preconditioning (RIPC) has two time windows for
organ protection: acute and delayed. Previous studies have mainly focused
on the acute time window to evaluate organ protection by RIPC. We
evaluated myocardial protection by delayed RIPC in adult patients
undergoing cardiac surgery. Methods A total of 160 adult patients
undergoing cardiac surgery with cardiopulmonary bypass were randomized to
receive either delayed RIPC (four cycles of 5 min of ischemia followed by
5 min of reperfusion by inflation to 200 mm Hg and deflation of a blood
pressure cuff on the upper arm) or the control treatment 24-48 h before
surgery. The primary endpoint was post-operative troponin I levels
serially measured for 72 h. Secondary endpoints included post-operative
serum creatinine levels, acute kidney injury, and composite complications.
Results There were no significant differences in post-operative troponin I
values. The incidence of acute kidney injury, defined by the Acute Kidney
Injury Network staging system, was lower in the delayed RIPC group
compared to the control group (30.0% vs. 47.5%; relative risk, 0.768; 95%
confidence interval, 0.599-0.985; p = 0.023). Moreover, the occurrence of
composite complications was lower in the delayed RIPC group compared with
the control group (65.0% vs. 81.3%; relative risk, 0.536; 95% confidence
interval, 0.311-0.924; p = 0.020). Conclusions While RIPC did not provide
cardioprotective effects in patients undergoing cardiac surgery, it
appeared to reduce acute kidney injury, as well as the rate of composite
complications. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<10>
Accession Number
613630413
Author
Varho V.; Nammas W.; Kiviniemi T.O.; Sia J.; Romppanen H.; Pietila M.;
Airaksinen J.K.; Karjalainen P.P.
Institution
(Varho, Kiviniemi, Pietila, Airaksinen) Heart Center, Turku University
Hospital, University of Turku, Turku, Finland
(Nammas, Kiviniemi, Karjalainen) Heart Centre, Satakunta Central Hospital,
Pori, Finland
(Sia) Department of Cardiology, Central Ostrobothnia Central Hospital,
Kokkola, Finland
(Romppanen) Cardiology Unit, Kuopio University Hospital, Kuopio, Finland
Title
Comparison of two different sampling intervals for optical coherence
tomography evaluation of neointimal healing response after coronary stent
implantation.
Source
International Journal of Cardiology. 227 (pp 194-200), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background/objectives Optical coherence tomography (OCT) is widely used
for evaluation of healing response to stent implantation. We sought to
test the agreement between the 1-mm and 0.6-mm sampling intervals for
assessment of the percentage of uncovered and malapposed struts by OCT.
Methods Thirty-eight patients presenting with acute coronary syndrome were
randomized to receive either a titanium-nitride-oxide-coated stent (n =
19) or an everolimus-eluting stent (n = 19). Neointimal strut coverage and
strut apposition were evaluated by OCT at 2-month follow-up. Two
independent investigators performed offline OCT image analysis at 1-mm
intervals. One investigator repeated the measurements at 0.6-mm intervals
and measurements were compared between the two sampling intervals. Results
At a median follow-up of 60 [8] days, 694 cross-sections (7603 struts) and
1138 cross-sections (12,331 struts) were analysed at 1-mm and at 0.6-mm
intervals, respectively. The median [IQR] percentage of uncovered struts
was 3.27% [11.1] versus 3.38% [9.76] (p = 0.001), and the mean (+/- SD)
percentage was 7.69 +/- 9.99% versus 6.27 +/- 8.14% (p = 0.004), for the
1-mm sampling interval versus the 0.6-mm sampling interval analysis,
respectively; the median percentage of malapposed struts was 0.42% [2.04]
versus 0.12% [1.63], respectively, (p = 0.003). The intraclass correlation
coefficient between the two observers for the percentage of uncovered
struts was 0.95. Conclusions The OCT-evaluated strut-level measurements of
neointimal healing after stent implantation differ significantly between
the 1-mm and the 0.6-mm sampling intervals. Copyright &#xa9; 2016 Elsevier
Ireland Ltd

<11>
Accession Number
613630402
Author
Banerjee K.; Ghosh R.K.; Kamatam S.; Banerjee A.; Gupta A.
Institution
(Banerjee) Cleveland Clinic, Cleveland, OH, United States
(Ghosh, Kamatam) Department of Internal Medicine, St. Vincent Charity
Medical Center, A Teaching Affiliate of Case Western Reserve University,
Cleveland, OH, United States
(Banerjee) IPGMER, Kolkata, India
(Gupta) Department of Cardiovascular Medicine, St. Vincent Charity Medical
Center, A Teaching Affiliate of Case Western Reserve University,
Cleveland, OH, United States
Title
Role of Ranolazine in cardiovascular disease and diabetes: Exploring
beyond angina.
Source
International Journal of Cardiology. 227 (pp 556-564), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Ranolazine was FDA approved for chronic angina in 2006. Since then, there
has been extensive research involving this drug. The mechanism of action,
debatable at the time of approval, has been demonstrated. Ranolazine acts
via inhibition of late sodium channel current in the myocardium. This acts
by lowering abnormally high cytosolic calcium levels. Other possible
clinical applications of Ranolazine have also been explored. Out of many
lines of investigation, its effects in atrial fibrillation, especially
post-CABG and recurrent atrial fibrillation show promise. It has also
shown definite HbA1c lowering effects when used in diabetics with coronary
artery disease. Other possible indications for the drug include pulmonary
arterial hypertension, diastolic dysfunction and chemotherapy-induced
cardiotoxicity. This review aims to summarize major research regarding
Ranolazine in potential applications beyond chronic angina. There are few
dedicated large, randomized, phase III trials exploring the newer effects
of Ranolazine. There are a few such trials underway, but more are needed.
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<12>
Accession Number
611452806
Author
Danek B.A.; Karatasakis A.; Karmpaliotis D.; Alaswad K.; Jaffer F.A.; Yeh
R.W.; Patel M.P.; Bahadorani J.; Lombardi W.L.; Wyman R.M.; Grantham J.A.;
Kandzari D.E.; Lembo N.J.; Doing A.H.; Toma C.; Moses J.W.; Kirtane A.J.;
Ali Z.A.; Parikh M.; Garcia S.; Nguyen-Trong P.-K.; Karacsonyi J.; Alame
A.J.; Kalsaria P.; Thompson C.; Banerjee S.; Brilakis E.S.
Institution
(Danek, Karatasakis, Nguyen-Trong, Karacsonyi, Alame, Kalsaria, Banerjee,
Brilakis) VA North Texas Health Care System and University of Texas
Southwestern Medical Center, Dallas, Texas, United States
(Karmpaliotis, Moses, Kirtane, Ali, Parikh) Henry Ford Hospital, Detroit,
Michigan, United States
(Alaswad) Columbia University, New York, New York, United States
(Jaffer) Massachusetts General Hospital, Boston, Massachusetts, United
States
(Yeh) Beth Israel Deaconess Medical Center, Boston, Massachusetts, United
States
(Patel, Bahadorani) VA San Diego Healthcare System and University of
California San Diego, La Jolla, California, United States
(Lombardi) PeaceHealth St Joseph Medical Center, Bellingham, Washington,
United States
(Wyman) Torrance Memorial Medical Center, Torrance, California, United
States
(Grantham) Mid America Heart Institute, Kansas City, Missouri, United
States
(Kandzari, Lembo) Piedmont Heart Institute, Atlanta, Georgia, United
States
(Doing) Medical Center of the Rockies, Loveland, Colorado, United States
(Toma) University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania,
United States
(Garcia) Minneapolis VA Health Care System and University of Minnesota,
Minneapolis, Minnesota, United States
(Thompson) Boston Scientific, Natick, Massachusetts, United States
Title
Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous
Coronary Intervention: Insights From a Contemporary US Multicenter
Registry.
Source
Canadian Journal of Cardiology. 32 (12) (pp 1433-1439), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Pulsus Group Inc.
Abstract
Background We sought to determine the effect of lesion age on procedural
techniques and outcomes of chronic total occlusion (CTO) percutaneous
coronary intervention (PCI). Methods We examined the characteristics and
outcomes of 394 CTO PCIs with data on lesion age, performed between 2012
and 2016 at 11 experienced US centres. Results Mean patient age was 66 +/-
10 years and 85.6% of the patients were men. Overall technical and
procedural success rates were 90.1% and 87.5%, respectively. A major
adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean
and median lesion ages were 43 +/- 62 months and 12 months (interquartile
range, 3-64 months), respectively. Patients were stratified into tertiles
according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age
was associated with older patient age (68 +/- 8 vs 65 +/- 10 vs 64 +/- 11
years; P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs
30%; P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; P =
0.001). Older lesions more often required use of the retrograde approach
and antegrade dissection/re-entry for successful lesion crossing. There
was no difference in technical (87.8% vs 89.6% vs 93.0%; P = 0.37) or
procedural (86.3% vs 87.4% vs 89.0%; P = 0.80) success, or the incidence
of MACE (3.1% vs 3.0% vs 6.3%; P = 0.31) for older vs younger occlusions.
Conclusions Older CTO lesions exhibit angiographic complexity and more
frequently necessitate the retrograde approach or antegrade
dissection/re-entry. Older CTOs can be recanalized with high technical and
procedural success and acceptable MACE rates. Lesion age appears unlikely
to be a significant determinant of CTO PCI success. Copyright &#xa9; 2016

<13>
Accession Number
613410872
Author
Perdreau E.; Seguela P.-E.; Jalal Z.; Perdreau A.; Mouton J.-B.;
Nelson-Veniard M.; Guillet E.; Iriart X.; Ouattara A.; Roubertie F.;
Mauriat P.; Thambo J.-B.
Institution
(Perdreau, Seguela, Jalal, Perdreau, Mouton, Nelson-Veniard, Guillet,
Iriart, Ouattara, Roubertie, Mauriat, Thambo) Paediatric Cardiology Unit,
hopital Haut-Leveque, Bordeaux University Hospital, Bordeaux, France
Title
Postoperative assessment of left ventricular function by two-dimensional
strain (speckle tracking) after paediatric cardiac surgery.
Source
Archives of Cardiovascular Diseases. 109 (11) (pp 599-606), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background Left ventricular (LV) dysfunction may complicate paediatric
cardiac surgery with cardiopulmonary bypass, notably after long aortic
cross-clamping (ACC). Assessment of occult myocardial injury by
conventional echocardiographic variables may be difficult in the
postoperative period. Aims To evaluate the feasibility of two-dimensional
(2D) strain in the postoperative period, and to assess the effect of ACC
duration on this variable. Methods Thirty-three paediatric patients (age <
18 years) with congenital heart disease undergoing cardiac surgery with
cardiopulmonary bypass were included in this prospective single-centre
study. Daily echocardiography was performed from the day before surgery to
the fifth postoperative day. LV ejection fraction and LV 2D strain were
measured. The cohort was divided into three groups according to ACC
duration (group 1: < 30 minutes; group 2: 30-80 minutes; group 3: > 80
minutes). Results Mean age and weight were 4.2 +/- 2.5 years and 15.1 +/-
5.2 kg, respectively. Feasibilities of longitudinal, circumferential and
radial strains were good, and quite similar to conventional variables.
Compared with conventional variables, intra- and interobserver agreements
regarding 2D strain were better (r = 0.916, P < 0.001 and r = 0.855, P <
0.001 for longitudinal strain versus r = 0.156, P = 0.54 and r = 0.064, P
= 0.80 for LV ejection fraction by Simpson's method). Postoperative
evolution of longitudinal and circumferential strains was significantly
different between the three groups (P < 0.001), whereas there was no
difference using conventional variables. Conclusion Postoperative LV 2D
strain is a feasible and reproducible method. Strain measurements seem to
indicate correlation with ACC duration. Copyright &#xa9; 2016 Elsevier
Masson SAS

<14>
[Use Link to view the full text]
Accession Number
609717367
Author
Lee A.C.H.; Feger M.A.; Singla A.; Abel M.F.
Institution
(Lee) University of Virginia, School of Medicine, PO Box 800739,
Charlottesville, VA 22908, United States
(Feger, Singla, Abel) Department of Orthopedic Surgery, University of
Virginia, Charlottesville, VA, United States
Title
Effect of surgical approach on pulmonary function in adolescent idiopathic
scoliosis patients a systemic review and meta-analysis.
Source
Spine. 41 (22) (pp E1343-E1355), 2016. Date of Publication: 15 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Study Design. Systemic review and meta-analysis. Objective. To analyze the
effect of spinal fusion and instrumentation for adolescent idiopathic
scoliosis (AIS) on absolute pulmonary function test (PFTs). Summary of
Background Data. Pulmonary function is correlated with severity of
deformity in AIS patients and studies that have analyzed the effect of
spinal fusion and instrumentation on PFTs for AIS have reported
inconsistent results. There is a need to analyze the effect of spinal
fusion on PFTs with stratification by surgical approach. Methods. Our
analysis included 22 studies. Cohen?s d effect sizes were calculated for
absolute PFT outcome measures with 95% confidence intervals (CI).
Meta-analyses were performed at each postoperative time frame for six
homogeneous surgical approaches: (i) combined anterior release and
posterior fusion with instrumentation; (ii) combined video assisted
anterior release and posterior fusion with instrumentation without
thoracoplasty; (iii) posterior fusion with instrumentation without
thoracoplasty; (iv) anterior fusion with instrumentation and without
thoracoplasty; (v) video assisted anterior fusion with instrumentation
without thoracoplasty; and (vi) any scoliosis surgery with additional
thoracoplasty. Results. Anterior spinal fusion with instrumentation, any
scoliosis surgery with concomitant thoracoplasty, or videoassisted
anterior fusion with instrumentation for AIS had similar absolute PFTs at
their 2 year postoperative follow up compared with their preoperative PFTs
(effect sizes ranging from -0.2-0.2 with all CI crossing 0). Posterior
spinal fusion with instrumentation (with or without an anterior release)
demonstrated small to moderate increases in PFTs 2 years postoperatively
(effect sizes ranging from 0.35-0.65 with all CI not crossing 0).
Conclusion. Anterior fusion with instrumentation, regardless of the
approach, and any scoliosis surgery with concomitant thoracoplasty do not
lead to significant change in pulmonary functions 2 year after surgery.
Posterior spinal fusion with instrumentation (with or without an anterior
release) resulted in small to moderate increases in PFTs. Copyright &#xa9;
2016 Wolters Kluwer Health, Inc. All rights reserved.

<15>
Accession Number
613296162
Author
Pelletier R.; Choi J.; Winters N.; Eisenberg M.J.; Bacon S.L.; Cox J.;
Daskalopoulou S.S.; Lavoie K.L.; Karp I.; Shimony A.; So D.; Thanassoulis
G.; Pilote L.
Institution
(Pelletier, Winters, Pilote) Divisions of Clinical Epidemiology and
General Internal Medicine, The Research Institute of the McGill University
Health Centre, Montreal, Quebec, Canada
(Choi) Faculty of Health Sciences, University of Manitoba, Winnipeg,
Manitoba, Canada
(Eisenberg) Divisions of Cardiology and Clinical Epidemiology, Department
of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
(Bacon) Department of Exercise Science, Concordia University, Montreal,
Quebec, Canada
(Cox) Division of Cardiology, Department of Medicine and Department of
Community Health and Epidemiology, Halifax, Nova Scotia, Canada
(Daskalopoulou) Division of General Internal Medicine, Department of
Medicine, McGill University, McGill University Health Centre, Montreal,
Quebec, Canada
(Lavoie) Department of Psychology, University of Quebec in Montreal,
Montreal, Quebec, Canada
(Karp) Department of Epidemiology and Biostatistics, Schulich School of
Medicine and Dentistry, University of Western Ontario, London, Ontario,
Canada
(Shimony) Division of Cardiology, Soroka Medical Center, Ben Gurion
University of the Negev, Beer-Sheva, Israel
(So) Department of Medicine, University of Ottawa Heart Institute, Ottawa,
Ontario, Canada
(Thanassoulis) Division of Cardiology, Department of Medicine, McGill
University Health Centre, Montreal, Quebec, Canada
Title
Sex Differences in Clinical Outcomes After Premature Acute Coronary
Syndrome.
Source
Canadian Journal of Cardiology. 32 (12) (pp 1447-1453), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Pulsus Group Inc.
Abstract
Background Over past decades, the incidence of acute coronary syndrome
(ACS) has increased in young women, and greater mortality rates after
discharge were observed among young women vs men. We revisited this issue
with contemporary data from the Gender and Sex Determinants of
Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary
Syndrome (GENESIS-PRAXY), a multicentre prospective cohort study. Methods
One thousand two hundred thirteen patients were enrolled in GENESIS-PRAXY
from 26 centres across Canada, the United States, and Switzerland between
January 2009 and April 2013. We assessed major adverse cardiac events
(MACE) and mortality over 12 months after ACS. The role of sex as a
predictor of outcomes was determined with Cox proportional hazard
regression analysis. Results We included 1163 patients with complete data.
The occurrence of MACE was 9% and 8% in women and men, respectively (P =
0.75), and 1% of women and men died during follow-up. In adjusted models,
there was no sex difference in the risk of MACE or mortality. The
proportion of patients with all-cause rehospitalization was higher in
women (13%) compared with men (9%; P = 0.006), but cardiac
rehospitalization rates were similar in both sexes regardless of ACS type.
Among first rehospitalizations, the majority was classified as cardiac
related (69%), with chest pain or angina (28%) and myocardial infarction
(19%) reported as the most common reasons for first rehospitalization.
Conclusions Women were more likely than men to be rehospitalized for all
causes but not for a cardiac cause. In contrast to earlier studies, men
and women had similar mortality and MACE outcomes at 1 year. Copyright
&#xa9; 2016 Canadian Cardiovascular Society

<16>
Accession Number
613411229
Author
Pishvaian M.; Morse M.A.; McDevitt J.; Norton J.D.; Ren S.; Robbie G.J.;
Ryan P.C.; Soukharev S.; Bao H.; Denlinger C.S.
Institution
(Pishvaian) Lombardi Comprehensive Cancer Center, Georgetown University
Medical Center, Washington, DC, United States
(Morse) Division of Hematology/Oncology, Duke Cancer Institute, Duke
University Medical Center, Durham, NC, United States
(McDevitt, Norton, Ren, Robbie, Ryan, Soukharev, Bao) MedImmune,
Gaithersburg, MD, United States
(Denlinger) Department of Hematology/Oncology, Fox Chase Cancer Center,
Philadelphia, PA, United States
Title
Phase 1 Dose Escalation Study of MEDI-565, a Bispecific T-Cell Engager
that Targets Human Carcinoembryonic Antigen, in Patients With Advanced
Gastrointestinal Adenocarcinomas.
Source
Clinical Colorectal Cancer. 15 (4) (pp 345-351), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Micro-Abstract This phase I, multicenter, open-label study evaluated
MEDI-565 (0.75-20 mug to 7.5 mg on days 1-5, 28-day cycles) in 39 adults
with gastrointestinal adenocarcinoma. The maximum tolerated dose was 5 mg
on days 1 through 5 every 28 days with dexamethasone. No objective
responses were observed. A study of MEDI-565 as a continuous infusion in
patients with gastrointestinal adenocarcinomas is ongoing. Copyright
&#xa9; 2016 Elsevier Inc.

<17>
Accession Number
613630429
Author
Wiebe J.; Detten G.; Scheckel C.; Gearhart D.; Wheeler D.; Sanders D.;
Vassar M.
Institution
(Wiebe, Detten, Scheckel, Gearhart, Wheeler, Sanders, Vassar) Oklahoma
State University Center for Health Sciences, United States
Title
The heart of the matter: Outcome reporting bias and registration status in
cardio-thoracic surgery.
Source
International Journal of Cardiology. 227 (pp 299-304), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Our objective is to compare registered outcomes to published
reports; to evaluate for discrepancies favoring statistically significant
outcomes; to examine funding source and likelihood of outcome reporting
bias; and to evaluate for any temporal trends in outcome reporting bias.
Methods PubMed was searched for randomized controlled trials published
between 2008 and 2015 from 4 high impact cardio-thoracic journals:
European Journal of Cardio-thoracic Surgery (EJCS), The Journal of
Cardiothoracic Surgery (JCS), The Journal of Thoracic and Cardiovascular
Surgery (JTCS), and Annals of Cardiothoracic Surgery (ACS). Data was
collected using a standardized extraction form. Results We reviewed 287
articles, of which 214 (74.6%) did not meet registration criteria. Of
those 214, 94 (43.9%) were published in the EJCS, 34 (15.9%) in JCS, 86
(40.2%) in JTCS, and 0 (0%) in the ACS. Of the remaining 73 articles, 34
(46.6%) had a discrepancy between the primary outcome registered and the
published outcome, and 11 of the 34 reported p-values favoring the change.
We also found that 12 of the 73 registrations had updated primary outcomes
from the initial report to the final report. The timing of registration
was an incidental finding showing 14 (19.1%) articles retrospectively
registered, 29 (39.7%) registered during patient enrollment, and 30
(41.1%) registered prospectively. Conclusion The results indicated that
selective outcome reporting is prevalent in cardio-thoracic surgery
journals. The more concerning issue, however, is the lack of registration
or provision of registration number for randomized controlled trials
within these journals. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<18>
Accession Number
611340982
Author
Hanedan M.O.; Cicekcioglu F.; Aksoyek A.; Diken A.I.; Unal E.U.; Parlar
A.I.; Katircioglu S.F.
Institution
(Hanedan, Cicekcioglu, Aksoyek, Diken, Unal, Parlar, Katircioglu) Turkiye
Yuksek Ihtisas Education and Research Hospital, Cardiovascular Surgery,
Ankara, Turkey
Title
Tricuspid Valve Replacement Through Right Thoracotomy has Better Outcomes
in Redo Cases.
Source
Heart Lung and Circulation. 26 (1) (pp 88-93), 2017. Date of Publication:
01 Jan 2017.
Publisher
Elsevier Ltd
Abstract
Background The tricuspid valve is usually ignored and tricuspid
interventions are mostly done in the context of other planned cardiac
surgery. Isolated tricuspid reoperative procedure, especially tricuspid
valve replacement (TVR) is very rare and carries a very high mortality
rate. In this prospective study, clinical results of isolated TVR either
through a median re-sternotomy or an antero-lateral thoracotomy with
conventional cardiopulmonary bypass (CPB) have been evaluated. Methods
Thirty patients with previous open heart surgery through median sternotomy
had isolated TVR between 2004 and 2011. Operative approaches were through
a median re-sternotomy in 13 patients and a right antero-lateral
thoracotomy in 17 patients. Results Follow-up period is complete with a
mean duration of 19.77+/-17.08 months. The hospital mortality rates were
46.2% (six patients) in the Median Re-sternotomy Group and 5.9% (one
patient) in the Thoracotomy Group (p= 0.025). The surgical procedures
lasted shorter and the postoperative drainage amounts were lower in the
Thoracotomy Group (298.08+/-76.64 min vs 246.76+/-47.40 min, p= 0.032 and
1787.50+/-1399.53 mL vs 903.33+/-692.43 mL, p= 0.03 respectively).
Presence of ascites in the preoperative period (p= 0.007), operative
technique (median re-sternotomy) (p= 0.025), use of cross-clamp (p=
0.048), and need for inotropic support during the operation (p= 0.002)
were statistically significant factors affecting the hospital mortality.
The mean estimated life period was better for the Thoracotomy Group
(16.7+/-5.03 versus 35.9+/-5.01 months, p= 0.044). Presence of ascites in
the preoperative period was a significant risk factor for overall
mortality according to Cox regression analysis. Conclusion Thoracotomy for
TVR in patients with previous median sternotomy is a practical and safe
technique with lower mortality rates. Copyright &#xa9; 2016 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<19>
Accession Number
613566789
Author
De Ribamar Costa J.; Abizaid A.; Bartorelli A.L.; Whitbourn R.; Jepson N.;
Perin M.; Steinwender C.; Stuteville M.; Ediebah D.; Sudhir K.; Serruys
P.W.
Institution
(De Ribamar Costa, Abizaid) Instituto de Cardiologia Dante Pazzanese, Av.
Dr. Dante Pazzanese 500, Vila Mariana, Sao Paulo SP-04012-180, Brazil
(Bartorelli) Centro Cardiologico Monzino, IRCCS, University of Milan,
Milan, Italy
(Whitbourn) St Vincent's Hospital, Fitzroy, VIC, Australia
(Jepson) Prince of Wales Public Hospital, Sydney, NSW, Australia
(Perin) Sociedade Beneficente Israelita Brasileira Hospital Albert
Einstein, Sao Paulo, Brazil
(Steinwender) Allgemeines Krankenhaus Linz, Linz, Austria
(Stuteville, Ediebah) Abbott Vascular, Diegem, Belgium
(Sudhir) Abbott Vascular, Santa Clara, CA, United States
(Serruys) Thoraxcenter, Erasmus University Medical Center, Rotterdam,
Netherlands
Title
One-year clinical outcomes of patients treated with everolimus-eluting
bioresorbable vascular scaffolds versus everolimus-eluting metallic
stents: A propensity score comparison of patients enrolled in the ABSORB
EXTEND and SPIRIT trials.
Source
EuroIntervention. 12 (10) (pp 1255-1262), 2016. Date of Publication:
November 2016.
Publisher
EuroPCR
Abstract
Aims: We sought to compare the outcomes of low/moderate complexity
patients treated with the Absorb BVS from the ABSORB EXTEND trial with
patients treated with the XIENCE everolimus-eluting stent (EES), using
propensity score (PS) matching of pooled data from the SPIRIT trials
(SPIRIT II, SPIRIT III, SPIRIT IV) and the XIENCE V USA trial. Methods and
results: ABSORB EXTEND was a prospective, single-Arm, open-label clinical
study in which 812 patients were enrolled at 56 sites. This study allowed
the treatment of lesions <28 mm in length and with a reference vessel
diameter of 2.0-3.8 mm (as assessed by online QCA). The propensity score
was obtained by fitting a logistic regression model with the cohort
indicator as the binary outcome and other variables as the predictor
variables. At one-year clinical follow-up, there was no statistical
difference between groups with regard to MACE (5.0% vs. 4.8%, p=0.83),
target lesion failure (5.0% vs. 4.7%, p=0.74), ischaemia-driven target
vessel revascularisation (2.3% vs. 3.0%, p=0.38) and device thrombosis
(1.0% vs. 0.3%, p=0.11). Myocardial infarction was higher with Absorb
(3.3% vs. 1.5%, p=0.02), at the expense of periprocedural CK-MB elevation.
Independent predictors of MACE among patients receiving Absorb BVS were
treatment of multivessel disease, insulin-dependent diabetes and
performance of post-dilation. Conclusions: At one-year follow-up,
propensity score-matched analysis demonstrated that the clinical safety
and effectiveness of Absorb are comparable to those of XIENCE EES among
non-complex patients treated with PCI. Copyright &#xa9; Europa Digital &
Publishing 2016. All rights reserved.

<20>
Accession Number
609671246
Author
Sharma K.K.; Gupta R.; Mathur M.; Natani V.; Lodha S.; Roy S.; Xavier D.
Institution
(Sharma, Mathur) Department of Pharmacology, SMS Medical College, Jaipur
302004, India
(Sharma, Gupta, Natani) Department of Medicine, Fortis Escorts Hospital,
Jaipur 302017, India
(Lodha) Department of Endocrinology, Fortis Escorts Hospital, Jaipur
302017, India
(Roy) Department of Cardiology, Fortis Escorts Hospital, Jaipur 302017,
India
(Gupta) Department of Medicine, Eternal Heart Care Centre and Research
Institute, Jaipur 302020, India
(Xavier) Department of Pharmacology, St John's Medical College, Bangalore
560068, India
Title
Non-physician health workers for improving adherence to medications and
healthy lifestyle following acute coronary syndrome: 24-month follow-up
study.
Source
Indian Heart Journal. 68 (6) (pp 832-840), 2016. Date of Publication: 01
Nov 2016.
Publisher
Elsevier B.V.
Abstract
Objective To evaluate usefulness of non-physician health workers (NPHW) to
improve adherence to medications and lifestyles following acute coronary
syndrome (ACS). Methods We randomized 100 patients at hospital discharge
following ACS to NPHW intervention (n = 50) or standard care (n = 50) in
an open label study. NPHW was trained for interventions to improve
adherence to medicines - antiplatelets, beta-blockers, renin-angiotensin
system (RAS) blockers and statins and healthy lifestyles. Intervention
lasted 12 months with passive follow-up for another 12. Both groups were
assessed for adherence using a standardized questionnaire. Results ST
elevation myocardial infarction (STEMI) was in 49 and non-STEMI in 51,
mean age was 59.0 +/- 11 years. 57% STEMI were thrombolyzed. On admission
majority were physically inactive (71%), consumed unhealthy diets (high
fat 77%, high salt 58%, low fiber 57%) and 21% were smokers/tobacco users.
Coronary revascularization was performed in 90% (percutaneous intervention
79%, bypass surgery 11%). Drugs at discharge were antiplatelets 100%,
beta-blockers 71%, RAS blockers 71% and statins 99%. Intervention and
control groups had similar characteristics. At 12 and 24 months,
respectively, in intervention vs control groups adherence (>80%) was: anti
platelets 92.0% vs 77.1% and 83.3% vs 40.9%, beta blockers 97.2% vs 90.3%
and 84.8% vs 45.0%), RAS blockers 95.1% vs 82.3% and 89.5% vs 46.1%, and
statins 94.0% vs 70.8% and 87.5% vs 29.5%; smoking rates were 0.0% vs
12.5% and 4.2% vs 20.5%, regular physical activity 96.0% vs 50.0%, and
37.5% vs 34.1%, and healthy diet score 5.0 vs 3.0, and 4.0 vs 2.0 (p <
0.01 for all). Intervention vs standard group at 12 months had
significantly lower mean systolic BP, heart rate, body mass index,
waist:hip ratio, total cholesterol, triglyceride, and LDL cholesterol (p <
0.01). Conclusions NPHW-led educational intervention for 12 months
improved adherence to evidence based medicines and healthy lifestyles.
Efficacy continued for 24 months with attrition. Copyright &#xa9; 2016
Cardiological Society of India

<21>
Accession Number
613663919
Author
Tang J.Y.; Ally M.S.; Chanana A.M.; Mackay-Wiggan J.M.; Aszterbaum M.;
Lindgren J.A.; Ulerio G.; Rezaee M.R.; Gildengorin G.; Marji J.; Clark C.;
Bickers D.R.; Epstein E.H.
Institution
(Tang, Ally, Chanana, Lindgren, Rezaee, Gildengorin, Epstein) Children's
Hospital of Oakland Research Institute, Oakland, CA, United States
(Tang, Ally) Department of Dermatology Stanford University School of
Medicine, Stanford, CA, United States
(Mackay-Wiggan, Ulerio, Marji, Clark, Bickers) Department of Dermatology,
Herbert Irving Comprehensive Cancer Center, Columbia University Medical
Center, New York, NY, United States
(Aszterbaum) Department of Dermatology University of California, Irvine,
CA, United States
Title
Inhibition of the hedgehog pathway in patients with basal-cell nevus
syndrome: final results from the multicentre, randomised, double-blind,
placebo-controlled, phase 2 trial.
Source
The Lancet Oncology. 17 (12) (pp 1720-1731), 2016. Date of Publication: 01
Dec 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Aberrant hedgehog signalling underlies the development of
basal-cell carcinomas. We previously reported the interim analysis of a
multicentre, randomised, double-blind, placebo-controlled, phase 2 trial
in patients with the basal-cell nevus (Gorlin) syndrome indicating that
the smoothened inhibitor vismodegib reduces basal-cell carcinoma tumour
burden and prevents new basal-cell carcinoma growth in patients with
basal-cell nevus syndrome. We report the final results of this 36 month
trial. Methods In our multicentre, randomised, double-blind,
placebo-controlled, phase 2 trial we enrolled patients aged 35-75 years
with basal-cell nevus syndrome with at least ten surgically eligible
basal-cell carcinomas at the Children's Hospital Oakland, Columbia
University outpatient dermatology clinic (NY, USA) and a private practice
outpatient dermatology office in Newport Beach (CA, USA). Patients were
assigned to vismodegib or placebo (2:1) according to a randomisation
sequence generated by computer code. The primary endpoint of the trial of
41 patients was to compare the effect of oral vismodegib (150 mg/day)
versus placebo on the incidence of new surgically eligible basal-cell
carcinomas after 3 months of treatment. In the subsequent, open-label
phase (n=37) patients continued vismodegib at two sites for as long as
month 36 (n=25) and at the third site were monitored up to month 36
(n=12). Additional endpoints for this phase were: whether continuous
versus interrupted dosing differentially affected tumour burden; time to
reach various levels of reduction in tumour burden; reduction in tumour
size in patients who took less than 50% of the expected number of
vismodegib tablets; reduction in the number of surgical excisions required
per year before, during, and after treatment; and the effect of vismodegib
on hedgehog target gene expression. We monitored patients at visits every
3 months for up to 36 months. The primary endpoint was analysed on a
modified intention-to-treat basis. This trial is registered with
ClinicalTrials.gov, number NCT00957229. Findings Between Sept 22, 2009,
and Jan 24, 2011, 41 patients were monitored for a median of 36 months
(IQR 36-36). Patients treated with vismodegib (n=26) had a mean reduced
rate of new surgically eligible basal-cell carcinomas compared with
patients randomly assigned to placebo (n=15; two [SD 0.12] new surgically
eligible basal-cell carcinomas per patient per year vs 34 [1.32] new
surgically eligible basal-cell carcinomas per patient per year, p<0.0001).
In the 11 patients initially assigned to placebo, mean cross over to
vismodegib reduced the development of new surgically eligible basal-cell
carcinomas compared with placebo (0.4 [SD 0.2] new surgically eligible
basal-cell carcinomas per patient per year vs 30.0 [7.8] new surgically
eligible basal-cell carcinomas per patient per year, p<0.0001). Only three
(17%) of 18 patients tolerated vismodegib continuously for the full 36
months. Fewer new surgically eligible basal-cell carcinomas developed in
patients receiving vismodegib continuously than in those who interrupted
dosing (mean 0.6 [0.72] new surgically eligible basal-cell carcinomas per
patient per year vs 1.7 [1.8] new surgically eligible basal-cell
carcinomas per patient per year, p<0.0001). Treatment-related grade 3-4
adverse events included weight loss of 20% or more (n=6) and muscle cramps
(n=2). Two patients died during the course of the trial, one each from
laryngeal and metastatic prostate cancer, deemed probably unrelated to
drug. Interpretation Vismodegib reduces basal-cell carcinoma tumour burden
in patients with basal-cell nevus syndrome. Adverse events associated with
vismodegib frequently led to interruption of treatment, which is followed
by basal-cell carcinoma recurrence. Funding Genentech
investigator-initiated trial funding, Clinical and Translational Science
Award from the National Institutes of Health, National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Cancer
Institute, Damon Runyon Cancer Research Foundation Clinical Investigator
Award, Swim across America Foundation, and Michael J Rainen Family
Foundation. Copyright &#xa9; 2016 Elsevier Ltd

<22>
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).

<23>
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).

<24>
Accession Number
613941616
Author
Ghione M.; Wykrzykowska J.J.; Windecker S.; Serruys P.W.; Buszman P.;
Linke A.; Sohn H.Y.; Corti R.; Antoni D.; Wijns W.; Estevez-Loureiro R.;
Morice M.-C.; Van Es G.-A.; van Geuns R.J.; Juni P.; Eerdmans P.; De Vries
T.; Konik S.; Di Mario C.
Institution
(Ghione, Estevez-Loureiro, Di Mario) NIHR Cardiovascular Biomedical
Research Unit, Royal Brompton Hospital, London, United Kingdom
(Wykrzykowska) Academic Medical Centre, Amsterdam, Netherlands
(Windecker) Department of Cardiology, University of Bern, Switzerland
(Serruys, van Geuns) Thoraxcenter, Erasmus University MC, Rotterdam,
Netherlands
(Buszman) American Heart of Poland, Ustron, Poland
(Linke) Herzzentrum Leipzig, Leipzig, Germany
(Sohn) Department of Cardiology, University Hospital Munich (Innenstadt),
Munich, Germany
(Corti) HerzKlinik Hirslanden, Zurich, Switzerland
(Antoni) Department of Cardiology, Hospital Bogenhausen, Munich, Germany
(Wijns) Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst,
Belgium
(Morice) Institut Cardiovasculaire Paris-Sud, Institut Hospitalier
Jacques-Cartier, Massy, France
(Van Es, De Vries) Cardialysis, Rotterdam, Netherlands
(Juni) CTU, University of Bern, Switzerland
(Eerdmans, Konik) Biosensors Europe SA, Morges, Switzerland
(Di Mario) University Hospital Careggi, Florence, Italy
Title
Five-year outcomes of chronic total occlusion treatment with a biolimus
A9-eluting biodegradable polymer stent versus a sirolimus-eluting
permanent polymer stent in the LEADERS all-comers trial.
Source
Cardiology Journal. 23 (6) (pp 626-636), 2016. Date of Publication: 2016.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Few data are available on long-term follow-up of drug-eluting
stents in the treatment of chronic total occlusion (CTO). The LEADERS CTO
sub-study compared the long-term results in CTO and non-CTO lesions of a
Biolimus A9TM-eluting stent (BES) with a sirolimus-eluting stent (SES).
Methods: Among 1,707 patients enrolled in the prospective, multi-center,
all-comers LEADERS trial, 81 with CTOs were treated with either a BES (n =
45) or a SES (n = 36). The primary endpoint was the occurrence of major
adverse cardiac events (MACE): cardiac death, myocardial infarction (MI)
and clinically-indicated target vessel revascularization (TVR). Results:
At 5 years, the rate of MACE was numerically higher in the CTO group than
in the non-CTO group (29.6% vs. 23.3%; p = 0.173), with a significant
increase in the incidence of target lesion revascularization (TLR) (21.0
vs. 12.6; p = 0.033), but no difference in stent thrombosis (ST). Patients
with CTO receiving a BES demonstrated a lower incidence of MACE (22.2% vs.
38.9%; p = 0.147) with a significant reduction in TLR compared to patients
receiving a SES (11.1% vs. 33.3%, p = 0.0214) with an incidence similar to
that observed in the non-CTO group treated with BES (11.6%). Definite ST
at 5 years nearly halved in the BES group (4.4% vs. 8.3%, p = 0.478) with
no ST in the BES group after the first year (0% vs. 8.3%, p for
interaction = 0.009). Conclusions: The use of a BES showed a reduction in
MACE, TVR, TLR, and ST over time in the CTO subset with similar outcome as
for non-CTO lesions. Copyright &#xa9; 2016 Via Medica.

<25>
Accession Number
613358968
Author
Magruder J.T.; Blasco-Colmenares E.; Crawford T.; Alejo D.; Conte J.V.;
Salenger R.; Fonner C.E.; Kwon C.C.; Bobbitt J.; Brown J.M.; Nelson M.G.;
Horvath K.A.; Whitman G.R.
Institution
(Magruder, Crawford, Alejo, Conte, Whitman) Division of Cardiac Surgery,
Department of Medicine, The Johns Hopkins University School of Medicine,
Baltimore, Maryland, United States
(Blasco-Colmenares) Division of Cardiology, Department of Medicine, The
Johns Hopkins University School of Medicine, Baltimore, Maryland, United
States
(Salenger, Brown) Division of Cardiac Surgery, University of Maryland
School of Medicine, Baltimore, Maryland, United States
(Fonner) Maryland Cardiac Surgery Quality Initiative, Baltimore, Maryland,
United States
(Kwon) Beverly & Jerome Fine Cardiac Valve Center, Sinai Hospital of
Baltimore, Baltimore, Maryland, United States
(Bobbitt) Department of Cardiac Surgery, Washington Adventist Hospital,
Takoma Park, Maryland, United States
(Nelson) The Heart Institute, Western Maryland Health System, Cumberland,
Maryland, United States
(Horvath) Cardiothoracic Surgery Research Program, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Maryland,
United States
Title
Variation in Red Blood Cell Transfusion Practices During Cardiac
Operations Among Centers in Maryland: Results From a State
Quality-Improvement Collaborative.
Source
Annals of Thoracic Surgery. 103 (1) (pp 152-160), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Variation in red blood cell (RBC) transfusion practices exists
at cardiac surgery centers across the nation. We tested the hypothesis
that significant variation in RBC transfusion practices between centers in
our state's cardiac surgery quality collaborative remains even after risk
adjustment. Methods Using a multiinstitutional statewide database created
by the Maryland Cardiac Surgery Quality Initiative (MCSQI), we included
patient-level data from 8,141 patients undergoing isolated coronary artery
bypass (CAB) or aortic valve replacement at 1 of 10 centers. Risk-adjusted
multivariable logistic regression models were constructed to predict the
need for any intraoperative RBC transfusion, as well as for any
postoperative RBC transfusion, with anonymized center number included as a
factor variable. Results Unadjusted intraoperative RBC transfusion
probabilities at the 10 centers ranged from 13% to 60%; postoperative RBC
transfusion probabilities ranged from 16% to 41%. After risk adjustment
with demographic, comorbidity, and operative data, significant intercenter
variability was documented (intraoperative probability range, 4% -59%;
postoperative probability range, 13%-39%). When stratifying patients by
preoperative hematocrit quartiles, significant variability in
intraoperative transfusion probability was seen among all quartiles
(lowest quartile: mean hematocrit value, 30.5% +/- 4.1%, probability
range, 17%-89%; highest quartile: mean hematocrit value, 44.8% +/- 2.5%;
probability range, 1%-35%). Conclusions Significant variation in
intercenter RBC transfusion practices exists for both intraoperative and
postoperative transfusions, even after risk adjustment, among our state's
centers. Variability in intraoperative RBC transfusion persisted across
quartiles of preoperative hematocrit values. Copyright &#xa9; 2017 The
Society of Thoracic Surgeons

<26>
Accession Number
613593348
Author
Winkler B.; Heinisch P.P.; Gahl B.; Aghlmandi S.; Jenni H.J.; Carrel T.P.
Institution
(Winkler, Heinisch, Gahl, Jenni, Carrel) Department of Cardiovascular
Surgery, Inselspital, University of Bern, Bern, Switzerland
(Aghlmandi) Institute of Social and Preventive Medicine, University of
Bern, Bern, Switzerland
Title
Minimally Invasive Extracorporeal Circulation Circuit Is Not Inferior to
Off-Pump Coronary Artery Bypass Grafting: Meta-Analysis Using the Bayesian
Method.
Source
Annals of Thoracic Surgery. 103 (1) (pp 342-350), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier USA
Abstract
The pathophysiologic side effects of cardiopulmonary bypass have already
been identified. Minimally invasive extracorporeal circulation
technologies (MiECT) and off-pump coronary artery bypass graft surgery
(OPCABG) aim to reduce these problems. This meta-analysis provides a
comparison of MiECT and OPCABG in randomized and observational studies. A
fully probabilistic, Bayesian approach of primary and secondary endpoints
was conducted. MiECT does not give inferior results when compared with
OPCABG. However, there is a trend to borderline significantly higher blood
loss in this group in randomized controlled trials. The question whether
MiECT is equivalent to OPCABG can be answered with the affirmative, but
long-term follow-up data are needed to detect any advantage over time.
Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<27>
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.

<28>
[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.

<29>
Accession Number
613351083
Author
Kilic A.; Magruder J.T.; Grimm J.C.; Dungan S.P.; Crawford T.; Whitman
G.J.R.; Conte J.V.
Institution
(Kilic) Division of Cardiovascular Surgery, University of Pennsylvania,
Philadelphia, Pennsylvania, United States
(Magruder, Grimm, Dungan, Crawford, Whitman, Conte) Division of Cardiac
Surgery, Johns Hopkins University, Baltimore, Maryland, United States
Title
Development and Validation of a Score to Predict the Risk of Readmission
After Adult Cardiac Operations.
Source
Annals of Thoracic Surgery. 103 (1) (pp 66-73), 2017. Date of Publication:
01 Jan 2017.
Publisher
Elsevier USA
Abstract
Background The purpose of this study was to develop and validate a risk
score for readmissions after cardiac operations. Methods Adults surviving
to discharge after cardiac operations at a single institution from 2008 to
2013 were randomly divided 3:1 into training and validation cohorts. The
primary outcome was readmission within 30 days of discharge. A
multivariable model was constructed in the training cohort incorporating
variables associated with 30-day readmission in univariate logistic
regression. Points were assigned to predictors in the multivariable model
proportional to their odds ratios. Results Among 5,193 patients undergoing
cardiac operations and surviving to discharge, the 30-day readmission rate
was 10.3% (n = 537). The most common reasons for readmission were volume
overload (24%; n = 131) and infection (21%; n = 113). The risk score
incorporated 5 multivariable predictors and was out of 20 possible points.
The predicted rate of 30-day readmission based on the training cohort
ranged from 5.9% (score = 0) to 54.7% (score = 20). Patients were
categorized as low (score = 0; readmission 5.7%), moderate (score 1-7;
readmission 11.0%), and high risk (score >7; readmission 24.2%) (p <
0.001). Thirty-day readmission rates based on these score categories were
similar in the validation cohort (low 6.4%, moderate 11.0%, high 17.4%; p
< 0.001). There was a robust correlation between predicted rates of
readmission in the training cohort based on the composite risk score and
actual rates of readmission in the validation cohort (r = 0.95; p <
0.001). Conclusions We developed and validated a risk score for
readmission after cardiac operations that may have utility in targeting
interventions and modifying risk factors in high-risk populations.
Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<30>
Accession Number
613459465
Author
Cholette J.M.; Swartz M.F.; Rubenstein J.; Henrichs K.F.; Wang H.; Powers
K.S.; Daugherty L.E.; Alfieris G.M.; Gensini F.; Blumberg N.
Institution
(Cholette, Rubenstein, Powers, Daugherty) Department of Pediatrics,
University of Rochester, Rochester, New York, United States
(Swartz, Alfieris, Gensini) Department of Surgery, University of
Rochester, Rochester, New York, United States
(Henrichs, Blumberg) Department of Pathology and Laboratory Medicine,
University of Rochester, Rochester, New York, United States
(Wang) Department of Biostatistics, University of Rochester, Rochester,
New York, United States
Title
Outcomes Using a Conservative Versus Liberal Red Blood Cell Transfusion
Strategy in Infants Requiring Cardiac Operation.
Source
Annals of Thoracic Surgery. 103 (1) (pp 206-214), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier USA
Abstract
Background The optimal hemoglobin for infants after cardiac operation is
unknown. Red blood cells (RBCs) are commonly transfused to maintain high
hemoglobin concentrations in the absence of a clinical indication. We
hypothesized that infants can be managed with a postoperative conservative
RBC transfusion strategy, resulting in lower daily hemoglobin
concentrations, without evidence of impaired oxygen delivery (ie, lactate,
arteriovenous oxygen difference [avO<inf>2</inf>diff]), or adverse
clinical outcomes. Methods Infants weighing 10 kg or less undergoing
biventricular repair or palliative (nonseptated) operation were randomly
assigned to either a postoperative conservative or liberal transfusion
strategy. Conservative group strategy was RBC transfusion for a hemoglobin
less than 7.0 g/dL for biventricular repairs or less than 9.0 g/dL for
palliative procedures plus a clinical indication. Liberal group strategy
was RBC transfusion for hemoglobin less than 9.5 g/dL for biventricular
repairs or less than 12 g/dL for palliative procedures regardless of
clinical indication. Results After the operation of 162 infants (82
conservative [53 biventricular, 29 palliative], 80 liberal [52
biventricular, 28 palliative]), including 12 Norwood procedures (6
conservative, 6 liberal), daily hemoglobin concentrations were
significantly lower within the conservative group than the liberal group
by postoperative day 1 and remained lower for more than 10 days. The
percentage of patients requiring a RBC transfusion, number of
transfusions, and volume of transfusions were all significantly lower
within the conservative group. Despite lower hemoglobin concentrations
within the conservative group, lactate, avO<inf>2</inf>diff, and clinical
outcomes were similar. Conclusions Infants undergoing cardiac operation
can be managed with a conservative RBC transfusion strategy. Clinical
indications should help guide the decision for RBC transfusion even in
this uniquely vulnerable population. Larger multicenter trials are needed
to confirm these results, and focus on the highest risk patients would be
of great interest. Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<31>
[Use Link to view the full text]
Accession Number
613925930
Author
Chaudhary N.; Kumar Bundhun P.; Yan H.
Institution
(Chaudhary, Kumar Bundhun, Yan) Department of Geriatric Cardiology, First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
530021, China
Title
Comparing the clinical outcomes in patients with atrial fibrillation
receiving dual antiplatelet therapy and patients receiving an addition of
an anticoagulant after coronary stent implantation: A systematic review
and meta-analysis of observational studies.
Source
Medicine (United States). 95 (50) (pp e5581), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Data regarding the clinical outcomes in patients with atrial
fibrillation (AF) receiving dual antiplatelet therapy (DAPT) and an
anticoagulant in addition to DAPT (DAPT+vitamin K antagonist [VKA]) after
coronary stent implantation are still controversial. Therefore, in order
to solve this issue, we aim to compare the adverse clinical outcomes in AF
patients receiving DAPT and DAPT+ VKA after percutaneous coronary
intervention and stenting (PCI-S). Methods: Observational studies
comparing the adverse clinical outcomes such as major bleeding, major
adverse cardiovascular events, stroke, myocardial infarction, all-cause
mortality, and stent thrombosis (ST) in AF patients receiving DAPT+VKA
therapy, and DAPT after PCI-S have been searched from Medline, EMBASE, and
PubMed databases. Odds ratios (ORs) with 95% confidence intervals (CIs)
were used to express the pooled effect on discontinuous variables, and the
pooled analyses were performed with RevMan 5.3. Results: Eighteen studies
consisting of a total of 20,456 patients with AF (7203 patients received
DAPT+VKA and 13,253 patients received DAPT after PCI-S) were included in
this meta-analysis. At a mean follow-up period of 15 months, the risk of
major bleeding was significantly higher in DAPT+VKA group, with OR 0.62
(95% CI 0.50-0.77, P<0.0001). There was no significant differences in
myocardial infarction and major adverse cardiovascular event between
DAPT+VKA and DAPT, with OR 1.27 (95% CI 0.92-1.77, P= 0.15) and OR 1.17
(95% CI 0.99-1.39, P=0.07), respectively. However, the ST, stroke, and
all-cause mortality were significantly lower in the DAPT+VKA group, with
OR 1.98 (95% CI 1.03-3.81, P=0.04), 1.59 (95% CI 1.08-2.34, P=0.02), and
1.41 (95% CI 1.03-1.94, P=0.03), respectively. Conclusion: At a mean
follow-up period of 15 months, DAPT+VKA was associated with significantly
lower risk of stroke, ST, and all-cause mortality in AF patients after
PCI-S compared with DAPT group. However, the risk of major bleeding was
significantly higher in the DAPT+VKA group. Copyright &#xa9; 2016 the
Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.

<32>
[Use Link to view the full text]
Accession Number
52689443
Author
Imazio M.; Belli R.; Beqaraj F.; Giammaria M.; Lestuzzi C.; Hoit B.; Le
Winter M.; Spodick D.H.; Adler Y.
Institution
(Imazio, Belli, Beqaraj, Giammaria) Cardiology Department, Maria Vittoria
Hospital, Via Luigi Cibrario 72, Torino 10141, Italy
(Lestuzzi) Cardiology CRO, National Cancer Institute, Aviano, Italy
(Hoit) Harrington Heart and Vascular Institute, University Hospitals Case
Medical Center, Cleveland, OH, United States
(Le Winter) Cardiology Unit, Fletcher Allen Healthcare, Burlington, MA,
United States
(Spodick) Internal Medicine Department, St. Vincent Hospital, Worcester,
MA, United States
(Adler) Chaim Sheba Medical Center, Tel Hashomer and Sacker Faculty of
Medicine, Tel Aviv, Israel
Title
DRainage or Pericardiocentesis alone for recurrent nonmalignant,
nonbacterial pericardial effusions requiring intervention: Rationale and
design of the DROP trial, a randomized, open-label, multicenter study.
Source
Journal of Cardiovascular Medicine. 15 (6) (pp 510-514), 2014. Date of
Publication: 2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives Evidence to support the use of pericardial drainage instead of
simple pericardiocentesis for nonmalignant pericardial effusions
refractory to medical therapy is based on observational studies and
experts' opinions, rather than randomized trials. The aim of the present
trial is to fill this knowledge gap and to provide a stronger base of
evidence to support a specific interventional treatment in this setting.
Methods DRainage Or Pericardiocentesis (DROP) alone for recurrent
nonmalignant, nonbacterial pericardial effusions requiring intervention is
a randomized, open-label and multicenter study. The primary efficacy
endpoints are the incidence of recurrent pericardial effusion, and the
need for additional pericardiocentesis or cardiac surgery at 12 months.
Secondary endpoints are hospital length stay, disease-related admission
and overall mortality. Safety and complications rates of each intervention
will be also assessed. Implications and conclusion The DROP trial will be
the first multicenter randomized trial to evaluate the efficacy and safety
of pericardiocentesis versus pericardiocentesis and extended pericardial
drainage for recurrent nonmalignant, nonbacterial pericardial effusions
refractory to medical therapy and requiring interventional treatments3.
Copyright &#xa9; 2014 Italian Federation of Cardiology.

<33>
[Use Link to view the full text]
Accession Number
52628268
Author
Gatti G.; Belgrano M.; Gon L.; Dell'Angela L.; Sinagra G.; Benussi B.;
Pappalardo A.
Institution
(Gatti, Gon, Dell'Angela, Sinagra, Benussi, Pappalardo) Cardiovascular
Department, AOU Ospedali Riuniti, University of Trieste, Ospedale di
Cattinara, Polo Cardiologico, via Pietro Valdoni, Trieste 7-34148, Italy
(Belgrano) Department of Radiology, AOU Ospedali Riuniti, University of
Trieste, Trieste, Italy
Title
Aortoaxillary bypass during cardiac operation.
Source
Journal of Cardiovascular Medicine. 15 (6) (pp 504-509), 2014. Date of
Publication: 2014.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims The aim of the present study was to analyze our experience in the use
of the aortoaxillary bypass during cardiac operation in a limited series
of patients with proximal atherosclerotic lesion of the subclavian artery
combined with cardiac disease amenable to surgical treatment. Methods Of
1953 consecutive patients who underwent cardiac operation at our unit
between April 2009 and July 2012, nine (0.5%; four women and five men;
mean age 69.0W6.2 years) suffered from symptomatic occlusive disease of
the subclavian artery, and underwent concomitant aortoaxillary bypass. A
ring-reinforced polytetrafluoroethylene vascular graft was anastomosed to
the proximal segment of the axillary artery, introduced into the pleural
cavity through the first or the second intercostal space, and anastomosed
to the ascending aorta. All perioperative data were collected
prospectively. Results Seven (77.8%) left and two (22.2%) right
aortoaxillary bypasses were achieved. Ten concomitant cardiac operations
were performed. There were no early postoperative complications related to
the subclavian artery revascularization. At a mean follow-up of 27.3W15.5
months, both the symptoms of the subclavian artery disease and those of
the heart disease improved. Highresolution computed tomography angiography
confirmed an excellent patency of the aortoaxillary bypass in all the
patients but one. Conclusion Concomitant aortoaxillary bypass and cardiac
operation may be an option to keep in mind for patients with coexisting
subclavian artery occlusion and heart disease, after the evidence that the
combined operation does not increase the risk. Attention should be paid to
the course of the bypass graft toward the axillary artery. Copyright
&#xa9; 2014 Italian Federation of Cardiology.

<34>
Accession Number
613340613
Author
Lange K.S.; Nave A.H.; Liman T.G.; Grittner U.; Endres M.; Ebinger M.
Institution
(Lange, Nave, Liman, Grittner, Endres, Ebinger) Center for Stroke Research
Berlin (CSB), Charite - Universitatsmedizin Berlin, Germany
(Nave, Liman, Endres, Ebinger) Klinik und Hochschulambulanz fur
Neurologie, Charite - Universitatsmedizin Berlin, Germany
(Grittner) Department of Biostatistics and Clinical Epidemiology, Charite
- Universitatsmedizin Berlin, Germany
(Nave, Endres) DZHK (German Center for Cardiovascular Research), Partner
Site, Berlin, Germany
(Endres) DZNE (German Center for Neurodegenerative Diseases), Partner
Site, Berlin, Germany
(Nave, Liman, Endres) Berlin Institute of Health (BIH), Germany
Title
Lipoprotein(a) levels and recurrent vascular events after first ischemic
stroke.
Source
Stroke. 48 (1) (pp 36-42), 2017. Date of Publication: 01 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose - The association of elevated lipoprotein(a)
(Lp(a)) levels and the incidence of cardiovascular disease, especially
coronary heart disease and ischemic stroke, is well established. However,
evidence on the association between Lp(a) levels and residual vascular
risk in stroke survivors is lacking. We aimed to elucidate the risk for
recurrent cardiovascular and cerebrovascular events in the patients with
first-ever ischemic stroke with elevated Lp(a). Methods - All patients
with acute ischemic stroke who participated in the prospective Berlin C&S
study (Cream & Sugar) between January 2009 and August 2014 with available
12-month follow-up data and stored blood samples were eligible for
inclusion. Lp(a) levels were determined in serum samples using an
isoform-insensitive nephelometry assay. We assessed the risk for the
composite vascular end point of ischemic stroke, transient ischemic
attack, myocardial infarction, nonelective coronary revascularization, and
cardiovascular death with elevated Lp(a) defined as >30 mg/dL using Cox
regression analyses. Results - Of 465 C&S study participants, 250 patients
were included into this substudy with a median National Institutes of
Health Stroke Scale score of 2 (1-4). Twenty-six patients (10%)
experienced a recurrent vascular event during follow-up. Among patients
with normal Lp(a) levels, 11 of 157 subjects (7%) experienced an event at
a median time of 161 days (interquartile range, 19-196 days), whereas in
patients with elevated Lp(a) levels, 15 of 93 subjects (16%) experienced
an event at a median time of 48 days (interquartile range, 9-194 days;
P=0.026). The risk for a recurrent event was significantly higher in
patients with elevated Lp(a) levels after adjustment for potential
confounders (hazard ratio, 2.60; 95% confidence interval, 1.19-5.67;
P=0.016). Conclusions - Elevated Lp(a) levels are associated with a higher
risk for combined vascular event recurrence in patients with acute,
first-ever ischemic stroke. This finding should be validated in larger,
multicenter trials. Copyright &#xa9; 2016 American Heart Association, Inc.

<35>
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.

<36>
Accession Number
613865822
Author
Bielecki J.M.; Wong J.; Mitsakakis N.; Shah P.S.; Krahn M.D.; Rac V.E.
Institution
(Bielecki, Wong, Mitsakakis, Krahn, Rac) Leslie Dan Faculty of Pharmacy,
University of Toronto, Toronto, ON, Canada
(Bielecki, Wong, Mitsakakis, Krahn, Rac) Toronto Health Economics and
Technology Assessment (THETA) Collaborative, Toronto General Research
Institute (TGRI), University Health Network, Toronto General Hospital,
Eaton Bldg., 10th Floor, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
(Shah) Department of Pediatrics, Mount Sinai Hospital, 600 University
Avenue, Toronto, ON M5G 1X5, Canada
(Shah) Department of Pediatrics, University of Toronto, Toronto, ON,
Canada
(Shah, Krahn, Rac) Institute of Health Policy, Management and Evaluation,
University of Toronto, Toronto, ON, Canada
Title
Disparities in a provision of in-hospital post-arrest interventions for
out-of-hospital cardiac arrest (OHCA) in the elderly population-protocol
for a systematic review.
Source
Systematic Reviews. 5 (1) (no pagination), 2016. Article Number: 55. Date
of Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Out-of-hospital cardiac arrest (OHCA) is a significant cause
of death in developed countries. The majority of OHCA patients are elderly
(=65 years), and it was documented that they were less likely than younger
patients to receive the evidence-based interventions, even though the
improvement in survival in the elderly age group was higher than in
younger population. Our goal is to investigate any disparity in the
provision of post-arrest care for the elderly with OHCA and a sustained
return of spontaneous circulation (ROSC). Methods/design: Eight relevant,
electronic databases will be systematically searched to identify eligible
studies. The searches will be supplemented with gray literature searching
of theses, dissertations, and hand searching of pertinent journals. Two
independent reviewers will screen the titles and abstracts and select
studies for full text analysis using Preferred Reporting Items for
Systematic Reviews and Meta-analyses (PRISMA) method, and both will
extract information from the selected studies employing a form based on
the Data Extraction Template for Cochrane Reviews. A team of three
reviewers will assess the quality of the studies with the modified Downs
and Black scale. Statistical methods for evidence synthesis, such as
meta-analysis and meta-regression, will be applied to compare and combine
the evidence regarding the association between age and intervention
provision/utilization, adjusting for a number of significant confounders,
such as patient characteristics and co-morbidities and availability of
intervention techniques, as well as study specific characteristics. The
strength of evidence from the selected studies will be assessed using a
modified Grades of Recommendation, Assessment, Development, and Evaluation
(GRADE) system. Discussion: The findings obtained from this systematic
review should inform whether disparity exists in the provision of
post-arrest care for the elderly (= 65 years old) with OHCA or not.
Addressing this problem has a potential to substantially increase the
number of > 65-year-old, long-term survivors. The results of our review
might also point to the gaps in the published literature that specifically
examines disparity in provision of care for this population. This
systematic review was designed in accordance with the Preferred Reporting
Guidelines for Systematic reviews and Meta-analyses (PRISMA statement),
while the protocol follows the Preferred Reporting items for Systematic
review and Meta-analysis protocols (PRISMA-P) statement. Copyright &#xa9;
2016 Bielecki et al.

<37>
[Use Link to view the full text]
Accession Number
612245929
Author
Mavrakanas T.A.; Charytan D.M.
Institution
(Mavrakanas) General Internal Medicine Division, Geneva University
Hospitals, Geneva, Switzerland
(Mavrakanas, Charytan) Renal Division, Brigham and Women's Hospital,
Harvard Medical School, 1620 Tremont Street, Boston, MA 02115, United
States
Title
Cardiovascular complications in chronic dialysis patients.
Source
Current Opinion in Nephrology and Hypertension. 25 (6) (pp 536-544), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Purpose of review This review article focuses on the most significant
cardiovascular complications in dialysis patients [sudden cardiac death
(SCD), acute coronary syndromes, heart failure, and atrial fibrillation].
Recent findings Current and ongoing research aims to quantify the rate and
pattern of significant arrhythmia in dialysis patients and to determine
the predominant mechanism of SCD. Preliminary findings from these studies
suggest a high rate of atrial fibrillation and that bradycardia and
asystole may be more frequent than ventricular arrhythmia as a cause of
sudden death. A recently published matched cohort study in dialysis
patients who received a defibrillator for primary prevention showed that
there was no significant difference in mortality rates between
defibrillator-treated patients and propensity-matched controls. Two
randomized controlled trials are currently recruiting participants and
will hopefully answer the question of whether implantable or wearable
cardioverter defibrillators can prevent SCD. An observational study using
United States Renal Data System data demonstrated how difficult it is to
keep hemodialysis patients on warfarin, as more than two-thirds
discontinued the drug during the first year. The ISCHEMIA-CKD trial may
provide answers about the optimal strategy for the treatment of
atherosclerotic coronary disease in patients with advanced chronic kidney
disease. Summary The article reviews the diagnosis of acute coronary
syndromes in dialysis patients, current literature on myocardial
revascularization, and data on fatal and nonfatal cardiac arrhythmia. The
new classification of heart failure in end-stage renal disease is
reviewed. Finally, available cohort studies on warfarin for stroke
prevention in dialysis patients with atrial fibrillation are reviewed.
Copyright &#xa9; 2016 Wolters Kluwer Health, Inc.

<38>
Accession Number
613411266
Author
Bainey K.R.; Welsh R.C.; Toklu B.; Bangalore S.
Institution
(Bainey, Welsh) Mazankowski Alberta Heart Institute, University of
Alberta, Edmonton, Alberta, Canada
(Toklu, Bangalore) Division of Cardiology, New York University School of
Medicine, New York, New York, United States
Title
Complete vs Culprit-Only Percutaneous Coronary Intervention in STEMI With
Multivessel Disease: A Meta-analysis and Trial Sequential Analysis of
Randomized Trials.
Source
Canadian Journal of Cardiology. 32 (12) (pp 1542-1551), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Pulsus Group Inc.
Abstract
Background Patients with ST-elevation myocardial infarction (STEMI) and
multivessel disease (MVD) most commonly are treated with culprit-only
percutaneous coronary intervention (PCI). However, this has been recently
challenged, suggesting benefit with complete revascularization (CR).
Still, these latest findings are largely based on clinical trials powered
for composite outcomes that frequently include "softer" end points. We
performed a meta-analysis comparing routine culprit-only PCI vs CR in
STEMI, with an emphasis on "hard" clinical end points. Methods MEDLINE,
EMBASE, ISI Web of Science, and CENTRAL were searched from 1996-May 2015.
Studies included patients with STEMI and MVD who received primary PCI. The
primary end point was long-term death/myocardial infarction (MI). Data
were combined using a fixed-effects model. Results Seven randomized trials
(2004 patients: 1065 CR and 939 culprit-only PCI procedures) were
included. Compared with culprit-only PCI, CR reduced the composite of
death/MI (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.52-0.96)
but not death (OR, 0.78; 95% CI, 0.53-1.15) or recurrent MI (OR, 0.85; 95%
CI, 0.58-1.24) alone. If CR was performed during the index
catheterization, a reduction in death/MI was observed (death/MI: OR, 0.41;
95% CI, 0.25-0.65; death: OR, 0.59; 95% CI, 0.34-1.00; recurrent MI: OR,
0.35; 95% CI, 0.18-0.69). If staged, no benefits were noted (death/MI: OR,
0.99; 95% CI, 0.67-1.45; death: OR, 0.95; 95% CI, 0.56-1.61; recurrent MI:
OR, 1.02; 95% CI, 0.61-1.70). However, when trial sequential analysis was
performed for the overall population, the cumulative z-curve did not cross
the monitoring boundary, suggesting a lack of evidence for reducing
death/MI with CR (similar for index catheterization). Conclusions In STEMI
with MVD, there is insufficient evidence to support a reduction in
death/MI with CR. Our results reinforce the need for larger clinical
trials powered for robust clinical end points. Copyright &#xa9; 2016
Canadian Cardiovascular Society

<39>
Accession Number
613362981
Author
Harris S.K.; Roos M.G.; Landry G.J.
Institution
(Harris, Roos, Landry) Oregon Health and Science University, Portland,
Ore, United States
Title
Statin use in patients with peripheral arterial disease.
Source
Journal of Vascular Surgery. 64 (6) (pp 1881-1888), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Statins are recommended for use in patients with peripheral
arterial disease (PAD) to reduce cardiovascular events and mortality.
However, much of the data regarding benefits of statins stem from the
cardiovascular literature. Here, we review the literature regarding statin
use specifically in patients with PAD regarding its effects on
cardiovascular events and mortality, limb-related outcomes, statin use
after endovascular interventions, statin dosing, and concerns about
statins. Methods We performed a literature review using PubMed for
literature after the year 2000. Search terms included "statins,"
"peripheral arterial disease," "peripheral vascular disease,"
"lipid-lowering medication," and "cardiovascular disease." Results There
is good evidence of statins lowering cardiovascular events and
cardiovascular-related mortality in patients with PAD. Though
revascularization rates were reduced with statins, amputation rates and
amputation-free survival did not improve. Small randomized controlled
trials show that patients taking statins can slightly improve pain-free
walking distance or pain-free walking time, although the extent of the
effect on quality of life is unclear. Statin use for patients undergoing
endovascular interventions is recommended because of the reduction of
postoperative cardiovascular events. Not enough data exist to support
local effects of systemic statin therapy, such as prevention of
restenosis. For statin dosing, there is little increased benefit to
intense therapy compared with the adverse effects, whereas moderate-dose
therapy has significant benefits with very few adverse effects. Adverse
effects of moderate-dose statin therapy are rare and mild and are greatly
outweighed by the cardiovascular benefits. Conclusions There is strong
evidence to support use of statins in patients with PAD to reduce
cardiovascular events and mortality. Use in patients undergoing open and
endovascular interventions is also recommended. Statin use may reduce the
need for revascularization, but reductions in amputation have not been
shown. Moderate-dose statin therapy is safe, and the minor risks are
greatly outweighed by benefits. Copyright &#xa9; 2016 Society for Vascular
Surgery

<40>
Accession Number
613362572
Author
Volodarskiy A.; Kumar S.; Amin S.; Bangalore S.
Institution
(Volodarskiy) Hofstra Northwell School of Medicine, Manhasset, NY, United
States
(Kumar) Cardiac Clinic of Kissimmee, Fla, United States
(Amin, Bangalore) New York University School of Medicine, United States
Title
Optimal Treatment Strategies in Patients with Chronic Kidney Disease and
Coronary Artery Disease.
Source
American Journal of Medicine. 129 (12) (pp 1288-1298), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Chronic kidney disease is an independent risk factor for
coronary artery disease and is associated with an increase in adverse
outcomes. However, the optimal treatment strategies for patients with
chronic kidney disease and coronary artery disease are yet to be defined.
Methods MEDLINE, EMBASE, and CENTRAL were searched for studies including
at least 100 patients with chronic kidney disease (defined as estimated
glomerular filtration rate <60 mL/min/1.73 m² or on dialysis)
and coronary artery disease treated with medical therapy, percutaneous
coronary intervention, or coronary artery bypass surgery and followed for
at least 1 month and reporting outcomes. The outcome evaluated was
all-cause mortality. Meta-analysis was performed to evaluate the outcomes
with revascularization (percutaneous coronary intervention or coronary
artery bypass surgery) when compared with medical therapy alone. In
addition, outcomes with percutaneous coronary intervention vs coronary
artery bypass surgery were evaluated. Results The search yielded 38
nonrandomized studies that enrolled 85,731 patients. Revascularization
(percutaneous coronary intervention or coronary artery bypass surgery) was
associated with lower long-term mortality (mean 4.0 years) when compared
with medical therapy alone (relative risk [RR] 0.73; 95% confidence
interval [CI], 0.62-0.87), driven by lower mortality with percutaneous
coronary intervention vs medical therapy and coronary artery bypass
surgery vs medical therapy. Coronary artery bypass surgery was associated
with a higher upfront risk of death (RR 1.81; 95% CI, 1.47-2.24) but a
lower long-term risk of death (RR 0.94; 95% CI, 0.89-0.98) when compared
with percutaneous coronary intervention. Conclusions In chronic kidney
disease patients with coronary artery disease, the current data from
nonrandomized studies indicate lower mortality with revascularization, via
either coronary artery bypass surgery or percutaneous coronary
intervention, when compared with medical therapy. These associations
should be tested in future randomized trials. Copyright &#xa9; 2016
Elsevier Inc.

<41>
Accession Number
613204495
Author
Noiseux N.; Mansour S.; Weisel R.; Stevens L.-M.; Der Sarkissian S.; Tsang
K.; Crean A.M.; Larose E.; Li S.-H.; Wintersperger B.; Vu M.Q.; Prieto I.;
Li R.-K.; Roy D.C.; Yau T.M.
Institution
(Noiseux, Stevens, Prieto) Division of Cardiac Surgery, Centre Hospitalier
de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
(Mansour) Division of Cardiology, Centre Hospitalier de l'Universite de
Montreal (CHUM), Montreal, Quebec, Canada
(Noiseux, Mansour, Stevens, Der Sarkissian, Vu) Centre Hospitalier de
l'Universite de Montreal Research Center (CRCHUM), Montreal, Quebec,
Canada
(Noiseux, Stevens, Der Sarkissian, Prieto, Roy) Department of Surgery,
Universite de Montreal, Montreal, Quebec, Canada
(Mansour) Department of Medicine, Universite de Montreal, Montreal,
Quebec, Canada
(Larose) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec City, Quebec, Canada
(Weisel, Tsang, Crean, Li, Wintersperger, Li, Yau) Peter Munk Cardiac
Centre, University Health Network, Toronto, Ontario, Canada
(Weisel, Tsang, Li, Li, Yau) Division of Cardiovascular Surgery,
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
(Crean, Wintersperger) Division of Medical Imaging, University of Toronto,
Toronto, Ontario, Canada
(Roy) Department of Hematology, Hopital Maisonneuve-Rosemont (HMR),
Montreal, Quebec, Canada
Title
The IMPACT-CABG trial: A multicenter, randomized clinical trial of
CD133⁺ stem cell therapy during coronary artery bypass grafting
for ischemic cardiomyopathy.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (6) (pp 1582-1588.e2),
2016. Date of Publication: 01 Dec 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives The IMPACT-CABG trial is the first North American multicenter
phase II randomized study of intramyocardial delivery of autologous
CD133⁺ stem cells in patients with chronic ischemic
cardiomyopathy undergoing coronary artery bypass grafting. The primary
objective was to demonstrate safety, including freedom from major adverse
cardiac events. The secondary objective was to evaluate feasibility of
same-day autologous cell preparation. Although the trial was not powered
to evaluate LV function, exploratory data were collected. Methods After 7
open-label patients who received cells, patients randomly received stem
cells or placebo (N = 40 total, 20 per center). After completion of
coronary anastomoses, up to 10 million CD133⁺,
CD34⁺, CD45⁺ triple-positive cells or placebo were
injected into the infarct and border zones. Patients were followed up
clinically and underwent magnetic resonance imaging preoperatively and
after 6 months. Results There were no procedural complications from bone
marrow isolation and cell injection, no in-hospital mortality, and no
protocol-related complications. Four patients had transient renal
insufficiency, with 1 death during 6-month follow-up. Magnetic resonance
imaging revealed that left ventricular volumes and ejection fractions
improved in all patients (no difference between groups). Conclusions The
trial successfully met both primary and secondary objectives,
demonstrating that same-day isolation and autologous CD133⁺
cell delivery with coronary artery bypass grafting is safe and feasible.
The positive findings support a larger randomized, multicenter trial, with
higher numbers of transplanted cells to demonstrate beneficial effects.
The upcoming IMPACT-CABG II trial will evaluate higher cell doses and
pharmacologic enhancement to determine whether these cells improve
perfusion and myocardial function. Copyright &#xa9; 2016 The American
Association for Thoracic Surgery

<42>
Accession Number
612433655
Author
Rex C.E.; Heiberg J.; Klaaborg K.-E.; Hjortdal V.E.
Institution
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Cardiothoracic & Vascular
Surgery, Aarhus University Hospital, Aarhus, Denmark
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
Title
Health-related quality-of-life after transapical transcatheter aortic
valve implantation.
Source
Scandinavian Cardiovascular Journal. 50 (5-6) (pp 377-382), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose. Transcatheter aortic valve implantation (TA-TAVI) is a
well-established treatment for aortic valve stenosis in high-risk patients
and indications have been continuously expanding to also include
intermediate-risk patients. However, in low-risk patients, experiences are
still sparse and although clinical outcomes have been shown favorable
results, HRQoL has remained unexplored. The aim of this report was to
describe the long-term health-related quality-of-life (HRQoL) in low-risk
patients randomized to TA-TAVI or surgical aortic valve replacement
(SAVR). Methods. In a prospective, randomized trial, patients with aortic
valve stenosis were randomized to either TA-TAVI or SAVR. TA-TAVI was
performed through a mini thoracotomy with the introduction of prosthesis
via the apex of the heart and antegradely advancement over the pre-dilated
native valve. SAVR was performed during cardiopulmonary bypass with
resection of the native valve and replacement with a prosthesis valve
through a median sternotomy. Afterwards, patients were followed yearly
with echocardiography and HRQoL assessment. Results. A total of 58
patients were included; 29 patients for TA-TAVI and 29 patients for SAVR.
The only difference in HRQoL was found in the physical component summary
after 1 year; 44 +/- 9 in the TA-TAVI group compared with 36 +/- 9 in the
SAVR group, p =.03. There were no differences in any of the remaining
timepoints in neither physical nor mental component summary, p =.19 and p
=.98, respectively, and there were no differences in survival during the 5
years. Conclusions. In low-risk patients with aortic valve stenosis
undergoing TA-TAVI, no differences appeared in HRQoL compared with SAVR
during a 5-year follow-up period. Copyright &#xa9; 2016 Informa UK
Limited, trading as Taylor & Francis Group.

<43>
Accession Number
610463283
Author
Gudbjartsson T.; Jeppsson A.; Sjogren J.; Steingrimsson S.; Geirsson A.;
Friberg O.; Dunning J.
Institution
(Gudbjartsson, Steingrimsson, Geirsson) Department of Cardiothoracic
Surgery, Landspitali University Hospital, Faculty of Medicine, University
of Iceland, Reykjavik, Iceland
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Sjogren) Department of Cardiothoracic Surgery, Skane University Hospital,
Lund, Sweden
(Friberg) Department of Cardiothoracic Surgery, Orebro University
Hospital, Orebro, Sweden
(Dunning) Department of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom
Title
Sternal wound infections following open heart surgery-a review.
Source
Scandinavian Cardiovascular Journal. 50 (5-6) (pp 341-348), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Surgical site infections (SSIs) are common complications after open heart
surgery. Fortunately, most are superficial and respond to minor wound
debridement and antibiotics. However, 1-3% of patients develop deep
sternal wound infections that can be fatal. Late infections with
sternocutaneous fistulas, are encountered less often, but represent a
complex surgical problem. This evidence-based review covers etiology, risk
factors, prevention and treatment of sternal SSIs following open heart
surgery with special focus on advances in treatment, especially
negative-pressure wound therapy. Copyright &#xa9; 2016 Informa UK Limited,
trading as Taylor & Francis Group.

<44>
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.

<45>
Accession Number
613437635
Author
Pilarczyk K.; Haake N.; Heckmann J.; Carstens H.; Haneya A.; Cremer J.;
Jakob H.; Pizanis N.; Kamler M.
Institution
(Pilarczyk, Haake) Department of Intensive Care Medicine, imland Klinik
Rendsburg, Rendsburg, Germany
(Pilarczyk, Heckmann, Carstens, Jakob, Pizanis, Kamler) Department of
Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center
Essen, University Hospital Essen, Essen, Germany
(Haneya, Cremer) Department of Cardiovascular Surgery, University of
Schleswig-Holstein, Kiel, Germany
Title
Is universal antifungal prophylaxis mandatory in adults after lung
transplantation? A review and meta-analysis of observational studies.
Source
Clinical Transplantation. 30 (12) (pp 1522-1531), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Lung transplant (LTX) recipients are at high risk of invasive
Aspergillus infections (IAI). However, no randomized-controlled trials
(RCT) or international guidelines on antifungal prophylaxis (AFP) in the
LTX population exist. Methods: A meta-analysis was performed to determine
whether AFP reduces the rate of IAI after LTX. A total of six eligible
observational studies (five with no prophylaxis, one with targeted
prophylaxis, three studies including heart/lung transplantation) with a
total of 748 patients were included. Results: The pooled odds ratio (OR)
for IAI (62 IFI in the intervention arm and 82 in the control group) was
0.234 (95% confidence interval [CI] 0.097-0.564, P=0.001, z=-3.237).
Pooled studies were characterized by substantial heterogeneity
(I²=66.64%); number needed to treat was 6.8. A subgroup
analyses with exclusion of heart transplant recipients also showed a
statistically significant reduction in IAI with AFP (OR 0.183, 95% CI
0.0449-0.744, P=0.018). Conclusion: This study suggests that universal
antifungal prophylaxes reduces incidence of IAI after LTX. However,
included studies are limited by small sample size, single-center structure
without randomization, mixed population (including heart/heart-lung
transplant), and heterogeneity due to variations in immunosuppression,
type, and duration of AFP. Therefore, there is a clear need for an
adequately powered RCT. Copyright &#xa9; 2016 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd

<46>
Accession Number
613992507
Author
Odashiro K.; Yokoyama T.; Fukata M.; Arita T.; Maruyama T.; Akashi K.
Institution
(Odashiro, Yokoyama, Fukata, Arita, Akashi) Department of Medicine and
Biosystemic Science, Kyushu University Graduate School of Medical
Sciences, Fukuoka, Japan
(Maruyama) Faculty of Arts and Science, Kyushu University, Fukuoka, Japan
Title
Anticoagulation stability depends on CHADS<inf>2</inf> score and
hepatorenal function in warfarin-treated patients, including those with
atrial fibrillation.
Source
Journal of Atherosclerosis and Thrombosis. 24 (1) (pp 68-76), 2017. Date
of Publication: 2017.
Publisher
Japan Atherosclerosis Society
Abstract
Aim: Although warfarin remains important despite the widespread use of
nonvitamin K antagonist oral anticoagulants (NOACs), to date, the reality
of warfarin use in the "NOACs era" is unclear. This multicenter
observational study aimed to clarify the key factors contributing to
warfarin treatment stability. Methods: The practical use of warfarin,
stability of warfarin therapy, and factors contributing to this stability
were investigated in community-based hospitals through a real-world study.
Clinical data were retrospectively extracted from the medical records of
warfarin-treated Japanese patients (age, 71.3+/-5.5 years) with atrial
fibrillation (AF), prosthetic heart valve, or other concerns requiring
anticoagulation. Treatment stability was considered as time in therapeutic
range of international normalized ratio of prothrombin time (TTR: %). The
factors contributing to TTR were investigated, including CHADS<inf>2</inf>
score components. Results: Mean CHADS<inf>2</inf> score was highest
(1.38+/-0.88, p<0.001), and most CHADS<inf>2</inf> score components in
addition to hepatorenal dysfunction were factors contributing to the low
TTR in patients with AF (n =176). The similarity was found in overall
patients who were prescribed warfarin (n = 518). TTR decreased according
to the CHADS<inf>2</inf> score component accumulation. Gender, dose and
prescription interval of warfarin, and co-administration of antiplatelet
agents did not correlate with the low TTR. Conclusions: This retrospective
study demonstrated that the CHADS<inf>2</inf> score component accumulation
and hepatorenal dysfunction are factors significantly contributing to the
low TTR, which is indicative of poor warfarin treatment stability, in
patients such as those with AF. Copyright &#xa9; 2017 Japan
Atherosclerosis Society.

<47>
Accession Number
613963146
Author
Frey N.; Steeds R.P.; Serra A.; Schulz E.; Baldus S.; Lutz M.; Pohlmann
C.; Kurucova J.; Bramlage P.; Messika-Zeitoun D.
Institution
(Frey, Lutz) University of Kiel, Department of Cardiology and Angiology,
Kiel, Germany
(Steeds) University of Birmingham, Queen Elizabeth Hospital and Institute
of Cardiovascular Sciences, Birmingham, United Kingdom
(Serra) University of Barcelona, Hospital de Sant Pau, Cardiology Unit,
Barcelona, Spain
(Schulz) University Clinic Mainz, Cardiology Department I, Mainz, Germany
(Baldus) Heart Center of the University Clinic Cologne, Clinic for
Cardiology, Angiology, and Pneumology and Intensive Care Medicine,
Cologne, Germany
(Pohlmann, Bramlage) Institute for Pharmacology and Preventive Medicine,
Cloppenburg, Germany
(Kurucova) Edwards Lifesciences, Prague, Czech Republic
(Messika-Zeitoun) Bichat Hospital, Department of Cardiology, Paris, France
Title
Quality of care assessment and improvement in aortic stenosis - rationale
and design of a multicentre registry (IMPULSE).
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 5. Date of Publication: 05 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Severe aortic stenosis (AS) is a common, serious valve disease
in which no effective medical therapy is available and, if not treated by
intervention, has a 5-year survival of only 40-60%. Despite the
availability of guidelines supporting the effective use of surgical aortic
valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI)
to treat the majority of these patients, adherence to these guidelines in
clinical practice is still unsatisfactory. Several recent studies have
emphasised the necessity for improved communication between
multidisciplinary teams, with the aim to ensure that severe AS patients
receive appropriate treatment. Methods/design: IMPULSE is a prospective,
multicentre, European registry designed to gather data over 12 months on
the treatment decisions made by referring physicians for patients newly
diagnosed with severe AS. Each patient has a follow-up of 3 months. The
study will consist of two observational phases to assess the
appropriateness and rate of referral based on current guidelines prior to
and after an interventional phase aiming to determine whether a simple
quality of care intervention improves patient management. Discussion: Data
will be analysed firstly, to determine the appropriateness of treatment
decisions for the management of severe AS in current European clinical
practice, and secondly, to evaluate the effectiveness of facilitated data
relay from a designated echocardiography department nurse to the referring
physician early after diagnosis in improving quality of care.
Additionally, variables will be identified that are associated with
inappropriate decision-making. Collectively, the aim will be to design a
clinical pathway that will improve the timely management of patients with
newly diagnosed severe AS. Copyright &#xa9; 2017 The Author(s).

<48>
Accession Number
613983813
Author
Arango-Granados M.C.; Ariza F.
Institution
(Arango-Granados) Fundacion Valle del Lili, Departamento de Anestesia y
Cuidado Intensivo, Cali, Colombia
(Ariza) Fundacion Valle del Lili, Departamento de Anestesia, Cali,
Colombia
Title
Protective ventilation and recruitment maneuvers during major surgery.
Source
Revista Argentina de Anestesiologia. 74 (1) (pp 1-9), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Elsevier Espana S.L.
Abstract
Mechanical ventilation is a common intervention during surgical
procedures, especially in major surgery and critically ill patients.
However, it involves exposure to certain risks and has potentially lethal
complications. Studies carried out in the last few years have been aimed
at defining the ventilatory approach that offers the best safety profile
during major surgery. This review attempts to present the available
evidence on protective ventilation and recruitment manoeuvres during major
surgery. A structured search was performed in MEDLINE and SciELO
databases. Some authors agree that the use of low tidal volumes reduces
postoperative pulmonary complications. There is conflicting evidence of
this benefit in thoracic surgery. There are mixed findings regarding the
use of positive end-expiratory pressure. There are suggestions in the
literature that this strategy has potential benefits in thoracic,
cardiovascular, and trauma surgery, but there is conflicting data for
major abdominal surgery and neurosurgery, suggesting the need for further
research. Additionally, it still needs to be determined whether
recruitment manoeuvres offer real benefits, regardless of the type of
surgery. Finally, it is still not possible to establish if protective
ventilation or recruitment manoeuvres performed during surgery have an
impact on long-term outcomes, such as mortality. Copyright &#xa9; 2016
Federacion Argentina de Asociaciones, Anestesia, Analgesia y Reanimacion

<49>
Accession Number
613957954
Author
Jambure N.; Nagrc A.S.
Institution
(Jambure, Nagrc) MGM Media/ CoBegt / MGM Medical Cento and Ktsesreb
Institute, Flat 13, 5th Floor, SA1 Heritage, Attrattgikid, Maharashtra,
Ulkanagari, Aurangabad, India
Title
Comparison of Intranasal dexmedetomidine and oral midazolam as
premedication for cardiac catheterization procedure in pediatric patients.
Source
Anaesthesia, Pain and Intensive Care. 20 (pp S42-S46), 2016. Date of
Publication: October 2016.
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Objccthre: The aim of study Is Co evaluate che preoperative sedative
effects of intranasal dexmedetomidine as compared to oral midazolam as
preanesthetic medication in children undergoing cardiac catheterization
for diagnostic and'or therapeutic procedure. Design: Prospective,
randomized, double-blind, controlled study. Method: 61 patients of cither
sex between the ages 2-10 years were recruited for cardiac catheterization
for diagnostic and/or therapeutic procedural sedation, 31 patients of
group D received intranasal dexmedetomidine 2 ngrtcg, by mucosal atomiser
spray and 30 patients of group M received oral midazolam 0.5 mg/kg.
Outcome: To compare the effects of drug between two groups. Behavior
score, sedation score, separation score and vitals were recorded before
shifting the patient to cathlab and at Induction of anesthesia. Results:
The result in the study shows that, group D patients (2 mug/kg) has
statistically significant faster onset of action, separation score,
sedation score, behavior score at induction and at 15 and 30 minutes as
compared to group M (0.5 mg/kg). Conclusion: Trasnasal dexmedetomidine has
faster and better onset of action, separation score, sedation score, and
behavior score than oral midazolam for cardiac cath procedure in pediatric
patients.

<50>
Accession Number
613957949
Author
Furqan A.; Ali L.; Fayyaz A.; Ahmad R.A.; Baig M.A.R.; Ahmad S.S.
Institution
(Furqan, Ahmad, Ahmad) Department of Cardiotboracic Anesthesia, Chaudbty
Pervaiz Elabi Institute of Cardiology (CPEIC), Multan, Pakistan
(Baig) Cbaudbry Pervai Elabi Institute of Cardiology (CPEIC), Multan,
Pakistan
(Ali, Fayyaz) Department of Anesthesiology, Children Hospital and
Institute of Child Health, Multan Medical and Dental College, Multan
(Pakistan). 1Assistant Professor, Multan, Pakistan
Title
Continuous low tidal volume ventilation during cardiopulmonary bypass
reduces the risk of pulmonary dysfunction.
Source
Anaesthesia, Pain and Intensive Care. 20 (pp S37-S41), 2016. Date of
Publication: October 2016.
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Objective: Pulmonary dysfunction is considered to be the most important
complication after open heart surgery. Different maneuvers like
intermittent or continuous positive pressure ventilation, low tidal volume
ventilation and different vital capacity maneuvers have been used for
reducing the incidence of pulmonary dysfunction after cardiac surgery. In
this study we evaluated the effects of low tidal volume ventilation versus
no-ventilation during cardiopulmonary bypass (CPB) in patients undergoing
conventional CABG surgery. Methodology: This randomized clinical trial was
conducted in a tertiary care cardiac hospital. One hundred patients who
were planned to undergo conventional CABG surgery were divided into two
groups by using draw randomization procedure. In Group A patients
(ventilation group) ventilation was continued at low tidal volume of 3
ml/kg, respiration rate of 12 breaths/min and PEEP of 5 cmH<inf>2</inf>O.
In Group B patients (non-ventilation group) ventilation was arrested
during CPB. For data analysis Statistical Package for Social Sciences
(SPSS) VI7 was used. Parametric variables were compared using unpaired
t-Test and non-parametric variables were compared using attest. Results:
The mean patient's age in this study was 57.70 +/- 8.57 years in
ventilated group and 54.5 +/- 8.33 years in non-ventilated group.
PaO<inf>2</inf>/Fio<inf>2</inf> ratio and alveolar-Arterial oxygen tension
gradient immediately after intubation was same in groups. But
PaO<inf>2</inf>/Fio<inf>2</inf> was significandy high in ventilated group
after one hours of CPB and even after four hours of CPB (p < 0.001 and
0.002 respectively). Alveolar arterial oxygen tension (A-A O<inf>2</inf>
gradient after 1 hour and four hours of CPB was significantly low in
Ventilated group (p < 0.001 and 0.001 respectively). Total Mechanical
ventilation time was also significantly shorter in ventilated group 5.19
+/- 1.96 hours versus 6.42 +/- 2.60 hours in non-ventilated group (p
0.009). On 4th post-operative day, incidence of atelectasis was
significantly low 20% in ventilated group versus 38% in non-ventilated
group (p = 0.04). Conclusion: Continuous low tidal volume ventilation is
associated with better oxygenation after surgery and reduced risk of
post-op pulmonary complications during cardiopulmonary bypass in patients
undergoing conventional coronary artery bypass graft surgery.

<51>
Accession Number
613957945
Author
Furqan A.; Fayyaz A.; Ahmad S.S.; Ahmad R.A.
Institution
(Furqan, Fayyaz) Department of Cardiothoracic Anesthesia, Chaudhry Pervaiz
Elabi Institute of Cardiology (CPEIC), Multan, Pakistan
(Ahmad) Children Hospital, Multan, Pakistan
(Ahmad) Chaudhry Pervaiz Elabi Institute of Cardiology (CPEIC), Multan,
Pakistan
Title
Effect of applying lignocaine gel, diclofenac gel or their combination on
endotracheal tube on the hemodynamic response and incidence of
postoperative complications in patients undergoing CABG surgery.
Source
Anaesthesia, Pain and Intensive Care. 20 (pp S32-S36), 2016. Date of
Publication: October 2016.
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Objectives: Hoarseness of voice, cough and sore throat are well known
complications of endotracheal intubation. Many pharmacological strategies
are used to reduce the Incidence of these complications post surgery. We
conducted this study to see the effectiveness of local application of
diclofenac sodium gel, lidocaine gel or the effect of these two drugs when
applied In combination on tracheal tube during intubation, regarding
hemodynamic response and the incidence of postoperative sore throat,
hoarseness of voice and cough. Methodology: In this prospective,
randomized single blind trial, 150 patients undergoing coronary artery
bypass graft (CABG) surgery at Chaudhry Pervaiz Elahi Institute of
Cardiology from January 2016 to March 2016, were selected. The patients
were divided into three groups; Group X (control Group) in which
endotracheal tube (ETT) was lubricated with 2% lignocaine gel. Group D:
ETT was lubricated with diclofenac sodium gel (2%). And Group XD: Where a
mixture of lignocaine and diclofenac sodium gels was used to lubricate ETT
before insertion. Data were analyzed in SPSS VI6. One way ANOVA and
chi-square test was used for analysis of quantitative and qualitative
variables respectively taking p-value < 0.05 to be significant. Results:
There was no difference in the age and gender of patients between groups.
Post Intubation HR increased more in Group D (108.94 +/- 7.40 beats/min.),
and least in Group XD 96.62 +/- 3 84 beats/mm and 100.72 +/- 6.98
beats/min in group X (p < 0.0001). HR returned back to baseline value in
group X and Group XD within five minutes after intubation but remained
higher in diclofenac group (p < 0.0001). The rise in blood pressure after
intubation was highest in Group D (162.46 +/- 5.05 mmHg), then 157.34 +/-
5.43 mmHg in Group X, and least in Group XD (154.12 +/- 6.07 mmHg) (p <
0.0001). Similarly blood pressure after five minutes of intubation was
still high in Group D and was least in Group XD (p < 0.0001). The time of
return of HR and systolic blood pressure to baseline value was 9.00 +/-
1.33 min in Group D, 4.59+/-1.03 min in Group X and 3.43 +/- 0.81 min in
group XD (p < 0.0001). Incidence of sore throat, hoarseness of voice and
cough was highest in Group X and less in Group D and was least in Group XD
(p-values 0.039, 0.025 and 0.002 respectively). Conclusion: Local
application of a combination of lignocaine and diclofenac sodium gels over
the endotracheal tube before intubation is associated with better
hemodynamic control and significantly lower incidence of postoperative
sore throat, hoarseness of voice and cough.

<52>
Accession Number
613877784
Author
Taggart D.P.; Altman D.G.; Gray A.M.; Lees B.; Gerry S.; Benedetto U.;
Flather M.
Institution
(Taggart, Lees) Nuffield Department of Surgical Sciences, United Kingdom
(Altman, Gerry) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology, Musculoskeletal Sciences, Botnar Research
Centre, United Kingdom
(Gray) Health Economics Research Centre, Nuffield Department of Population
Health, United Kingdom
(Benedetto) University of Oxford, Oxford, United Kingdom
(Benedetto) School of Clinical Sciences, University of Bristol and Bristol
Royal Infirmary, Bristol, United Kingdom
(Flather) Norwich Medical School, University of East Anglia and Norfolk
and Norwich University Hospital, Norwich NR4 7TJ, United Kingdom
Title
Randomized trial of bilateral versus single internal-thoracic-artery
grafts.
Source
New England Journal of Medicine. 375 (26) (pp 2540-2549), 2016. Date of
Publication: 29 Dec 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The use of bilateral internal thoracic (mammary) arteries for
coronary-artery bypass grafting (CABG) may improve long-term outcomes as
compared with the use of a single internal-thoracic-artery plus vein
grafts. METHODS We randomly assigned patients scheduled for CABG to
undergo single or bilateral internal-thoracic-artery grafting in 28
cardiac surgical centers in seven countries. The primary outcome was death
from any cause at 10 years. The composite of death from any cause,
myocardial infarction, or stroke was a secondary outcome. Interim analyses
were prespecified at 5 years of follow-up. RESULTS A total of 3102
patients were enrolled; 1554 were randomly assigned to undergo single
internal-thoracic-artery grafting (the single-graft group) and 1548 to
undergo bilateral internal-thoracic-artery grafting (the bilateral-graft
group). At 5 years of follow-up, the rate of death was 8.7% in the
bilateral-graft group and 8.4% in the single-graft group (hazard ratio,
1.04; 95% confidence interval [CI], 0.81 to 1.32; P = 0.77), and the rate
of the composite of death from any cause, myocardial infarction, or stroke
was 12.2% and 12.7%, respectively (hazard ratio, 0.96; 95% CI, 0.79 to
1.17; P = 0.69). The rate of sternal wound complication was 3.5% in the
bilateralgraft group versus 1.9% in the single-graft group (P = 0.005),
and the rate of sternal reconstruction was 1.9% versus 0.6% (P = 0.002).
CONCLUSIONS Among patients undergoing CABG, there was no significant
difference between those receiving single internal-thoracic-artery grafts
and those receiving bilateral internal-thoracic-artery grafts with regard
to mortality or the rates of cardiovascular events at 5 years of
follow-up. There were more sternal wound complications with bilateral
internal-thoracic-artery grafting than with single internal-thoracicartery
grafting. Ten-year follow-up is ongoing. Copyright &#xa9; 2016
Massachusetts Medical Society. All rights reserved.

<53>
Accession Number
613771830
Author
Salcher M.; Naci H.; Pender S.; Kuehne T.; Kelm M.
Institution
(Salcher, Naci, Pender) Department of Social Policy, LSE Health, London
School of Economics and Political Science, London, United Kingdom
(Pender) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Kuehne, Kelm) Department of Paediatric Cardiology and Congenital Heart
Diseases, German Heart Institute, Berlin, Germany
Title
Bicuspid aortic valve disease: Systematic review and meta-analysis of
surgical aortic valve repair.
Source
Open Heart. 3 (2) (no pagination), 2016. Article Number: e000502. Date of
Publication: 01 Dec 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Aortic valve repair is still emerging, and its role in the treatment of
bicuspid aortic valve disease (BAVD) is not yet fully understood. Our
objective is to synthesise available evidence on outcomes after surgical
aortic valve repair in patients with BAVD. We conducted a systematic
review of clinical studies using prespecified methods for searching,
identifying and selecting eligible studies in 4 databases, and
synthesising results (PROSPERO 2014:CRD42014014415). 2 researchers
independently reviewed full-text articles and extracted data. The results
of included studies were quantitatively synthesised in frequentist
meta-analyses. We included 11 aortic valve repair studies or study arms
with a total of 2010 participants. Pooled estimates for the proportion of
patients surviving at 30 days, 1 year, 5 years and 10 years were 0.995
(95% CI 0.991 to 0.995), 0.994 (0.989 to 0.999), 0.945 (0.898 to 0.993)
and 0.912 (0.845 to 0.979), respectively. The pooled proportion of late
deaths from valve-related causes was 0.008 (0.000 to 0.019) at a mean
follow-up of 3.5 years. Proportion of patients with valve-related
reinterventions was 0.075 (0.037 to 0.113) at a mean follow-up of 3.9
years, and the linearised reintervention rate was 1.3 (0.7 to 1.9) per 100
patient-years. Outcome reporting was insufficient to pool the results for
a number of predefined outcomes. In conclusion, existing evidence on
aortic valve repair in BAVD is limited to mostly small case series,
case-control and small retrospective cohort studies. Despite the low
quality, available evidence suggests favourable survival outcomes after
aortic valve repair in selected patients with BAVD. Valve-related
reinterventions at follow-up are common in all patients undergoing repair
surgery. Copyright &#xa9; Published by the BMJ Publishing Group Limited.
For permission to use (where not already granted under a licence) please
go to http://www.bmj.com/company/products-services/rights-and-licensing/.

<54>
Accession Number
613939934
Author
Shi Q.; Hong L.; Mu X.; Zhang C.; Chen X.
Institution
(Shi, Hong, Mu, Zhang) Department of Critical Care Medicine, Nanjing First
Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
(Chen) Department of Thoracic and Cardiovascular Surgery, Nanjing First
Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
Title
Meta-analysis for outcomes of acute kidney injury after cardiac surgery.
Source
Medicine (United States). 95 (49) (pp e5558), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
This study aimed to investigate the outcomes of acute kidney injury (AKI)
after cardiac surgery by the meta-analysis. Electronic databases PubMed
and Embase were searched for relative studies from December 2008 to June
2015. For eligible studies, the R software was conducted to meta-analyze
outcomes of AKI patients (AKI group) and none-AKI patients after cardiac
surgery (NO AKI group). The chi-square-based Q test and I2 statistic were
used for heterogeneity analysis. P<0.1 or I2>50% revealed significant
heterogeneity among studies, and then a random effects model was used;
otherwise a fixed effect model was performed. Egger's test was performed
for publication bias assessment. Subgroup analysis was performed by
stratifying AKI definitions and study type. Totally 17 studies with 9656
subjects (2331 in the AKI group and 7325 in the NO AKI group) were
enrolled. Significantly higher renal replacement therapy (RRT) (OR=23.67,
95%CI: 12.58-44.55), mortality (OR=6.27, 95%CI: 3.58-11.00), serum
creatinine (SMD= 1.42, 95%CI: 1.01-1.83), and hospital length of stay
(LOS) (SMD=0.45, 95%CI: 0.02-0.88) were shown in the AKI group compared
with patients in the NO AKI group. Subgroup analysis showed that results
of only 3 subgroups were reversed indicating that the definition of AKI
did not affect its outcomes. Publication bias was only found among studies
involving mortality and serum creatinine, but the 2 outcomes were not
reversed after correction. This meta-analysis confirmed the worse outcomes
of AKI in patients after cardiac surgery, including higher RRT rates,
mortality, and longer hospital LOS than those of NO AKI patients.
Copyright &#xa9; 2016 the Author(s).

<55>
Accession Number
613995767
Author
Mariscalco G.; Wozniak M.J.; Dawson A.G.; Serraino G.F.; Porter R.; Nath
M.; Klersy C.; Kumar T.; Murphy G.J.
Institution
(Mariscalco) 1Leicester Cardiovascular Biomedical Research Unit &
Department of Cardiovascular Sciences, University of Leicester, Glenfield
Hospital, Leicester, UK; 2Department of Anaesthesia and Critical Care,
Glenfield Hospital, University Hospitals of Leicester NHS Trust,
Leicester, UK; 3Service of Biometry and Clinical Epidemiology, IRCCS
Policlinico San Matteo Foundation, Pavia, Italy.
Title
Body-Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A
Nationwide Study with a Systematic Review and Meta-Analysis.
Source
Circulation. (no pagination), 2017. Date of Publication: 03 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: In an apparent paradox morbidity and mortality are lower in
obese patients undergoing cardiac surgery, although the nature of this
association is unclear. We sought to determine whether the obesity paradox
observed in cardiac surgery is attributable to reverse epidemiology, bias,
or confounding. METHODS-: Data from the National Adult Cardiac Surgery
registry for all cardiac surgical procedures performed between April 2002
and March 2013 were extracted. A parallel systematic review and
meta-analysis (MEDLINE, Embase, SCOPUS, Cochrane Library) through June
2015 was also accomplished. Exposure of interest was body mass index (BMI)
categorised into 6 groups according to the World Health Organisation
classification. RESULTS-: A total of 401 227 adult patients in the cohort
study, and 557 720 patients in the systematic review were included. A
"U-shape" association between mortality and BMI classes was observed in
both studies, with lower mortality in overweight (adjusted odds ratio
[OR], 0.79; 95% confidence interval [CI], 0.76-0.83) and obese class I and
II (OR, 0.81; 95%CI, 0.76-0.86 and OR, 0.83; 95%CI, 0.74-0.94) patients
relative to normal weight patients and increased mortality in underweight
individuals (OR, 1.51; 95%CI 1.41-1.62). In the cohort study, a 'U-shaped'
relationship was observed for stroke and low cardiac output syndrome, but
not for renal replacement therapy or deep sternal wound infection. Counter
to the reverse epidemiology hypotheses the protective effects of obesity
were less in patients with severe chronic renal, lung or cardiac disease
and greater in older patients, and in those with complications of obesity
including the metabolic syndrome and atherosclerosis. Adjustments for
important confounders did not alter our results. CONCLUSIONS-: Obesity is
associated with lower risks after cardiac surgery, with consistent effects
noted in multiple analyses attempting to address residual confounding and
reverse causation. Copyright &#xa9; 2017 by the American College of
Cardiology Foundation and the American Heart Association, Inc.

<56>
Accession Number
613995063
Author
Mei M.; Zhao H.-W.; Pan Q.-G.; Pu Y.-M.; Tang M.-Z.; Shen B.-B.
Institution
(Mei, Zhao, Pan, Pu, Tang, Shen) Department of Kidney, Southwest Hospital,
Third Military Medical University, Chongqing 400038, P.R. China
Title
Efficacy of N-Acetylcysteine in Preventing Acute Kidney Injury After
Cardiac Surgery: A Meta-Analysis Study.
Source
Journal of Investigative Surgery. (pp 1-10), 2017. Date of Publication: 06
Jan 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose: To evaluate whether perioperative N-acetylcysteine (NAC)
administration reduces the risk of cardiac surgery associated acute kidney
injury (CSA-AKI). Materials and Methods: A systematic literature review
(Medline, PubMed, Cochrane, Biomedical central, Google Scholar) identified
10 studies (1391 patients; 695 NAC and 696 placebo) that compared the
efficacy and adverse effects of perioperative NAC administration for
CSA-AKI prevention in adults undergoing elective cardiac surgery.
Meta-analysis was performed using Comprehensive Meta-Analysis statistical
software. Results: Patients in the NAC-treated and placebo groups had
similar rate of CSA-AKI occurrence, change in creatinine levels, as well
as the in-hospital mortality rate (RR = 0.841, 95% CI = 0.691 to 1.023, p
= 0.083; pooled difference in means = -0.328, 95% CI = -0.712 to 0.056, p
= 0.094; RR = 0.741, 95% CI = 0.388 to 1.418, p = 0.366, respectively).
Conclusions: Our study does not support perioperative NAC administration
as a mean to reduce the risk of CSA-AKI. Copyright &#xa9; 2017 Taylor &
Francis Group, LLC

<57>
Accession Number
613982038
Author
Chinnaiyan K.M.; Akasaka T.; Amano T.; Bax J.J.; Blanke P.; De Bruyne B.;
Kawasaki T.; Leipsic J.; Matsuo H.; Morino Y.; Nieman K.; Norgaard B.L.;
Patel M.R.; Pontone G.; Rabbat M.; Rogers C.; Sand N.P.; Raff G.
Institution
(Chinnaiyan, Raff) William Beaumont Hospital, Royal Oaks, MI, USA
(Akasaka) Wakayama Medical University, Wakayama, Japan
(Amano) Aichi Medical University, Aichi, Japan
(Bax) Leiden University Medical Center, Leiden, The Netherlands
(Blanke, Leipsic) Department of Radiology, University of British Columbia,
Vancouver, BC, Canada
(De Bruyne) Onze-Lieve-Vrouwziekenhuis Aalst, Aalst, Belgium
(Kawasaki) Shin Koga Hospital, Fukuoka, Japan
(Matsuo) Gifu Heart Center, Gifu, Japan
(Morino) Iwate Medical University, Iwate, Japan
(Nieman) Erasmus Medical Center, Rotterdam, The Netherlands
(Norgaard) Aarhus University Hospital, Aarhus Skejby, Denmark
(Patel) Duke University School of Medicine, Durham, NC, USA
(Pontone) Centro Cardiologico Monzino, IRCCS, University of Milan, Milan,
Italy
(Rabbat) Loyola University Medical Center, Maywood, IL, USA
(Rogers) HeartFlow, Redwood City, CA, USA
(Sand) University of Southern Denmark, Odense, Denmark
Title
Rationale, design and goals of the HeartFlow assessing diagnostic value of
non-invasive FFR<inf>CT</inf> in Coronary Care (ADVANCE) registry.
Source
Journal of Cardiovascular Computed Tomography. (no pagination), 2016. Date
of Publication: October 24, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Coronary CT angiography (CTA) is a reliable tool for the
detection of coronary artery disease (CAD) that conveys significant
prognostic information. It does not provide data on the hemodynamic
significance of a given lesion, particularly in intermediate-grade
stenosis. Fractional flow reserve by CT (FFR<inf>CT</inf>) can accurately
predict the hemodynamic significance of coronary lesions. The primary
objective of this registry is to determine whether the integration of
FFR<inf>CT</inf> as an adjunct to coronary CTA will lead to a significant
change in the management of CAD in patients with stable angina. Methods:
The ADVANCE Registry is a multi-center, prospective registry designed to
evaluate utility, clinical outcomes and resource utilization following
FFR<inf>CT</inf>-guided treatment in clinically stable, symptomatic
patients diagnosed with CAD by coronary CTA. Approximately 5000 patients
will be enrolled from up to 50 sites in Europe, USA, Canada and Asia.
Requirement for enrollment is the presence of atherosclerosis on coronary
CTA. For each enrolled patient, a clinical management review committee
will use data from coronary CTA and FFR<inf>CT</inf> to determine the
management plan using the following criteria: (a) optimal medical therapy,
(b) percutaneous coronary intervention, (c) coronary artery bypass graft
surgery, or (d) more information required. The primary endpoint of the
registry is the reclassification rate between the management plan based on
coronary CTA alone versus CTA plus FFR<inf>CT</inf>. The secondary
endpoints of the registry include the evaluation of the rate of invasive
coronary angiography (ICA), revascularization, major adverse coronary
events, resource utilization, cumulative radiation dose exposure and the
rate of ICA without obstructive CAD at 3-year follow-up. Conclusions: The
ADVANCE registry is designed to assess the real-world impact of
FFR<inf>CT</inf> on the clinical management of stable CAD when used along
with coronary CTA. Copyright &#xa9; 2016.

<58>
Accession Number
613981795
Author
Naqvi S.Y.; Klein J.; Saha T.; McCormick D.J.; Goldberg S.
Institution
(Naqvi, Klein, Saha) Department of Internal Medicine, Pennsylvania
Hospital, University of Pennsylvania Health System, Philadelphia,
Pennsylvania
(McCormick, Goldberg) Department of Cardiology, Pennsylvania Hospital,
University of Pennsylvania Health System, Philadelphia, Pennsylvania
Title
Comparison of Percutaneous Coronary Intervention Versus Coronary Artery
Bypass Grafting for Unprotected Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. (no pagination), 2016. Date of
Publication: May 20, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Coronary artery bypass grafting (CABG) decreases mortality in patients
with significant left main (LM) coronary artery disease and for years
remained the therapy of choice for patients with this ominous lesion.
Advances in percutaneous coronary intervention (PCI) have enabled it to
become an alternative to CABG. The results of observational registries and
randomized comparisons have shown the safety and efficacy of PCI in
appropriately selected patients with low or intermediate angiographic risk
scores. Furthermore, the use of physiological measures of flow limitation
and the use of intracoronary imaging techniques has added benefit and
improved outcomes. The use of fractional flow reserve to more accurately
evaluate the significance of intermediate lesions and guide the extent of
revascularization has been an important refinement. Intravascular
ultrasound and optical coherence tomography assessment of optimal stent
deployment has led to reductions in restenosis. Newer generation stents,
combined with improvements in specific techniques, especially at the LM
bifurcation have extended PCI to more complex anatomic scenarios. The
availability of left ventricular support devices in patients with complex
coronary anatomy and severely depressed left ventricular function has
added a margin of safety to LM and multivessel intervention. Randomized
comparisons of CABG with PCI in carefully selected patients, using
contemporaneous surgical and interventional techniques and optimal medical
therapy, will further aid heart teams in the decision-making process. In
conclusion, this review will give a concise overview of the management of
unprotected LM disease. Copyright &#xa9; 2016 Elsevier Inc.

<59>
Accession Number
613979054
Author
Polites S.F.; Potter D.D.; Glasgow A.E.; Klinkner D.B.; Moir C.R.;
Ishitani M.B.; Habermann E.B.
Institution
(Polites, Potter, Klinkner, Moir, Ishitani) Division of Pediatric Surgery,
Mayo Clinic, Rochester, MN
(Glasgow, Habermann) Robert D. and Patricia E. Kern Center for the Science
of Health Care Delivery, Mayo Clinic, Rochester, MN
Title
Rates and risk factors of unplanned 30-day readmission following general
and thoracic pediatric surgical procedures.
Source
Journal of Pediatric Surgery. (no pagination), 2016. Date of Publication:
September 14, 2016.
Publisher
W.B. Saunders
Abstract
Background/Purpose: Postoperative unplanned readmissions are costly and
decrease patient satisfaction; however, little is known about this
complication in pediatric surgery. The purpose of this study was to
determine rates and predictors of unplanned readmission in a
multi-institutional cohort of pediatric surgical patients. Methods:
Unplanned 30-day readmissions following general and thoracic surgical
procedures in children <. 18 were identified from the 2012-2014 National
Surgical Quality Improvement Program- Pediatric. Time-dependent rates of
readmission per 30 person-days were determined to account for varied
postoperative length of stay (pLOS). Patients were randomly divided into
70% derivation and 30% validation cohorts which were used for creation and
validation of a risk model for readmission. Results: Readmission occurred
in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days.
Adjusted predictors of readmission included hepatobiliary procedures,
increased wound class, operative duration, complications, and pLOS. The
predictive model discriminated well in the derivation and validation
cohorts (AUROC 0.710 and 0.701) with good calibration between observed and
expected readmission events in both cohorts (p. > .05). Conclusions:
Unplanned readmission occurs less frequently in pediatric surgery than
what is described in adults, calling into question its use as a quality
indicator in this population. Factors that predict readmission including
type of procedure, complications, and pLOS can be used to identify at-risk
children and develop prevention strategies. Level of evidence: III.
Copyright &#xa9; 2016 Elsevier Inc.

<60>
Accession Number
613978612
Author
Stowell C.P.; Whitman G.; Granger S.; Gomez H.; Assmann S.F.; Massey M.J.;
Shapiro N.I.; Steiner M.E.; Bennett-Guerrero E.
Institution
(Stowell) Blood Transfusion Service, Department of Pathology,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass
(Whitman) Department of Surgery, Division of Cardiac Surgery, Johns
Hopkins Hospital, Baltimore, Md
(Granger, Assmann) New England Research Institutes, Watertown, Mass
(Gomez) Department of Critical Care Medicine, Center for Critical Care
Nephrology, University of Pittsburgh, Pittsburgh, Pa
(Massey, Shapiro) Center for Vascular Biology Research, Beth Israel
Deaconess Medical Center, Boston, Mass
(Steiner) Department of Pediatrics, University of Minnesota, Minneapolis,
Minn
(Bennett-Guerrero) Department of Anesthesiology, Duke University Medical
Center, Durham, NC
Title
The impact of red blood cell storage duration on tissue oxygenation in
cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2016.
Date of Publication: January 30, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Although storage alters red blood cells, several recent,
randomized trials found no differences in clinical outcomes between
patients transfused with red blood cells stored for shorter versus longer
periods of time. The objective of this study was to see whether storage
impairs the in vivo ability of erythrocytes to traverse the
microcirculation and deliver oxygen at the tissue level. Methods: A subset
of subjects from a clinical trial of cardiac surgery patients randomized
to receive transfusions of red blood cells stored <10 days or >21 days
were assessed for thenar eminence and cerebral tissue hemoglobin oxygen
saturation (S<inf>t</inf>O<inf>2</inf>) via the use of near-infrared
spectroscopy and sublingual microvascular blood flow via side-stream
darkfield videomicroscopy. Results: Among 55 subjects, there was little
change in the primary endpoint (thenar eminence S<inf>t</inf>O<inf>2</inf>
from before to after transfusion of one unit) and the change was similar
in the 2 groups: +1.7% (95% confidence interval, -0.3, 3.8) for
shorter-storage and +0.8% (95% confidence interval, -1.1, 2.9) for
longer-storage; P = .61). Similarly, no significant differences were
observed for cerebral S<inf>t</inf>O<inf>2</inf> or sublingual
microvascular blood flow. These parameters also were not different from
preoperatively to 1 day postoperatively, reflecting the absence of a
cumulative effect of all red blood cell units transfused during this
period. Conclusions: There were no differences in thenar eminence or
cerebral S<inf>t</inf>O<inf>2</inf>, or sublingual microcirculatory blood
flow, in cardiac surgery patients transfused with red blood cells stored
<10 days or >21 days. These results are consistent with the clinical
outcomes in the parent study, which also did not differ, indicating that
storage may not impair oxygen delivery by red blood cells in this setting.
Copyright &#xa9; 2016 The American Association for Thoracic Surgery.

<61>
Accession Number
613977497
Author
Toeg H.; French D.; Gilbert S.; Rubens F.
Institution
(Toeg, Rubens) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
(French, Gilbert) Division of Thoracic Surgery, University of Ottawa,
Ottawa, Ontario, Canada
Title
Incidence of sternal wound infection after tracheostomy in patients
undergoing cardiac surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2016.
Date of Publication: February 19, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Purpose: This systematic review and meta-analysis was performed to
determine whether timing or type of tracheostomy was associated with
superficial or deep sternal wound infections after cardiac surgery.
Methods: All studies reporting the incidence of sternal wound infection
after tracheostomy in patients undergoing cardiac surgery were collected
and analyzed. Subgroup analyses determined a priori included timing of
tracheostomy and type of procedure (open vs percutaneous). All analyses
used the random effects model. A meta-regression analysis was performed on
the proportion of sternal wound infection and number of days between
tracheostomy and initial cardiac surgery. Results: A total of 13 studies
met inclusion criteria. The incidence of sternal wound infection across
all studies reported was 7% (95% confidence interval [CI], 4-10). The
percutaneous tracheostomy group had a sternal wound infection proportion
of 3% (95% CI, 1-8), and the open tracheostomy group had a sternal wound
infection proportion of 9% (95% CI, 5-14). The incidence of sternal wound
infection with early (<14 days) (7%; 95% CI, 3-11) versus late (>14 days)
(7%; 95% CI, 4-10) tracheostomy was similar. Meta-regression demonstrated
no significant relationship between incidence of sternal wound infection
and number of days between tracheostomy and initial cardiac surgery
(R² = 6.13%, P = .72). Reported secondary outcomes included
30-day and 1-year mortality, which were high at 23% (95% CI, 19-28) and
63% (95% CI, 43-80), respectively. Conclusions: The incidence of sternal
wound infection after tracheostomy in patients undergoing cardiac surgery
remains high at 7% (95% CI, 4-10). Open or percutaneous tracheostomy after
cardiac surgery is a feasible option because the incidence of sternal
wound infection and short-term mortality are comparable. Moreover, the
timing of tracheostomy (early or late) had comparable rates of sternal
wound infection and short-term mortality. Copyright &#xa9; 2016 The
American Association for Thoracic Surgery.

<62>
Accession Number
613977260
Author
Goldman S.; Cheung A.; Bavaria J.E.; Petracek M.R.; Groh M.A.; Schaff H.V.
Institution
(Goldman) Lankenau Heart Group, Lankenau Hospital, Wynnewood, Pa
(Cheung) Division of Cardiovascular Surgery, St Paul's Hospital -
University of British Columbia, Vancouver, British Columbia, Canada
(Bavaria) Division of Cardiovascular Surgery, Hospital of the University
of Pennsylvania, Philadelphia, Pa
(Petracek) Department of Cardiac Surgery, Vanderbilt University Medical
Center, Nashville, Tenn
(Groh) Asheville Heart, Mission Health and Hospitals, Asheville, NC
(Schaff) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Title
Midterm, multicenter clinical and hemodynamic results for the Trifecta
aortic pericardial valve.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2016.
Date of Publication: April 15, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To evaluate the midterm hemodynamic performance and clinical
outcomes of the Trifecta aortic pericardial valve. Methods: In a
multicenter, prospective, nonrandomized, follow-up study, 710 patients
underwent surgical implantation of a pericardial stented aortic prosthesis
(Trifecta valve; St Jude Medical, St. Paul, Minn). The valve is
constructed from bovine pericardium mounted externally onto a titanium
stent. Subjects were followed on an annual basis over 6 years. Results:
Operations were performed from 2007 to 2009, and mean age was 72.4 +/- 9.3
years; 471 of 710 (66.3%) were men. Preoperatively, 361 of 710 (50.8%) of
patients were in New York Heart Association class III or IV, and at 6
years postoperatively, 92 of 96 (95.8%) were New York Heart Association
class I or II. Six years postoperatively, average mean gradient across all
valve sizes was 11.0 mm Hg, and the average effective orifice area index
was 0.80 cm²/m². The proportion of patients without
moderate-to-severe valvular regurgitation at 6 years was 95.2% (80/84).
Six years postoperatively, freedom from valve-related mortality,
nonstructural dysfunction, and paravalvular leak were 98.3%, 98.6%, and
98.9%, respectively, and freedom from reoperation due to structural valve
deterioration was 97.3% (95% confidence limits, 98.6-94.7). Conclusion:
These midterm results demonstrate that the Trifecta valve is a safe and
effective valve substitute with excellent hemodynamic performance and
durability that is maintained through the 6-year follow-up period.
Copyright &#xa9; 2016 The American Association for Thoracic Surgery.

<63>
Accession Number
613974291
Author
Reinartz S.D.; Winkler M.; Diefenbach S.B.; Allmendinger T.; Penzkofer T.;
Kuhl C.K.; Mahnken A.H.
Institution
(Reinartz, Winkler, Diefenbach, Kuhl) Department of Diagnostic and
Interventional Radiology, University hospital RWTH Aachen, Pauwelsstrasse
30, Aachen 52074, Germany
(Allmendinger) Computed Tomography, Siemens Medical Healthcare, Forchheim,
Germany
(Penzkofer) Department of Diagnostic and Interventional Radiology, Charite
University Hospital, Berlin University, Berlin, Germany
(Mahnken) Department of Diagnostic and Interventional Radiology,
University Hospital, Philipps University Marburg, Marburg, Germany
Title
Reconstructions Using RIF in Motion Mapping Technique Have Substantially
Less Arrhythmogenic Artifacts in Dual-source Coronary CTA.
Source
Academic Radiology. (no pagination), 2016. Date of Publication: February
15, 2016.
Publisher
Elsevier USA
Abstract
Rationale and Objectives: Particularly for patients with heart
arrhythmias, conventional BestSystole (BS) and BestDiastole (BD)
reconstruction techniques in computed tomography (CT) frequently show
artifacts that hinder the readability of the coronary tree. To address
this problem, this paper presents an alternative reconstruction method
that combines the technique reconstructions with identical filling (RIF)
with motion mapping: This new technique is called RIF in motion mapping
(RIMM). This study compares the diagnostic quality of images generated
with RIMM to that of the other reconstruction techniques. Materials and
Methods: Having shown major artifacts in standard reconstructions, the CT
datasets of 23 patients with suspected coronary artery disease or prior to
transcatheter aortic valve replacement were selected manually. Each
dataset was evaluated with four reconstruction techniques: BS, BD, RIF,
and RIMM. Two radiologists, blinded to the applied reconstruction type,
then evaluated the entire coronary tree of each sample using the
15-segment American Heart Association model and the six-grade Likert
scale. Results: Of the 345 analyzed coronary segments, the RIMM technique
showed a significant number of images with reliable diagnostic quality (n
= 228, 66%) as compared to RIF (P = 0.002) and BS/BD reconstructions (P <
0.001). Per coronary segment, vessel, and patient, the RIMM technique
scored significantly better than the conventional BS/BD reconstructions (P
= 0.003) and better than the RIF reconstructions with regard to the right
coronary artery (P = 0.041). Conclusions: This new technique works: Using
RIMM on the worst CT images substantially erased many of these artifacts,
thereby enabling the radiologists to clearly visualize these segments. As
RIMM considerably eliminates artifacts, this new CT reconstruction
technique can help make a fast reliable evaluation of a patient's coronary
tree. Thus, this enhanced visualization of cardiac images by RIMM avoids
the need for further invasive diagnostic procedures. Copyright &#xa9;
2016.

<64>
Accession Number
613970653
Author
Bockeria O.L.; Shvartz V.A.; Akhobekov A.A.; Glushko L.A.; Le T.G.;
Kiselev A.R.; Prokhorov M.D.; Bockeria L.A.
Institution
(Bockeria, Shvartz, Akhobekov, Glushko, Le, Kiselev, Bockeria) Department
of Surgical Treatment for Interactive Pathology, Bakoulev Scientific
Center for Cardiovascular Surgery, Moscow, Russia
(Prokhorov) Saratov Branch of the Institute of Radio Engineering and
Electronics of Russian Academy of Sciences, Saratov, Russia
Title
Statin therapy in the prevention of atrial fibrillation in the early
postoperative period after coronary artery bypass grafting: A
meta-analysis.
Source
Cor et Vasa. (no pagination), 2016. Date of Publication: April 21, 2016.
Publisher
Elsevier Science B.V.
Abstract
Background: Postoperative atrial fibrillation (POAF) is observed in the
early postoperative period in approximately every third patient after
coronary artery bypass grafting (CABG). The pathogenesis of POAF is
multifactorial and is not yet fully studied. In many studies,
postoperative inflammatory response has been extensively investigated as a
potential basic factor of POAF. It is known that statins have
anti-inflammatory properties. In some studies, pre- and perioperative use
of statins has shown the decrease of incidence of POAF after CABG.
Objective: We conducted meta-analysis of randomized and observational
studies of efficiency of statin therapy for the prevention of POAF after
CABG. Material and methods: The meta-analysis included 15 clinical trials
of statins in 9369 patients with performed CABG during the past 10 years.
5598 patients (59.75%) were taking statins and 3771 patients (40.25%) were
not taking statins. The following outcomes observed in the early
postoperative period were studied: incidence of POAF, total mortality
rate, total stroke rate, and total rate of myocardial infarction. The
duration of hospitalization and levels of inflammatory markers before and
after CABG were also assessed. Results: The statin therapy reduced the
incidence of POAF after CABG (OR. =0.48, 95% CI: 0.35-0.67, . P . <.
0.001). Moreover, the statin therapy decreased the total length of
hospital stay and levels of inflammatory markers in the blood serum.
Conclusion: The results of our meta-analysis leave no doubt in the
presence of anti-inflammatory and anti-arrhythmic effect of statin
therapy. We confirmed the overall positive role of using statins before
CABG for POAF prevention. Copyright &#xa9; 2016 The Czech Society of
Cardiology.

<65>
Accession Number
613967152
Author
Kahlert P.; Hildebrandt H.A.; Patsalis P.C.; Al-Rashid F.; Janosi R.A.;
Nensa F.; Schlosser T.W.; Schlamann M.; Wendt D.; Thielmann M.; Kottenberg
E.; Frey U.; Neuhauser M.; Forsting M.; Jakob H.G.; Rassaf T.; Peters J.;
Heusch G.; Kleinbongard P.
Institution
(Kahlert, Hildebrandt, Patsalis, Al-Rashid, Janosi, Rassaf) Department of
Cardiology and Vascular Medicine, West-German Heart and Vascular Center
Essen, Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Nensa, Schlosser, Schlamann, Forsting) Institute for Diagnostic and
Interventional Radiology and Neuroradiology, Universitatsklinikum Essen,
Universitat Duisburg-Essen, Germany
(Wendt, Thielmann, Jakob) Department of Thoracic and Cardiovascular
Surgery, West-German Heart and Vascular Center Essen, Universitatsklinikum
Essen, Universitat Duisburg-Essen, Germany
(Kottenberg, Frey, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Neuhauser) Institute for Medical Informatics, Biometry, and Epidemiology,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Heusch, Kleinbongard) Institute for Pathophysiology, West-German Heart
and Vascular Center Essen, Universitatsklinikum Essen, Universitat
Duisburg-Essen, Germany
(Schlamann) Department of Neuroradiology, University Hospital Giesen,
Giesen, Germany
(Kottenberg) Klinik fur Anasthesiologie, Intensivmedizin und
Schmerztherapie, Evangelisches Krankenhaus Mulheim, Germany
(Neuhauser) Department of Mathematics and Technology, Koblenz, University
of Applied Science, Remagen, Germany
Title
No protection of heart, kidneys and brain by remote ischemic
preconditioning before transfemoral transcatheter aortic valve
implantation: Interim-analysis of a randomized single-blinded,
placebo-controlled, single-center trial.
Source
International Journal of Cardiology. (no pagination), 2016. Date of
Publication: November 10, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Remote ischemic preconditioning (RIPC) reduces myocardial
injury and improves clinical outcome in patients undergoing coronary
revascularization, but only in the absence of propofol-anesthesia. We
investigated whether RIPC provides protection of heart, kidneys and brain
and improves outcome in patients undergoing transfemoral transcatheter
aortic valve implantation (TF-TAVI). Methods: Patients undergoing TF-TAVI
were randomized to receive RIPC (3. cycles of 5. min left upper arm
ischemia and 5. min reperfusion) or placebo. The primary endpoint was
myocardial injury, reflected by the area under the curve for serum
troponin I concentrations (AUC-TnI) over the first 72. h. Secondary
endpoints included the incidences of periprocedural myocardial infarction,
delayed gadolinium enhancement on postprocedural cardiac MRI, acute kidney
injury, periprocedural stroke, and the incidence and volume of new lesions
on postprocedural cerebral MRI. All-cause and cardiovascular mortality and
major adverse cardiac and cerebrovascular events (MACCE) were assessed
over 1-year follow-up. A prespecified interim-analysis was performed after
the last patient had completed 1-year follow-up (NCT02080299). Results:
100 consecutive patients were enrolled between September 2013 and June
2015. There were no significant between-group differences in the primary
endpoint of peri-interventional myocardial injury (ratio RIPC/placebo
AUC-TnI: 0.87, 95% CI: 0.57-1.34, . p = 0.53) or the secondary endpoints
of cardiac, renal and cerebral impairment. There was no significant
treatment effect in subgroup-analyses of patients undergoing cardiac or
cerebral MRI. Mortality and MACCE did not differ. No RIPC-related adverse
events were observed. Conclusions: RIPC did neither protect heart, kidneys
and brain nor improve clinical outcome in patients undergoing TF-TAVI.
Copyright &#xa9; 2016 Elsevier Ireland Ltd.

<66>
Accession Number
613973933
Author
Borde D.P.; Futane S.S.; Asegaonkar B.; Apsingekar P.; Khade S.; Khodve
B.; Puranik M.; George A.; Joshi S.
Institution
(Borde, Futane, Asegaonkar, Apsingekar, Khade, Khodve) Ozone Anesthesia
Group, Aurangabad, Maharashtra, India
(Puranik) Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
(George) Fortis Hospitals, Bengaluru, Karnataka, India
(Joshi) Nayati Super-Speciality Hospital, Mathura, Uttar Pradesh, India
Title
Effect of Perioperative Pregabalin on Postoperative Quality of Recovery in
Patients Undergoing Off-Pump Coronary Artery Bypass Grafting (OPCABG): A
Prospective, Randomized, Double-Blind Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objectives: Use of pregabalin is increasing in cardiac surgical patients.
However, studies using comprehensive scoring systems are lacking on the
drug's impact on postoperative recovery. The authors tested the hypothesis
that perioperative oral pregabalin improves the postoperative quality of
recovery as assessed using the Quality of Recovery (QoR-40) questionnaire
in patients undergoing off-pump coronary artery bypass grafting (OPCABG).
Design: This was a randomized, double-blind, placebo-controlled study.
Settings: Tertiary-care hospital. Participants: Patients undergoing
OPCABG. Interventions: Patients were assigned randomly to the following 2
groups: the pregabalin group (those who received pregabalin, 150 mg
capsule orally, 1 hour before surgery and 2 days postoperatively [75 mg
twice a day] starting after extubation; n = 37); and the control group
(those who received 2 similar-looking multivitamin capsules at similar
times; n = 34). The QoR-40 scores were noted preoperatively and 24 hours
after extubation. Measurements and Main Results: Both groups were
comparable in terms of preoperative patient characteristics and baseline
QoR-40 scores. Global scores were significantly improved in the pregabalin
group compared with the control group in the postoperative period (177+/-9
. v 170+/-9; p = 0.002). QoR-40 values in the dimensions of emotional
state (p = 0.005), physical comfort (p = 0.04), and pain (p = 0.02) were
improved in the pregabalin group. Conclusions: Perioperative pregabalin
improved postoperative quality of recovery as assessed using the QoR-40
questionnaire in patients undergoing OPCABG. Perioperative pregabalin
offered advantages beyond better pain control, such as improved physical
comfort and better emotional state; therefore, the drug's use in the
perioperative period is recommended. Copyright &#xa9; 2016 Elsevier Inc.

<67>
Accession Number
613973595
Author
Lamarche Y.; Elmi-Sarabi M.; Ding L.; Abel J.G.; Sirounis D.; Denault A.Y.
Institution
(Lamarche) Department of Surgery and Research Centre, Montreal Heart
Institute, Universite de Montreal, Montreal, Quebec, Canada
(Elmi-Sarabi, Denault) Department of Anesthesiology and Research Centre,
Montreal Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
(Ding) Provincial Health Services Authority, Vancouver, British Columbia,
Canada
(Abel) Division of Cardiac and Thoracic Surgery, St Paul's Hospital,
University of British Columbia, Vancouver, British Columbia, Canada
(Sirounis) Division of Critical Care Medicine, Providence Health Care,
University of British Columbia, Vancouver, British Columbia, Canada
Title
A score to estimate 30-day mortality after intensive care admission after
cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2016.
Date of Publication: February 17, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Several risk-scoring systems have been developed to predict
surgical mortality and complications in cardiac surgical patients, but
none of the current systems include factors related to the intraoperative
period. The purpose of this study was to develop a score that incorporates
both preoperative and intraoperative factors so that it could be used for
patients admitted to a cardiac surgical intensive care unit (ICU)
immediately after surgery. Method: Preoperative and intraoperative data
from 30,350 patients in four hospitals were used to build a multiple
logistic regression model estimating 30-day mortality after cardiac
surgery. Sixty percent of the patients were used as a derivation group and
forty percent as a validation group. Results: Mortality occurred in 2.6%
of patients (n = 790). Preoperative factors identified in the model were
age, female sex, emergency status, pulmonary hypertension, peripheral
vascular disease, renal dysfunction, diabetes, peptic ulcer disease,
history of alcohol abuse, and refusal of blood products. Intraoperative
risk factors included the need for an intra-aortic balloon pump,
ventricular assist device or extracorporeal membrane oxygenation leaving
the operating room, presence of any intraoperative complication reported
by the surgeon, the use of inotropes, high-dose vasopressors, red blood
cell transfusion, and cardiopulmonary bypass time. When used after surgery
at ICU admission, the model had C-statistics of 0.86 in both derivation
and validation sets to estimate the 30-day mortality. Conclusions:
Preoperative and intraoperative variables can be used on admission to a
cardiac surgical ICU to estimate 30-day mortality. The score could be used
for risk stratification after cardiac surgery and evaluation of
performance of cardiac surgical ICUs. Copyright &#xa9; 2016 The American
Association for Thoracic Surgery.

<68>
Accession Number
613961578
Author
Wikkelso A.; Wetterslev J.; Moller A.M.; Afshari A.
Institution
(Wikkelso) Department of Anaesthesia and Intensive Care Medicine Hvidovre
Hospital, Copenhagen University Hospital Hvidovre Denmark
(Wetterslev) Copenhagen Trial Unit Centre for Clinical Intervention
Research University of Copenhagen Copenhagen Denmark
(Moller) Department of Anaesthesia and Intensive Care Medicine Herlev
Hospital Herlev Denmark
(Afshari) Department of Paediatric and Obstetric Anaesthesia Juliane Marie
Center Copenhagen University Hospital Copenhagen Denmark
Title
Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to
monitor haemostatic treatment in bleeding patients: A systematic review
with meta-analysis and trial sequential analysis.
Source
Anaesthesia. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Coagulopathy and severe bleeding are associated with high mortality. We
evaluated haemostatic treatment guided by the functional viscoelastic
haemostatic assays, thromboelastography or rotational thromboelastometry
in bleeding patients. We searched for randomised, controlled trials
irrespective of publication status, publication date, blinding status,
outcomes published or language from date of inception to 5 January 2016 in
six bibliographic databases. We included 17 trials (1493 participants),
most involving cardiac surgery. Thromboelastography or rotational
thromboelastometry seemed to reduce overall mortality compared to any of
our comparisons (3.9% vs. 7.4%, RR (95% CI) 0.52 (0.28-0.95);
I² = 0%, 8 trials, 717 participants). However, the quality of
evidence is graded as low due to the high risk of bias, heterogeneity,
imprecision and low event rate. Thromboelastography or rotational
thromboelastometry significantly reduced the proportion of patients
transfused with red blood cells (RR (95% CI) 0.86 (0.79-0.94);
I² = 0%, 10 trials, 832 participants), fresh frozen plasma (RR
(95% CI) 0.57 (0.33-0.96); I² = 86%, 10 trials, 832
participants) and platelets (RR (95% CI) 0.73 (0.60-0.88); I² =
0%, 10 studies, 832 participants). There was no difference in proportion
needing surgical re-interventions (RR (95% CI) 0.75 (0.50-1.10);
I² = 0%, 9 trials, 887 participants). Trial sequential analysis
of mortality suggests that only 54% of the required information size has
been reached so far. Transfusion strategies guided by thromboelastography
or rotational thromboelastometry may reduce the need for blood products in
patients with bleeding, but the results are mainly based on trials of
elective cardiac surgery involving cardiopulmonary bypass, with
low-quality evidence. Copyright &#xa9; 2017 The Association of
Anaesthetists of Great Britain and Ireland.

<69>
Accession Number
613955627
Author
Sun Y.; Liu X.; He Y.; Tang M.; Zhu Q.; Xu X.; Guo D.; Shi K.; Hu P.; Wang
L.; Kong H.; Jiang J.; Lin X.; Xu Q.; Gao F.; Wang J.
Institution
(Sun, Zhu, Xu, Guo, Shi, Wang) Zhejiang University School of Medicine,
Hangzhou, People's Republic of China
(Liu, He, Tang, Hu, Wang, Kong, Jiang, Lin, Xu, Gao, Wang) Department of
Cardiology, Second Affiliated Hospital Zhejiang University School of
Medicine, Hangzhou, People's Republic of China
Title
Meta-Analysis of Impact of Diabetes Mellitus on Outcomes After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2016. Date of
Publication: August 27, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To date, the impact of diabetes mellitus (DM) on prognosis after
transcatheter aortic valve implantation (TAVI) is still contradictory and
thus merits further investigation. The purpose of this meta-analysis was
to evaluate the impact of DM on outcomes after TAVI. A systematic search
of the PubMed database was performed. Primary end points were 30-day and
1-year all-cause mortality after TAVI. Risk ratios (RRs) and 95% CIs were
calculated using the random-effect or fixed-effect model, depending on
heterogeneity between studies, and p values <0.05 was considered
significant. A total of 16 studies involving 13,253 patients were included
in our meta-analysis. There was no significant difference between the
groups with DM and without DM regarding 30-day (RR 1.07, 95% CI 0.90 to
1.27, p = 0.45) or 1-year (RR 1.04, 95% CI 0.94 to 1.15, p = 0.42)
all-cause mortality. The risks of 30-day complications, including
myocardial infarction, stroke, major vascular complications, major
bleeding, and acute kidney injury, were similar between patients with and
without DM. In conclusion, DM neither affected short- or mid-term
all-cause mortality nor short-term complications after TAVI. Copyright
&#xa9; 2016 Elsevier Inc.

<70>
Accession Number
613945139
Author
Ramos dos Santos P.M.; Aquaroni Ricci N.; Aparecida Bordignon Suster E.;
de Moraes Paisani D.; Dias Chiavegato L.
Institution
(Ramos dos Santos, Aquaroni Ricci, Aparecida Bordignon Suster, Dias
Chiavegato) Masters and Doctoral Programmes in Physical Therapy,
Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
(de Moraes Paisani) Research Institute, Hospital do Coracao, Sao Paulo,
Brazil
(Dias Chiavegato) Pulmonary Division, Universidade Federal de Sao Paulo,
Sao Paulo, Brazil
Title
Effects of early mobilisation in patients after cardiac surgery: A
systematic review.
Source
Physiotherapy (United Kingdom). (no pagination), 2016. Date of
Publication: 2016.
Publisher
Elsevier Ltd
Abstract
Background: Early mobilisation is prescribed after cardiac surgery to
prevent postoperative complications, decrease length of hospital stay, and
augment return to daily activities. Objective: To evaluate the evidence
for the effects of early mobilisation in patients after cardiac surgery on
length of hospital stay, functional capacity and postoperative
complications. Data sources: The data sources used were Medline, Embase,
CINAHL, PEDro, Web of Science and Cochrane Central Register of Controlled
Trials. Study selection: Randomised controlled trials of early
mobilisation after cardiac surgery. Study selection was not restricted by
language or publication time. Study appraisal and synthesis methods: The
methodological quality of each article was appraised with the PEDro scale.
All review phases (selection, data extraction and appraisal) were
conducted by two investigators, and a third investigator provided
consensus. Results: Nine trials were selected. The PEDro scale showed that
the studies had a low risk of bias (range 5 to 9 points). The trials
revealed diversity in techniques used for mobilisation, as well as periods
considered early for the start of the intervention. Early mobilisation
groups had improved outcomes compared with control groups without
treatment. Generally, these advantages did not differ when groups of
interventions were compared. Limitations: It was not possible to perform a
meta-analysis due to the variability of the interventions proposed as
early mobilisation. Conclusions: Regardless of the techniques used as
mobilisation, the essential point is to avoid bed rest. Early mobilisation
seems to be important to prevent postoperative complications, improve
functional capacity and reduce length of hospital stay in patients after
cardiac surgery. Copyright &#xa9; 2016 Chartered Society of Physiotherapy.

<71>
Accession Number
613939231
Author
Wang Y.; Shi X.; du R.; Chen Y.; Zhang Q.
Institution
(Wang, Shi, du, Chen, Zhang) Department of Cardiology, West China
Hospital, Sichuan University, 37 Guoxue Street, Chengdu, Sichuan 610041,
China
Title
Off-pump versus on-pump coronary artery bypass grafting in patients with
diabetes: a meta-analysis.
Source
Acta Diabetologica. (pp 1-10), 2016. Date of Publication: 30 Dec 2016.
Publisher
Springer-Verlag Italia s.r.l. (E-mail: springer@springer.it)
Abstract
Aims: The effects of off-pump CABG (OFF-CABG) versus on-pump CABG
(ON-CABG) in diabetic patients remain controversial. The aim of our study
was to compare mortality and postoperative morbidity between OFF-CABG and
ON-CABG for diabetic patients. Methods: Electronic databases including
PubMed, EMBASE and Cochrane Library for studies investigating clinical
outcomes of OFF-CABG versus ON-CABG in diabetic patients were searched,
collecting data from inception until June 2016. We pooled the odds ratios
from individual studies and performed heterogeneity, quality assessment
and publication bias analysis. Results: A total of 543,220 diabetic
patients in 10 studies were included. The overall mortality (OR, 0.87; 95%
CI, 0.58-1.31; p = 0.50) was comparable between the OFF-CABG and ON-CABG.
OFF-CABG was associated with significantly fewer cerebrovascular accidents
(OR, 0.45; 95% CI, 0.31-0.65; p < 0.0001), bleeding complications (OR,
0.59; 95% CI, 0.43-0.80; p < 0.001) and pulmonary complications. However,
no differences in myocardial infarction (OR, 0.76; 95% CI, 0.52-1.12; p =
0.16), renal failure (OR, 0.74; 95% CI, 0.50-1.11; p = 0.14) and other
postoperative morbidity outcomes were found. Conclusions: OFF-CABG
significantly reduces the incidence of postoperative cerebrovascular
accidents and bleeding complications compared with ON-CABG in diabetic
patients. No differences were found regarding mortality, myocardial
infarction and renal failure between these two techniques. Our study
suggests that OFF-CABG may be an optimal strategy for diabetic patients
although adequately powered randomized trials are needed to further verify
the finding. Copyright &#xa9; 2016 Springer-Verlag Italia