EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
613864102
Author
Ohya M.; Kadota K.; Toyofuku M.; Morimoto T.; Higami H.; Fuku Y.; Yamaji
K.; Muranishi H.; Yamaji Y.; Nishida K.; Furukawa D.; Tada T.; Ko E.; Ando
K.; Sakamoto H.; Tamura T.; Kawai K.; Kimura T.
Institution
(Ohya, Kadota, Fuku) Department of Cardiology, Kurashiki Central Hospital,
Kurashiki, Japan
(Toyofuku, Ko, Tamura) Department of Cardiology, Japanese Red Cross
Society Wakayama Medical Center, Wakayama, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
(Higami, Kimura) Department of Cardiovascular Medicine, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
(Yamaji, Muranishi, Yamaji, Ando) Department of Cardiology, Kokura
Memorial Hospital, Kokura, Japan
(Nishida, Furukawa, Kawai) Department of Cardiology, Chikamori Hospital,
Kochi, Japan
(Tada, Sakamoto) Department of Cardiology, Shizuoka General Hospital,
Shizuoka, Japan
Title
Long-Term Outcomes After Stent Implantation for Left Main Coronary Artery
(from the Multicenter Assessing Optimal Percutaneous Coronary Intervention
for Left Main Coronary Artery Stenting Registry).
Source
American Journal of Cardiology. 119 (3) (pp 355-364), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We assessed long-term outcomes after left main coronary artery (LMCA)
stenting based on lesion types and stenting strategies. In the Assessing
Optimal percutaneous coronary Intervention for Left Main Coronary Artery
stenting registry, we evaluated 1,607 consecutive patients undergoing
stent implantation for unprotected LMCA lesions (bifurcation lesions: n =
1318 and nonbifurcation lesions: n = 289). Among the bifurcation lesions,
1,281 lesions were treated with stenting across the bifurcation
(bifurcation 1-stent strategy: n = 999 or bifurcation 2-stent strategy: n
= 282). Among the nonbifurcation lesions, 219 lesions were treated with
nonbifurcation stenting. The median follow-up duration was 4.6 (95% CI 4.5
to 4.8) years. The 5-year risk of bifurcation lesions relative to
nonbifurcation lesions was neutral for target lesion revascularization
(TLR) (adjusted hazard ratio [HR] 0.82, 95% CI 0.55 to 1.23, p = 0.34) and
all-cause death (adjusted HR 1.22, 95% CI 0.87 to 1.71, p = 0.26). The
risk of the bifurcation 1-stent strategy relative to nonbifurcation
stenting in nonbifurcation lesions was also neutral for TLR (adjusted HR
1.19, 95% CI 0.74 to 1.90, p = 0.47) and all-cause death (adjusted HR
0.81, 95% CI 0.56 to 1.18, p = 0.27). However, the bifurcation 2-stent
strategy was associated with worse clinical outcomes than the bifurcation
1-stent strategy in TLR (adjusted HR 1.76, 95% CI 1.23 to 2.52, p = 0.002)
and definite or probable stent thrombosis (crude HR 3.50, 95% CI 1.32 to
9.33, p = 0.01), despite neutral risk for all-cause death (adjusted HR
1.00, 95% CI 0.74 to 1.36, p = 0.99). There was no definite or probable
very late stent thrombosis up to 5 years. In conclusion, long-term
outcomes after stent implantation for unprotected LMCA lesions were not
dependent on the bifurcation lesion types but related to the bifurcation
stenting strategies with worse outcomes for the bifurcation 2-stent
strategy. Copyright &#xa9; 2016 Elsevier Inc.

<2>
Accession Number
612362080
Author
Pearson K.L.; Hall N.J.
Institution
(Pearson) Department of General Surgery, Queen Alexandra Hospital,
Portsmouth, United Kingdom
(Pearson, Hall) University Surgery Unit, Faculty of Medicine, University
of Southampton, Southampton, United Kingdom
(Hall) Department of Paediatric Surgery and Urology, Southampton
Children's Hospital, Southampton, United Kingdom
Title
What is the role of enhanced recovery after surgery in children? A scoping
review.
Source
Pediatric Surgery International. 33 (1) (pp 43-51), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Enhanced recovery after surgery (ERAS) pathways are standard
practice in adult specialties resulting in improved outcomes. It is
unclear whether ERAS principles are applicable to Paediatric Surgery. We
performed a scoping review to identify the extent to which ERAS has been
used in Paediatric Surgery, the nature of interventions, and outcomes.
Methods: Pubmed, Cochrane library, Google Scholar, and Embase were
searched using the terms enhanced recovery, post-operative
protocol/pathway, fast track surgery, and paediatric surgery. Studies were
excluded if they did not include abdominal/thoracic/urological procedures
in children. Results: Nine studies were identified (2003-2014; total 1269
patients): three case control studies, one retrospective review and five
prospective implementations, no RCTs. Interventional elements identified
were post-operative feeding, mobilisation protocols, morphine-sparing
analgesia, reduced use of nasogastric tubes and urinary catheters.
Outcomes reported included post-operative length of stay (LOS), time to
oral feeding and stooling, complications, and parent satisfaction.
Fast-track programmes significantly reduced LOS in 6/7 studies, time to
oral feeding in 3/3 studies, and time to stooling in 2/3 studies.
Conclusion: The use of ERAS pathways in Paediatric surgery appears very
limited but such pathways may have benefits in children. Prospective
studies should evaluate interventions used in adult ERAS on appropriate
outcomes in the paediatric setting. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<3>
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. 24 (2) (pp 167-174), 2017. Date of Publication: 01 Feb
2017.
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; 2017

<4>
Accession Number
611532826
Author
Karabayirli S.; Ugur K.S.; Demircioglu R.I.; Muslu B.; Usta B.; Sert H.;
Ark N.
Institution
(Karabayirli, Demircioglu, Muslu, Usta, Sert) Department of Anesthesiology
and Reanimation, Faculty of Medicine, Turgut Ozal University, Alparslan
Turkes Caddesi, No: 57, Emek, Ankara 06510, Turkey
(Ugur, Ark) Department of Otolaryngology and Head and Neck Surgery,
Faculty of Medicine, Turgut Ozal University, Ankara, Turkey
Title
Surgical conditions during FESS; comparison of dexmedetomidine and
remifentanil.
Source
European Archives of Oto-Rhino-Laryngology. 274 (1) (pp 239-245), 2017.
Date of Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
To compare dexmedetomidine with remifentanil in functional endoscopic
sinus surgery (FESS) in regards to intra-operative bleeding, anesthetic
consumption and post-operative recovery. Randomized, double blind study.
Tertiary care medical center. Fifty patients with nasal polyposis who had
been scheduled for FESS were randomly divided into two groups. In group D
(n = 25), dexmedetomidine 1 micro&#32;g/kg infused intravenous (IV) over
10 min before anesthesia induction, followed by a continuous of 0.7
micro&#32;g/kg/h infusion during operation. In group R (n = 25), 1
micro&#32;g/kg remifentanil IV bolus, was administered with induction of
anesthesia and continued 0.25-0.50 micro&#32;g/kg/min during operation.
Heart rates, mean arterial pressure, end tidal CO<inf>2</inf>, end tidal
sevoflurane were recorded. The amount of bleeding, surgical field
condition for bleeding and the time to reach Aldrete recovery score 9-10
were recorded. Postoperative nausea, vomiting, pain, shivering, sedation
were followed up over 24 h. There was no significant difference between
groups according to the amount of bleeding during surgery, assessment of
surgical field condition, consumption of sevoflurane, scores of
postoperative VAS, rates of nausea and vomiting, shivering, demands of
additional analgesic medication (P > 0.05). The time to reach Aldrete
recovery score 9-10, sedation scores at the postoperative first hour were
significantly higher in group D (P = 0.001). We concluded that in
comparison to remifentanil, dexmedetomidine during FESS for controlled
hypotension is of limited value as it has no additional benefits in terms
of control of hypotension and amount of bleeding in the surgical field and
it is associated with higher recovery time and first-hour postoperative
sedation scores. Copyright &#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<5>
Accession Number
608106073
Author
den Harder A.M.; de Heer L.M.; Maurovich-Horvat P.; Merkely B.; de Jong
P.A.; Das M.; de Wit G.A.; Leiner T.; Budde R.P.J.
Institution
(den Harder, de Jong, Leiner) Department of Radiology, University Medical
Center, P.O. Box 85000, Utrecht 3508GA, Netherlands
(de Heer) Department of Cardiothoracic Surgery, University Medical Center,
P.O. Box 85000, Utrecht 3508GA, Netherlands
(Maurovich-Horvat, Merkely) MTA-SE Cardiovascular Imaging Research Group,
Heart and Vascular Center, Semmelweis University, 68 Varosmajor ut,
Budapest 1122, Hungary
(Das) Department of Radiology, Maastricht University Medical Center, P.O.
Box 5800, Maastricht 6202 AZ, Netherlands
(Das) CARIM School for Cardiovascular Diseases, Maastricht University
Medical Center, P.O. Box 5800, Maastricht 6202AZ, Netherlands
(de Wit) Department of Epidemiology, Julius Center for Health Sciences and
Primary Care, P.O. Box 85000, Utrecht 3508GA, Netherlands
(de Wit) National Institute of Public Health and the Environment, P.O. Box
1, Bilthoven 3720 BA, Netherlands
(Budde) Department of Radiology, Erasmus Medical Center, P.O. Box 2040,
Rotterdam 3000CA, Netherlands
Title
Ultra low-dose chest ct with iterative reconstructions as an alternative
to conventional chest x-ray prior to heart surgery (CRICKET study):
Rationale and design of a multicenter randomized trial.
Source
Journal of Cardiovascular Computed Tomography. 10 (3) (pp 242-245), 2016.
Date of Publication: 01 Jun 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Stroke after cardiac surgery is a severe complication with a
persistently high incidence of 1.4 - 9.7%. Postoperative strokes are
mainly embolic and can be provoked by manipulation and clamping of the
aorta during cardiac surgery, resulting in the mobilization of
atherothrombotic material and calcifications from the aortic wall.
Computed tomography (CT) can offer preoperative visualization of aortic
calcifications with low radiation exposure. We hypothesize that
preoperative knowledge regarding the location and extent of aortic
calcifications can be used to optimize surgical strategy and decrease
postoperative stroke rate. Methods/design The CRICKET study (ultra
low-dose chest CT with iterative reconstructions as an alternative to
conventional chest x-ray prior to heart surgery) is a prospective
multicenter randomized clinical trial to evaluate whether non-contrast
chest CT before cardiac surgery can decrease postoperative stroke rate by
optimizing surgical strategy. Patients scheduled to undergo cardiac
surgery aged 18 years and older are eligible for inclusion. Exclusion
criteria are pregnancy, a chest/cardiac CT in the past three months,
emergency surgery, concomitant or prior participation in a study with
ionizing radiation and unwillingness to be informed about incidental
findings. Subjects (n = 1.724) are randomized between routine care,
including a chest x-ray, or routine care with an additional low dose chest
CT. The primary objective is to investigate whether the postoperative
in-hospital stroke rate is reduced in the CT arm compared to the routine
care arm of the randomized trial. The secondary outcome measures are
altered surgical approach based on CT findings and cost-effectiveness.
Copyright &#xa9; 2016 Society of Cardiovascular Computed Tomography

<6>
Accession Number
610189145
Author
Xu W.; Wang Y.; Song J.; Mo L.; Jiang T.
Institution
(Xu, Wang, Song, Jiang) Department of Respiratory Medicine, The First
Affiliated Hospital of Chongqing Medical University, Chongqing 400016,
China
(Mo) Department of Respiratory Medicine, Dazu District People's Hospital,
Chongqing 400016, China
Title
One-port video-assisted thoracic surgery versus three-port video-assisted
thoracic surgery for primary spontaneous pneumothorax: a meta-analysis.
Source
Surgical Endoscopy and Other Interventional Techniques. 31 (1) (pp 17-24),
2017. Date of Publication: 01 Jan 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Objective: To further understand the effects of video-assisted thoracic
surgery (VATS) with one-port versus three-port VATS for primary
spontaneous pneumothorax (PSP). Methods: In this study, we searched
information from the PubMed, Cochrane Library, Embase, ScienceDirect, Web
of Science, China National Knowledge Infrastructure (CNKI), and Wanfang
Data databases from inception to September 2015 to collect data of
randomized controlled trials (RCTs) and cohort studies about one-port VATS
versus three-port VATS for PSP. Two independent authors were committed to
screen literature, extract data, and assess the risk of bias of related
studies. Then, we used the RevMan 5.20 software for a meta-analysis of
one-port VATS versus three-port VATS for PSP. Results: Six cohort studies
involving 310 patients were finally selected in this meta-analysis. The
results of our study indicate that one-port VATS had a shorter hospital
stay (SMD = -0.39, 95 % CI -0.69 to 0.09, P = 0.01), lower VAS score of
24-h post-operative pain (SMD = -0.78, 95 % CI -1.40 to -0.52, P <
0.00001), shorter chest drainage time (SMD = -0.68, 95 % CI -1.15 to
-0.22, P = 0.004), and lower incidence of post-operative paraesthesia (OR
= 0.13, 95 % CI 0.06 to 0.29, P < 0.00001) compared with three-port VATS.
However, one-port VATS had a lower patient satisfaction score at 24 h (SMD
= -0.65, 95 % CI -0.95 to -0.35, P < 0.0001) and 48 h (SMD = -0.46, 95 %
CI -0.71 to -0.21, P = 0.0002). No differences in the recurrence of
pneumothorax (OR = 0.58, 95 % CI 0.20 to 1.67, P = 0.32), the operation
time (SMD = 1.01, 95 % CI -4.63 to 2.60, P = 0.58), and the satisfaction
score at 72 h (SMD = -0.11, 95 % CI -0.44 to 0.22, P < 0.00001) were noted
between the groups. Conclusion: Current evidence suggests that one-port
VATS may have certain advantages over three-port VATS for PSP. More
large-scale and high-quality studies are needed for authentication.
Copyright &#xa9; 2016, Springer Science+Business Media New York.

<7>
Accession Number
614034004
Author
Murniece S.; Mamaja B.; Skudre A.; Stepanovs J.
Institution
(Murniece, Mamaja, Skudre, Stepanovs) Departement of Anaesthesiology, Riga
East University Hospital, Letonia, Latvia
(Murniece, Mamaja, Stepanovs) Riga Stradins University, Letonia, Latvia
Title
Systematic review of regional cerebral oxygen saturation changes using
near infrared spectroscopy during neurosurgical spine operations in prone
position and our first experience.
Source
Journal of Neurosurgical Anesthesiology. Conference: 9th International
Update on Neuroanesthesia and Neurointensive Care, EURONEURO 2016. Spain.
Conference Start: 20160414. Conference End: 20160416. 28 (2) (pp S35-S36),
2016. Date of Publication: April 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Near infrared spectroscopy (NIRS) mainly used in cardiac
surgery, has lately gained its actuality in other fields. Maintained
adequate cerebral oxygenation during operation prevents complications like
cognitive dysfunction, stroke, and organ failure. Neurosurgery is a
complex medical field covering a wide range of operations not only on
brain but also on spine. Methods: A systematic review was undertaken to
determine whether operations on spine in prone position impact cerebral
oxygenation using NIRS devices intraoperatively. Relevant publications
were found using the PubMed database. In total, 309 articles were found.
All the articles were screened for eligibility. Only 3 articles met all
the criteria. Results: Fuchs et al1 in his study included 48 patients for
lumbar discectomy. Results reveal that there were no significant changes
in rScO<inf>2</inf> from baseline values during supine with head
left/right, prone, sitting position after 1, 3, 5 minutes in anesthetized
and awake volunteers. Deiner et al2 included 205 patients (above 68 y). A
total of 63 patients underwent spinal surgery in prone position, 142-major
surgery in supine position. Results showed that mild desaturation is 2.3
times more likely for patients in prone position. Andersen et al3 had 52
patients undergoing spinal surgery in prone position hypothesing that head
rotation >45 degrees would affect rScO<inf>2</inf>. Conclusion is made
that the neutral head position is recommended for prone patients.
Discussion: As there are only 3 articles reviewed no significant results
can be made. All the studies have left an open field to investigate the
relation to postoperative period. We have had 8 patients so far. Our
results showed no significant changes in rScO<inf>2</inf> from baseline
values during change from supine to prone and backwards, a close relation
to NIBP measurements, no changes in MMSE after surgery, no incidence of
stroke, organ dysfunction, and no patients were admitted to ICU.
Conclusions: Patients undergoing spinal surgery are at risk to altered
cerebral saturation because of the circulatory changes during prone
position as well as bleeding risk. Only a couple of studies have been made
and more investigations have to be performed.

<8>
Accession Number
614023911
Author
Jetton J.G.; Boohaker L.J.; Kent A.L.; Askenazi D.J.
Institution
(Jetton) Pediatric Nephrology, Dialysis and Transplantation, University of
Iowa, Iowa City, IA, United States
(Boohaker, Askenazi) Pediatric Nephrology, University of Alabama,
Birmingham, AL, United States
(Kent) Dept of Neonatology, Centenary Hospital for Women and Children,
Canberra Hospital, ACT, Australia
(Kent) Australian National University Medical School, Canberra, ACT,
Australia
Title
Assessment of worldwide acute kidney injury epidemiology in neonates
(AWAKEN study): Incidence and outcomes from an international multi-centre
cohort.
Source
Journal of Paediatrics and Child Health. Conference: 20th Annual Meeting
of the Perinatal Society of Australia and New Zealand, PSANZ 2016.
Australia. Conference Start: 20160522. Conference End: 20160525. 52 (pp
49), 2016. Date of Publication: December 2016.
Publisher
Blackwell Publishing
Abstract
Background: Single centre studies report neonatal acute kidney injury
(AKI) incidence 12-70%; neonates with AKI appear to have worse outcomes.
These findings prompted the formation of the Neonatal Kidney Collaborative
(NKC) to improve our understanding of neonatal AKI. The aim of the study
was to assess the incidence of neonatal AKI and its association with
outcomes in a large, multi-centre cohort. Method: NICU admissions from Jan
1, 2014 to Mar 31, 2014 were screened; data from 20 centres are presented
(USA, Canada, Australia and India). Inclusion criteria: 1) admission
during the study period, 2) need for intravenous fluids >48 hrs. Exclusion
criteria: 1) admission at >2 weeks of age, 2) congenital heart disease
requiring surgical repair at <7days of age, 3) lethal chromosomal anomaly,
4) death within 48 hours of admission. AKI was defined using the KDIGO SCr
based definition. Results: Of 3397 screened neonates, 1742 (51%) met study
criteria. Of these, 960 (55%) had at least 2 SCr measured and were
included in the analyses. 192/960 (20%) developed AKI: stage 1 = 22%,
stage 2 = 28%, stage 3 = 50%. Compared with patients without AKI, those
with AKI were more likely to die, have neurologic, cardiovascular,
pulmonary, infectious and renal diagnoses, and be hospitalized >120 days.
10% (N = 20) of those with AKI received renal replacement therapy.
Conclusions: The AWAKEN study demonstrated an AKI incidence of 20%. Those
with AKI are at risk for significant clinical outcomes. Further analysis
of this robust database is underway.

<9>
Accession Number
612005502
Author
Wu X.; Kubilay N.Z.; Ren J.; Allegranzi B.; Bischoff P.; Zayed B.; Pittet
D.; Li J.
Institution
(Wu, Ren, Li) Department of Surgery, Jinling Hospital, Medical School of
Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
(Kubilay, Allegranzi, Zayed) Infection Prevention and Control Unit,
Department of Service Delivery & Safety, World Health Organization,
Geneva, Switzerland
(Bischoff) Institute of Hygiene and Environmental Medicine,
Charite-University Medicine Berlin, Berlin, Germany
(Pittet) Infection Control Programme, University of Geneva Hospitals and
Faculty of Medicine, Geneva, Switzerland
Title
Antimicrobial-coated sutures to decrease surgical site infections: a
systematic review and meta-analysis.
Source
European Journal of Clinical Microbiology and Infectious Diseases. 36 (1)
(pp 19-32), 2017. Date of Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
To investigate the effectiveness of antimicrobial-coated sutures compared
with non-coated sutures in reducing surgical site infection (SSI) and
develop recommendations for World Health Organization (WHO) SSI prevention
guidelines. We searched Medline, Embase, Cinahl, Cochrane Central Register
of Controlled Trials, and WHO Global Health from 1990-16/02/2015 with
language restricted to English, Spanish, and French. Meta-analysis was
performed with a random-effects model. Meta-regression analysis assessed
whether the effect of antimicrobial coating changed according to the type
of suture and surgery. Subgroup analyses were based on types of sutures.
Quality of the retrieved evidence was assessed using the Grading of
Recommendations Assessment, Development, and Evaluation. Thirteen
randomized controlled trials (RCTs) and five observational studies (OBSs)
met the inclusion criteria. Antimicrobial sutures significantly reduced
SSI risk (for RCTs: OR 0.72, 95 % CI 0.59-0.88, p = 0.001, I² =
14 %; for OBSs: OR 0.58, 95 % CI 0.40-0.83, p = 0.003, I² = 22
%). Only Vicryl Plus vs Vicryl revealed consistent results in favor of
antimicrobial sutures (for seven RCTs: OR 0.62, 95 % CI 0.44-0.88, p =
0.007, I² = 3 %; for four OBSs: OR 0.58, 95 % CI 0.37-0.92, p =
0.02, I² = 41 %). The effect of antimicrobial coating was
similar between different suture, wound, and procedure types. Quality of
RCT evidence was moderate, and OBS evidence was very low quality.
Triclosan-coated sutures may reduce SSI risk. However, the available
evidence is of moderate/low quality, and many studies had conflicts of
interest. Copyright &#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<10>
Accession Number
613808216
Author
Yardley M.; Gullestad L.; Bendz B.; Bjorkelund E.; Rolid K.; Arora S.;
Nytroen K.
Institution
(Yardley, Gullestad, Bendz, Bjorkelund, Rolid, Arora, Nytroen) Department
of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Yardley) The Norwegian Health Association, Oslo, Norway
(Yardley, Gullestad, Bendz, Nytroen) Faculty of Medicine, University of
Oslo, Oslo, Norway
(Gullestad) Center for Heart Failure Research, Faculty of Medicine,
University of Oslo, Oslo, Norway
Title
Long-term effects of high-intensity interval training in heart transplant
recipients: A 5-year follow-up study of a randomized controlled trial.
Source
Clinical Transplantation. 31 (1) (no pagination), 2017. Article Number:
e12868. Date of Publication: 01 Jan 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Previous studies have demonstrated that high-intensity
interval training (HIT) is superior to moderate-continuous exercise in
general and in cardiovascular diseases. Recently, we also found HIT safe
and efficient after heart transplantation (HTx). This study reports the
5-year long-term effects. Design and Methods: Forty-one HTx patients who
had completed the previous 12-month randomized controlled trial, comparing
HIT intervention with usual care, were eligible. In particular, we
measured VO<inf>2peak</inf>, muscular capacity, intravascular ultrasound,
and questionnaires measuring physical and mental health. Results: The
baseline mean+/-SD values were as follows: age; 49.1+/-16.5 years, men;
68%, time since HTx: 4.1+/-2.2 years. Within the HIT group, initial
VO<inf>2peak</inf> increased significantly from 27.7+/-5.7 to 31.2+/-5.3
mL/kg/min. However, during the next 4 years, VO<inf>2peak</inf> decreased
to 26.0+/-6.2 mL/kg/min. The control group showed slightly decreasing
VO<inf>2peak</inf> values during the entire 5-year period. The HIT group
reported significantly less anxiety symptoms, but there were no long-term
differences in VO<inf>2peak</inf>, muscular capacity, or cardiac allograft
vasculopathy between the groups. The similar VO<inf>2peak</inf> values
correspond to our findings of similar everyday activity. Conclusion: Our
findings suggest that intermittent periods of HIT may be necessary to
maintain the initial benefits gained from the intervention. However, HIT
probably reduces the burden of anxiety, which is a frequent health issue
following HTx. Copyright &#xa9; 2016 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd

<11>
Accession Number
613807117
Author
Ebrahimi L.; Kheirandish M.; Foroughi M.
Institution
(Ebrahimi, Kheirandish) Department of Immunology, Blood Transfusion
Research Center, High Institute for Research and Education in Transfusion
Medicine, Tehran, Iran, Islamic Republic of
(Foroughi) Cardiovascular Research Center, Modarres Hospital, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
The effect of methylprednisolone treatment on fibrinolysis, the
coagulation system, and blood loss in cardiac surgery.
Source
Turkish Journal of Medical Sciences. 46 (6) (pp 1645-1654), 2016. Date of
Publication: 2016.
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Background/aim: The purpose of this study was to examine steroid
pretreatment in order to decrease postoperative coagulopathy disorders and
bleeding. Materials and methods: In this randomized double-blinded study,
the efficacy of low versus high doses of methylprednisolone on the
coagulation system and postoperative bleeding was compared in patients who
were undergoing cardiac surgery with cardiopulmonary bypass (CPB). The
platelet response to agonists, D-dimer concentration, tissue plasminogen
activator (tPA), plasminogen activator inhibitor (PAI-1) antigens, and
platelet receptors CD42b, CD62P, and CD41a were evaluated. Results: The
platelet response to agonists was reduced. The mean concentrations of
D-dimer and tPA antigen increased although PAI-1 concentration did not
show any significant changes following heparin neutralization.
Postoperative expression of CD42b showed no changes in comparison with
preoperation values in both groups. There was a significant increase in
the expression of CD62P with a methylprednisolone dose of 15 mg/kg, while
there was just a slight increase with a dose of 5 mg/kg. CD41a, as a
fibrinogen receptor, was increased significantly after CPB in both groups.
Significant data were shown in decreasing blood loss with a high dose of
methylprednisolone. Conclusion: Methylprednisolone at a dose of 15 mg/kg
reduced bleeding, probably by increasing CD62P after heparin
neutralization, which can activate platelet activation in favor of better
hemostasis. Copyright &#xa9; TUBITAK.

<12>
Accession Number
613791885
Author
Gorki H.; Hoenicka M.; Rupp P.; Muller-Eising K.; Deininger S.; Kunert A.;
Liebold A.
Institution
(Gorki, Hoenicka, Rupp, Muller-Eising, Deininger, Kunert, Liebold) Dept.
of Cardiothoracic and Vascular Surgery, University Hospital,
Albert-Einstein-Allee 23, Ulm 89081, Germany
Title
Similarity of coagulation and inflammation despite different surgical
revascularization strategies - A prospective randomized trial.
Source
Perfusion (United Kingdom). 31 (8) (pp 640-647), 2016. Date of
Publication: 01 Nov 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Supposedly, minimized extracorporeal circulation or off-pump
revascularization as alternatives to conventional extracorporeal
circulation (ONCAB) reduce inflammation and coagulation disturbances.
Methods: One hundred and twenty coronary artery bypass graft (CABG)
patients were prospectively randomized for three surgical techniques.
Coagulation and inflammation markers were measured up to 72 hours
postoperatively. Results: Coagulation factors I, II, V, X, antithrombin
III and C-reactive protein did not differ perioperatively between the
groups and increased, as did several other markers, 12 to 72 hours
postoperatively. Compared to its alternatives, ONCAB showed the most
obvious transient increase in thrombin-antithrombin complexes (p<0.0001),
D-dimers (p=0.0059), tissue factor pathway inhibitor (p=0.0005), factor
VIII (p=0.0041) and tumor necrosis factor alpha (p=0.0300) during the
operation and up to 12 hours postoperatively. Furthermore, ONCAB generated
lower leukocyte and platelet counts and higher values of soluble
P-selectin and soluble intercellular adhesion molecule 1 at some time
points. Conclusions: With similarity in pivot coagulation factors, a
specific detrimental influence of ONCAB on common coagulation pathways was
excluded. Higher perioperative concentrations of products from the
coagulation cascade most likely indicate activation of pericardial blood -
recirculated only in ONCAB. Furthermore, with only temporary differences
in markers of inflammation, the alternatives to ONCAB altogether were
without advantage at 72 hours postoperatively. In the general answer to
surgical trauma, the part of modern extracorporeal circulation is possibly
overestimated. The study is registered at the German Clinical Trial
Registry. Registration number DRKS00007580. URL:
https://drks-neu.uniklinik-freiburg.de/drks-web/ URL:
http://apps.who.int/trialsearch/ Copyright &#xa9; SAGE Publications.

<13>
[Use Link to view the full text]
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).

<14>
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.

<15>
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.

<16>
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.

<17>
Accession Number
613630476
Author
Sharma A.; Helft G.; Garg A.; Agrawal S.; Chatterjee S.; Lavie C.J.; Goel
S.; Mukherjee D.; Marmur J.D.
Institution
(Sharma, Marmur) Division of Cardiovascular Medicine, State University of
New York Downstate Medical Center, New York, NY, United States
(Helft) Institut de Cardiologie, Hopital Pitie-Salpetriere, Assistance
Publique Hopitaux de Paris, Universite Pierre et Marie Curie, Boulevard de
l'Hopital, Paris, France
(Helft) Institute of Cardiometabolism and Nutrition, Hopital
Pitie-Salpetriere, Paris, France
(Garg) Department of Medicine, James J. Peters VA Medical Center, Mount
Sinai School of Medicine, New York, NY, United States
(Agrawal) Division of Cardiology, St. Luke's University Health Network,
Bethlehem, PA, United States
(Chatterjee) Division of Cardiovascular Diseases, New York, NY, United
States
(Lavie) Department of Cardiovascular Diseases, John Ochsner Heart and
Vascular Institute, Ochsner Clinical School-the University of Queensland
School of Medicine, New Orleans, LA, United States
(Goel) Department of Cardiology, Maimonides Medical Center, New York, NY,
United States
(Mukherjee) Division of Cardiology, Texas Tech University, El Paso, TX,
United States
(Sharma) Institute of Cardiovascular Research and Technology, Brooklyn,
NY, United States
Title
Safety and efficacy of vorapaxar in secondary prevention of
atherosclerotic disease: A meta-analysis of randomized control trials.
Source
International Journal of Cardiology. 227 (pp 617-624), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To study the cumulative evidence for vorapaxar use in patients
with atherosclerotic cardiovascular disease. Methods A systematic review
of randomized control trials in MEDLINE, EMBASE, EBSCO, CINAHL, Web of
Science and Cochrane databases comparing vorapaxar with placebo was
performed. Pre-specified efficacy endpoints were all-cause mortality, CV
mortality, myocardial infarction (MI), ischemic stroke and repeat
revascularization. The pre-specified safety endpoint was intracranial
hemorrhage (ICH) and a composite of TIMI major and minor bleeding. Risk
ratios were used as the metric of choice by applying random effects
models. Results Five randomized controlled trials with 40,630 patients
were included in final analysis. Compared with placebo, vorapaxar led to a
statistically non-significant reduction in risk of MI [RR 0.86; 95% CI
0.80-0.93, p = 0.427] and ischemic stroke [RR 0.84; 95% CI 0.72-0.97, p =
0.920]. No differences were observed between vorapaxar and placebo with
respect to all-cause mortality [RR 0.99; 95% CI 0.90-1.08, p = 0.620],
cardiovascular mortality [RR 0.94; 95% CI 0.83-1.06, p = 0.351], repeat
revascularization [RR 0.97; 95% CI 0.82-1.15, p = 0.236], and TIMI
bleeding [RR 1.29; 95% CI 0.98-1.69, p = 0.126]. Vorapaxar was associated
with a statistically non-significant higher risk of ICH [RR 2.36; 95% CI
1.40-3.96, p = 0.137] compared with placebo. Conclusion Addition of
Vorapaxar to standard medical therapy in in patients with atherosclerotic
disease led to a statistically non-significant reduction in the risk of MI
and ischemic stroke at the cost of statistically non-significant increase
in risk of ICH. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<18>
Accession Number
613630466
Author
Attizzani G.F.; Ohno Y.; Latib A.; Petronio A.S.; Giannini C.; Ettori F.;
Curello S.; Bedogni F.; Todaro D.; Brambilla N.; Bruschi G.; Colombo P.;
Presbitero P.; Fiorilli R.; Poli A.; Martina P.; Colombo A.; Barbanti M.;
Tamburino C.
Institution
(Attizzani, Ohno, Todaro, Barbanti, Tamburino) Ferrarotto Hospital,
University of Catania, Catania, Italy
(Latib, Colombo) Scientific Institute S. Raffaele, Milan, Italy
(Petronio, Giannini) AOU Pisana, Pisa, Italy
(Ettori, Curello) Ospedali Civili, Brescia, Italy
(Bedogni, Brambilla) IRCCS Policlinico San Donato, San Donato, Italy
(Bruschi, Colombo) "De Gasperis" Cardio Center ASST Niguarda Metropolitan
Hospital, Milan, Italy
(Presbitero) Clinical Institute Humanitas, Rozzano, Milan, Italy
(Fiorilli) A. O. San Camillo Forlanini Hospital, Rome, Italy
(Poli, Martina) Ospedale Civile, Legnano, Italy
Title
Acute and long-term (2-years) clinical outcomes of the CoreValve 31 mm in
large aortic annuli: A multicenter study.
Source
International Journal of Cardiology. 227 (pp 543-549), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction Little is known about the early and late performance of the
31 mm CoreValve Revalving System (CRS, Medtronic Inc., Galway, Ireland).
Our aim was to compare acute and long-term results of the 31 mm CRS with
other valve sizes. Methods Consecutive patients undergoing transcatheter
aortic valve implantation (TAVI) with CRS in nine Italian centers were
prospectively included and dichotomized according to prosthesis size in
two different groups, as follows: 31 mm and other valve sizes (i.e., 23,
26, and 29 mm combined). End points were defined according to Valve
Academic Research Consortium definitions. Propensity score matching was
performed. Results In total, 2069 patients (n = 169 [8%] in the 31 mm
group and n = 1900 [92%] in the other valve sizes group) were included.
After propensity matching, the implantation of the 31 mm valve was
associated with lower rates of procedural- (91.3% vs. 98.1%, p = 0.030)
and device-success (88.5% vs. 97.1%, p = 0.016), longer procedural time
(120 [80-180] min. vs. 90 [60-120] min., p < 0.001), and higher rates of
implantation of a second valve (10.6% vs. 2.9%, respectively, p = 0.027).
The rates of permanent pacemaker implantation in the 31 mm group were
higher but not statistically different from other valve sizes (41.7% vs.
30.9%, respectively, p = 0.149). Significant improvement, without
between-group differences, was observed in NYHA functional class.
Cardiovascular death was lower in the 31 mm valve group through 2-years
(3.8% vs. 13.5%, respectively, p = 0.014). Conclusions The acute
performance of the 31 mm CRS was worse than other valve sizes but no
negative impact was observed in long-term outcomes. Copyright &#xa9; 2016
Elsevier Ireland Ltd

<19>
Accession Number
611338580
Author
Sanchis J.; Nunez E.; Barrabes J.A.; Marin F.; Consuegra-Sanchez L.;
Ventura S.; Valero E.; Roque M.; Bayes-Genis A.; del Blanco B.G.; Degano
I.; Nunez J.
Institution
(Sanchis, Nunez, Ventura, Valero, Nunez) Department of Cardiology,
Hospital Clinico Universitario, IncLIVA, Universitat de Valencia,
Valencia, Spain
(Barrabes, del Blanco) Department of Cardiology, Hospital Universitari
Vall d'Hebron, VHIR, Universitat Autonoma de Barcelona, Barcelona, Spain
(Marin) Department of Cardiology, Hospital Virgen Arrixaca, Murcia, Spain
(Consuegra-Sanchez) Department of Cardiology, Hospital Santa Lucia,
Cartagena, Spain
(Roque) Department of Cardiology, Hospital Clinic, Barcelona, Spain
(Bayes-Genis) Department of Cardiology, Hospital Universitari Germans
Trias i Pujol, Badalona, Spain
(Degano) IMIM (Hospital del Mar Medical Research Institute), Universitat
Autonoma de Barcelona, Barcelona, Spain
Title
Randomized comparison between the invasive and conservative strategies in
comorbid elderly patients with non-ST elevation myocardial infarction.
Source
European Journal of Internal Medicine. 35 (pp 89-94), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier B.V.
Abstract
Background Comorbid elderly patients with non-ST-elevation myocardial
infarction (non-STEMI) are underrepresented in randomized trials and
undergo fewer cardiac catheterizations according to registries. Our aim
was to compare the conservative and invasive strategies in these patients.
Methods Randomized multicenter study, including 106 patients (January
2012-March 2014) with non-STEMI, over 70 years and with comorbidities
defined by at least two of the following: peripheral artery disease,
cerebral vascular disease, dementia, chronic pulmonary disease, chronic
renal failure or anemia. Patients were randomized to invasive (routine
coronary angiogram, n = 52) or conservative (coronary angiogram only if
recurrent ischemia or heart failure, n = 54) strategy. Medical treatment
was identical. The main endpoint was the composite of all-cause mortality,
reinfarction and readmission for cardiac cause (postdischarge
revascularization or heart failure), at long-term (2.5-year follow-up).
Analysis of cumulative event rate (incidence rate ratio = IRR) and time to
first event (hazard ratio = HR), were performed. Results Cardiac
catheterization/revascularization rates were 100%/58% in the invasive
versus 20%/9% in the conservative arm. There were no differences between
groups in the main endpoint (invasive vs conservative: IRR = 0.946, 95% CI
0.466-1.918, p = 0.877) at long-term. The invasive strategy, however,
tended to improve 3-month outcomes in terms of mortality (HR = 0.348, 95%
CI 0.122-0.991, p = 0.048), and of mortality or ischemic events
(reinfarction or postdischarge revascularization) (HR = 0.432, 95% CI
0.190-0.984, p = 0.046). This benefit declined during follow-up.
Conclusions Invasive management did not modify long-term outcome in
comorbid elderly patients with non-STEMI. The finding of a tendency
towards an improvement in the short-term needs confirmation in larger
studies (clinicaltrials.govNCT1645943). Copyright &#xa9; 2016 European
Federation of Internal Medicine.

<20>
Accession Number
607491013
Author
Christopoulos G.; Papayannis A.C.; Alomar M.; Christakopoulos G.E.; Kotsia
A.; Michael T.T.; Rangan B.V.; Roesle M.; Shorrock D.; Makke L.;
Maragkoudakis S.; Mohammad A.; Sarode K.; Chambers C.E.; Banerjee S.;
Brilakis E.S.
Institution
(Christopoulos, Papayannis, Alomar, Christakopoulos, Kotsia, Michael,
Rangan, Roesle, Shorrock, Makke, Mohammad, Sarode, Banerjee, Brilakis) VA
North Texas Health Care System and University of Texas Southwestern
Medical Center, Dallas, TX, United States
(Maragkoudakis) Department of Cardiovascular Diseases, University of
Heraklion, Heraklion, Greece
(Chambers) Penn State Hershey Medical Center, Hershey, PA, United States
Title
Determinants of operator and patient radiation exposure during cardiac
catheterization: Insights from the RadiCure (RADIation reduction during
cardiac catheterization using real-timE monitoring) trial.
Source
Catheterization and Cardiovascular Interventions. 88 (7) (pp 1046-1055),
2016. Date of Publication: 01 Dec 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In the RadiCure study 505 catheterization procedures were 1:1
randomized to use or no use of real-time radiation monitoring. Use of the
Bleeper Sv monitor resulted in a significant reduction in operator
radiation exposure. Methods: We examined the association between several
baseline and procedural parameters with operator and patient radiation
exposure using univariable and multivariable analysis in the 505 patients
that were enrolled in RadiCure. All baseline demographic and procedure
characteristics recorded were included in the univariable analysis.
Results: Median fluoroscopy time was 6.2 (2.5-12.5) minutes, median
patient air kerma dose was 0.908 (0.602-1.636) Gray and median first
operator exposure was 10 (5-22) muSv. For analysis purposes, the 505
procedures were dichotomized based on the median operator exposure (10
muSv) and median patient radiation dose (0.908 Gray). On multivariable
analysis, factors associated with high (above median or >10 muSv) first
operator radiation exposure included radial access (odds ratio [OR] 5.44,
95% Confidence Interval [CI] 2.88-10.76), chronic total occlusion (CTO)
intervention (OR 12.78, 95% CI 4.42-43.60), real-time radiation monitoring
(OR 0.42, 95% CI 0.26-0.66), and use of a radioabsorbent drape (OR 0.53,
95% CI 0.28-0.96). High patient radiation dose (above median or >0.908
Gray) was associated with body mass index>30 kg/m² (OR 3.22,
95% CI 1.99-5.29), prior MI (OR 2.26, 95% CI 1.29-4.04), prior
cerebrovascular disease (OR 0.34, 95% CI 0.15-0.75), hypertension (OR
2.40, 95% CI 1.05-5.82), prior coronary artery bypass graft surgery (OR
2.46, 95% CI 1.40-4.39) and CTO intervention (OR 12.93, 95% CI
3.28-87.31), but was not associated with real-time radiation monitoring
and use of a radioabsorbent drape. Conclusions: Several clinical and
procedural factors are associated with higher patient and operator
radiation exposure. Real-time radiation monitoring and use of disposable
radiation shields were associated with lower operator, but not patient,
radiation dose. &#xa9; 2015 Wiley Periodicals, Inc. Copyright &#xa9; 2015
Wiley Periodicals, Inc.

<21>
Accession Number
608854631
Author
Du X.; Pi Y.; Dreyer R.P.; Li J.; Li X.; Downing N.S.; Li L.; Feng F.;
Zhan L.; Zhang H.; Guan W.; Xu X.; Li S.-X.; Lin Z.; Masoudi F.A.; Spertus
J.A.; Krumholz H.M.; Jiang L.
Institution
(Du, Pi, Li, Li, Li, Feng, Zhan, Zhang, Guan, Jiang) National Clinical
Research Center of Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Dreyer, Downing, Xu, Li, Lin, Krumholz) Center for Outcomes Research and
Evaluation, Yale-New Haven Hospital, New Haven, CT, United States
(Xu) Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale
School of Medicine, New Haven, CT, United States
(Masoudi) Division of Cardiology, University of Colorado Anschutz Medical
Campus, Aurora, CO, United States
(Spertus) Saint Luke's Mid America Heart Institute/University of
Missouri-Kansas City, Kansas City, MO, United States
(Krumholz) Section of Cardiovascular Medicine, Robert Wood Johnson
Clinical Scholars Program, Department of Internal Medicine, Yale
University School of Medicine, New Haven, CT, United States
(Krumholz) Department of Health Policy and Management, Yale School of
Public Health, New Haven, CT, United States
Title
The china patient-centered evaluative assessment of cardiac events (PEACE)
prospective study of percutaneous coronary intervention: Study design.
Source
Catheterization and Cardiovascular Interventions. 88 (7) (pp E212-E221),
2016. Date of Publication: 01 Dec 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The number of percutaneous coronary interventions (PCI) in
China has increased more than 20-fold over the last decade. Consequently,
there is a need for national-level information to characterize PCI
indications and long-term patient outcomes, including health status, to
understand and improve evolving practice patterns. Objectives: This
nationwide prospective study of patients receiving PCI is to: (1) measure
long-term clinical outcomes (including death, acute myocardial infarction
[AMI], and/or revascularization), patient-reported outcomes (PROs),
cardiovascular risk factor control and adherence to medications for
secondary prevention; (2) determine patient- and hospital-level factors
associated with care process and outcomes; and (3) assess the
appropriateness of PCI procedures. Methods: The China Patient-centered
Evaluative Assessment of Cardiac Events (PEACE) Prospective Study of PCI
has enrolled 5,000 consecutive patients during 2012-2014 from 34 diverse
hospitals across China undergoing PCI for any indication. We abstracted
details of patient's medical history, treatments, and in-hospital outcomes
from medical charts, and conducted baseline, 1-, 6-, and 12-month
interviews to characterize patient demographics, risk factors, clinical
presentation, healthcare utilization, and health status using validated
PRO measures. The primary outcome, a composite measure of death, AMI
and/or revascularization, as well as PROs, medication adherence and
cardiovascular risk factor control, was assessed throughout the 12-month
follow-up. Blood and urine samples were collected at baseline and 12
months and stored for future analyses. To validate reports of coronary
anatomy, 2,000 angiograms are randomly selected and read by two
independent core laboratories. Hospital characteristics regarding their
facilities, processes and organizational characteristics are assessed by
site surveys. Conclusion: China PEACE Prospective Study of PCI will be the
first study to generate novel, high-quality, comprehensive national data
on patients' socio-demographic, clinical, treatment, and metabolic/genetic
factors, and importantly, their long-term outcomes following PCI,
including health status. This will build the foundation for PCI
performance improvement efforts in China. &#xa9; 2016 The Authors.
Catheterization and Cardiovascular Interventions. Published by Wiley
Periodicals, Inc. Copyright &#xa9; 2016 The Authors. Catheterization and
Cardiovascular Interventions. Published by Wiley Periodicals, Inc.

<22>
Accession Number
612819573
Author
Goudar S.P.; Baker G.H.; Chowdhury S.M.; Reid K.J.; Shirali G.; Scheurer
M.A.
Institution
(Goudar, Reid, Shirali) Ward Family Heart Center, Children's Mercy
Hospital, Kansas City, MO, United States
(Baker, Chowdhury, Scheurer) Department of Pediatrics, Division of
Pediatric Cardiology, Medical University of South Carolina, Charleston,
SA, United States
Title
Interpreting measurements of cardiac function using vendor-independent
speckle tracking echocardiography in children: a prospective, blinded
comparison with catheter-derived measurements.
Source
Echocardiography. 33 (12) (pp 1903-1910), 2016. Date of Publication: 01
Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Adult studies demonstrate that echocardiographic measurements
of cardiac function using speckle tracking correlate with invasive
measurements, but such data in the pediatric population are sparse. Our
aim was to compare speckle-derived measures of cardiac function to
measurements routinely obtained by cardiac catheterization in children.
Methods: Echocardiograms were performed on the day of cardiac
catheterization. Using Tomtec 2D Cardiac Performance Analysis,
longitudinal strain (LS), longitudinal strain rate (LSR), early diastolic
LSR, and ejection fraction (EF) for the right and left ventricle (RV and
LV) were calculated via speckle tracking. Global LS and LSR were
calculated for the LV. These results were compared to cardiac index,
maximum ventricular dp/dt (max dp/dt), ventricular end-diastolic pressure
(EDP), and pulmonary capillary wedge pressure (PCWP) obtained by
fluid-filled catheters. A blinded observer performed all echo
measurements. Results: Fifty studies were performed on 28 patients ages 4
months to 20 years old. Their diagnoses included cardiac transplant (48
studies), repaired AV septal defect (1), and dilated cardiomyopathy (1).
RVEDP ranged from 2 to 22 mm Hg (median=6) and PCWP ranged from 6 to 32
mmHg (median 10). LV global LS and LV 2-chamber LSR by speckle-tracking
negatively correlated with LV max dp/dt (LV global LS R=-.83, P=.001; LV
2-chamber LSR R=-.69, P=.009). RV LS weakly correlated with max dp/dt
(R=.363, P=.002). Early diastolic strain rate did not correlate with EDP
in either ventricle. Conclusion: Speckle-derived measurements of function
in the LV have stronger correlation than the RV to catheter-derived
measures. LV global LS has the strongest correlation with invasive
function measures in children. Copyright &#xa9; 2016, Wiley Periodicals,
Inc.

<23>
Accession Number
603013543
Author
Qi Z.; Liu S.; Lv X.; Duan F.; Wang H.; Gao Y.; Wang J.
Institution
(Qi, Lv, Duan, Wang, Gao, Wang) Department of Echocardiography, Fuwai
Hospital & Cardiovascular Institute, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences & Tsinghua University,
Peking Union Medical College, Beijing, China
(Liu) Department of Cardiovascular Surgery, Fuwai Hospital &
Cardiovascular Institute, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences & Tsinghua University, Peking Union
Medical College, Beijing, China
Title
Effects of Bone Marrow Mononuclear Cells Delivered through a Graft Vessel
for Patients with Previous Myocardial Infarction and Chronic Heart
Failure: An Echocardiographic Study of Left Atrium Function.
Source
Echocardiography. 33 (12) (pp 1835-1843), 2016. Date of Publication: 01
Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The graft of stem cells to treat ischemic cardiomyopathy is
popular in many clinical trials. The aim of this study was to evaluate the
effectiveness of isolated coronary artery bypass graft combined with bone
marrow mononuclear cells (BMMNC) delivered through the graft vessels to
improve left atrium (LA) function of patients with previous myocardial
infarction and chronic heart failure using echocardiography. Methods:
Forty-two patients with previous myocardial infarction and chronic heart
failure were randomly allocated to one of the two groups: coronary artery
bypass graft (CABG) only (18 in CABG group) or CABG with BMMNC
transplantation (24 in CABG + BMMNC group). Echocardiographic parameters
were measured on two-dimensional (2D) imaging, three-dimensional imaging,
2D strain, and strain rate imaging, eight parameters were measured
totally. Results: Postoperative LA global strain (LAGS) versus
Preoperative LAGS were 24.875 +/- 1.588% versus 14.250 +/- 1.281% (P <
0.05) in CABG + BMMMNC group and 17.556 +/- 1.834% versus 13.111 +/-
1.479% (P < 0.05) in CABG group, LVEF was 49.083 +/- 1.914% versus 36.042
+/- 1.185% (P < 0.05) in CABG + BMMMNC group and 41.389 +/- 2.210% versus
34.667 +/- 1.369% (P < 0.05) in CABG group, and LA volume (LAV) was 15.651
+/- 0.631 mL versus 23.894 +/- 0.831 mL (P < 0.05) in CABG + BMMMNC group
and 21.429 +/- 0.707 mL versus 22.379 +/- 0.959 mL (P < 0.05) in CABG
group. LAGS, LVEF, and LAV were significantly improved postoperatively in
both groups. The degree of the improvement was significantly different
between the two groups with the CABG + BMMNC group improved more versus
the group of CABG only (P < 0.05). Postoperative LVEDV and LVESV were
significantly improved compared with those obtained prior to operation in
CABG + BMMNC group (P < 0.05). Conclusions: The improvement of LA function
in CABG + BMMNC group is better than CABG group. 2D strain imaging is a
more sensitive tool to evaluate LA function. Copyright &#xa9; 2015, Wiley
Periodicals, Inc.

<24>
[Use Link to view the full text]
Accession Number
606627138
Author
Ziegler T.R.; May A.K.; Hebbar G.; Easley K.A.; Griffith D.P.; Dave N.;
Collier B.R.; Cotsonis G.A.; Hao L.; Leong T.; Manatunga A.K.; Rosenberg
E.S.; Jones D.P.; Martin G.S.; Jensen G.L.; Sax H.C.; Kudsk K.A.; Galloway
J.R.; Blumberg H.M.; Evans M.E.; Wischmeyer P.E.
Institution
(Ziegler, Hebbar, Hao) Division of Endocrinology, Metabolism and Lipids,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Ziegler, Galloway) Center for Clinical and Molecular Nutrition, Emory
University, School of Medicine, Atlanta, GA, United States
(Ziegler, Hebbar, Griffith, Dave, Galloway) Emory University Hospital,
Nutrition and Metabolic Support Service, Atlanta Clinical and
Translational Science Institute, 1364 Clifton Rd, Atlanta, GA 30322,
United States
(May, Collier) Department of Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Easley, Cotsonis, Leong, Manatunga) Department of Biostatistics and
Bioinformatics, Rollins School of Public Health, Emory University,
Atlanta, GA, United States
(Collier) Department of Surgery, Virginia Technical Institute Carilion,
School of Medicine, Roanoke, VA, United States
(Rosenberg) Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, United States
(Jones) Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Martin) Department of Nutritional Sciences, Pennsylvania State
University, University Park, PA, United States
(Jensen, Blumberg) Department of Surgery, Miriam Hospital, Providence, RI,
United States
(Sax) Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA,
United States
(Sax) Department of Surgery, University of Wisconsin, Schools of Medicine
and Public Health, Madison, WI, United States
(Kudsk) Department of Surgery, Emory University, School of Medicine,
Atlanta, GA, United States
(Galloway) Division of Infectious Diseases, Department of Medicine, Emory
University, School of Medicine, Atlanta, GA, United States
(Evans) Hubert Department of Global Health Rollins, School of Public
Health, Emory University, Atlanta, GA, United States
(Wischmeyer) National Institutes of Health, National Institute of Diabetes
and Digestive and Kidney Diseases, Bethesda, MD, United States
(Wischmeyer) Department of Anesthesiology, University of Colorado, School
of Medicine, Aurora, CO, United States
Title
Efficacy and safety of glutamine-supplemented parenteral nutrition in
surgical ICU patients: An American mul ticenter rand omized controlled
trial.
Source
Annals of Surgery. 263 (4) (pp 646-655), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To determine whether glutamine (GLN)-supplemented parenteral
nutrition (PN) improves clinical outcomes in surgical intensive care unit
(SICU) patients. Summary Background Data: GLN requirements may increase
with critical illness. GLN-supplemented PN may improve clinical outcomes
in SICU patients. Methods: A parallel-group, multicenter, double-blind,
randomized, controlled clinical trial in 150 adults after
gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care.
Patients were without significant renal or hepatic failure or shock at
entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids
(AAs) and energy at 1.3x estimated basal energy expenditure]. Controls (n
= 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75)
received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally
replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN
weaned as indicated. Hospital mortality and infections were primary
endpoints. Results: Baseline characteristics, days on study PN and daily
macronutrient intakes via PN and EN, were similar between groups. There
were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the
STD-PN group (17.3%; difference,-2.6%; 95% confidence interval,-14.6% to
9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN
group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream
infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and
STD-PN groups, respectively (P = 0.73). Other clinical outcomes and
adverse events were similar. Conclusions: PN supplemented with GLN
dipeptide was safe, but did not alter clinical outcomes among SICU
patients. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc. All rights
reserved.

<25>
Accession Number
606579913
Author
Amanda Dew M.; Rosenberger E.M.; Myaskovsky L.; DiMartini A.F.; DeVito
Dabbs A.J.; Posluszny D.M.; Steel J.; Switzer G.E.; Shellmer D.A.;
Greenhouse J.B.
Institution
(Amanda Dew, DiMartini) University of Pittsburgh School of Medicine and
Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
(Amanda Dew) Department of Psychology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Biostatistics, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew, Rosenberger) Clinical and Translational Science Institute,
University of Pittsburgh, Pittsburgh, PA, United States
(Rosenberger, Myaskovsky, Posluszny, Switzer) Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Myaskovsky, Switzer) Center for Health Equity Research and Promotion,
Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA,
United States
(DiMartini, Steel, Shellmer) Department of Surgery, University of
Pittsburgh, Pittsburgh, PA, United States
(DeVito Dabbs) Department of Acute and Tertiary Care, University of
Pittsburgh School of Nursing, Pittsburgh, PA, United States
(Greenhouse) Department of Statistics, Carnegie Mellon University,
Pittsburgh, PA, United States
Title
Depression and anxiety as risk factors for morbidity and mortality after
organ transplantation: A systematic review and meta-analysis.
Source
Transplantation. 100 (5) (pp 988-1003), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background. Depression and anxiety are common mental health problems in
transplant populations. There is mixed evidence concerning whether they
increase morbidity and mortality risks after transplantation. If such
associations exist, additional risk reduction strategiesmay be
needed.Methods. Four bibliographic databases were searched from1981
through September 2014 for studies prospectively examining whether
depression or anxiety (determined with diagnostic evaluations or
standardized symptomscales) affected risk for posttransplant mortality,
graft loss, acute graft rejection, chronic rejection, cancer, infection,
and rehospitalization. Results. Twenty-seven studies (10 heart, total n =
1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas,
n = 80; 1 mixed recipient sample, n = 205) were identified. In each,
depression and/or anxiety were typically measured before or early after
transplantation. Follow-up for outcomes was a median of 5.8 years (range,
0.50-18.0). Depression increased the relative risk (RR) of mortality by
65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies).
Meta-regression indicated that risk was stronger in studies that did (vs
did not) control for potential confounders (P = .032). Risk was unaffected
by type of transplant or other study characteristics. Depression increased
death-censored graft loss risk (RR, 1.65; 95% CI, 1.21- 2.26, 3 studies).
Depression was not associated with other morbidities (each morbidity was
assessed in 1-4 studies). Anxiety did not significantly increase mortality
risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed
in single studies). Conclusions. Depression increases risk for
posttransplant mortality. Few studies considered morbidities; the
depression-graft loss association suggests that linkages with morbidities
deserve greater attention. Depression screening and treatment may be
warranted, although whether these activities would reduce posttransplant
mortality requires study. Copyright &#xa9; 2016 Wolters Kluwer Health,
Inc. All rights reserved.

<26>
Accession Number
613747036
Author
Verma S.; Garg A.; Yan A.T.; Gupta A.K.; Al-Omran M.; Sabongui A.; Teoh
H.; Mazer C.D.; Connelly K.A.
Institution
(Verma, Teoh) Division of Cardiac Surgery, Li Ka Shing Knowledge Institute
of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Garg) Department of Medicine, University of Toronto, Toronto, ON, Canada
(Yan, Connelly) Division of Cardiology, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Gupta, Sabongui) Heart Wellness Cardiac and Diagnostic Clinic, Toronto,
ON, Canada
(Al-Omran) Division of Vascular Surgery, Li Ka Shing Knowledge Institute
of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, Li Ka Shing Knowledge
Institute of St. Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, University of Toronto, Toronto, ON, Canada
Title
Effect of empagliflozin on left ventricular mass and diastolic function in
individuals with diabetes: An important clue to the EMPA-REG OUTCOME
trial?.
Source
Diabetes Care. 39 (12) (pp e212-e213), 2016. Date of Publication: 2016.
Publisher
American Diabetes Association Inc. (E-mail: membership@diabetes.org)

<27>
Accession Number
613441012
Author
Franzone A.; Piccolo R.; Siontis G.C.M.; Lanz J.; Stortecky S.; Praz F.;
Roost E.; Vollenbroich R.; Windecker S.; Pilgrim T.
Institution
(Franzone, Piccolo, Siontis, Lanz, Stortecky, Praz, Vollenbroich,
Windecker, Pilgrim) Department of Cardiology, Swiss Cardiovascular Center,
University Hospital, Bern, Switzerland
(Roost) Department of Cardiovascular Surgery, University Hospital, Bern,
Switzerland
Title
Transcatheter Aortic Valve Replacement for the Treatment of Pure Native
Aortic Valve Regurgitation: A Systematic Review.
Source
JACC: Cardiovascular Interventions. 9 (22) (pp 2308-2317), 2016. Date of
Publication: 28 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to summarize available evidence on
transcatheter aortic valve replacement (TAVR) for the treatment of native
pure aortic regurgitation (AR). Background Surgical aortic valve
replacement (SAVR) is the gold standard for the treatment of AR. However,
case series of high-risk patients undergoing TAVR for native pure AR were
reported. Methods We systematically searched Medline, Embase, and Scopus
for reports of at least 5 patients with native pure AR undergoing TAVR.
Patients' and procedural characteristics were summarized. The primary
outcome of interest was all-cause mortality. Pooled estimates were
calculated using a random-effects meta-analysis. The study protocol was
registered in PROSPERO (CRD42016038422). Results Thirteen reports
including 237 patients were included in the analysis. Self-expandable
prostheses were used in 79% of patients, whereas 21% of the patients were
treated with a balloon-expandable valve. Device success ranged between 74%
and 100%. Seventeen patients (7%) required the implantation of a second
valve. Conversion to SAVR was reported in 6 (2.5%) cases. The rate of
all-cause mortality at 30 days amounted to 7% (95% confidence interval
[CI]: 3% to 13%; I² = 37%). Cerebrovascular events were rare
(0%, 95% CI: 0% to 1%; I² = 0); major bleeding and vascular
complications occurred in 2% (95% CI: 0% to 7%; I² = 41%), and
3% (95% CI: 1% to 7%; I² = 0%), respectively. Permanent
pacemaker implantation was required in 11% of patients (95% CI: 5% to 19%;
I² = 50%). The rate of moderate or severe post-procedural AR
amounted to 9% (95% CI: 0% to 28%; I² = 90%). Conclusions Among
selected patients with native pure AR deemed at high risk for SAVR, TAVR
is technically feasible and associated with an acceptable risk of early
mortality. Copyright &#xa9; 2016 American College of Cardiology Foundation

<28>
Accession Number
613441002
Author
Bonello L.; Laine M.; Puymirat E.; Lemesle G.; Thuny F.; Paganelli F.;
Michelet P.; Roch A.; Kerbaul F.; Boyer L.
Institution
(Bonello, Laine, Thuny, Paganelli) Service de Cardiologie, Centre
Hospitalier Universitaire de Marseille, Hopital Nord, Aix-Marseille
Universite, Marseille, France
(Bonello) Aix-Marseille Universite, INSERM UMR-S 1076, Vascular Research
Center of Marseille, Marseille, France
(Bonello, Laine, Thuny, Michelet, Roch, Kerbaul) MARS Cardio,
Mediterranean Association for Research and Studies in Cardiology, Hopital
Nord, Marseille, France
(Puymirat) Departement de Cardiologie, Hopital Europeen Georges Pompidou,
Assistance Publique des Hopitaux de Paris, Paris, France
(Puymirat) Universite Paris Descartes, INSERM U-970, Paris, France
(Lemesle) Service d'Accueil des Urgences, Hopital Timone, Marseille,
France
(Michelet) Departement de Cardiologie, CHU de Lille, Lille, France
(Roch) Service d'Accueil des Urgence, Hopital Nord, Marseille, France
(Kerbaul) Pole RUSH, Assistance-Publique Hopitaux de Marseille, Marseille,
France
(Boyer) EA 3279-Public Health, Chronic Diseases and Quality of
Life-Research Unit, Aix-Marseille University, Marseille, France
Title
Timing of Coronary Invasive Strategy in Non-ST-Segment Elevation Acute
Coronary Syndromes and Clinical Outcomes: An Updated Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 9 (22) (pp 2267-2276), 2016. Date of
Publication: 28 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to compare an early versus a delayed
invasive strategy in non-ST-segment elevation acute coronary syndromes by
performing a meta-analysis of all available randomized controlled clinical
trials. Background An invasive approach is recommended to prevent death
and myocardial infarction in non-ST-segment elevation acute coronary
syndromes. However, the timing of angiography and the subsequent
intervention, when required, remains controversial. Methods A previous
meta-analysis of 7 randomized clinical trials comparing early and delayed
invasive strategies in non-ST-segment elevation acute coronary syndromes
with 3 new randomized clinical trials identified in a search of the
published research (n = 10 trials, n = 6,397 patients) was updated.
Results The median time between randomization and angiography ranged from
0.5 to 14.0 h in the early group and from 18.3 to 86.0 h in the delayed
group. There was no difference in the primary endpoint of mortality (4%
vs. 4.7%; random-effects odds ratio [OR]: 0.85; 95% confidence interval
[CI]: 0.67 to 1.09; p = 0.20; I² = 0%). The rate of myocardial
infarction was also similar (6.7% vs. 7.7%; random-effects OR: 0.88; 95%
CI: 0.53 to 1.45; p = 0.62; I² = 77.5%). An early strategy was
associated with a reduction in recurrent ischemia or refractory angina
(3.8% vs. 5.8%; random-effects OR: 0.54; 95% CI: 0.40 to 0.74; p < 0.01;
I² = 28%) and a shorter in-hospital stay (median 112 h
[interquartile range: 61 to 158 h] vs. 168 h [interquartile range: 90.3 to
192 h]; random-effects standardized mean difference -0.40; 95% CI: -0.59
to -0.21; p < 0.01; I² = 79%). Major bleeding was similar in
the 2 groups (3.9% vs. 4.2%; random-effects OR: 0.94; 95% CI: 0.73 to
1.22; p = 0.64; I² = 0%). Conclusions An early invasive
strategy does not reduce the risk for death or myocardial infarction
compared with a delayed strategy. Recurrent ischemia and length of stay
were significantly reduced with an early invasive strategy. Copyright
&#xa9; 2016 American College of Cardiology Foundation

<29>
Accession Number
613440971
Author
Capodanno D.; Gargiulo G.; Buccheri S.; Chieffo A.; Meliga E.; Latib A.;
Park S.-J.; Onuma Y.; Capranzano P.; Valgimigli M.; Narbute I.; Makkar
R.R.; Palacios I.F.; Kim Y.-H.; Buszman P.E.; Chakravarty T.; Sheiban I.;
Mehran R.; Naber C.; Margey R.; Agnihotri A.; Marra S.; Leon M.B.; Moses
J.W.; Fajadet J.; Lefevre T.; Morice M.-C.; Erglis A.; Alfieri O.; Serruys
P.W.; Colombo A.; Tamburino C.
Institution
(Capodanno, Gargiulo, Buccheri, Capranzano, Tamburino)
Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(Chieffo, Latib, Alfieri, Colombo) Department of Cardio-Thoracic and
Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy
(Meliga) Interventional Cardiology Unit, A. O. Ordine Mauriziano Umberto
I, Turin, Italy
(Park, Kim) Department of Cardiology, Center for Medical Research and
Information, University of Ulsan College of Medicine, Asan Medical Center,
Seoul, South Korea
(Onuma, Serruys) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Valgimigli) Bern University Hospital, Bern, Switzerland
(Narbute, Erglis) Latvian Centre of Cardiology, Pauls Stradins Clinical
University Hospital, Institute of Cardiology, University of Latvia, Riga,
Latvia
(Makkar, Chakravarty, Margey) Cedars-Sinai Heart Institute, Cedars-Sinai
Medical Center, Los Angeles, California, United States
(Palacios, Agnihotri) Cardiac Catheterization Laboratory, Massachusetts
General Hospital and Harvard Medical School, Boston, Massachusetts, United
States
(Buszman) Center for Cardiovascular Research and Development of American
Heart of Poland, Katowice, Poland
(Sheiban, Marra) Interventional Cardiology, Division of Cardiology,
University of Turin, S. Giovanni Battista Molinette Hospital, Turin, Italy
(Mehran) Mount-Sinai Medical Center, New York, New York, United States
(Naber) Klinik fur Kardiologie und Angiologie, Elisabeth-Krankenhaus,
Essen, Germany
(Leon, Moses) Columbia University Medical Center and Cardiovascular
Research Foundation, New York, New York, United States
(Fajadet) Clinique Pasteur, Toulouse, France
(Lefevre, Morice) Hopital prive Jacques Cartier, Ramsay Generale de Sante,
Massy, France
Title
Computing Methods for Composite Clinical Endpoints in Unprotected Left
Main Coronary Artery Revascularization: A Post Hoc Analysis of the DELTA
Registry.
Source
JACC: Cardiovascular Interventions. 9 (22) (pp 2280-2288), 2016. Date of
Publication: 28 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to investigate the impact of different
computing methods for composite endpoints other than time-to-event (TTE)
statistics in a large, multicenter registry of unprotected left main
coronary artery (ULMCA) disease. Background TTE statistics for composite
outcome measures used in ULMCA studies consider only the first event, and
all the contributory outcomes are handled as if of equal importance.
Methods The TTE, Andersen-Gill, win ratio (WR), competing risk, and
weighted composite endpoint (WCE) computing methods were applied to ULMCA
patients revascularized by percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG) at 14 international centers.
Results At a median follow-up of 1,295 days (interquartile range: 928 to
1,713 days), all analyses showed no difference in combinations of death,
myocardial infarction, and cerebrovascular accident between PCI and CABG.
When target vessel revascularization was incorporated in the composite
endpoint, the TTE (p = 0.03), Andersen-Gill (p = 0.04), WR (p = 0.025),
and competing risk (p < 0.001) computing methods showed CABG to be
significantly superior to PCI in the analysis of 1,204 propensity-matched
patients, whereas incorporating the clinical relevance of the component
endpoints using WCE resulted in marked attenuation of the treatment effect
of CABG, with loss of significance for the difference between
revascularization strategies (p = 0.10). Conclusions In a large study of
ULMCA revascularization, incorporating the clinical relevance of the
individual outcomes resulted in sensibly different findings as compared
with the conventional TTE approach. In particular, using the WCE computing
method, PCI and CABG were no longer significantly different with respect
to the composite of death, myocardial infarction, cerebrovascular
accident, or target vessel revascularization at a median of 3 years.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<30>
Accession Number
613716507
Author
Liebenberg J.J.; Dold C.J.; Olivier L.R.
Institution
(Liebenberg) Worcester Hospital, Worcester, South Africa
(Dold) Hanover Park Day Hospital, Cape Town, South Africa
(Olivier) Medi-Clinic Hospital, Durbanville, South Africa
Title
A prospective investigation into the effect of colchicine on tuberculous
pericarditis.
Source
Cardiovascular Journal of Africa. 27 (6) (pp 350-355), 2016. Date of
Publication: November-December 2016.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Introduction: Tuberculous (TB) pericarditis carries significant mortality
and morbidity rates, not only during the primary infection, but also as
part of the granulomatous scar-forming fibrocalcific constrictive
pericarditis so commonly associated with this disease. Numerous therapies
have previously been investigated as adjuvant strategies in the prevention
of pericardial constriction. Colchicine is well described in the treatment
of various aetiologies of pericarditis. The aim of this research was to
investigate the merit for the use of colchicine in the management of
tuberculous pericarditis, specifically to prevent constrictive
pericarditis. Methods: This pilot study was designed as a prospective,
double-blinded, randomised, control cohort study and was conducted at a
secondary level hospital in the Northern Cape of South Africa between
August 2013 and December 2015. Patients with a probable or definite
diagnosis of TB pericarditis were included (n = 33). Study participants
with pericardial effusions amenable to pericardiocentesis underwent
aspiration until dryness. All patients were treated with standard TB
treatment and corticosteroids in accordance with the South African
Tuberculosis Treatment Guidelines. Patients were randomised to an
intervention and control group using a webbased computer system that
ensured assignment concealment. The intervention group received colchicine
1.0 mg per day for six weeks and the control group received a placebo for
the same period. Patients were followed up with serial echocardiography
for 16 weeks. The primary outcome assessed was the development of
pericardial constriction. Upon completion of the research period, the
blinding was unveiled and data were presented for statistical analysis.
Results: TB pericarditis was found exclusively in HIV-positive
individuals. The incidence of pericardial constriction in our cohort was
23.8%. No demonstrable benefit with the use of colchicine was found in
terms of prevention of pericardial constriction (p = 0.88, relative risk
1.07, 95% CI: 0.46-2.46). Interestingly, pericardiocentesis appeared to
decrease the incidence of pericardial constriction. Conclusion: Based on
this research, the use of colchicine in TB pericarditis cannot be advised.
Adjuvant therapy in the prevention of pericardial constriction is still
being investigated and routine pericardiocentesis may prove to be
beneficial in this regard.

<31>
Accession Number
613716503
Author
Ozel E.; Tastan A.; Ozturk A.; Ozcan E.E.; Kilicaslan B.; Ozdogan O.
Institution
(Ozel, Kilicaslan, Ozdogan) Cardiology Department, Tepecik Training and
Research Hospital, Izmir, Turkey
(Tastan, Ozturk) Cardiology Department, Sifa University, Izmir, Turkey
(Ozcan) Cardiology Department, Dokuz Eylul University, Izmir, Turkey
Title
Procedural and one-year clinical outcomes of bioresorbable vascular
scaffolds for the treatment of chronic total occlusions: A single-centre
experience.
Source
Cardiovascular Journal of Africa. 27 (6) (pp 345-349), 2016. Date of
Publication: November-December 2016.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Introduction: The bioresorbable vascular scaffold system (BVS) is the
latest fully absorbable vascular therapy system that is used to treat
coronary artery disease. The BVS has been used in different coronary
lesion subsets, such as acute thrombotic lesions, bifurcation lesions,
ostial lesions and lesions originating from bypass grafts. However, data
about the use of BVS in chronic total occlusions (CTO) are limited. We
report our BVS experience for the treatment of CTOs in terms of procedural
features and one-year clinical follow-up results. Methods: An analysis was
made of 41 consecutive patients with CTO lesions who were referred to our
clinic between January 2013 and December 2014. A total of 52 BVS were
implanted. An analysis was made of patient characteristics, procedural
features [target vessel, BVS diameter, BVS length, post-dilatation rate,
type of post-dilatation balloon, procedure time, fluoroscopy time,
contrast volume, postprocedure reference vessel diameter (RVD),
post-procedure minimal lesion diameter (MLD), type of CTO technique and
rate of microcatheter use] and one-year clinical follow-up results [death,
myocardial infarction, angina, coronary artery bypass graft (CABG),
target-lesion revascularisation (TLR) and target-vessel revascularisation
(TVR)]. Descriptive and frequency statistics were used for statistical
analysis. Results: The mean age of the patient group was 61.9 +/- 9.7
years, 85.4% were male, and 51.2 % had diabetes. Prior myocardial
infarction incidence was 65.9%, 56.1% of the patients had percutaneous
coronary intervention and 17.1% had a previous history of CABG. The
procedure was performed via the radial route in 24.3% of the patients. The
target vessel was the right coronary artery in 48.7% of the patients.
Post-dilatation was performed on the implanted BVS in 97.5% of the
patients, mainly by non-compliant balloon; 87.8% of the BVS were implanted
by the antegrade CTO technique. Mean procedure time was 92 +/- 35.6
minutes. Mean contrast volume was 146.6 +/- 26.7 ml. At one year, there
were no deaths. One patient had lesionrelated myocardial infarction and
needed revascularisation because of early cessation of dual anti-platelet
therapy. Eleven patients had angina and five of them needed target-vessel
revascularisation. Conclusions: BVS implantation appeared to be effective
and safe in CTO lesions but randomised studies with a larger number of
patients and with longer follow-up times are needed.

<32>
Accession Number
613971249
Author
Agus M.S.; Hirshberg E.; Srinivasan V.; Faustino E.V.; Luckett P.M.;
Curley M.A.; Alexander J.; Asaro L.A.; Coughlin-Wells K.; Duva D.; French
J.; Hasbani N.; Sisko M.T.; Soto-Rivera C.L.; Steil G.; Wypij D.; Nadkarni
V.M.
Institution
(Agus, Alexander, Coughlin-Wells, French, Soto-Rivera, Steil) Boston
Children's Hospital Division of Medicine Critical Care, Harvard Medical
School, 300 Longwood Ave., Boston, MA 02115, United States
(Hirshberg) Intermountain Medical Center Division of Pulmonary and
Critical Care, University of Utah, 100 Mario Capecchi Dr., Salt Lake City,
UT 84132, United States
(Srinivasan, Sisko, Nadkarni) The Children's Hospital of Philadelphia,
University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA
19104, United States
(Faustino) Yale-New Haven Children's Hospital, Yale University, 1 Park
St., New Haven, CT 06510, United States
(Luckett) Children's Medical Center Dallas, University of Texas
Southwestern, 1935 Medical District Dr., Dallas, TX 75235, United States
(Curley) University of Pennsylvania School of Nursing, University of
Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, United States
(Asaro, Duva, Hasbani, Wypij) Boston Children's Hospital Department of
Cardiology, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115,
United States
Title
Design and rationale of Heart and Lung Failure - Pediatric INsulin
Titration Trial (HALF-PINT): A randomized clinical trial of tight glycemic
control in hyperglycemic critically ill children.
Source
Contemporary Clinical Trials. 53 (pp 178-187), 2017. Date of Publication:
01 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives Test whether hyperglycemic critically ill children with
cardiovascular and/or respiratory failure experience more ICU-free days
when assigned to tight glycemic control with a normoglycemic versus
hyperglycemic blood glucose target range. Design Multi-center randomized
clinical trial. Setting Pediatric ICUs at 35 academic hospitals. Patients
Children aged 2 weeks to 17 years receiving inotropic support and/or acute
mechanical ventilation, excluding cardiac surgical patients. Interventions
Patients receive intravenous insulin titrated to either 80-110 mg/dL
(4.4-6.1 mmol/L) or 150-180 mg/dL (8.3-10.0 mmol/L). The intervention
begins upon confirmed hyperglycemia and ends when the patient meets
study-defined ICU discharge criteria or after 28 days. Continuous glucose
monitoring, a minimum glucose infusion, and an explicit insulin infusion
algorithm are deployed to achieve the BG targets while minimizing
hypoglycemia risk. Measurements and main results The primary outcome is
ICU-free days (equivalent to 28-day hospital mortality-adjusted ICU length
of stay). Secondary outcomes include 90-day hospital mortality, organ
dysfunction scores, ventilator-free days, nosocomial infection rate,
neurodevelopmental outcomes, and nursing workload. To detect an increase
of 1.25 ICU-free days (corresponding to a 20% relative reduction in 28-day
hospital mortality and a one-day reduction in ICU length of stay), 1414
patients are needed for 80% power using a two-sided 0.05 level test.
Conclusions This trial tests whether hyperglycemic critically ill children
randomized to 80-110 mg/dL benefit more than those randomized to 150-180
mg/dL. This study implements validated bedside support tools including
continuous glucose monitoring and a computerized algorithm to enhance
patient safety and ensure reproducible bedside decision-making in
achieving glycemic control. Copyright &#xa9; 2017 The Authors

<33>
Accession Number
613430248
Author
Dora K.A.; Stanley C.P.; Jaaly E.A.; Fiorentino F.; Ascione R.; Reeves
B.C.; Angelini G.D.
Institution
(Dora, Stanley) Department of Pharmacology, University of Oxford, United
Kingdom
(Jaaly, Fiorentino, Angelini) Department of Cardiothoracic Surgery,
Hammersmith Hospital, Imperial College London, London, United Kingdom
(Ascione, Reeves, Angelini) Bristol Heart Institute, Bristol Royal
Infirmary, University of Bristol, United Kingdom
(Stanley) The Victor Chang Cardiac Research Institute, Sydney, Australia
Title
Isolated human pulmonary artery structure and function pre -and
post-cardiopulmonary bypass surgery.
Source
Journal of the American Heart Association. 5 (2) (no pagination), 2016.
Article Number: e002822. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Pulmonary dysfunction is a known complication after cardiac
surgery using cardiopulmonary bypass, ranging from subclinical functional
changes to prolonged postoperative ventilation, acute lung injury, and
acute respiratory distress syndrome. Whether human pulmonary arterial
function is compromised is unknown. The aim of the present study was to
compare the structure and function of isolated and cannulated human
pulmonary arteries obtained from lung biopsies after the chest was opened
(pre-cardiopulmonary bypass) to those obtained at the end of
cardiopulmonary bypass (post-cardiopulmonary bypass) from patients
undergoing coronary artery bypass graft surgery. Methods and
Results-Pre-and post-cardiopulmonary bypass lung biopsies were received
from 12 patients undergoing elective surgery. Intralobular small arteries
were dissected, cannulated, pressurized, and imaged using confocal
microscopy. Functionally, the thromboxane mimetic U46619 produced
concentration-dependent vasoconstriction in 100% and 75% of pre-and
post-cardiopulmonary bypass arteries, respectively. The
endothelium-dependent agonist bradykinin stimulated vasodilation in 45%
and 33% of arteries pre-and post-cardiopulmonary bypass, respectively.
Structurally, in most arteries smooth muscle cells aligned
circumferentially; live cell viability revealed that although 100% of
smooth muscle and 90% of endothelial cells from pre -cardiopulmonary
bypass biopsies had intact membranes and were considered viable, only 60%
and 58%, respectively, were viable from post-cardiopulmonary bypass
biopsies. Conclusions-We successfully investigated isolated pulmonary
artery structure and function in fresh lung biopsies from patients
undergoing heart surgery. Pulmonary artery contractile tone and
endothelium-dependent dilation were significantly reduced in
post-cardiopulmonary bypass biopsies. The decreased functional responses
were associated with reduced cell viability. Clinical Trial
Registration--URL: http://www.isrctn.com/ISRCTN34428459. Copyright &#xa9;
2016 The Authors.

<34>
Accession Number
610525755
Author
Chen J.; Yang Z.-G.; Xu H.-Y.; Shi K.; Long Q.-H.; Guo Y.-K.
Institution
(Chen, Yang, Xu, Shi, Long) Department of Radiology, West China Hospital,
Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
(Guo) Department of Radiology, West China Second University Hospital,
Sichuan University, Chengdu, China
Title
Assessments of pulmonary vein and left atrial anatomical variants in
atrial fibrillation patients for catheter ablation with cardiac CT.
Source
European Radiology. 27 (2) (pp 660-670), 2017. Date of Publication: 01 Feb
2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objectives: To provide a road map of pulmonary vein (PV) and left atrial
(LA) variants in patients with atrial fibrillation (AF) before catheter
ablation procedure using cardiac CT. Methods: Cardiac CT was performed in
1420 subjects for accurate anatomical information, including 710 patients
with AF and 710 matched controls without AF. PV variants, PV ostia and
spatial orientation, LA enlargement, and left atrial diverticulum (LAD)
were measured, respectively. Differences between these two groups were
also respectively compared. Some risk factors for the occurrence of LAD
were analyzed. Results: In total, PV variants were observed in 202 (28.5
%) patients with AF patients and 206 (29.0 %) controls without AF (p =
0.8153). The ostial sizes of all accessory veins were generally smaller
than those of the typical four PVs (p = 0.0153 to 0.3958). There was a
significant difference of LA enlargement between the AF and control groups
(36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar
in these two groups (43.2 % vs. 41.9 %, p = 0.6293). Conclusion: PV
variants are common. Detailed knowledge of PVs and LA variants are helpful
for providing anatomical road map to determine ablation strategy. Key
points: * PVs variants are helpful for providing anatomical road map to
ablation. * PV variants are common. * DSCT could recognize these anatomic
features before ablation as a non-invasive imaging. Copyright &#xa9; 2016,
European Society of Radiology.

<35>
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.

<36>
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, p0.001), 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.

<37>
Accession Number
613672296
Author
Vallabhajosyula S.; Kanmanthareddy A.; Erwin P.J.; Esterbrooks D.J.;
Morrow L.E.
Institution
(Vallabhajosyula) Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
(Vallabhajosyula) Multidisciplinary Epidemiology and Translational
Research in Intensive Care (METRIC) Laboratory, Mayo Clinic, Rochester,
MN, United States
(Kanmanthareddy, Esterbrooks) Division of Cardiovascular Diseases,
Department of Internal Medicine, Creighton University School of Medicine,
Omaha, NE, United States
(Erwin) Mayo Clinic Libraries, Mayo Clinic College of Medicine, Mayo
Clinic, Rochester, MN, United States
(Erwin) Evidence-Based Practice Research Program, Mayo Clinic, Rochester,
MN, United States
(Morrow) Division of Pulmonary, Critical Care and Sleep Medicine,
Department of Internal Medicine, Creighton University School of Medicine,
Omaha, NE, United States
(Morrow) Division of Pulmonary, Critical Care and Sleep Medicine,
Department of Internal Medicine, Veterans Affairs Nebraska-Western Iowa
Health Care System, Omaha, NE, United States
Title
Role of statins in delirium prevention in critical ill and cardiac surgery
patients: A systematic review and meta-analysis.
Source
Journal of Critical Care. 37 (pp 189-196), 2017. Date of Publication: 01
Feb 2017.
Publisher
W.B. Saunders
Abstract
Background The data evaluating the role of statins in delirium prevention
in the intensive care unit are conflicting and limited. Methods We
performed a systematic review and meta-analysis of literature from 1975 to
2015. All English-language adult studies evaluating delirium incidence in
statin and statin nonusers were included and studies without a control
group were excluded. Mantel-Haenszel model was used to calculate pooled
risk ratios (RRs) and 95% confidence intervals (CIs). Statistical
significance was defined as CI not including unity and P value less
than.05. Results Of a total 57 identified studies, 6 were included. The
studies showed high heterogeneity (I² = 73%) for all and
moderate for cardiac surgery studies (I² = 55%). Of 289 773
patients, statins were used in 22 292 (7.7%). Cardiac surgery was
performed in 4382 (1.5%) patients and 2321 (53.0%) used statins. Delirium
was noted in 710 (3.2%) and 3478 (1.3%) of the patients in the statin and
nonstatin groups, respectively, with no difference between groups in the
total cohort (RR, 1.05 [95% CI, 0.85-1.29]; P =.56) or in cardiac surgery
patients (RR, 1.03 [95% CI, 0.68-1.56]; P =.89). Conclusions In critically
ill and cardiac surgery patients, this meta-analysis did not show a
benefit with statin therapy in the prevention of delirium. Copyright
&#xa9; 2016 Elsevier Inc.

<38>
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

<39>
Accession Number
613668721
Author
Lamy A.; Devereaux P.J.; Prabhakaran D.; Taggart D.P.; Hu S.; Straka Z.;
Piegas L.S.; Avezum A.; Akar A.R.; Zanetti F.L.; Jain A.R.; Noiseux N.;
Padmanabhan C.; Bahamondes J.C.; Novick R.J.; Tao L.; Olavegogeascoechea
P.A.; Airan B.; Sulling T.A.; Whitlock R.P.; Ou Y.; Gao P.; Pettit S.;
Yusuf S.
Institution
(Lamy, Devereaux, Pettit, Yusuf) Population Health Research Institute,
Hamilton Health Sciences, McMaster University, Hamilton, ON, New Zealand
(Noiseux) Centre Hospitalier de l'Universite de Montral, Montreal, Canada
(Novick) University of Calgary, Calgary, AB, Canada
(Prabhakaran, Airan) Center for Chronic Disease Control, Gurgaon, India
(Taggart, Jain) SAL Hospital, Ahmedabad, India
(Hu, Padmanabhan) G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
(Tao, Airan) All India Institute of Medical Sciences, New Delhi, India
(Taggart, Straka) University of Oxford, Oxford, United Kingdom
(Hu, Piegas, Avezum) Fu Wai Cardiovascular Hospital, Xicheng
District,Beijing, China
(Akar) Wuhan Asia Heart Hospital, Wuhan, China
(Zanetti, Bahamondes) Third Faculty of Medicine Charles University,
University Hospital Kralovske Vinohrady, Prague, Czech Republic
(Olavegogeascoechea) Instituto Dante Pazzanese de Cardiologia, Sao Paulo,
Brazil
(Sulling) Ankara University School of Medicine, Ankara, Turkey
(Whitlock) Hospital Regional de Temuco and Universidad de la Frontera,
Temuco, Chile
(Ou) Fundacion Medica de Rio Negro y Neuquen, Rio Negro, Argentina
(Gao) North Estonia Medical Center, Tallinn, Estonia
Title
Five-year outcomes after off-pump or on-pump coronary-artery bypass
grafting.
Source
New England Journal of Medicine. 375 (24) (pp 2359-2368), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND We previously reported that there was no significant difference
at 30 days or at 1 year in the rate of the composite outcome of death,
stroke, myocardial infarction, or renal failure between patients who
underwent coronary-artery bypass grafting (CABG) performed with a
beating-heart technique (off-pump) and those who underwent CABG performed
with cardiopulmonary bypass (on-pump). We now report the results at 5
years (the end of the trial). METHODS A total of 4752 patients (from 19
countries) who had coronary artery disease were randomly assigned to
undergo off-pump or on-pump CABG. For this report, we analyzed a composite
outcome of death, stroke, myocardial infarction, renal failure, or repeat
coronary revascularization (either CABG or percutaneous coronary
intervention). The mean follow-up period was 4.8 years. RESULTS There were
no significant differences between the off-pump group and the onpump group
in the rate of the composite outcome (23.1% and 23.6%, respectively;
hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87
to 1.10; P = 0.72) or in the rates of the components of the outcome,
including repeat coronary revascularization, which was performed in 2.8%
of the patients in the offpump group and in 2.3% of the patients in the
on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P = 0.29). The
secondary outcome for the overall period of the trial - The mean cost in
U.S. dollars per patient - Also did not differ significantly between the
off-pump group and the on-pump group ($15,107 and $14,992, respectively;
between-group difference, $115; 95% CI, -$697 to $927). There were no
significant between-group differences in quality-of-life measures.
CONCLUSIONS In our trial, the rate of the composite outcome of death,
stroke, myocardial infarction, renal failure, or repeat revascularization
at 5 years of follow-up was similar among patients who underwent off-pump
CABG and those who underwent onpump CABG. (Funded by the Canadian
Institutes of Health Research; CORONARY ClinicalTrials.gov number,
NCT00463294.). Copyright &#xa9; 2016 Massachusetts Medical Society. All
rights reserved.

<40>
Accession Number
613544518
Author
Stone G.W.; Sabik J.F.; Serruys P.W.; Simonton C.A.; Genereux P.; Puskas
J.; Kandzari D.E.; Morice M.-C.; Lembo N.; Brown W.M.; Taggart D.P.;
Banning A.; Merkely B.; Horkay F.; Boonstra P.W.; Van Boven A.J.; Ungi I.;
Bogats G.; Mansour S.; Noiseux N.; Sabate M.; Pomar J.; Hickey M.;
Gershlick A.; Buszman P.; Bochenek A.; Schampaert E.; Page P.; Dressler
O.; Kosmidou I.; Mehran R.; Pocock S.J.; Kappetein A.P.
Institution
(Stone) New York Presbyterian Hospital, Columbia University Medical
Center, New York, United States
(Stone, Genereux, Dressler, Kosmidou, Mehran) Cardiovascular Research
Foundation, New York, United States
(Puskas, Mehran) Mount Sinai Medical Center, New York, United States
(Sabik) Cleveland Clinic Foundation, Cleveland, United States
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Taggart, Banning) Oxford University Hospitals, Oxford, United Kingdom
(Hickey, Gershlick) University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Genereux, Schampaert, Page) Hopital du Sacre-Coeur de Montreal, Montreal,
Canada
(Mansour, Noiseux) Centre Hospitalier de L'Universite de Montreal, Hopital
Hotel-Dieu de Montreal, Montreal, Canada
(Kandzari, Lembo, Brown) Piedmont Hospital, Atlanta, United States
(Morice) Ramsay Generale de Sante, Hopital Prive Jacques Cartier, Massy,
France
(Merkely, Horkay) Semmelweis University, Budapest, Hungary
(Ungi, Bogats) University of Szeged, Szeged, Hungary
(Boonstra, Van Boven) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Sabate, Pomar) Hospital Clinic, Barcelona, Spain
(Buszman, Bochenek) Medical University of Silesia, Katowice, Poland
(Buszman, Bochenek) American Heart of Poland, Ustron, Poland
Title
Everolimus-eluting Stents or bypass surgery for left main coronary artery
disease.
Source
New England Journal of Medicine. 375 (23) (pp 2223-2235), 2016. Date of
Publication: 08 Dec 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Patients with obstructive left main coronary artery disease are
usually treated with coronary-artery bypass grafting (CABG). Randomized
trials have suggested that drug-eluting stents may be an acceptable
alternative to CABG in selected patients with left main coronary disease.
METHODS We randomly assigned 1905 eligible patients with left main
coronary artery disease of low or intermediate anatomical complexity to
undergo either percutaneous coronary intervention (PCI) with
fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group,
948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was
assessed at the sites and defined by a Synergy between Percutaneous
Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32
or lower (the SYNTAX score reflects a comprehensive angiographic
assessment of the coronary vasculature, with 0 as the lowest score and
higher scores [no upper limit] indicating more complex coronary anatomy).
The primary end point was the rate of a composite of death from any cause,
stroke, or myocardial infarction at 3 years, and the trial was powered for
noninferiority testing of the primary end point (noninferiority margin,
4.2 percentage points). Major secondary end points included the rate of a
composite of death from any cause, stroke, or myocardial infarction at 30
days and the rate of a composite of death, stroke, myocardial infarction,
or ischemia-driven revascularization at 3 years. Event rates were based on
Kaplan-Meier estimates in time-to-first-event analyses. RESULTS At 3
years, a primary end-point event had occurred in 15.4% of the patients in
the PCI group and in 14.7% of the patients in the CABG group (difference,
0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage
points; P = 0.02 for noninferiority; hazard ratio, 1.00; 95% confidence
interval, 0.79 to 1.26; P = 0.98 for superiority). The secondary end-point
event of death, stroke, or myocardial infarction at 30 days occurred in
4.9% of the patients in the PCI group and in 7.9% in the CABG group
(P<0.001 for noninferiority, P = 0.008 for superiority). The secondary
end-point event of death, stroke, myocardial infarction, or
ischemia-driven revascularization at 3 years occurred in 23.1% of the
patients in the PCI group and in 19.1% in the CABG group (P = 0.01 for
noninferiority, P = 0.10 for superiority). CONCLUSIONS In patients with
left main coronary artery disease and low or intermediate SYNTAX scores by
site assessment, PCI with everolimus-eluting stents was noninferior to
CABG with respect to the rate of the composite end point of death, stroke,
or myocardial infarction at 3 years. Copyright &#xa9; 2016 Massachusetts
Medical Society.

<41>
Accession Number
613746668
Author
Carson J.L.; Guyatt G.; Heddle N.M.; Grossman B.J.; Cohn C.S.; Fung M.K.;
Gernsheimer T.; Holcomb J.B.; Kaplan L.J.; Katz L.M.; Peterson N.; Ramsey
G.; Rao S.V.; Roback J.D.; Shander A.; Tobian A.A.R.
Institution
(Carson) Division of General Internal Medicine, Rutgers Robert Wood
Johnson Medical School, Rutgers University, 125 Paterson St, New
Brunswick, NJ 08901, United States
(Guyatt) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
(Heddle) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Grossman) Department of Pathology and Immunology, Washington University,
School of Medicine, St Louis, MO, United States
(Cohn) Department of Laboratory Medicine and Pathology, University of
Minnesota Medical School, Minneapolis, United States
(Fung) Department of Pathology and Laboratory Medicine, University of
Vermont Medical Center, Burlington, United States
(Gernsheimer) Division of Hematology, University of Washington, Seattle,
United States
(Holcomb) Department of Surgery, University of Texas Medical School,
Galveston, United States
(Kaplan) Department of Surgery, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, United States
(Katz) America's Blood Centers, Washington, DC, United States
(Katz) Department of Medicine, Division of Infectious Diseases, Carver
College of Medicine, University of Iowa, Iowa City, United States
(Peterson) Glenn DaleMDUnited States
(Ramsey) Department of Pathology, Feinberg School of Medicine,
Northwestern University, Evanston, IL, United States
(Rao) Division of Cardiology, Duke University Medical Center, Durham, NC,
United States
(Roback) Department of Pathology and Laboratory Medicine, Emory
University, School of Medicine, Atlanta, GA, United States
(Shander) Departments of Anesthesiology, Critical Care Medicine, Pain
Management, and Hyperbaric Medicine, Englewood Hospital and Medical
Center, Englewood, NJ, United States
(Tobian) Department of Pathology, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
Title
Clinical practice guidelines from the AABB: Red blood cell transfusion
thresholds and storage.
Source
JAMA - Journal of the American Medical Association. 316 (19) (pp
2025-2035), 2016. Date of Publication: 15 Nov 2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE More than 100 million units of blood are collected worldwide
each year, yet the indication for red blood cell (RBC) transfusion and the
optimal length of RBC storage prior to transfusion are uncertain.
OBJECTIVE To provide recommendations for the target hemoglobin level for
RBC transfusion among hospitalized adult patients who are hemodynamically
stable and the length of time RBCs should be stored prior to transfusion.
EVIDENCE REVIEW Reference librarians conducted a literature search for
randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC
transfusion (1950-May 2016) and RBC storage duration (1948-May 2016)
without language restrictions. The results were summarized using the
Grading of Recommendations Assessment, Development and Evaluation method.
For RBC transfusion thresholds, 31 RCTs included 12 587 participants and
compared restrictive thresholds (transfusion not indicated until the
hemoglobin level is 7-8 g/dL) with liberal thresholds (transfusion not
indicated until the hemoglobin level is 9-10 g/dL). The summary estimates
across trials demonstrated that restrictive RBC transfusion thresholds
were not associated with higher rates of adverse clinical outcomes,
including 30-day mortality,myocardial infarction, cerebrovascular
accident, rebleeding, pneumonia, or thromboembolism. For RBC storage
duration, 13 RCTs included 5515 participants randomly allocated to receive
fresher blood or standard-issue blood. These RCTs demonstrated that
fresher blood did not improve clinical outcomes. FINDINGS It is good
practice to consider the hemoglobin level, the overall clinical context,
patient preferences, and alternative therapies when making transfusion
decisions regarding an individual patient. Recommendation 1: a restrictive
RBC transfusion threshold in which the transfusion is not indicated until
the hemoglobin level is 7 g/dL is recommended for hospitalized adult
patients who are hemodynamically stable, including critically ill
patients, rather than when the hemoglobin level is 10 g/dL (strong
recommendation, moderate quality evidence). A restrictive RBC transfusion
threshold of 8 g/dL is recommended for patients undergoing orthopedic
surgery, cardiac surgery, and those with preexisting cardiovascular
disease (strong recommendation, moderate quality evidence). The
restrictive transfusion threshold of 7 g/dL is likely comparable with 8
g/dL, but RCT evidence is not available for all patient categories. These
recommendations do not apply to patients with acute coronary syndrome,
severe thrombocytopenia (patients treated for hematological or oncological
reasons who are at risk of bleeding), and chronic transfusion-dependent
anemia (not recommended due to insufficient evidence). Recommendation 2:
patients, including neonates, should receive RBC units selected at any
point within their licensed dating period (standard issue) rather than
limiting patients to transfusion of only fresh (storage length: <10 days)
RBC units (strong recommendation, moderate quality evidence). CONCLUSIONS
AND RELEVANCE Research in RBC transfusion medicine has significantly
advanced the science in recent years and provides high-quality evidence to
inform guidelines. A restrictive transfusion threshold is safe in most
clinical settings and the current blood banking practices of using
standard-issue blood should be continued. Copyright 2016 American Medical
Association. All rights reserved.

<42>
[Use Link to view the full text]
Accession Number
606901254
Author
Bode L.G.M.; Rijen M.M.L.V.; Wertheim H.F.L.; Vandenbroucke-Grauls
C.M.J.E.; Troelstra A.; Voss A.; Verbrugh H.A.; Vos M.C.; Kluytmans
J.A.J.W.
Institution
(Bode, Wertheim, Verbrugh, Vos) Erasmus University, Department of Medical
Microbiology and Infectious Diseases, Rotterdam, Netherlands
(Rijen, Kluytmans) Amphia Hospital, Laboratory for Microbiology and
Infection Control, Breda, Netherlands
(Vandenbroucke-Grauls, Kluytmans) VU Medical Center, Department of Medical
Microbiology and Infection Control, Amsterdam, Netherlands
(Troelstra) University Medical Center, Department of Medical Microbiology,
Utrecht, Netherlands
(Voss) Can-Canisius Wilhelmina Hospital, Department of Medical
Microbiology and Infectious Diseases, Nijmegen, Netherlands
(Bode) Department of Medical Microbiology, Heidelberglaan 100, Utrecht
3584, Netherlands
Title
Long-term mortality after rapid screening and decolonization of
staphylococcus aureus carriers : Observational follow-up study of a
randomized, placebo-controlled trial.
Source
Annals of Surgery. 263 (3) (pp 511-515), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
To identify patients who benefit most from Staphylococcus aureus screening
and decolonization treatment upon admission. Background: S. aureus
carriers are at increased risk of developing surgicalsite infections with
S. aureus. Previously, we demonstrated in a randomized, placebo-controlled
trial (RCT) that these infections can largely be prevented by detection of
carriage and decolonization treatment upon admission. In this study, we
analyzed 1-and 3-year mortality rates in both treatment arms of the RCT to
identify patient groups that should be targeted when implementing the
screen-and-treat strategy. Methods: Three years after enrolment in the
RCT, mortality dates of all surgical patients were checked. One-and 3-year
mortality rates were calculated for all patients and for various
subgroups. Results: After 3 years, 44 of 431 (10.2%) and 43 of 362 (11.9%)
patients had died in the mupirocin/chlorhexidine and placebo groups,
respectively. No significant differences in mortality rates were observed
between the treatment groups or the subgroups according to type of
surgery. In the subgroup of patients with clean procedures (382
cardiothoracic, 167 orthopedic, 61 vascular, and 56 other),
mupirocin/chlorhexidine reduced 1-year mortality: 11 of 365 (3.0%) died in
the mupirocin/chlorhexidine versus 21 of 301 (7.0%) in the placebo group
[hazard ratio=0.38 (95% CI: 0.18-0.81)]. Conclusions: Detection and
decolonization of S. aureus carriage not only prevents S. aureus
surgical-site infections but also reduces 1-year mortality in surgical
patients undergoing clean procedures. Such patients with a high risk of
developing S. aureus infections should therefore be the primary target
when implementing the screen-and-treat strategy in clinical practice.
Copyright &#xa9; 2015 Wolters Kluwer Health, Inc.

<43>
Accession Number
613099930
Author
Kashani R.; Bowles C.; Sareh S.; Toppen W.; Ou R.; Shemin R.; Benharash P.
Institution
(Kashani, Bowles, Sareh, Toppen, Ou, Shemin, Benharash) Division of
Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at
the University of California Los Angeles, Los Angeles, CA, United States
Title
Use of preoperative aspirin in combined coronary and valve operations.
Source
Surgery (United States). 160 (6) (pp 1612-1618), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The aim of this study was to determine the relationship between
preoperative aspirin use and postoperative outcomes in patients undergoing
combined coronary artery bypass grafting and valve operations. Methods All
combined coronary artery bypass grafting and valve procedures from 2008 to
2015 at our institution were identified. After exclusions, patients were
stratified according to those that received preoperative aspirin and those
who did not. Propensity score methodology was used to match the 2 groups
using baseline and operative characteristics. Logistic regression models
were then developed to assess differences in postoperative outcomes
between groups. Results Of the 563 patients identified, 534 met inclusion
criteria: preoperative aspirin = 327 (61.2%), no preoperative aspirin =
207 (38.8%). After propensity matching, 194 patient pairs were analyzed,
with no significant differences in preoperative characteristics. No
significant differences were observed between the preoperative aspirin and
no preoperative aspirin groups in rates of 30-day mortality (3.6% vs 4.1%,
P = 1.00), major adverse cardiovascular events (23.2% vs 24.2%, P = .91),
or 30-day readmission (12.4% vs 11.9%, P = 1.00), among others. Conclusion
Preoperative aspirin use in patients undergoing combined coronary artery
bypass grafting and valve operations was not associated with significant
differences in major postoperative outcomes. Large-scale, randomized
trials are needed to better establish the role of preoperative aspirin in
this population. Copyright &#xa9; 2016 Elsevier Inc.

<44>
Accession Number
613688515
Author
Zhang J.; Tian L.; Huang J.; Huang S.; Chai T.; Shen J.
Institution
(Zhang) Department of Pharmacy, Fujian Medical University Union Hospital,
Fuzhou, China
(Tian) Department of Hematology/Rheumatology, The Second Hospital of
Xiamen, Xiamen, China
(Huang, Huang, Chai, Shen) Fujian Institute of Hematology, Fujian
Provincial Key Laboratory on Hematology, Fujian Medical University Union
Hospital, Fuzhou, China
Title
Cytochrome P450 2C9 gene polymorphism and warfarin maintenance dosage in
pediatric patients: A systematic review and meta-analysis.
Source
Cardiovascular Therapeutics. 35 (1) (pp 26-32), 2017. Date of Publication:
01 Feb 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aim: To assess the effect of Cytochrome P450 2C9 (CYP2C9) gene
polymorphism on pediatric warfarin maintenance dosage requirement.
Methods: A previously developed search strategy was conducted in PubMed,
EMBASE, and the Cochrane Library. Eligible studies published prior to
January 27, 2016, were identified and compared against strict
inclusion/exclusion criteria. Required data were extracted, and
researchers were consulted for additional data if needed. Review Manager
version 5.2.3 software was used to analyze the relationship between CYP2C9
polymorphisms and warfarin maintenance doses in pediatric patients. Eight
articles with a combined total of 507 pediatric patients were included in
the meta-analysis. Results: Maintenance warfarin doses in patients with
CYP2C9 *1/*2 genotype, CYP2C9 *1/*3 genotype, and CYP2C9 variant carriers
which contain at least one variant allele (*2 or *3) were from 15% to 41%
lower than doses in patients with the wild-type allele (CYP2C9 *1/*1): All
differences were significant with P-values <.05. The Fontan procedure as a
medical indication for anticoagulation was also associated with a lower
warfarin maintenance dose; however, target INR range was not. Conclusions:
We found that CYP2C9 gene polymorphism (referring to the presence of
*1/*2, *1/*3, and variant genotypes in the population in addition to the
wild type) was significantly associated with decreased warfarin
maintenance dose requirements. Additionally, a specific indication for
warfarin, the Fontan procedure, was associated with a lower daily warfarin
dose. However, the results of our study require confirmation from more
research with larger numbers of pediatric patients. Copyright &#xa9; 2016
John Wiley & Sons Ltd

<45>
Accession Number
613688511
Author
Papageorgiou N.; Briasoulis A.; Lazaros G.; Imazio M.; Tousoulis D.
Institution
(Papageorgiou) Barts Heart Centre, St Bartholomew's Hospital, London,
United Kingdom
(Papageorgiou, Lazaros, Tousoulis) First Cardiology Department, University
of Athens Medical School, Hippokration General Hospital, Athens, Greece
(Briasoulis) Cardiovascular Institute, Wayne State University, Detroit,
MI, United States
(Imazio) Cardiology Department, Maria Vittoria Hospital, Torino, Italy
(Imazio) Department of Public Health and Pediatrics, University of Torino,
Torino, Italy
Title
Colchicine for prevention and treatment of cardiac diseases: A
meta-analysis.
Source
Cardiovascular Therapeutics. 35 (1) (pp 10-18), 2017. Date of Publication:
01 Feb 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims: Colchicine has been suggested to be beneficial in preventing
recurrent pericarditis. The goal of this study was to review all
randomized controlled trials that assess the use of colchicine for the
prevention and treatment of cardiac diseases. Methods: We performed a
meta-analysis of the effects of colchicine on pericarditis,
postpericardiotomy syndrome and postprocedural atrial fibrillation
recurrence, in-stent restenosis, gastrointestinal adverse effects, and
treatment discontinuation rates. We conducted an EMBASE and MEDLINE search
for prospective controlled trials. Results: We identified 17 prospective
controlled randomized studies with 2082 patients that received colchicine
and 1982 controls with an average follow-up duration of 12 months.
Treatment with colchicine is associated with reduced risk of pericarditis
recurrence/postpericardiotomy syndrome (OR: 0.37; 95% CI: 0.29-0.47;
P<0.001) and lower recurrence of atrial fibrillation rates after cardiac
surgery and ablation procedures. However, gastrointestinal side effects
were more common in patients treated with colchicine (OR: 2.6; 95% CI:
1.82-3.72; P<0.001) in all subgroups except for those treated for
prevention of recurrent pericarditis. The higher rates of side effects
resulted in higher incidence of treatment discontinuation in patients
treated with colchicine. Conclusion: Colchicine appears to be efficacious
and well tolerated for recurrent pericarditis/postpericardiotomy syndrome
and recurrence of postprocedural atrial fibrillation. However, its
efficacy may be limited by its gastrointestinal adverse events and
treatment discontinuation rates particularly in postoperative patients.
Copyright &#xa9; 2016 John Wiley & Sons Ltd

<46>
Accession Number
613696421
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
A review of comparative studies of MitraClip versus surgical repair for
mitral regurgitation.
Source
International Journal of Cardiology. 228 (pp 289-294), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives We summarized comparative studies of MitraClip versus surgical
repair for mitral regurgitation (MR) with a systematic literature search
and meta-analytic estimates. Methods MEDLINE, EMBASE, and the Cochrane
Central Register of Controlled Trials were searched through June 2016.
Eligible studies were randomized controlled or observational comparative
studies of MitraClip versus surgical repair enrolling patients with MR and
reporting early (30-day or in-hospital) or late (> 6-month including
early) all-cause mortality. For each study, data regarding all-cause
mortality and incidence of recurrent > 2 + MR in both groups were used to
generate odds ratios (ORs). Alternatively, ORs or hazard ratios (HRs) for
mortality and recurrent MR themselves were directly abstracted from each
study. Results Eight reports of 7 studies comparing MitraClip with
surgical repair enrolling a total of 1015 patients with MR were identified
and included. Pooled analyses demonstrated significantly higher age and
logistic European System of Cardiac Operative Risk Evaluation and
significantly lower ejection fraction in the MitraClip than surgical
repair group, no significant difference in rate of women and patients with
New York Heart Association functional class of > II, no statistically
significant difference in early- (OR, 0.54; p = 0.08) and late-mortality
(HR/OR, 1.17; p = 0.46), and significantly higher incidence of recurrent
MR in the MitraClip than surgical repair group (HR/OR, 4.80; p < 0.00001).
Conclusions In patients with MR, the MitraClip procedure achieves similar
survival to surgical MV repair despite higher risk profiles. Recurrent MR,
however, occurs more frequently (4.8-fold) after the MitraClip than
surgical repair. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<47>
Accession Number
613630502
Author
Wang S.; Li H.; He N.; Sun Y.; Guo S.; Liao W.; Liao Y.; Chen Y.; Bin J.
Institution
(Wang, Li, He, Sun, Guo, Liao, Chen, Bin) State Key Laboratory of Organ
Failure Research, Department of Cardiology, Nanfang Hospital, Southern
Medical University, Guangzhou, China
(Liao) Department of Oncology, Nanfang Hospital, Southern Medical
University, Guangzhou, China
Title
Impact of remote ischaemic preconditioning on major clinical outcomes in
patients undergoing cardiovascular surgery: A meta-analysis with trial
sequential analysis of 32 randomised controlled trials.
Source
International Journal of Cardiology. 227 (pp 882-891), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The impact of remote ischaemic preconditioning (RIPC) on major
clinical outcomes in patients undergoing cardiovascular surgery remains
controversial. We systematically reviewed the available evidence to
evaluate the potential benefits of RIPC in such patients. Methods PubMed,
Embase, and Cochrane Library databases were searched for relevant
randomised controlled trials (RCTs) conducted between January 2006 and
March 2016. The pooled population of patients who underwent cardiovascular
surgery was divided into the RIPC and control groups. Trial sequential
analysis was applied to judge data reliability. The pooled relative risks
(RRs) with 95% confidence intervals (CIs) between the groups were
calculated for all-cause mortality, major adverse cardiovascular and
cerebral events (MACCEs), myocardial infarction (MI), and renal failure.
Results RIPC was not associated with improvement in all-cause mortality
(RR, 1.04; 95%CI, 0.82-1.31; I² = 26%; P > 0.05) or MACCE
incidence (RR, 0.90; 95%CI, 0.71-1.14; I² = 40%; P > 0.05)
after cardiovascular surgery, and both results were assessed by trial
sequential analysis as sufficient and conclusive. Nevertheless, RIPC was
associated with a significantly lower incidence of MI (RR, 0.87; 95%CI,
0.76-1.00; I² = 13%; P < 0.05). However, after excluding a
study that had a high contribution to heterogeneity, RIPC was associated
with increased rates of renal failure (RR, 1.53; 95%CI, 1.12-2.10;
I² = 5%; P < 0.05). Conclusions In patients undergoing
cardiovascular surgery, RIPC reduced the risk for postoperative MI, but
not that for MACCEs or all-cause mortality, a discrepancy likely related
to the higher rate of renal failure associated with RIPC. Copyright &#xa9;
2016 Elsevier Ireland Ltd

<48>
Accession Number
613439296
Author
Mansukhani N.A.; Yoon D.Y.; Teter K.A.; Stubbs V.C.; Helenowski I.B.;
Woodruff T.K.; Kibbe M.R.
Institution
(Mansukhani, Yoon, Teter, Stubbs, Helenowski, Kibbe) Department of
Surgery, Northwestern University, Chicago, IL, United States
(Woodruff) Department of Obstetrics and Gynecology, Northwestern
University, Chicago, IL, United States
(Woodruff, Kibbe) Women's Health Research Institute, Northwestern
University, Chicago, IL, United States
(Kibbe) JAMA Surgery, United States
(Kibbe) Department of Surgery, University of North Carolina at Chapel
Hill, 4041 Burnett Womack, 101 Manning Dr, Campus Box 7050, Chapel Hill,
NC 27599, United States
Title
Determining if sex bias exists in human surgical clinical research.
Source
JAMA Surgery. 151 (11) (pp 1022-1030), 2016. Date of Publication: 01 Nov
2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Sex is a variable that is poorly controlled for in clinical
research. OBJECTIVES To determine if sex bias exists in human surgical
clinical research, to determine if data are reported and analyzed using
sex as an independent variable, and to identify specialties in which the
greatest and least sex biases exist. Design, Setting, and Participants:
For this bibliometric analysis, datawere abstracted from 1303 original
peer-reviewed articles published from January 1, 2011, through December
31, 2012, in 5 surgery journals. Main Outcomes and Measures: Study type,
location, number and sex of participants, degree of sex matching of
included participants, and inclusion of sex-based reporting, statistical
analysis, and discussion of data. Results: Of 2347 articles reviewed, 1668
(71.1%) included human participants. After excluding 365 articles, 1303
remained: 17 (1.3%) included males only, 41 (3.1%) included females only,
1020 (78.3%) included males and females, and 225 (17.3%) did not document
the sex of the participants. Although female participants represent more
than 50% (n = 57 688 606) of the total number (115 377 213) included,
considerable variability existed with the number of male (46 111 818),
female (58 805 665), and unspecified (10 459 730) participants included
among the journals, between US domestic and international studies, and
between single vs multicenter studies. For articles included in the study,
38.1% (497 of 1303) reported these data by sex, 33.2%(432 of 1303)
analyzed these data by sex, and 22.9% (299 of 1303) included a discussion
of sex-based results. Sex matching of the included participants in the
research overall was poor, with 45.2%(589 of 1303) of the studies matching
the inclusion of both sexes by 50%. During analysis of the different
surgical specialties, a wide variation in sex-based inclusion, matching,
and data reporting existed, with colorectal surgery having the best
matching of male and female participants and cardiac surgery having the
worst. Conclusions and Relevance: Sex bias exists in human surgical
clinical research. Few studies included men and women equally, less than
one-third performed data analysis by sex, and there was wide variation in
inclusion and matching of the sexes among the specialties and the journals
reviewed. Because clinical research is the foundation for evidence-based
medicine, it is imperative that this disparity be addressed so that
therapies benefit both sexes. Copyright &#xa9; 2016 American Medical
Association. All rights reserved.

<49>
Accession Number
610923123
Author
Zaragoza R.; Aguado J.M.; Ferrer R.; Rodriguez A.H.; Maseda E.; Llinares
P.; Grau S.; Munoz P.; Fortun J.; Bouzada M.; Pozo J.C.D.; Leon R.
Institution
(Zaragoza, Aguado, Ferrer, Rodriguez, Maseda, Llinares, Grau, Munoz,
Fortun, Bouzada, Pozo, Leon) Servicio de Medicina Intensiva, Coordinador
Unidad de Sepsis, Hospital Universitario Dr. Peset, Avda Gaspar Aguilar,
90, Valencia, Spain
Title
EPICO 3.0. Antifungal prophylaxis in solid organ transplant recipients.
Source
Revista Iberoamericana de Micologia. 33 (4) (pp 187-195), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Asociacion Espanola de Micologia
Abstract
Background Although over the past decade the management of invasive fungal
infection has improved, considerable controversy persists regarding
antifungal prophylaxis in solid organ transplant recipients. Aims To
identify the key clinical knowledge and make by consensus the high level
recommendations required for antifungal prophylaxis in solid organ
transplant recipients. Methods Spanish prospective questionnaire, which
measures consensus through the Delphi technique, was conducted anonymously
and by e-mail with 30 national multidisciplinary experts, specialists in
invasive fungal infections from six national scientific societies,
including intensivists, anesthetists, microbiologists, pharmacologists and
specialists in infectious diseases that responded to 12 questions prepared
by the coordination group, after an exhaustive review of the literature in
the last few years. The level of agreement achieved among experts in each
of the categories should be equal to or greater than 70% in order to make
a clinical recommendation. In a second term, after extracting the
recommendations of the selected topics, a face-to-face meeting was held
with more than 60 specialists who were asked to validate the pre-selected
recommendations and derived algorithm. Measurements and primary outcomes
Echinocandin antifungal prophylaxis should be considered in liver
transplant with major risk factors (retransplantation, renal failure
requiring dialysis after transplantation, pretransplant liver failure, not
early reoperation, or MELD > 30); heart transplant with hemodialysis, and
surgical re-exploration after transplantation; environmental colonization
by Aspergillus, or cytomegalovirus (CMV) infection; and pancreas and
intestinal transplant in case of acute graft rejection, hemodialysis,
initial graft dysfunction, post-perfusion pancreatitis with anastomotic
problems or need for laparotomy after transplantation. Antifungal
fluconazole prophylaxis should be considered in liver transplant without
major risk factors and MELD 20-30, split or living donor,
choledochojejunostomy, increased transfusion requirements, renal failure
without replacement therapy, early reoperation, or multifocal colonization
or infection with Candida; intestinal and pancreas transplant with no risk
factors for echinocandin treatment. Liposomal amphotericin B antifungal
prophylaxis should be considered in lung transplant (inhalant form) and
liver transplant with major risk factors. Antifungal prophylaxis with
voriconazole should be considered in lung transplant, and heart transplant
with hemodialysis, surgical re-exploration after transplantation,
environmental colonization by Aspergillus, or CMV infection. Conclusions
The management of antifungal prophylaxis in solid organ transplant
recipients requires the application of knowledge and skills that are
detailed in our recommendations and the algorithm developed therein. These
recommendations, based on the DELPHI methodology, may help to identify
potential patients, standardize their management and improve overall
prognosis. Copyright &#xa9; 2016 Asociacion Espanola de Micologia

<50>
[Use Link to view the full text]
Accession Number
613915008
Author
Wan L.; Liao M.; Li L.; Qian W.; Hu R.; Chen K.; Chuanhan Zhang; Yao W.
Institution
(Wan, Liao, Qian, Hu, Chen, Chuanhan Zhang, Yao) Department of
Anesthesiology, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
(Li) Department of Physiology, Hubei University of Chinese Medicine,
Wuhan, China
Title
McGrath Series 5 videolaryngoscope vs Airtraq DL videolaryngoscope for
double-lumen tube intubation: A randomized trial.
Source
Medicine (United States). 95 (51) (pp e5739), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Many studies have shown Airtraq videolaryngoscope provided
faster tracheal intubation and a higher success rate than other
videolaryngoscopes. Recently, different types of videolaryngoscopes have
been reported for use in double-lumen tube (DLT) intubation. However, the
advantages and disadvantages between them remain undetermined for DLT
intubation. In this study, we compared the Airtraq DL videolaryngoscope
with the McGrath Series 5 videolaryngoscope for DLT intubation by
experienced anesthesiologists. Methods: Ninety patients with expected
normal airways were randomly allocated to either the Airtraq orMcGrath
group. The primary outcome was DLT intubation time. The secondary outcomes
were glottic view, success rate, subjective ease of intubation (100-mm
visual analog scale, 0=easy; 100=difficult), incidence of DLT malposition,
and postoperative intubation-related complication. Results: The airway
characteristics were comparable between the 2 groups. Cormack and Lehane
grades significantly improved with the use of the McGrath and Airtraq
videolaryngoscopes, compared with the Macintosh laryngoscope. The
intubation success rate on the first attempt was 93% in the Airtraq group
and 95% in the McGrath group (P>0.05). The intubation time in the McGrath
group is longer than that in the Airtraq group (39.9 [9.1]s vs 28.6
[13.6]s, P>0.05). But intubation difficulty score, the incidence of DLT
malposition and intubation-related complication were comparable between
groups (P>0.05). Conclusions: When using videolaryngoscopes for DLT
intubation, the Airtraq DL is superior to the McGrath Series 5 in
intubation time, but it does not decrease intubation difficulty.
Abbreviations: ASA = American Society of Anaesthesiologists, DLT =
double-lumen tube, FOB = fibreoptic bronchoscopy, SARI = simplified airway
risk index, SLT = single-lumen tube. Copyright &#xa9; 2016 the Author(s).

<51>
Accession Number
614048985
Author
Ahn T.; Suh S.Y.; Lee K.; Kang W.C.; Han S.H.; Ahn Y.; Jeong M.H.
Institution
(Ahn, Suh, Lee, Kang, Han) Gachon University Gil Hospital, 21
Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, South Korea
(Ahn, Jeong) Chonnam National University Hospital, Gwangju, South Korea
Title
Clinical outcomes according to the achievement of target low density
lipoprotein-cholesterol in patients with acute myocardial infarction.
Source
Korean Circulation Journal. 47 (1) (pp 31-35), 2017. Date of Publication:
January 2017.
Publisher
Korean Society of Circulation (E-mail: herz4@circulation.or.kr)
Abstract
Background and Objectives: The clinical outcome of patient with an acute
myocardial infarction (AMI) undergoing percutaneous coronary intervention
(PCI), with or without achievement of target low density
lipoprotein-cholesterol (LDL-C), has little known information. This study
investigated if target LDL-C level (below 70 mg/dL) achievements in
patients with AMI showed better clinical outcomes or not. Subjects and
Methods: Between May 2008 and September 2012, this study enrolled 13473
AMI patients in a large-scale, prospective, multicenter Korean Myocardial
Infarction (KorMI) registry. 12720 patients survived and 6746 patients
completed a 1-year clinical follow up. Among them 3315 patients received
serial lipid profile follow-ups. Propensity score matching was applied to
adjust for differences in clinical baseline and angiographic
characteristics, producing a total of 1292 patients (646 target LDL-C
achievers vs. 646 non-achievers). The primary end point was the composite
of a 1-year major adverse cardiac event (MACE) including cardiac death,
recurrent myocardial infarction (MI), target lesion revascularization
(TLR) and coronary artery bypass grafting. Results: After propensity score
matching, baseline clinical and angiographic characteristics were similar
between the two groups. Clinical outcomes of the propensity score matched
patients who showed no significant differences in cardiac death (0.5% vs.
0.5%, p=1.000), recurrent MI (1.1% vs. 0.8%, p=0.562), TLR (5.0% vs. 4.5%,
p=0.649), MACEs (6.5% vs. 5.9%, p=0.644) and stent thrombosis (2.5% vs.
1.9%, p=0.560). Conclusion: In this propensity-matched comparison, AMI
patients undergoing PCI with a target LDL-C (below 70 mg/dL) achievement
did not show better clinical outcomes.

<52>
Accession Number
614048872
Author
Youn J.-C.; Han S.; Ryu K.-H.
Institution
(Youn, Han, Ryu) Division of Cardiology, Dongtan Sacred Heart Hospital,
Hallym University, College of Medicine, Keunjaebong-gil 7, Hwaseong 18450,
South Korea
Title
Temporal trends of hospitalized patients with heart failure in Korea.
Source
Korean Circulation Journal. 47 (1) (pp 16-24), 2017. Date of Publication:
January 2017.
Publisher
Korean Society of Circulation (E-mail: herz4@circulation.or.kr)
Abstract
Heart failure (HF) is an important cardiovascular disease because of its
increasing prevalence, significant morbidity, high mortality and rapidly
expanding health care costs. The number of HF patients is increasing
worldwide and Korea is no exception. Temporal trends of four
representative Korean hospitalized HF registries-the Hallym HF study, the
Korean Multicenter HF study, the Korean Heart Failure (KorHF) registry and
the Korean Acute Heart Failure (KorAHF) registry showed mild survival
improvement reflecting overall HF patient care development in Korea
despite the increased severity of enrolled patients with higher incidence
of multiple comorbidities. Moreover, device therapies such as implantable
cardioverter defibrillator and cardiac resynchronization therapy and
definitive treatment such as heart transplantation have been increasing in
Korea as well. To prevent HF burden increase, it is essential to set up
long term effective prevention strategies for better control of ischemic
heart disease, hypertension and diabetes, which might be risk factors for
HF development. Moreover, proper HF guidelines, performance measures, and
performance improvement programs might be necessary to limit HF burden as
well.

<53>
Accession Number
613943865
Author
Tereshchenko L.G.; Henrikson C.A.; Cigarroa J.; Steinberg J.S.
Institution
(Tereshchenko, Henrikson, Cigarroa) Knight Cardiovascular Institute,
Oregon Health and Science University, Portland, OR, United States
(Steinberg) University of Rochester School of Medicine and Dentistry, The
Arrhythmia Institute of The Valley Health System, New York, NY, United
States
(Steinberg) University of Rochester School of Medicine and Dentistry, The
Arrhythmia Institute of The Valley Health System, Ridgewood, NJ, United
States
Title
Comparative effectiveness of interventions for stroke prevention in atrial
fibrillation: A network meta-analysis.
Source
Journal of the American Heart Association. 5 (5) (no pagination), 2016.
Article Number: e003206. Date of Publication: May 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background The goal of this study was to compare the safety and
effectiveness of individual antiembolic interventions in nonvalvular
atrial fibrillation (AF): novel oral anticoagulants (NOACs) (apixaban,
dabigatran, edoxaban, and rivaroxaban); vitamin K antagonists (VKA);
aspirin; and the Watchman device. Methods and Results A network
meta-analysis of randomized, clinical trials (RCTs) was performed. RCTs
that included patients with prosthetic cardiac valves or mitral stenosis,
mean or median follow-up <6 months, <200 participants, without published
report in English language, and NOAC phase II studies were excluded. The
placebo/control arm received either placebo or no treatment. The primary
efficacy outcome was the combination of stroke (of any type) and systemic
embolism. All-cause mortality served as a secondary efficacy outcome. The
primary safety outcome was the combination of major extracranial bleeding
and intracranial hemorrhage. A total of 21 RCTs (96 017 nonvalvular AF
patients; median age, 72 years; 65% males; median follow-up, 1.7 years)
were included. In comparison to placebo/control, use of aspirin (odds
ratio [OR], 0.75 [95% CI, 0.60-0.95]), VKA (0.38 [0.29-0.49]), apixaban
(0.31 [0.22-0.45]), dabigatran (0.29 [0.20-0.43]), edoxaban (0.38
[0.26-0.54]), rivaroxaban (0.27 [0.18-0.42]), and the Watchman device
(0.36 [0.16-0.80]) significantly reduced the risk of any stroke or
systemic embolism in nonvalvular AF patients, as well as all-cause
mortality (aspirin: OR, 0.82 [0.68-0.99]; VKA: 0.69 [0.57-0.85]; apixaban:
0.62 [0.50-0.78]; dabigatran: 0.62 [0.50-0.78]; edoxaban: 0.62
[0.50-0.77]; rivaroxaban: 0.58 [0.44-0.77]; and the Watchman device: 0.47
[0.25-0.88]). Apixaban (0.89 [0.80-0.99]), dabigatran (0.90 [0.82-0.99]),
and edoxaban (0.89 [0.82-0.96]) reduced risk of allcause death as compared
to VKA. Conclusions--The entire spectrum of therapy to prevent
thromboembolism in nonvalvular AF significantly reduced stroke/ systemic
embolism events and mortality. Copyright &#xa9; 2016 The Authors.

<54>
[Use Link to view the full text]
Accession Number
613955096
Author
Pedersen P.U.; Larsen P.; Hakonsen S.J.
Institution
(Pedersen, Larsen, Hakonsen) Danish Center of Systematic Reviews in
Nursing: a Collaborating Center of the Joanna Briggs Institute, Australia
Title
The effectiveness of systematic perioperative oral hygiene in reduction of
postoperative respiratory tract infections after elective thoracic surgery
in adults: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 14 (1) (pp
140-173), 2016. Date of Publication: 2016.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Nosocomial infections are a significant contributor to patient morbidity
and mortality. Nosocomial infections significantly increase hospital
length of stay and total hospital costs. Thoracic surgery, mechanical
ventilation and/or admission to an intensive care unit are known to
increase patients' risk for nosocomial respiratory tract infection.
Objectives To identify, appraise and synthesize the best available
evidence on the effectiveness of systematic perioperative oral hygiene in
the reduction of postoperative respiratory airway infections in adult
patients undergoing elective thoracic surgery. Inclusion criteria Types of
participants Patients over the age of 18 years who had been admitted for
elective thoracic surgery, regardless of gender, ethnicity, diagnosis
severity, co-morbidity or previous treatment. Types of intervention(s)
Perioperative systematic oral hygiene (such as mechanical removal of
dental biofilm or plaques and/or systematic use of mouth rinse) performed
by patients themselves or by healthcare staff (such as nurses). Types of
studies Randomized controlled trials and quasi-experimental studies. Types
of outcomes Nosocomial infections, specifically respiratory tracts
infections, and surgical site infections Search strategy Multiple
databases (PubMed, CINAHL, Embase, Scopus, Swemed+, Health Technology
Assessment Database and Turning Research Into Practice [TRIP] database)
were searched from 1980 to December 2014. Studies published in English,
German, Danish, Swedish and Norwegian were considered for inclusion in
this review. Methodological quality Two independent reviewers used the
standard critical appraisal tool from the Joanna Briggs Institute to
assess the methodological quality of studies. Data extraction The process
of data extraction was undertaken independently by two reviewers using
tools from the Joanna Briggs Institute. Data synthesis Quantitative
results were synthesized in meta-analysis. Results This review includes
six studies: three randomized controlled trials and three
quasi-experimental studies. The absolute magnitude of the summary effect
sizes were: for nosocomial infections relative risk (RR) 0.65 (95%
confidence interval [CI] 0.55-0.78) for respiratory tract infections RR
0.48 (95%CI: 0.36-0.65) and for deep surgical site infections RR 0.48
(95%CI 0.27-0.84). Conclusions Systematic perioperative oral hygiene
reduces postoperative nosocomial, lower respiratory tract infections and
surgical site infections but not urinary tract infections. The effect is
statistically, clinically and practically significant. Implications for
practice Perioperative decontamination of the nasopharynx and/or
oropharynx is a strategy worth pursuing. The intervention is cheap and can
easily be carried out by the patients themselves. (Grade A) Implications
for research Studies testing decontamination of the nasopharynx and/or
oropharynx have until now only included patients undergoing thoracic
surgical procedures. As the interventions are cheap, easy to carry out and
have a great impact on the patients' outcome, it is recommendable to carry
out more studies involving other type of patients undergoing major surgery
with a high prevalence of nosocomial infections, respiratory tract
infections and surgical site infections. Copyright &#xa9; the authors
2016.

<55>
Accession Number
614046171
Author
Schidlow D.N.; Jenkins K.J.; Gauvreau K.; Croti U.A.; Giang D.T.C.; Konda
R.K.; Novick W.M.; Sandoval N.F.; Castaneda A.
Institution
(Schidlow) Children's National Heart Institute, Children's National
Medical Center, George Washington University, Washington, DC, United
States
(Jenkins, Gauvreau) Department of Cardiology, Boston Children's Hospital,
Boston, Massachusetts, United States
(Croti) Hospital da Crianca e Maternidade de Sao Jose do Rio Preto, Sao
Jose do Rio Preto, Brazil
(Giang) Children's Hospital 1, Ho Chi Minh City, Vietnam
(Konda) Care Hospital, Hyderabad, India
(Novick) Department of Surgery, University of Tennessee Health Science
Center and William Novick Global Cardiac Alliance, Memphis, Tennessee,
United States
(Sandoval) Fundacion Cardioinfantil IC, Bogota, Colombia
(Castaneda) UNICAR and the Fundacion Aldo Castaneda, Guatemala City,
Guatemala
Title
Transposition of the Great Arteries in the Developing World: Surgery and
Outcomes.
Source
Journal of the American College of Cardiology. 69 (1) (pp 43-51), 2017.
Date of Publication: 03 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Little has been published regarding surgery for transposition
of the great arteries (TGA) in the developing world. Objectives This study
sought to identify patient characteristics, surgical interventions,
institutional characteristics, risk factors for mortality, and outcomes
among patients undergoing surgery for TGA in this setting. Methods
Developing world congenital heart surgical programs submitted
de-identified data to a novel international collaborative database as part
of a quality improvement project. We conducted a retrospective cohort
study that included all cases of TGA with intact ventricular septum and
TGA with ventricular septal defect performed from 2010 to 2013.
Demographic, surgical, and institutional characteristics and their
associations with in-hospital mortality were identified. Results There
were 778 TGA operations performed at 26 centers, 480 (62%) for TGA with
intact ventricular septum and 298 (38%) for TGA with ventricular septal
defect. Most (80%) were single-stage arterial switch operations, but 20%
were atrial baffling procedures (atrial switch operation) or 2-stage
repairs (pulmonary artery band followed by arterial switch operation). Age
at operation was >30 days in one-half of the cases and did not vary
significantly with operation type. Survival was 85% and did not
significantly vary with age at operation or operation type. Preceding
septostomy was infrequently reported (16%) and was not associated with
surgical mortality. Mortality was associated with lower World Health
Organization weight/body mass index-for-age percentile and lower
institutional volume of TGA repair. Conclusions Surgical repair of TGA
performed in the developing world is associated with an early survival of
85%. Type of surgical repair and age at operation varied considerably, but
no associations with mortality were identified. In contrast, poor
nutrition and small surgical volume were most strongly associated with
mortality. Multicenter collaborative quality improvement efforts may
benefit patients with TGA in the developing world. Copyright &#xa9; 2017
American College of Cardiology Foundation

<56>
Accession Number
614046164
Author
Aboulhosn J.; Cabalka A.K.; Levi D.S.; Himbert D.; Testa L.; Latib A.;
Makkar R.R.; Boudjemline Y.; Kim D.W.; Kefer J.; Bleiziffer S.; Kerst G.;
Dvir D.; McElhinney D.B.
Institution
(Aboulhosn, Levi) Ahmanson/UCLA Adult Congenital Heart Disease Center,
David Geffen School of Medicine, University of California, Los Angeles,
California, United States
(Cabalka) Mayo Clinic, Rochester, Minnesota, United States
(Himbert) Bichat Hospital, Paris, France
(Testa) Department of Cardiology, IRCCS Pol. S. Donato, Milan, Italy
(Latib) EMO-GVM Centro Cuore Columbus & San Raffaele Hospital, Milan,
Italy
(Makkar) Cedars-Sinai Medical Center, Los Angeles, California, United
States
(Boudjemline) Necker Enfants Malades Hospital, Paris, France
(Kim) Emory University, Atlanta, Georgia
(Kefer) Cliniques Universitaires Saint-Luc, Brussels, Belgium
(Bleiziffer) German Heart Center, Munich, Germany
(Kerst) University Hospital of Giessen, Giessen, Germany
(Dvir) St. Paul's Hospital, Vancouver, Canada
(McElhinney) Stanford University, Palo Alto, California, United States
Title
Transcatheter Valve-in-Ring Implantation for the Treatment of Residual or
Recurrent Tricuspid Valve Dysfunction After Prior Surgical Repair.
Source
JACC: Cardiovascular Interventions. 10 (1) (pp 53-63), 2017. Date of
Publication: 09 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to describe the results of transcatheter
tricuspid valve-in-ring (TVIR) implantation for treatment of tricuspid
regurgitation (TR). Background Off-label use of transcatheter valves
within surgically placed tricuspid annuloplasty prostheses has only been
described in small reports. An international multicenter registry was
developed to collect data on TVIR implantation. Methods Data were
collected from 13 sites on 22 patients (5 to 69 years of age) with TR who
underwent catheterization with the intent to perform TVIR implantation.
Results TVIR implantation was performed in 20 patients (91%). Most
patients were severely impaired (86% in New York Heart Association
functional class III or IV); TR was severe in 86%. A Sapien valve (Edwards
Lifesciences, Irvine, California) was implanted in 17 patients and a
Melody valve (Medtronic, Minneapolis, Minnesota) in 3. There were no
procedural deaths. There was 1 valve embolization requiring retrieval and
placement of second TVIR implant and 1 valve malposition with severe
paravalvular regurgitation requiring a second TVIR implantation. Over a
median follow-up of 12 months, 1 patient died and 2 underwent repeat TVIR
implantation, 1 of whom subsequently underwent surgical valve replacement.
Significant paravalvular leak (PVL) was treated at the time of TVIR
implantation in 4 patients: 3 underwent device occlusion and 1 received a
second TVIR implant. On follow-up echocardiography, 15 patients had PVL
(75%), the majority of which (n = 10) were trivial or mild and did not
require treatment. PVL intervention was performed in 3 patients during
follow-up. Functional capacity improved in most patients (70%).
Conclusions TVIR implantation using commercially available transcatheter
prostheses is technically feasible and clinically effective in reducing
TR. Paravalvular regurgitation is common and may necessitate further
interventions. Copyright &#xa9; 2017 American College of Cardiology
Foundation

<57>
Accession Number
614041007
Author
Senanayake E.L.; Giri R.; Gopal S.; Nevill A.; Luckraz H.
Institution
(Senanayake, Luckraz) Department of Cardiothoracic Surgery, Heart and Lung
Centre, Wolverhampton, United Kingdom
(Giri) Department of Cardiothoracic Anaesthesia, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Gopal) Department of Intensive Care, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nevill) University of Wolverhampton, Wolverhampton, United Kingdom
Title
Incidence of endotracheal tube colonization with the use of PneuX
endotracheal tubes in patients following cardiac surgery.
Source
Journal of Hospital Infection. 95 (1) (pp 81-86), 2017. Date of
Publication: 01 Jan 2017.
Publisher
W.B. Saunders Ltd
Abstract
Introduction Ventilator-associated pneumonia (VAP) develops in up to 25%
of patients following cardiac surgery. Colonization of the endotracheal
tube (ETT) contributes to VAP. The PneuX ETT has been shown to halve VAP
in high-risk patients undergoing cardiac surgery. This article reports on
the secondary analysis of bacterial colonization in relation to VAP
between the PneuX and standard ETTs. Methods In this randomized controlled
trial, patients were randomized on a 1:1 basis to Group A (PneuX ET,
N=120) or Group B (standard ETT, N=120). Patients aged >70 years with or
without impaired left ventricular function (<50%) undergoing elective and
urgent cardiac surgery were included in this study. Incidence of
postoperative VAP and analysis of bacterial colonization within the ETT
(N=234) were measured for patients requiring <24 h, 24-48 h and >48 h of
intubation. Results Baseline patient demographics were comparable. VAP was
lower in Group A compared with Group B (10.8% vs 21%; P=0.03). The
incidence of VAP was lower at each time point for Group A. There was a
lower incidence of ETT colonization in Group A for patients needing >48 h
of intubation. There was no difference in the type of bacterial
colonization (P=0.5) or the mean number of colony-forming units
[4.35x10⁷ (1.18x10⁸) and 2.16x10⁸
(1.24x10⁹) in Groups A and B, respectively (P=0.8)]. Conclusion
Colonization of the ETT does not seem to play an important role in
early-onset VAP. There is a tendency for reduced colonization in the PneuX
ETT with longer intubation times. This may have an impact on reducing the
incidence of late-onset VAP. Copyright &#xa9; 2016 The Healthcare
Infection Society

<58>
Accession Number
614001760
Author
Debray T.P.A.; Damen J.A.A.G.; Snell K.I.E.; Ensor J.; Hooft L.; Reitsma
J.B.; Riley R.D.; Moons K.G.M.
Institution
(Debray, Damen, Hooft, Reitsma, Moons) Cochrane Netherlands, University
Medical Center Utrecht, PO Box 85500 Str 6.131, Utrecht 3508 GA,
Netherlands
(Debray, Damen, Hooft, Reitsma, Moons) Julius Center for Health Sciences
and Primary Care, University Medical Center Utrecht, PO Box 85500 Str
6.131, Utrecht 3508 GA, Netherlands
(Snell, Ensor, Riley) Research Institute for Primary Care and Health
Sciences, Keele University, Staffordshire, United Kingdom
Title
A guide to systematic review and meta-analysis of prediction model
performance.
Source
BMJ (Online). 356 (no pagination), 2017. Article Number: i6460. Date of
Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Validation of prediction models is highly recommended and increasingly
common in the literature. A systematic review of validation studies is
therefore helpful, with meta-analysis needed to summarise the predictive
performance of the model being validated across different settings and
populations. This article provides guidance for researchers systematically
reviewing and meta-analysing the existing evidence on a specific
prediction model, discusses good practice when quantitatively summarising
the predictive performance of the model across studies, and provides
recommendations for interpreting meta-analysis estimates of model
performance. We present key steps of the meta-analysis and illustrate each
step in an example review, by summarising the discrimination and
calibration performance of the EuroSCORE for predicting operative
mortality in patients undergoing coronary artery bypass grafting.

<59>
Accession Number
614025709
Author
Constantin J.-M.; Momon A.; Mantz J.; Payen J.-F.; De Jonghe B.; Perbet
S.; Cayot S.; Chanques G.; Perreira B.
Institution
(Constantin, Momon, Perbet, Cayot) Perioperative Department, University
Hospital of Clermont-Ferrand, Clermont-Ferrand 63000, France
(Perreira) Biostatistics Unit, Department of Clinical Research and
Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand
63000, France
(Mantz) Department of Anaesthesiology and Critical Care Medicine, Hopital
Europeen Georges-Pompidou, Universite Paris-Descartes Sorbonne Paris Cite,
Paris 75908, France
(Payen) Department of Anaesthesia and Critical Care, Michallon Hospital,
boulevard de la Chantourne, Grenoble 38000, France
(Payen) Joseph-Fourier University, Grenoble Institute of Neurosciences,
chemin Fortune-Ferrini, Grenoble 38042, France
(De Jonghe) Reanimation Medico-Chirurgicale, Centre Hospitalier de
Poissy-St-Germain, Poissy 78300, France
(Chanques) Intensive Care and Anaesthesiology Department, University of
Montpellier Saint-Eloi Hospital, Montpellier 34000, France
Title
Efficacy and safety of sedation with dexmedetomidine in critical care
patients: A meta-analysis of randomized controlled trials.
Source
Anaesthesia Critical Care and Pain Medicine. 35 (1) (pp 7-15), 2016. Date
of Publication: 01 Feb 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction Dexmedetomidine may help physicians target a low level of
sedation. Unfortunately, the impact of dexmedetomidine on major endpoints
remains unclear in intensive care unit (ICU). Material and methods To
evaluate the association between dexmedetomidine use with efficacy and
safety outcomes, two reviewers independently identified randomized
controlled trials comparing dexmedetomidine with other sedative agents in
non-post-cardiac surgery critically ill patients in the PubMed and
Cochrane databases. Random effects models were considered if heterogeneity
was detected using the DerSimonian and Laird estimation method.
Statistical heterogeneity between results was assessed by examining forest
plots, confidence intervals (CI) and by using the I² statistic.
The risk of bias was assessed using the risk of bias tool. Results This
meta-analysis included 1994 patients from 16 randomized controlled trials.
Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was
associated with a reduction in ICU length of stays (WMD = -0.304; 95% CI
[-0.477, -0.132]; P = 0.001), mechanical ventilation duration (WMD =
-0.313, 95% CI [-0.523, -0.104]; P = 0.003) and delirium incidence (RR =
0.812, 95% CI [0.680, 0.968]; P = 0.020). Dexmedetomidine is also
associated with an increase in the incidence of bradycardia (RR = 1.947,
95% CI [1.387, 2.733]; P = 0.001) and hypotension (RR = 1.264; 95% CI
[1.013, 1.576]; P = 0.038). Conclusions and relevance In this first
meta-analysis including only randomized controlled trials related to ICU
patients, dexmedetomidine was associated with a 48 h reduction in ICU
length of stay, mechanical ventilation duration and delirium occurrence
despite a significant heterogeneity among studies. Dexmedetomidine was
also associated with an increase in bradycardia and hypotension. Copyright
&#xa9; 2015 Societe francaise d'anesthesie et de reanimation (Sfar)

<60>
Accession Number
614043412
Author
Thiago L.; Tsuji S.R.; Nyong J.; Dos Santos Puga M.E.; De Gois A.F.T.;
Macedo C.R.; Valente O.; Atallah A.N.
Title
Statins for aortic valve stenosis.
Source
Sao Paulo Medical Journal. 134 (6) (pp 555), 2016. Date of Publication:
November-December 2016.
Publisher
Associacao Paulista de Medicina (E-mail: revistas@apm.org.br)
Abstract
BACKGROUND: Aortic valve stenosis is the most common type of valvular
heart disease in the USA and Europe. Aortic valve stenosis is considered
similar to atherosclerotic disease. Some studies have evaluated statins
for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and
safety of statins in aortic valve stenosis. METHODS: Search methods: We
searched the Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These
databases were searched from their inception to 24 November 2015. We also
searched trials in registers for ongoing trials. We used no language
restrictions. Selection criteria: Randomized controlled clinical trials
(RCTs) comparing statins alone or in association with other systemic drugs
to reduce cholesterol levels versus placebo or usual care. Data collection
and analysis: Primary outcomes were severity of aortic valve stenosis
(evaluated by echocardiographic criteria: mean pressure gradient, valve
area and aortic jet velocity), freedom from valve replacement and death
from cardiovascular cause. Secondary outcomes were hospitalization for any
reason, overall mortality, adverse events and patient quality of life. Two
review authors independently selected trials for inclusion, extracted data
and assessed the risk of bias. The GRADE methodology was employed to
assess the quality of result findings and the GRADE profiler (GRADEPRO)
was used to import data from Review Manager 5.3 to create a 'Summary of
findings' table. MAIN RESULTS: We included four RCTs with 2360
participants comparing statins (1185 participants) with placebo (1175
participants). We found low-quality evidence for our primary outcome of
severity of aortic valve stenosis, evaluated by mean pressure gradient
(mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80;
participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to
0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06,
95% CI -0.26 to 0.14; participants = 155; study = 1). Moderate-quality
evidence showed no effect on freedom from valve replacement with statins
(risk ratio (RR) 0.93, 95% CI 0.81 to 1.06; participants = 2360; studies =
4), and no effect on muscle pain as an adverse event (RR 0.91, 95% CI 0.75
to 1.09; participants = 2204; studies = 3; moderate-quality evidence).
Lowand very low-quality evidence showed uncertainty around the effect of
statins on death from cardiovascular cause (RR 0.80, 95% CI 0.56 to 1.15;
participants = 2297; studies = 3; low-quality evidence) and
hospitalization for any reason (RR 0.84, 95% CI 0.39 to 1.84; participants
= 155; study = 1; very low-quality evidence). None of the four included
studies reported on overall mortality and patient quality of life. AUTHORS
CONCLUSIONS: Result findings showed uncertainty surrounding the effect of
statins for aortic valve stenosis. The quality of evidence from the
reported outcomes ranged from moderate to very low. These results give
support to European and USA guidelines (2012 and 2014, respectively) that
so far there is no clinical treatment option for aortic valve stenosis.
Copyright &#xa9; 2016, Associacao Paulista de Medicina. All rights
reserved.

<61>
Accession Number
614028466
Author
Vener D.F.; Gaies M.; Jacobs J.P.; Pasquali S.K.
Institution
(Vener) Department of Anesthesiology, Perioperative and Pain Medicine,
Pediatric Cardiovascular Anesthesia, Texas Children's Hospital, Baylor
College of Medicine, Houston, TX, United States
(Gaies, Pasquali) Department of Pediatric Cardiology, C. S. Mott
Children's Hospital, University of Michigan, Ann Arbor, MI, United States
(Jacobs) Cardiovascular Surgery, Johns Hopkins All Children's Hospital, St
Petersburg, FL, United States
Title
Clinical Databases and Registries in Congenital and Pediatric Cardiac
Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 8 (1) (pp
77-87), 2017. Date of Publication: 01 Jan 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The growth in large-scale data management capabilities and the successful
care of patients with congenital heart defects have coincidentally
paralleled each other for the last three decades, and participation in
multicenter congenital heart disease databases and registries is now a
fundamental component of cardiac care. This manuscript attempts for the
first time to consolidate in one location all of the relevant databases
worldwide, including target populations, specialties, Web sites, and
participation information. Since at least 1,992 cardiac surgeons and
cardiologists began leveraging this burgeoning technology to create
multi-institutional data collections addressing a variety of specialties
within this field. Pediatric heart diseases are particularly well suited
to this methodology because each individual care location has access to
only a relatively limited number of diagnoses and procedures in any given
calendar year. Combining multiple institutions data therefore allows for a
far more accurate contemporaneous assessment of treatment modalities and
adverse outcomes. Additionally, the data can be used to develop outcome
benchmarks by which individual institutions can measure their progress
against the field as a whole and focus quality improvement efforts in a
more directed fashion, and there is increasing utilization combining
clinical research efforts within existing data structures. Efforts are
ongoing to support better collaboration and integration across data sets,
to improve efficiency, further the utility of the data collection
infrastructure and information collected, and to enhance return on
investment for participating institutions. Copyright &#xa9; 2016, &#xa9;
The Author(s) 2016.

<62>
Accession Number
613982512
Author
Andersen L.W.; Holmberg M.J.; Berg K.M.; Chase M.; Cocchi M.N.; Sulmonte
C.; Balkema J.; MacDonald M.; Montissol S.; Senthilnathan V.; Liu D.;
Khabbaz K.; Lerner A.; Novack V.; Liu X.; Donnino M.W.
Institution
(Andersen, Holmberg, Chase, Cocchi, Sulmonte, Balkema, MacDonald,
Montissol, Liu, Donnino) Center for Resuscitation Science, Department of
Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline
Avenue, Boston, MA 02215, United States
(Andersen) Department of Anesthesiology, Aarhus University Hospital,
Norrebrogade 44, Aarhus C 8000, Denmark
(Andersen, Holmberg) Research Center for Emergency Medicine, Aarhus
University Hospital, Norrebrogade 44, Aarhus C 8000, Denmark
(Berg, Donnino) Department of Medicine, Division of Pulmonary and Critical
Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston,
MA 02215, United States
(Cocchi) Department of Anesthesia Critical Care, Division of Critical
Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston,
MA 02215, United States
(Senthilnathan, Liu, Khabbaz) Department of Surgery, Division of
Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, 330
Brookline Avenue, Boston, MA 02215, United States
(Lerner) Department of Anesthesia, Beth Israel Deaconess Medical Center,
330 Brookline Avenue, Boston, MA 02215, United States
(Novack) Clinical Research Center, Soroka University Medical Center, POB
151, Beer-Sheva 84965, Israel
(Novack) Faculty of Health Sciences, Ben-Gurion University, POB 151,
Beer-Sheva 84965, Israel
Title
Thiamine as an adjunctive therapy in cardiac surgery: A randomized,
doubleblind, placebo-controlled, phase II trial.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 92. Date of
Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Thiamine is a vitamin that is essential for adequate aerobic
metabolism. The objective of this study was to determine if thiamine
administration prior to coronary artery bypass grafting would decrease
post-operative lactate levels as a measure of increased aerobic
metabolism. Methods: We performed a randomized, double-blind,
placebo-controlled trial of patients undergoing coronary artery bypass
grafting. Patients were randomized to receive either intravenous thiamine
(200 mg) or placebo both immediately before and again after the surgery.
Our primary endpoint was post-operative lactate levels. Additional
endpoints included pyruvate dehydrogenase activity, global and cellular
oxygen consumption, post-operative complications, and hospital and
intensive care unit length of stay. Results: Sixty-four patients were
included. Thiamine levels were significantly higher in the thiamine group
as compared to the placebo group immediately after surgery (1200 [683,
1200] nmol/L vs. 9 [8, 13] nmol/L, p < 0.001). There was no difference
between the groups in the primary endpoint of lactate levels immediately
after the surgery (2.0 [1.5, 2.6] mmol/L vs. 2.0 [1.7, 2.4], p = 0.75).
Relative pyruvate dehydrogenase activity was lower immediately after the
surgery in the thiamine group as compared to the placebo group (15 % [11,
37] vs. 28 % [15, 84], p = 0.02). Patients receiving thiamine had higher
post-operative global oxygen consumption 1 hour after the surgery
(difference: 0.37 mL/min/kg [95 % CI: 0.03, 0.71], p = 0.03) as well as
cellular oxygen consumption. We found no differences in clinical outcomes.
Conclusions: There were no differences in post-operative lactate levels or
clinical outcomes between patients receiving thiamine or placebo.
Post-operative oxygen consumption was significantly increased among
patients receiving thiamine. Copyright &#xa9; 2016 Andersen et al.

<63>
Accession Number
613982128
Author
Vincent J.-L.; e Silva A.Q.; Couto L.; Taccone F.S.
Institution
(Vincent, e Silva, Couto, Taccone) Department of Intensive Care, Erasme
Hospital, Universite Libre de Bruxelles, Route de Lennik 808, Brussels
1070, Belgium
Title
The value of blood lactate kinetics in critically ill patients: A
systematic review.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 257. Date of
Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The time course of blood lactate levels could be helpful to
assess a patient's response to therapy. Although the focus of published
studies has been largely on septic patients, many other studies have
reported serial blood lactate levels in different groups of acutely ill
patients. Methods: We performed a systematic search of PubMed, Science
Direct, and Embase until the end of February 2016 plus reference lists of
relevant publications. We selected all observational and interventional
studies that evaluated the capacity of serial blood lactate concentrations
to predict outcome. There was no restriction based on language. We
excluded studies in pediatric populations, experimental studies, and
studies that did not report changes in lactate values or all-cause
mortality rates. We separated studies according to the type of patients
included. We collected data on the number of patients, timing of lactate
measurements, minimum lactate level needed for inclusion if present, and
suggested time interval for predictive use. Results: A total of 96 studies
met our criteria: 14 in general ICU populations, five in general surgical
ICU populations, five in patients post cardiac surgery, 14 in trauma
patients, 39 in patients with sepsis, four in patients with cardiogenic
shock, eight in patients after cardiac arrest, three in patients with
respiratory failure, and four in other conditions. A decrease in lactate
levels over time was consistently associated with lower mortality rates in
all subgroups of patients. Most studies reported changes over 6, 12 or 24
hrs, fewer used shorter time intervals. Lactate kinetics did not appear
very different in patients with sepsis and other types of patients. A few
studies suggested that therapy could be guided by these measurements.
Conclusions: The observation of a better outcome associated with
decreasing blood lactate concentrations was consistent throughout the
clinical studies, and was not limited to septic patients. In all groups,
the changes are relatively slow, so that lactate measurements every 1-2
hrs are probably sufficient in most acute conditions. The value of lactate
kinetics appears to be valid regardless of the initial value. Copyright
&#xa9; 2016 The Author(s).

<64>
Accession Number
614004331
Author
Engoren M.; Brown R.R.; Dubovoy A.
Institution
(Engoren, Dubovoy) Department of Anesthesiology, University of Michigan,
1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
(Brown) Department of Anesthesiology, Mercy St. Vincent Medical Center,
Toledo, OH, United States
(Brown) Department of Information Technology Services, Promedica Health
System, Toledo, OH, United States
Title
A retrospective analysis of the effect of blood transfusion on cerebral
oximetry entropy and acute kidney injury.
Source
Perfusion (United Kingdom). 32 (1) (pp 35-43), 2017. Date of Publication:
01 Jan 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Purpose: Acute anemia is associated with both cerebral dysfunction and
acute kidney injury and is often treated with red blood cell transfusion.
We sought to determine if blood transfusion changed the cerebral oximetry
entropy, a measure of the complexity or irregularity of the oximetry
values, and if this change was associated with subsequent acute kidney
injury. Methods: This was a retrospective, case-control study of patients
undergoing cardiac surgery with cardiopulmonary bypass at a tertiary care
hospital, comparing those who received a red blood cell transfusion to
those who did not. Acute kidney injury was defined as a perioperative
increase in serum creatinine by >3/426.4 mumol/L or by >3/450% increase.
Entropy was measured using approximate entropy, sample entropy, forbidden
word entropy and basescale4 entropy in 500-point sets. Results: Forty-four
transfused patients were matched to 88 randomly selected non-transfused
patients. All measures of entropy had small changes in the transfused
group, but increased in the non-transfused group (p<0.05, for all
comparisons). Thirty-five of 132 patients (27%) suffered acute kidney
injury. Based on preoperative factors, patients who suffered kidney injury
were similar to those who did not, including baseline cerebral oximetry
levels. After analysis with hierarchical logistic regression, the change
in basescale4 entropy (odds ratio = 1.609, 95% confidence interval =
1.057-2.450, p = 0.027) and the interaction between basescale entropy and
transfusion were significantly associated with subsequent development of
acute kidney injury. Conclusions: The transfusion of red blood cells was
associated with a smaller rise in entropy values compared to
non-transfused patients, suggesting a change in the regulation of cerebral
oxygenation, and these changes in cerebral oxygenation are also associated
with acute kidney injury. Copyright &#xa9; The Author(s) 2016.

<65>
Accession Number
613998401
Author
Rief W.; Shedden-Mora M.C.; Laferton J.A.C.; Auer C.; Petrie K.J.;
Salzmann S.; Schedlowski M.; Moosdorf R.
Institution
(Rief, Laferton, Auer, Salzmann) University of Marburg, Division of
Clinical Psychology, Gutenbergstrasse 18, Marburg 35032, Germany
(Shedden-Mora) University Medical Center Hamburg Eppendorf, Department of
Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
(Petrie) University of Auckland, Department of Psychological Medicine,
Auckland, New Zealand
(Schedlowski) Institute of Medical Psychology and Behavioral
Immunobiology, University Hospital Essen, Essen, Germany
(Moosdorf) University of Marburg, Department of Cardiac and Thoracic
Vessel Surgery, Heart Centre, Marburg, Germany
Title
Preoperative optimization of patient expectations improves long-term
outcome in heart surgery patients: Results of the randomized controlled
PSY-HEART trial.
Source
BMC Medicine. 15 (1) (no pagination), 2017. Article Number: 4. Date of
Publication: 10 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Placebo effects contribute substantially to outcome in most
fields of medicine. While clinical trials typically try to control or
minimize these effects, the potential of placebo mechanisms to improve
outcome is rarely used. Patient expectations about treatment efficacy and
outcome are major mechanisms that contribute to these placebo effects. We
aimed to optimize these expectations to improve outcome in patients
undergoing coronary artery bypass graft (CABG) surgery. Methods: In a
prospective three-arm randomized clinical trial with a 6 month follow-up,
124 patients scheduled for CABG surgery were randomized to either a brief
psychological pre-surgery intervention to optimize outcome expectations
(EXPECT); or a psychological control intervention focusing on emotional
support and general advice, but not on expectations (SUPPORT); or to
standard medical care (SMC). Interventions were kept brief to be feasible
with a heart surgery environment; "dose" of therapy was identical for both
pre-surgery interventions. Primary outcome was disability 6 months after
surgery. Secondary outcomes comprised further clinical and immunological
variables. Results: Patients in the EXPECT group showed significantly
larger improvements in disability (-12.6; -17.6 to -7.5) than the SMC
group (-1.9; -6.6 to +2.7); patients in the SUPPORT group (-6.7; -11.8 to
1.7) did not differ from the SMC group. Comparing follow-up scores and
controlling for baseline scores of EXPECT versus SUPPORT on the variable
disability only revealed a trend in favor of the EXPECT group (P = 0.09).
Specific advantages for EXPECT compared to SUPPORT were found for mental
quality of life and fitness for work (hours per week). Both psychological
pre-surgery interventions induced less pronounced increases in
pro-inflammatory cytokine concentrations reflected by decreased
interleukin-8 levels post-surgery compared to changes in SMC patients and
lower interleukin-6 levels in patients of the EXPECT group at follow-up.
Both pre-surgery interventions were characterized by great patient
acceptability and no adverse effects were attributed to them. Considering
the innovative nature of this approach, replication in larger, multicenter
trials is needed. Conclusions: Optimizing patients' expectations
pre-surgery helps to improve outcome 6 months after treatment. This
implies that making use of placebo mechanisms has the potential to improve
long-term outcome of highly invasive medical interventions. Further
studies are warranted to generalize this approach to other fields of
medicine. Trial registration: Ethical approval for the study was obtained
from the IRB of the Medical School, University of Marburg, and the trial
was registered at (NCT01407055) on July 25, 2011. Copyright &#xa9; 2017
The Author(s).

<66>
Accession Number
614067047
Author
Sumitomo N.; Horigome H.; Miura M.; Ono H.; Ueda H.; Takigiku K.;
Yoshimoto J.; Ohashi N.; Suzuki T.; Sagawa K.; Ushinohama H.; Takahashi
K.; Miyazaki A.; Sakaguchi H.; Iwamoto M.; Takamuro M.; Tokunaga C.;
Nagano T.
Institution
(Sumitomo) Department of Pediatric Cardiology, Saitama Medical University
International Medical Center, Saitama, Japan
(Horigome) Department of Child Health, Faculty of Medicine, University of
Tsukuba, Ibaraki, Japan
(Miura) Division of Cardiology, Tokyo Metropolitan Children's Medical
Center, Tokyo, Japan
(Ono) Division of Cardiology, National Center for Child Health and
Development, Tokyo, Japan
(Ueda) Department of Cardiology, Kanagawa Children's Medical Center,
Yokohama, Japan
(Takigiku) Department of Pediatric Cardiology, Nagano Children's Hospital,
Azumino, Japan
(Yoshimoto) Department of Pediatric Cardiology, Shizuoka Children's
Hospital, Shizuoka, Japan
(Ohashi) Department of Pediatric Cardiology, Japan Community Health Care
Organization Chukyo Hospital, Nagoya, Japan
(Suzuki) Department of Pediatric Electrophysiology, Osaka City General
Hospital, Osaka, Japan
(Sagawa, Ushinohama) Department of Pediatric Cardiology, Fukuoka
Children's Hospital Medical Center, Fukuoka, Japan
(Takahashi) Department of Pediatric Cardiology, Okinawa Children's Medical
Center, Okinawa, Japan
(Miyazaki, Sakaguchi) Department of Pediatric Cardiology, National
Cerebral and Cardiovascular Center, Osaka, Japan
(Iwamoto) Department of Pediatrics, Saiseikai Yokohamashi Tobu Hospital,
Yokohama, Japan
(Takamuro) Department of Pediatric Cardiology, Hokkaido Medical Center for
Child Health and Rehabilitation, Sapporo, Japan
(Tokunaga) Department of Cardiovascular Surgery, Faculty of Medicine,
University of Tsukuba, Tsukuba, Japan
(Nagano) Ono Pharmaceutical Co. Ltd., Osaka, Japan
Title
Study design for control of HEART rate in inFant and child tachyarrhythmia
with heart failure Using Landiolol (HEARTFUL): A prospective, multicenter,
uncontrolled clinical trial.
Source
Journal of Cardiology. (no pagination), 2017. Date of Publication: October
03, 2016.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Persistent tachycardia in pediatric patients after congenital
heart surgery further deteriorates their hemodynamic condition, and may
become fatal. Therefore, immediate control of the tachycardia is mandatory
in these patients. For this purpose, quick-acting, short-acting,
titratable intravenous agents are required. However, there are no agents
with such characteristics among the drugs approved for control of
pediatric arrhythmias in Japan, and thus novel and effective medications
for these patients are awaited. Landiolol, an ultrashort-acting
beta-blocker, was approved in 2013 for tachyarrhythmias in adult patients
with heart failure. However, its efficacy and safety in pediatric patients
remain unclear. The aim of this prospective, multicenter, open-label phase
IIb/III study is to investigate the efficacy and safety of landiolol in
pediatric patients with tachyarrhythmias as well as heart failure.
Methods: Eligible patients are aged > 3 months and <15 years, and have
tachyarrhythmia (atrial fibrillation, atrial flutter, supraventricular
tachycardia) as well as heart failure. The primary endpoint of the study
is >20% reduction from baseline heart rate or return to normal sinus
rhythm within 2. h after starting intravenous administration of landiolol.
Patients will receive intravenous infusion of landiolol, starting at 1.
mug/kg/min. The dose will be increased by 1. mug/kg/min every 15-20. min
until the tachycardia rate has decreased by >20% or tachycardia has
terminated, and the dose will then be maintained or further increased
depending on the patient's condition. The study was started in April 2015
and will end within a few years. Conclusions: The study was designed and
designated the "HEARTFUL study" in the hope of establishing a basis for
control of HEART rate in inFant and child tachyarrhythmia Using Landiolol
in children with heart failure. Copyright &#xa9; 2017 Japanese College of
Cardiology.

<67>
Accession Number
614031385
Author
Olper L.; Bignami E.; Di Prima A.L.; Albini S.; Nascimbene S.; Cabrini L.;
Landoni G.; Alfieri O.
Institution
(Olper, Bignami, Di Prima, Albini, Nascimbene, Cabrini, Landoni, Alfieri)
Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific
Institute
(Landoni, Alfieri) Vita-Salute San Raffaele University, Milan, Italy
Title
Continuous Positive Airway Pressure Versus Oxygen Therapy in the Cardiac
Surgical Ward: A Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Background: Noninvasive ventilation (NIV) is a common technique to manage
patients with acute respiratory failure in the intensive care unit.
However, use of NIV in general wards is less well described. The authors'
aim was to demonstrate efficacy of NIV, applied in a cardiac surgery ward,
in improving oxygenation in patients who developed hypoxemic acute
respiratory failure after being discharged from the intensive care unit.
Design: Randomized, open-label trial. Setting: University hospital.
Participants: Sixty-four patients with hypoxemia
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio between 100 and 250)
admitted to the main ward after cardiac surgery. Interventions: Patients
were randomized to receive standard treatment (oxygen, early mobilization,
a program of breathing exercises and diuretics) or continuous positive
airway pressure in addition to standard treatment. Continuous positive
airway pressure was administered 3 times a day for 2 consecutive days.
Every cycle lasted 1 to 3 hours. All patients completed their 1-year
follow-up. Data were analyzed according to the intention-to-treat
principle. Measurements and Main Results: The primary endpoint was the
number of patients with PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf><200 48
hours after randomization. Continuous positive airway pressure use was
associated with a statistically significant reduction in the number of
patients with PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf><200 (4/33 [12%] v
14/31 [45%], p = 0.003). One patient in the control group died at the
30-day follow-up. Conclusions: Among patients with acute respiratory
failure following cardiac surgery, administration of continuous positive
airway pressure in the main ward was associated with improved respiratory
outcome. This was the first study that was performed in the main ward of
post-surgical patients with acute respiratory failure. Copyright &#xa9;
2016 Elsevier Inc.

<68>
Accession Number
614031379
Author
Nappi F.; Spadaccio C.; Nenna A.; Lusini M.; Fraldi M.; Acar C.; Chello M.
Institution
(Nappi, Spadaccio, Nenna, Lusini, Chello) Department of Cardiovascular
Surgery, Universita Campus Bio-Medico di Roma, Rome, Italy
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Fraldi) Department of Structures for Engineering and Architecture and
Interdisciplinary Research Center for Biomaterials, Universita di Napoli
Federico II, Naples, Italy
(Acar) Department of Cardiac Surgery, Hopital La Pitie Salpetriere, Paris,
France
Title
Is subvalvular repair worthwhile in severe ischemic mitral regurgitation?
Subanalysis of the Papillary Muscle Approximation trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2016.
Date of Publication: April 26, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The symmetry of mitral valve tethering and regional left
ventricle wall dysfunction are reported to play a fundamental role in the
outcomes and long-term durability of surgical repair in ischemic mitral
regurgitation (IMR). We recently demonstrated in a randomized clinical
trial (the Papillary Muscle Approximation trial) the superiority of
papillary muscle approximation (PMA) in combination with standard
restrictive annuloplasty (RA) in severe IMR over annuloplasty alone in
terms of adverse left ventricular remodeling and mitral regurgitation (MR)
recurrence. This approach, however, failed to produce a survival advantage
and was still plagued by a high incidence of reoperation. We therefore
performed a subanalysis of the PMA trial on the basis of preoperative
parameters to elucidate the value of subvalvular surgery in certain
subcategories of patients with the aim of creating a decisional algorithm
on the best operative strategy. Methods: We performed a subanalysis of PMA
trial, evaluating 96 patients with severe IMR and eligible for myocardial
revascularization randomized to PMA + RA (n = 48) versus RA alone (n = 48)
in association with coronary artery bypass grafting. Endpoints included
left ventricular remodeling, MR recurrence, overall mortality,
reoperation, and a composite cardiac endpoint (cardiac death, stroke,
reintervention, hospitalization for heart failure, or New York Heart
Association class worsening). Stratification variables were preoperative
symmetry of mitral valve tethering and regional wall motion abnormality.
Results: PMA improved ventricular remodeling and recurrence of MR in both
preoperative symmetric and asymmetric tethering and in case of inferior
wall dyskinesia but did not produce an additional benefit in anterolateral
wall dysfunction. Conclusions: Preoperative symmetric and asymmetric
tethering and isolated inferior wall dyskinesia are an indication for
subvalvular apparatus surgery in IMR. Copyright &#xa9; 2016 The American
Association for Thoracic Surgery.

<69>
Accession Number
614029465
Author
Cajita M.I.; Denhaerynck K.; Dobbels F.; Berben L.; Russell C.L.; Davidson
P.M.; De Geest S.
Institution
(Cajita, Davidson) School of Nursing, Johns Hopkins University, Baltimore,
Maryland, USA
(Denhaerynck, Berben, De Geest) Institute of Nursing Science, Department
of Public Health, University of Basel, Basel, Switzerland
(Dobbels, De Geest) Academic Center for Nursing and Midwifery, Department
of Public Health and Primary Care, KU Leuven, Leuven, Belgium
(Russell) School of Nursing and Health Studies, University of
Missouri-Kansas City, Kansas City, Missouri, USA
Title
Health literacy in heart transplantation: Prevalence, correlates and
associations with health behaviors-Findings from the international BRIGHT
study.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2016. Date of
Publication: 2016.
Publisher
Elsevier USA
Abstract
Background: Health literacy (HL) is a major determinant of health
outcomes; however, there are few studies exploring the role of HL among
heart transplant recipients. The objectives of this study were to: (1)
explore and compare the prevalence of inadequate HL among heart transplant
recipients internationally; (2) determine the correlates of HL; and (3)
assess the relationship between HL and health-related behaviors. Methods:
A secondary analysis was conducted using data of the 1,365 adult patients
from the BRIGHT study, an international multicenter, cross-sectional study
that surveyed heart transplant recipients across 11 countries and 4
continents. Using the Subjective Health Literacy Screener, inadequate HL
was operationalized as being confident in filling out medical forms none/a
little/some of the time (HL score of 0 to 2). Correlates of HL were
determined using backward stepwise logistic regression. The relationship
between HL and the health-related behaviors were examined using
hierarchical logistic regression. Results: Overall, 33.1% of the heart
transplant recipients had inadequate HL. Lower education level (adjusted
odds ratio [AOR] 0.24, p < 0.001), unemployment (AOR 0.69, p = 0.012) and
country (residing in Brazil, AOR 0.25, p < 0.001) were shown to be
associated with inadequate HL. Heart transplant recipients with adequate
HL had higher odds of engaging in sufficient physical activity (AOR 1.6, p
= 0.016). HL was not significantly associated with the other health
behaviors. Conclusions: Clinicians should recognize that almost one third
of heart transplant participants have inadequate health literacy.
Furthermore, they should adopt communication strategies that could
mitigate the potential negative impact of inadequate HL. Copyright &#xa9;
2016 International Society for Heart and Lung Transplantation.

<70>
Accession Number
614021021
Author
Cortez D.; Barham W.; Ruckdeschel E.; Sharma N.; McCanta A.C.; von
Alvensleben J.; Sauer W.H.; Collins K.K.; Kay J.; Patel S.; Nguyen D.T.
Institution
(Cortez, von Alvensleben, Collins, Kay, Patel) Department of Cardiology,
Children's Hospital of Colorado, Aurora, Colorado
(Cortez, von Alvensleben, Sauer, Collins, Kay, Patel, Nguyen) Department
of Cardiology, University of Colorado, Aurora, Colorado
(Cortez, Barham) Division of Cardiovascular Sciences, Lund University,
Lund, Sweden
(Cortez, Sharma) Department of Electrophysiology, Penn State Milton S.
Hershey Medical Center, Hershey, Pennsylvania
(Ruckdeschel) Department of Adult and Pediatric Cardiology, Children's
Hospital of Philadelphia, Philadelphia, Pennsylvania
(McCanta) Department of Cardiology, CHOC Children's, Orange, California
Title
Noninvasive Predictors of Ventricular Arrhythmias in Patients With
Tetralogy of Fallot Undergoing Pulmonary Valve Replacement.
Source
JACC: Clinical Electrophysiology. (no pagination), 2016. Date of
Publication: June 06, 2016.
Publisher
Elsevier Inc
Abstract
Objectives: This study sought to test the hypothesis that a
vectorcardiographic parameter, the QRS vector magnitude (QRSVm), can risk
stratify those patients at risk for sustained spontaneous ventricular
arrhythmias (VAs) or ventricular arrhythmia inducibility (VAI) in a large
cohort of patients with tetralogy of Fallot (TOF). Background: Patients
with TOF have an increased risk of VAs, but predicting those at risk can
often be challenging. Methods: Blinded retrospective analyses of 177 TOF
patients undergoing pulmonary valve replacement (PVR) between 1997 and
2015 were performed. VAI was evaluated by programmed electrical
stimulation in 48 patients. QRS intervals and QRSVm voltage measurements
were assessed from resting 12-lead electrocardiograms, and risk of VA was
determined. Clinical characteristics, including imaging and cardiac
catheterizations, were used for other modality comparisons. Results:
Sustained spontaneous VA occurred in 12 patients and inducible VA in 18
patients. Age and QRSVm were significant univariate predictors of VA.
QRSVm was the only independent predictor of VAI (p < 0.001). Using a root
mean square QRS value of 1.24 mV, the positive and negative predictive
values were 47.9% and 97.8%, respectively, for spontaneous sustained VA.
For VAI, using a QRSVm cutoff of 1.31 mV, positive and negative predictive
values were 63.0% and 95.3%, respectively. Conclusions: In TOF patients
undergoing PVR, older age was associated with increased spontaneous VA
risk. Lower QRSVm predicted spontaneous VA or VAI risk with high negative
predictive values. QRSVm is the only independent predictor of VAI. These
clinical features may help further risk stratify TOF patients requiring
therapies to prevent sudden death. Copyright &#xa9; 2016 American College
of Cardiology Foundation.

<71>
Accession Number
614024062
Author
Brooks M.; Ellis C.; Gamble G.; Devlin G.; Elliott J.; Hammett C.; Chew
D.; French J.; Briffa T.; Redfern J.; Rankin J.; Hyun K.; D'Souza M.;
Brieger D.
Institution
(Brooks) Concord Medical School, The University of Sydney, Sydney, NSW,
Australia
(Ellis) Department of Cardiology, Auckland City Hospital, Auckland, NZ
(Gamble) Department of Medicine, University of Auckland, Auckland, NZ
(Devlin) Cardiology, Waikato Hospital, Waikato, NZ
(Elliott) Cardiology, Christchurch Hospital, Christchurch, NZ
(Hammett) Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld.,
Australia
(Chew) Cardiology, Department of Cardiovascular Medicine, Flinders
University, Adelaide, SA, Australia
(French) Coronary Care Unit, Liverpool Hospital, Sydney, NSW, Australia
(Briffa) Cardiovascular Research Group, School of Population Health,
University of Western Australia, Perth, WA, Australia
(Redfern) Cardiovascular Division, The George Institute of Global Health,
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
(Rankin) Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
(Hyun) The George Institute for Global Health, Sydney, NSW, Australia
(D'Souza) Concordance Registry, Concord Hospital, Sydney, NSW, Australia
(Brieger) Coronary Care and Coronary Intervention, Department of
Cardiology, Concord Hospital, Sydney, NSW, Australia
Title
A Comparison of Radial and Femoral Coronary Angiography in Patients From
SNAPSHOT ACS, a Prospective Acute Coronary Syndrome Audit in Australia and
New Zealand.
Source
Heart Lung and Circulation. (no pagination), 2016. Date of Publication:
March 24, 2016.
Publisher
Elsevier Ltd
Abstract
Background: There is wide variation in the use of radial over femoral
access for patients with ACS. This study evaluates the factors associated
with the selection of radial versus femoral angiography in Australia and
New Zealand and the effect of access site on clinical events in acute
coronary syndrome (ACS) patients. Methods: An analysis of the SNAPSHOT ACS
audit was conducted during May 2012 across 286 hospitals in Australia and
New Zealand. Data collected included baseline patient characteristics,
hospital site details, treatment received, clinical events in-hospital and
mortality at 18 months. Univariate and multivariable analyses were
performed. Results: Of the 1621 patients undergoing coronary angiography,
access was through the femoral artery in 1043 (63%), and the radial in 578
(36%) patients. Radial access dominated in New Zealand (241 out of 327,
73.7%), compared to Australia (337 out of 1293, 26.1%, p=<0.001), with
interstate variation (6% to 54%, p=<0.001). Independent predictors of
access site included country of admission (Odds of radial, Aus v NZ OR
0.14, 95% CI 0.08-0.24, p=<0.0001), prior CABG surgery (OR 0.16, 95% CI
0.09-0.31, p=<0.0001), high GRACE score (90^th decile) (OR 0.44,
95% CI 0.21-0.91, p=0.026) and admission to a centre with high annual PCI
volume (>209 cases per year) (OR 1.86, 95% CI 1.06-3.26, p=0.03). After
adjustment, there was no difference in clinical events in-hospital or
mortality at 18 months. Conclusion: Coronary angiography in New Zealand
rather than Australia is the strongest predictor of radial access in ACS
patients. There was no difference in outcomes according to access site in
this population based cohort study. Copyright &#xa9; 2016.

<72>
Accession Number
614006996
Author
Mastropietro C.W.; Cashen K.; Grimaldi L.M.; Narayana Gowda K.M.; Piggott
K.D.; Wilhelm M.; Gradidge E.; Moser E.A.S.; Benneyworth B.D.; Costello
J.M.
Institution
(Mastropietro, Benneyworth) Department of Pediatrics, Division of Critical
Care, Indiana University School of Medicine, Riley Hospital for Children,
Indianapolis, IN
(Cashen) Division of Critical Care, Department of Pediatrics, Wayne State
University School of Medicine, Children's Hospital of Michigan, Detroit,
MI
(Grimaldi) Division of Cardiovascular Intensive Care, Phoenix Children's
Hospital, Department of Child Health, University of Arizona, College of
Medicine - Phoenix, Phoenix, AZ
(Narayana Gowda) Division of Pediatric Critical Care Medicine, Department
of Pediatrics, Cleveland Clinic, Cleveland, OH
(Piggott) The Heart Center at Arnold Palmer Hospital for Children,
Division of Pediatric Cardiac Intensive Care, Department of Pediatrics,
University of Central Florida College of Medicine, Orlando, FL
(Wilhelm) Division of Pediatric Cardiac Intensive Care, Department of
Pediatrics, University of Wisconsin, Madison, WI
(Gradidge) Division of Critical Care at Phoenix Children's Hospital,
Department of Child Health, University of Arizona, College of Medicine -
Phoenix, Phoenix, AZ
(Moser) Department of Biostatistics, Indiana University School of Medicine
and Richard M. Fairbanks School of Public Health, Indianapolis, IN
(Costello) Divisions of Cardiology and Critical Care Medicine, Department
of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago,
Northwestern University Feinberg School of Medicine, Chicago, IL
Title
Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis.
Source
Journal of Pediatrics. (no pagination), 2016. Date of Publication: August
18, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To describe the epidemiology of extubation failure and
identify risk factors for its occurrence in a multicenter population of
neonates undergoing surgery for congenital heart disease. Study design: We
conducted a prospective observational study of neonates <30 days of age
who underwent cardiac surgery at 7 centers within the US in 2015.
Extubation failure was defined as reintubation within 72 hours of the
first planned extubation. Risk factors were identified with the use of
multivariable logistic regression analysis and reported as OR with 95%
CIs. Multivariable logistic regression analysis was conducted to examine
the relationship between extubation failure and worse clinical outcome,
defined as hospital length of stay in the upper 25% or operative
mortality. Results: We enrolled 283 neonates, of whom 35 (12%) failed
their first extubation at a median time of 7.5 hours (range 1-70 hours).
In a multivariable model, use of uncuffed endotracheal tubes (OR 4.6; 95%
CI 1.8-11.6) and open sternotomy of 4 days or more (OR 4.8; 95% CI
1.3-17.1) were associated independently with extubation failure.
Accordingly, extubation failure was determined to be an independent risk
factor for worse clinical outcome (OR 5.1; 95% CI 2-13). Conclusions: In
this multicenter cohort of neonates who underwent surgery for congenital
heart disease, extubation failure occurred in 12% of cases and was
associated independently with worse clinical outcome. Use of uncuffed
endotracheal tubes and prolonged open sternotomy were identified as
independent and potentially modifiable risk factors for the occurrence of
this precarious complication. Copyright &#xa9; 2016 Elsevier Inc.