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<1>
Accession Number
610283134
Author
Al-Shawabkeh Z.; Al-Nawaesah K.; Anzeh R.A.; Al-Odwan H.; Al-Rawashdeh
W.A.B.; Altaani H.
Institution
(Al-Shawabkeh, Al-Nawaesah, Anzeh, Al-Rawashdeh, Altaani) Department of
Cardiac Surgery, Queen Alia Heart Institute, Amman, Jordan
(Al-Odwan) Department of Cardiac Anaesthesia, Queen Alia Heart Institute,
Amman, Jordan
Title
Use of short-term steroids in the prophylaxis of atrial fibrillation after
cardiac surgery.
Source
Journal of the Saudi Heart Association. 29 (1) (pp 23-29), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier B.V.
Abstract
Objectives To assess the effectiveness of corticosteroids in the
prophylaxis of postoperative atrial fibrillation (AF) in patients
undergoing elective coronary artery bypass grafting or valvular heart
surgery in terms of reducing its incidence and decreasing the length of
hospital stay. Methods This prospective double blinded randomized study
was conducted at Queen Alia Heart Institute (Amman, Jordan) from June 2014
to June 2015 on 340 patients who underwent their first on-pump elective
coronary artery bypass grafting (CABG) alone or combined with valvular
surgery. Inclusion criteria consisted of elective first time CABG or
combined with valvular surgery, use of beta-adrenergic blockade, and
normal sinus rhythm. Exclusion criteria included a history of heart block,
previous episodes of AF or flutter, uncontrolled diabetes mellitus,
history of peptic ulcer disease, systemic bacterial or mycotic infection,
permanent pacemaker, and any documented or suspected supraventricular or
ventricular arrhythmias. Patients were randomized into two equal groups (n
= 170 each), then each group was subdivided into patients who underwent
CABG alone (n = 120), and patients underwent valvular heart surgery with
or without CABG (n = 50). In the treatment group, patients were given 1 g
of methylprednisolone before cardiopulmonary bypass then 100 mg of
hydrocortisone every 8 hours for the first 3 days postoperatively. The
primary endpoint was the overall occurrence of postoperative AF. Results
AF developed in 21.1% (36 patients) in the treatment group in contrast to
38.2% (65 patients) in the control group (p < 0.05). In the subdivided
groups (CABG only), approximately 20% (24 patients) developed AF in the
treatment group in contrast to 35% (42 patients) in the control group (p <
0.05). In the other group, (CABG + VALVE) 24% (12 patients) developed AF
compared with 46% (23 patients) in the control group (p < 0.05). The
length of hospital stay was 6.02 +/- 11.23 days in the treatment group
while it was 5.98 +/- 1.86 days in the control group, which was found to
be statistically nonsignificant. No statistical significant difference in
the rate of postoperative complications including mediastinitis as well
superficial wound infections was observed between the two groups.
Conclusion Prophylactic short-term use of steroids both intraoperatively
and postoperatively proved to be safe and effective in reducing the
incidence of postoperative AF in patients undergoing CABG alone or
combined with valve surgery. Copyright &#xa9; 2016 King Saud University

<2>
Accession Number
611451917
Author
Herrington W.G.; Emberson J.; Mihaylova B.; Blackwell L.; Reith C.; Solbu
M.D.; Mark P.B.; Fellstrom B.; Jardine A.G.; Wanner C.; Holdaas H.;
Fulcher J.; Haynes R.; Landray M.J.; Keech A.; Simes J.; Collins R.;
Baigent C.
Title
Impact of renal function on the effects of LDL cholesterol lowering with
statin-based regimens: a meta-analysis of individual participant data from
28 randomised trials.
Source
The Lancet Diabetes and Endocrinology. 4 (10) (pp 829-839), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Statin therapy is effective for the prevention of coronary
heart disease and stroke in patients with mild-to-moderate chronic kidney
disease, but its effects in individuals with more advanced disease,
particularly those undergoing dialysis, are uncertain. Methods We did a
meta-analysis of individual participant data from 28 trials (n=183 419),
examining effects of statin-based therapy on major vascular events (major
coronary event [non-fatal myocardial infarction or coronary death],
stroke, or coronary revascularisation) and cause-specific mortality.
Participants were subdivided into categories of estimated glomerular
filtration rate (eGFR) at baseline. Treatment effects were estimated with
rate ratio (RR) per mmol/L reduction in LDL cholesterol. Findings Overall,
statin-based therapy reduced the risk of a first major vascular event by
21% (RR 0.79, 95% CI 0.77-0.81; p<0.0001) per mmol/L reduction in LDL
cholesterol. Smaller relative effects on major vascular events were
observed as eGFR declined (p=0.008 for trend; RR 0.78, 99% CI 0.75-0.82
for eGFR >60 mL/min per 1.73 m²; 0.76, 0.70-0.81 for eGFR 45 to
<60 mL/min per 1.73 m²; 0.85, 0.75-0.96 for eGFR 30 to <45
mL/min per 1.73 m²; 0.85, 0.71-1.02 for eGFR <30 mL/min per
1.73 m²and not on dialysis; and 0.94, 0.79-1.11 for patients on
dialysis). Analogous trends by baseline renal function were seen for major
coronary events (p=0.01 for trend) and vascular mortality (p=0.03 for
trend), but there was no significant trend for coronary revascularisation
(p=0.90). Reducing LDL cholesterol with statin-based therapy had no effect
on non-vascular mortality, irrespective of eGFR. Interpretation Even after
allowing for the smaller reductions in LDL cholesterol achieved by
patients with more advanced chronic kidney disease, and for differences in
outcome definitions between dialysis trials, the relative reductions in
major vascular events observed with statin-based treatment became smaller
as eGFR declined, with little evidence of benefit in patients on dialysis.
In patients with chronic kidney disease, statin-based regimens should be
chosen to maximise the absolute reduction in LDL cholesterol to achieve
the largest treatment benefits. Funding UK Medical Research Council,
British Heart Foundation, Cancer Research UK, European Community Biomed
Programme, Australian National Health and Medical Research Council,
Australian National Heart Foundation. Copyright &#xa9; 2016 The Author(s).
Published by Elsevier Ltd. This is an Open Access article under the CC BY
license

<3>
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.

<4>
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.

<5>
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.

<6>
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

<7>
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,
United States
(Gamble) Department of Medicine, University of Auckland, Auckland, NZ,
United States
(Devlin) Cardiology, Waikato Hospital, Waikato, NZ, United States
(Elliott) Cardiology, Christchurch Hospital, Christchurch, NZ, United
States
(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. 26 (3) (pp 258-267), 2017. Date of
Publication: 01 Mar 2017.
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

<8>
Accession Number
609137589
Author
Hosten T.; Kus A.; Gumus E.; Yavuz S.; Irkil S.; Solak M.
Institution
(Hosten, Kus, Gumus, Yavuz, Solak) Department of Anesthesiology and
Reanimation, Kocaeli University of Medical Faculty, Umuttepe, Kocaeli,
Turkey
(Irkil) Department of Cardiovascular Surgery, Kocaeli University,
Umuttepe, Kocaeli, Turkey
Title
Comparison of intraoperative volume and pressure-controlled ventilation
modes in patients who undergo open heart surgery.
Source
Journal of Clinical Monitoring and Computing. 31 (1) (pp 75-84), 2017.
Date of Publication: 01 Feb 2017.
Publisher
Springer Netherlands
Abstract
Respiratory problems occur more frequently in patients who undergo open
heart surgery. Intraoperative and postoperative ventilation strategies can
prevent these complications and reduce mortality. We hypothesized that PCV
would have better effects on gas exchange, lung mechanics and hemodynamics
compared to VCV in CABG surgery. Our primary outcome was to compare the
PaO<inf>2</inf>/FiO<inf>2</inf> ratio. Patients were randomized into two
groups, (VCV, PCV) consisting of 30 individuals each. Two patients were
excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min
fresh air gas flow was set at 3L/min in all patients. In the VCV group TV
was set at 8 mL/kg of the predicted body weight. In the PCV group, peak
inspiratory pressure was adjusted to the same tidal volume with the VCV
group. PaO2/FiO2 was found to be higher with PCV at the end of the
surgery. Time to extubation and ICU length of stay was shorter with PCV.
Ppeak was similar in both groups. Pplateau was lower and Pmean was higher
at the and of the surgery with PCV compared to VCV. The hemodynamic
effects of both ventilation modes were found to be similar. PVC may be
preferable to VCV in patients who undergo open heart surgery. However, it
would be convenient if our findings are supported by similar studies.
Copyright &#xa9; 2016, Springer Science+Business Media Dordrecht.

<9>
Accession Number
612953391
Author
Howard-Quijano K.; Salem A.; Barkulis C.; Mazor E.; Scovotti J.C.; Ho
J.K.; Shemin R.J.; Grogan T.; Elashoff D.; Mahajan A.
Institution
(Howard-Quijano, Salem, Barkulis, Mazor, Scovotti, Ho, Mahajan) Department
of Anesthesiology and Perioperative Medicine, David Geffen School of
Medicine, University of California, Los Angeles, 757 Westwood Blvd, Los
Angeles, CA 90095, United States
(Shemin) Departments of Cardiothoracic Surgery, University of California,
Los Angeles, Los Angeles, CA, United States
(Grogan) Departments of Medicine Statistics Core, University of
California, Los Angeles, Los Angeles, CA, United States
(Elashoff) Departments of Biomathematics and Medicine, University of
California, Los Angeles, Los Angeles, CA, United States
Title
Preoperative three-dimensional strain imaging identifies reduction in left
ventricular function and predicts outcomes after cardiac surgery.
Source
Anesthesia and Analgesia. 124 (2) (pp 419-428), 2017. Date of Publication:
01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Echocardiography-based speckle-tracking strain imaging is an
emerging modality to assess left ventricular function. The aim of this
study was to investigate the change in left ventricular systolic function
after cardiac surgery with 3-dimensional (3D) speckle-tracking strain
imaging and to determine whether preoperative 3D strain is an independent
predictor of acute and long-term clinical outcomes after aortic valve,
mitral valve, and coronary artery bypass grafting operations. METHODS: In
total, 163 adult patients undergoing aortic valve, mitral valve, and
coronary artery bypass surgeries were enrolled prospectively and had
complete data sets. Demographic, operative, and outcome data were
collected. 3D transthoracic echocardiograms were preformed preoperatively
and on second to fourth postoperative day. Blinded off-line analysis was
performed for left ventricular 2-dimensional (2D) ejection fraction (EF
2D) and 3D ejection fraction (EF 3D) and global peak systolic area,
longitudinal, circumferential, and radial strain. RESULTS: 3D global
strain correlated well with EF 3D. Ventricular function as measured by
strain imaging decreased significantly after all types of cardiac surgery.
When preoperative EF 3D was used, receiver operating characteristic curves
identified reference values for 3D global strain corresponding to normal,
mildly reduced, and severely reduced ventricular function. Normal
ventricular function (EF 3D > 50%) corresponded to 3D global area strain
-25%, with area under curve = 0.86 (0.81-0.89). Patients with reduced
preoperative 3D global area strain had worse postoperative outcomes,
including length of intensive care unit stay (4 vs 3 days, P =.001), major
adverse events (27% vs 11%, P =.03), and decreased 1-year event-free
survival (69% vs 88%, P =.005). After we controlled for baseline
preoperative risk models including European System for Cardiac Operative
Risk Evaluation score and surgery type, preoperative strain was an
independent predictor of both short- and long-term outcomes, including
length of intensive care unit stay, postoperative inotrope score, and
1-year event-free survival. CONCLUSIONS: This study shows that cardiac
surgery was associated with an acute reduction in postoperative left
ventricular function, when evaluated with 3D strain imaging. In addition,
preoperative 3D strain was demonstrated to be an independent predictor of
acute and long-term clinical outcomes after cardiac surgery. The use of
noninvasive 3D transthoracic echocardiogram strain imaging before cardiac
surgery may provide added information to aid in perioperative risk
stratification and management for these high-risk patients. Copyright
&#xa9; 2016 International Anesthesia Research Society.

<10>
Accession Number
613748997
Author
Barnhart G.R.; Accola K.D.; Grossi E.A.; Woo Y.J.; Mumtaz M.A.; Sabik
J.F.; Slachman F.N.; Patel H.J.; Borger M.A.; Garrett H.E.; Rodriguez E.;
McCarthy P.M.; Ryan W.H.; Duhay F.G.; Mack M.J.; Chitwood W.R.
Institution
(Barnhart) Swedish Heart and Vascular Institute, Structural Heart Program,
Seattle, Wash, United States
(Accola) Florida Hospital Cardiovascular Institute, Florida Hospital
Orlando, Orlando, Fla, United States
(Grossi) Department of Cardiothoracic Surgery, New York University School
of Medicine, New York, NY, United States
(Woo) Department of Cardiothoracic Surgery, Stanford University, Palo
Alto, Calif, United States
(Mumtaz) Cardiovascular & Thoracic Surgery, Pinnacle Health, Harrisburg,
Pa, United States
(Sabik) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, Ohio, United States
(Slachman) Mercy Medical Group, Mercy General Hospital, Sacramento, Calif,
United States
(Patel) Cardiac Surgery Department, University of Michigan, Ann Arbor,
Mich, United States
(Borger) Department of Surgery, Columbia University Medical Center, New
York, NY, United States
(Garrett) Cardiovascular Surgery Clinic, Baptist Memorial Hospital,
Memphis, Tenn, United States
(Rodriguez) Saint Thomas Heart Program, Saint Thomas Heart Hospital,
Nashville, Tenn, United States
(McCarthy) Division of Cardiac Surgery, Northwestern Memorial Hospital,
Chicago, Ill, United States
(Ryan, Mack) Cardiac Surgery Specialists, Baylor Plano Heart Hospital,
Plano, Tex, United States
(Duhay) Edwards Lifesciences LLC, Irvine, Calif, United States
(Chitwood) Department of Cardiovascular Sciences, East Carolina
University, Greenville, NC, United States
Title
TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY
Valve System for Aortic Valve Replacement) US clinical trial: Performance
of a rapid deployment aortic valve.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (2) (pp 241-251.e2),
2017. Date of Publication: 01 Feb 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The TRANSFORM (Multicenter Experience With Rapid Deployment
Edwards INTUITY Valve System for Aortic Valve Replacement) trial
(NCT01700439) evaluated the performance of the INTUITY rapid deployment
aortic valve replacement (RDAVR) system in patients with severe aortic
stenosis. Methods TRANSFORM was a prospective, nonrandomized, multicenter
(n = 29), single-arm trial. INTUITY is comprised of a cloth-covered
balloon-expandable frame attached to a Carpentier-Edwards PERIMOUNT Magna
Ease aortic valve. Primary and effectiveness endpoints were evaluated at 1
year. Results Between 2012 and 2015, 839 patients underwent RDAVR. Mean
age was 73.5 +/- 8.3 years. Full sternotomy (FS) was used in 59% and
minimally invasive surgical incisions in 41%. Technical success rate was
95%. For isolated RDAVR, mean crossclamp and cardiopulmonary bypass times
for FS were 49.3 +/- 26.9 minutes and 69.2 +/- 34.7 minutes, respectively,
and for minimally invasive surgical 63.1 +/- 25.4 minutes and 84.6 +/-
33.5 minutes, respectively. These times were favorable compared with
Society of Thoracic Surgeons database comparators for FS: 76.3 minutes and
104.2 minutes, respectively, and for minimally invasive surgical, 82.9
minutes and 111.4 minutes, respectively (P < .001). At 30 days, all-cause
mortality was 0.8%; valve explant, 0.1%; thromboembolism, 3.5%; and major
bleeding, 1.3%. In patients with isolated aortic valve replacement, the
rate of permanent pacemaker implantation was 11.9%. At 1 year, mean
effective orifice area was 1.7 cm²; mean gradient, 10.3 mm Hg;
and moderate and severe paravalvular leak, 1.2% and 0.4%, respectively.
Conclusions INTUITY RDAVR performed effectively in this North American
trial. It may lead to a relative reduction in aortic crossclamp time and
cardiopulmonary bypass time and has excellent hemodynamic performance.
Pacemaker implantation rate observed was somewhat greater than European
trials and requires further investigation. Copyright &#xa9; 2016 The
American Association for Thoracic Surgery

<11>
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. 153 (2) (pp 286-295.e2),
2017. Date of Publication: 01 Feb 2017.
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

<12>
Accession Number
613216203
Author
Burrage M.; Moore P.; Cole C.; Cox S.; Lo W.C.; Rafter A.; Garlick B.;
Garrahy P.; Mundy J.; Camuglia A.
Institution
(Burrage, Moore, Cole, Cox, Lo, Garrahy, Mundy, Camuglia) Department of
Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
(Burrage, Moore, Cole, Cox, Lo, Rafter, Garlick, Garrahy, Mundy, Camuglia)
University of Queensland, Brisbane, QLD, Australia
(Cox, Rafter, Garlick, Camuglia) The Wesley Hospital, Brisbane, QLD,
Australia
Title
Transcatheter Aortic Valve Replacement is Associated with Comparable
Clinical Outcomes to Open Aortic Valve Surgery but with a Reduced Length
of In-Patient Hospital Stay: A Systematic Review and Meta-Analysis of
Randomised Trials.
Source
Heart Lung and Circulation. 26 (3) (pp 285-295), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Aortic valve replacement is indicated in patients with severe
symptomatic aortic stenosis (AS). Transcatheter aortic valve replacement
(TAVR) has evolved as a potential strategy in a growing proportion of
patients in preference to surgical aortic valve replacement (SAVR). This
meta-analysis aims to assess the differential outcomes of TAVR and SAVR in
patients enrolled in published randomised controlled trials (RCTs).
Methods A systematic literature search of Cochrane Library, EMBASE, OVID,
and PubMed MEDLINE was performed. Randomised controlled trials of patients
with severe AS undergoing TAVR compared with SAVR were included. Clinical
outcomes and procedural complications were assessed. Results Five RCTs
with a total of 3,828 patients (1,928 TAVR and 1,900 SAVR) were analysed.
There was no statistically significant difference in combined rates of
all-cause mortality and stroke at 30-days for TAVR vs SAVR (6.3% vs 7.5%;
OR 0.83; 95% CI: 0.64-1.08; P = 0.17) or at 12 months (17.2% vs 19.2%; OR
0.87; 95% CI: 0.73-1.03; P = 0.29). No statistically significant
difference was seen for death or stroke separately at any time point
although a numerical trend in favour of TAVR for both was recorded. Length
of in-patient stay was significantly less with TAVR vs SAVR (9.6 +/- 7.7
days vs 12.2 +/- 8.8 days; OR -2.94; 95% CI: -4.64 to -1.24; P = 0.0007).
Major vascular complications were more frequent in patients undergoing
TAVR vs SAVR (8.2% vs. 4.0%; OR 2.15; 95% CI: 1.62-2.86; P <0.00001) but
major bleeding was more common among SAVR patients (20.5% vs 44.2%; OR
0.34; 95% CI: 0.22-0.52; P = <0.00001). Conclusions Transcatheter aortic
valve replacement and SAVR are associated with overall similar rates of
death and stroke among patients in intermediate to high-risk cohorts but
with reduced length of in-patient hospital stay. Copyright &#xa9; 2016

<13>
Accession Number
613193506
Author
Barba-Navarro R.; Tapia-Silva M.; Garza-Garcia C.; Lopez-Giacoman S.;
Melgoza-Toral I.; Vazquez-Rangel A.; Bazua-Valenti S.; Bobadilla N.;
Wasung de Lay M.; Baranda F.; Chawla L.S.; Gamba G.; Madero M.
Institution
(Barba-Navarro, Tapia-Silva, Garza-Garcia, Lopez-Giacoman, Melgoza-Toral,
Vazquez-Rangel, Wasung de Lay, Baranda, Madero) Departamento de
Nefrologia, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City,
Mexico
(Bazua-Valenti, Bobadilla, Gamba) Departamento de Nefrologia y Metabolismo
Mineral, Instituto Nacional de Ciencias Medicas y Nutricion Salvador
Zubiran, Mexico City, Mexico
(Chawla) Division of Intensive Care Medicine and Nephrology, Department of
Medicine, Veterans Affairs Medical Center, Washington, DC, United States
(Bazua-Valenti, Bobadilla, Gamba) Molecular Physiology Unit, Instituto de
Investigaciones Biomedicas, Universidad Nacional Autonoma de Mexico,
Mexico City, Mexico
Title
The Effect of Spironolactone on Acute Kidney Injury After Cardiac Surgery:
A Randomized, Placebo-Controlled Trial.
Source
American Journal of Kidney Diseases. 69 (2) (pp 192-199), 2017. Date of
Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Background Cardiac surgery-related acute kidney injury (AKI) is a common
postoperative complication that greatly increases morbidity and mortality.
There are currently no effective interventions to prevent AKI associated
with cardiac surgery. Experimental data have shown that administration of
the mineralocorticoid receptor blocker spironolactone prevents renal
injury induced by ischemia-reperfusion in rats. The objective of this
study was to test whether short-term perioperative administration of oral
spironolactone could reduce the incidence of AKI in cardiac surgical
patients. Study Design Randomized, double-blinded, placebo-controlled
trial. Setting & Participants Data were collected from April 2014 through
July 2015 at the National Heart Institute in Mexico. 233 patients were
included; 115 and 118 received spironolactone or placebo, respectively.
Intervention Spironolactone or placebo once at a dose of 100 mg 12 to 24
hours before surgery and subsequently 3 further doses of 25 mg in
postoperative days 0, 1, and 2 were administered. Outcomes Patients were
followed up for 7 days or until discharge from the intensive care unit
(ICU). The primary end point was AKI incidence defined by KDIGO criteria.
Secondary end points included requirement of renal replacement therapy,
ICU length of stay, and ICU mortality. Data were analyzed according to the
intention-to-treat principle. Results Mean age was 53.2 +/- 15 years, mean
serum creatinine level was 0.9 +/- 0.2 mg/dL, median Thakar score for
estimation of AKI risk was 2 (IQR, 1-3), and 25% had diabetes. The
incidence of AKI was higher for the spironolactone group (43% vs 29%; P =
0.02). No significant differences were found for secondary end points.
Limitations Single center, AKI was mostly driven by AKI stage 1, planned
sample size was not achieved, and there was no
renin-angiotensin-aldosterone system washout period. Conclusions Our trial
demonstrated that spironolactone was not protective for AKI associated
with cardiac surgery and there may be a trend toward risk. Copyright
&#xa9; 2016 National Kidney Foundation, Inc.

<14>
Accession Number
611879803
Author
Puri R.; Byrne J.; Muller R.; Baumbach H.; Eltchaninoff H.; Redwood S.;
Cheema A.; Dubois C.; Ihlberg L.; Wijeysundera H.C.; Cerillo A.; Gotberg
M.; Klaaborg K.E.; Pelletier M.; Blanco-Mata R.; Edwards R.; Gandolfo C.;
Muir D.; Meucci F.; Sinning J.-M.; Stella P.; Veulemans V.; Virtanen M.;
Regueiro A.; Thoenes M.; Pibarot P.; Pelletier-Beaumont E.; Rodes-Cabau J.
Institution
(Puri, Regueiro, Pibarot, Pelletier-Beaumont, Rodes-Cabau) Quebec Heart
and Lung Institute, Laval University, Quebec City, QC, Canada
(Byrne) King's College Hospital, London, United Kingdom
(Muller) Helios Klinikum Siegburg, Siegburg, Germany
(Baumbach) Robert-Bosch-Krankenhaus, Stuttgart, Germany
(Eltchaninoff) Hopital Charles-Nicolle, Rouen, France
(Redwood) St. Thomas' Hospital, London, United Kingdom
(Cheema) St. Michael's Hospital, Toronto, ON, Canada
(Dubois) Universitaire Ziekenhuizen and Katholieke Universiteit Leuven,
Leuven, Belgium
(Ihlberg) Helsinki University Hospital, Helsinki, Finland
(Wijeysundera) Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Cerillo) G. Pasquinucci Hospital, Massa, Italy
(Gotberg) Skane University Hospital, Lund, Sweden
(Klaaborg) Aarhus University Hospital, Aarhus, Denmark
(Pelletier) New Brunswick Heart Centre, Saint John, NB, Canada
(Blanco-Mata) Hospital Universitario de Cruces, Baracaldo, Spain
(Edwards) Freeman Hospital, Newcastle Upon Tyne, United Kingdom
(Gandolfo) ARNAS Ospedale Civico, Palermo, Italy
(Muir) James Cook University Hospital, Middlesbrough, United Kingdom
(Meucci) Azienda Ospedaliero Universitaria Careggi Largo Brambilla,
Florence, Italy
(Sinning) University Hospital Bonn, Bonn, Germany
(Stella) University Medical Center Utrecht, Utrecht, Netherlands
(Veulemans) University Hospital Dusseldorf, Dusseldorf, Germany
(Virtanen) Tampere University Hospital, Tampere, Finland
(Thoenes) Edwards LifeSciences, Nyon, Switzerland
(Thoenes) Leman Research Institute, Switzerland
Title
Transcatheter aortic valve implantation in patients with small aortic
annuli using a 20 mm balloon-expanding valve.
Source
Heart. 103 (2) (pp 148-153), 2017. Date of Publication: 15 Jan 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background While transcatheter aortic valve implantation (TAVI) is
established for treating high-operative risk surgical aortic valve
replacement candidates, until recently the smallest transcatheter heart
valve (THV) measured 23 mm, posing greater risk for annular rupture and
THV failure in patients with aortic stenosis (AS) with small aortic annuli
(<20 mm). Objectives In the setting of a multicentre registry, we report
on the safety, efficacy and early clinical outcomes of the SAPIEN XT 20 mm
balloon-expanding THV. Results Among TAVI 55 recipients (n=30 for native
AS, n=25 for a valve-in-valve procedure (V-in-V)), median age and Society
of Thoracic Surgeons score were 85 (81 to 87) years and 7.8 (4.7 to
12.4)%, respectively. Mean and minimum annular diameters were 19+/-1 and
17+/-2 mm, respectively, in native patients with AS, and 17+/-1 mm
(internal diameter) in V-in-V recipients. Successful device implantation
rate was 96%, with no procedural-related death. Overall in-hospital-30-day
death, stroke and major bleeding rates were 5%, 2% and 9%, respectively.
In native AS TAVI recipients, mean transaortic gradient decreased from
54+/-20 to 12+/-5 mm Hg (p<0.001), and from 45+/-17 to 24+/-8 mm Hg
(p<0.001) in V-in-V recipients. Severe prosthesis-patient mismatch (PPM)
rates were 10% and 48% in native AS and V-in-V TAVI recipients,
respectively (p=0.03). Post-TAVI, the rate of moderate aortic
regurgitation was 7% and 0% in native AS and V-in-V TAVI recipients,
respectively. Conclusions TAVI with the 20 mm SAPIEN XT THV appears safe
and technically feasible, with acceptable short-term clinical outcomes and
low rates of severe PPM in those with native AS. Copyright &#xa9;
Published by the BMJ Publishing Group Limited.

<15>
Accession Number
613732051
Author
Kowalewski M.; Malvindi P.G.; Suwalski P.; Raffa G.M.; Pawliszak W.;
Perlinski D.; Kowalkowska M.E.; Kowalewski J.; Carrel T.; Anisimowicz L.
Institution
(Kowalewski, Pawliszak, Perlinski, Anisimowicz) Department of Cardiac
Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Department of Hygiene, Epidemiology and Ergonomics, Division
of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz,
Bydgoszcz, Poland
(Malvindi) University Hospital Southampton NHS Foundation Trust, Wessex
Cardiothoracic Centre, Southampton, United Kingdom
(Suwalski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of the Interior and Administration in Warsaw,
Warsaw, Poland
(Suwalski) Faculty of Health Science and Physical Education, Pulaski
University of Technology and Humanities, Radom, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology, and
Oncological Gynecology, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum, Nicolaus Copernicus University, Torun, Poland
(Carrel) Clinic for Cardiovascular Surgery, University Hospital and
University of Bern, Bern, Switzerland
Title
Clinical Safety and Effectiveness of Endoaortic as Compared to
Transthoracic Clamp for Small Thoracotomy Mitral Valve Surgery:
Meta-Analysis of Observational Studies.
Source
Annals of Thoracic Surgery. 103 (2) (pp 676-686), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier USA
Abstract
Controversies remain on the increased rate of neurological events after
small thoracotomy mitral valve surgery attributed to endoaortic balloon
occlusion (EABO). Systematic literature search of databases identified 17
studies enrolling 6,643 patients comparing safety and effectiveness of
EABO versus transthoracic clamp. In a meta-analysis, there was no
difference in occurrence of cerebrovascular events, all-cause mortality,
and kidney injury. EABO was associated with a significantly higher risk of
iatrogenic aortic dissection (0.93% versus 0.13%; risk ratio, 4.67; 95%
confidence interval, 1.62 to 13.49; p = 0.004) and a trend toward longer
operative times. The data is limited to observational studies. Copyright
&#xa9; 2017 The Society of Thoracic Surgeons

<16>
[Use Link to view the full text]
Accession Number
612933994
Author
Royse C.F.; Saager L.; Whitlock R.; Ou-Young J.; Royse A.; Vincent J.;
Devereaux P.J.; Kurz A.; Awais A.; Panjasawatwong K.; Sessler D.I.
Institution
(Royse, Ou-Young, Royse) Department of Surgery, University of Melbourne,
PO Box 2135, Melbourne, VIC 3050, Australia
(Royse) Department of Anaesthesia and Pain Management, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Saager, Royse, Kurz, Awais, Panjasawatwong, Sessler) Department of
Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland,
OH, United States
(Whitlock) Department of Surgery, United States
(Whitlock, Vincent, Devereaux) Population Health Research Institute,
Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
(Devereaux, Panjasawatwong) Department of Anesthesiology, Faculty of
Medicine, Chiang Mai University, Thailand
Title
Impact of Methylprednisolone on Postoperative Quality of Recovery and
Delirium in the Steroids in Cardiac Surgery Trial: A Randomized,
Double-blind, Placebo-controlled Substudy.
Source
Anesthesiology. 126 (2) (pp 223-233), 2017. Date of Publication: 01 Feb
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Inflammation after cardiopulmonary bypass may contribute to
postoperative delirium and cognitive dysfunction. The authors evaluated
the effect of high-dose methylprednisolone to suppress inflammation on the
incidence of delirium and postoperative quality of recovery after cardiac
surgery. Methods: Five hundred fifty-five adults from three hospitals
enrolled in the randomized, double-blind Steroids in Cardiac Surgery trial
were randomly allocated to placebo or 250 mg methylprednisolone at
induction and 250 mg methylprednisolone before cardiopulmonary bypass.
Each completed the Postoperative Quality of Recovery Scale before surgery
and on days 1, 2, and 3 and 1 and 6 months after surgery and the Confusion
Assessment Method scale for delirium on days 1, 2, and 3. Recovery was
defined as returning to preoperative values or improvement at each time
point. Results: Four hundred eighty-two participants for recovery and 498
participants for delirium were available for analysis. The quality of
recovery improved over time but without differences between groups in the
primary endpoint of overall recovery (odds ratio range over individual
time points for methylprednisolone, 0.39 to 1.45; 95% CI, 0.08-2.04 to
0.40-5.27; P = 0.943) or individual recovery domains (all P > 0.05). The
incidence of delirium was 10% (control) versus 8% (methylprednisolone; P =
0.357), with no differences in delirium subdomains (all P > 0.05). In
participants with normal (51%) and low baseline cognition (49%), there
were no significant differences favoring methylprednisolone in any domain
(all P > 0.05). Recovery was worse in patients with postoperative delirium
in the cognitive (P = 0.004) and physiologic (P < 0.001) domains.
Conclusions: High-dose intraoperative methylprednisolone neither reduces
delirium nor improves the quality of recovery in high-risk cardiac
surgical patients.

<17>
Accession Number
612123594
Author
Trikha R.; Kowey P.R.
Institution
(Trikha, Kowey) Lankenau Institute for Medical Research, Medical Office
Building East, 100 East Lancaster Avenue, Wynnewood, PA 19096, United
States
(Kowey) Jefferson Medical College, Philadelphia, PA, United States
Title
Practical Considerations for the Nonvitamin K Antagonist Oral
Anticoagulants.
Source
Cardiology (Switzerland). 136 (2) (pp 115-124), 2017. Date of Publication:
01 Jan 2017.
Publisher
S. Karger AG
Abstract
Objectives: Dabigatran, rivaroxaban, apixaban, and edoxaban are nonvitamin
K antagonist oral anticoagulants (NOACs) approved for stroke prevention in
patients with nonvalvular atrial fibrillation (NVAF). Phase-3 clinical
trials demonstrated NOACs were as effective as warfarin in the prevention
of stroke or systemic embolism and associated with decreased incidences of
intracranial bleeding. Additionally, NOACs provide quicker onset of
action, simpler dosing, more predictable pharmacokinetic profiles, and
decreased food and drug interactions compared with warfarin. Despite the
advantages of NOACs, the lack of knowledge may limit their use in clinical
practice. Methods: A search was performed on the terms 'atrial
fibrillation' and 'dabigatran', 'apixaban', 'edoxaban', or 'rivaroxaban'
to identify relevant papers; large randomized clinical trials,
meta-analyses, and treatment guideline recommendations were given
preference. Searches to identify registries, treatment guidelines, and
meta-analyses relevant to patient subgroups were also employed. Results:
Dosing recommendations, initiation of treatment, and applications in
patients who undergo NVAF procedures, have mechanical heart valves, or
experience other cardiovascular conditions such as myocardial infarction,
previous stroke, and valvular heart disease are summarized. The
NOAC-specific reversal approaches are also discussed. Conclusions: Several
important factors should be considered regarding the adequate use of
NOACs, especially in patients with renal impairment or cardiovascular
conditions other than NVAF. Copyright &#xa9; 2016 S. Karger AG, Basel.

<18>
Accession Number
613813542
Author
Yue D.; Song C.; Zhang B.; Liu Z.; Chai J.; Luo Y.; Wu H.
Institution
(Yue) Employee Health, Southwest Hospital, Third Military Medical
University, Chongqing, China
(Song) Nursing Department, Xinqiao Hospital, Third Military Medical
University, Chongqing, China
(Zhang) Department of Hospital Infection Control, Southwest Hospital,
Third Military Medical University, Chongqing, China
(Liu) The Clinical Laboratory of Hospital, Southwest Hospital, Third
Military Medical University, Chongqing, China
(Chai) Cholestatic Liver Diseases Center, Digestive Diseases Institute of
PLA, Southwest Hospital, Third Military Medical University, Chongqing,
China
(Luo) Medical Research Center, Southwest Hospital, Third Military Medical
University, Chongqing, China
(Wu) Bureau of Medical Administration, Southwest Hospital, Third Military
Medical University, Chongqing, China
Title
Hospital-wide comparison of health care-associated infection among 8
intensive care units: A retrospective analysis for 2010-2015.
Source
American Journal of Infection Control. 45 (1) (pp e7-e13), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Exploring the distribution of nosocomial pathogens among
different categories of intensive care units (ICUs) is critical to
improving the management of health care-associated infection (HAI).
Despite both single- and multicenter studies, the nature of the variations
of HAIs within various ICUs remains inadequately evaluated. Methods Data
on HAIs at our hospital during the period January 2010-December 2015 were
collected from 8 ICUs, namely, respiratory, cardiovascular, neurology,
neonatal, hematology, emergency, cardiothoracic surgery, and neurosurgery
ICUs, at a tertiary hospital. Results We observed a cumulative HAI
incidence of 15.6/1,000 patient-days among 6,254 cases of infection at the
hospital, as well as obvious interunit variations in HAI distribution.
Acinetobacter baumannii was the leading organism of infection in almost
every ICU, especially in emergency, neurosurgery, and neonatal ICUs. The
most common pathogens were Pseudomonas aeruginosa in the cardiothoracic
surgery, emergency, and neonatal ICUs; Klebsiella pneumoniae and
Escherichia coli in the neurosurgery, emergency, neonatal, and neurology
ICUs; and Candida albicans in both neurology and emergency ICUs.
Conclusions Our findings revealed that A baumannii and P aeruginosa were
the most common pathogens associated with invasive operations, whereas K
pneumoniae and E coli were the most common pathogens in the medical ICUs.
Copyright &#xa9; 2017 Association for Professionals in Infection Control
and Epidemiology, Inc.

<19>
Accession Number
613224245
Author
Vakil K.; Duval S.; Cogswell R.; Eckman P.; Levy W.C.; Anand I.; Dardas
T.; Adabag S.
Institution
(Vakil, Anand, Adabag) Cardiovascular Division, Veterans Affairs Medical
Center, Minneapolis, Minnesota, United States
(Vakil, Duval, Cogswell, Anand, Adabag) Cardiovascular Division,
University of Minnesota Medical School, Minneapolis, Minnesota, United
States
(Eckman) Division of Cardiology, Minneapolis Heart Institute, Minneapolis,
Minnesota, United States
(Levy, Dardas) Division of Cardiology, University of Washington, Seattle,
Washington, United States
Title
Impact of Implantable Cardioverter-Defibrillators on Waitlist Mortality
Among Patients Awaiting Heart Transplantation: An UNOS/OPTN Analysis.
Source
JACC: Clinical Electrophysiology. 3 (1) (pp 33-40), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Inc
Abstract
Objectives This study sought to assess the impact of implantable
cardioverter-defibrillators (ICDs) on waitlist mortality in patients
listed for heart transplantation (HT). Background The impact of ICDs on
preventing sudden cardiac death in patients awaiting HT has not been
studied in large multicenter cohorts. Furthermore, whether ICDs benefit
patients with a left ventricular assist device (LVAD) is unknown. Methods
Adults (age >18 years) listed for first-time HT in the United States
between January 1, 1999, and September 30, 2014, were retrospectively
identified from the United Network for Organ Sharing registry. The primary
predictor variable was the presence of an ICD at the time of listing.
Primary outcome variable was all-cause waitlist mortality. Results Data on
32,599 patients (mean age 53 +/- 12 years, 77% male, 70% Caucasian) were
analyzed. During median follow-up of 154 days, 3,638 patients (11%) died
on the waitlist (9% in ICD group vs. 15% in no-ICD group; p < 0.0001),
whereas 63% underwent HT. Having an ICD at listing was associated with an
adjusted 13% relative reduction in mortality (hazard ratio: 0.87; 95%
confidence interval: 0.80 to 0.94). In the subgroup of patients with LVAD
(n = 9,478), having an ICD was associated with an adjusted 19% relative
reduction in mortality (hazard ratio: 0.81; 95% confidence interval: 0.70
to 0.94). Conclusions ICD use was associated with improved survival on the
HT waitlist in patients with or without LVADs. These findings strengthen
the current guideline recommendations of using ICDs in nonhospitalized
patients awaiting HT and provide new insight into the effectiveness of
ICDs on survival in LVAD-supported patients. Copyright &#xa9; 2017
American College of Cardiology Foundation

<20>
Accession Number
614160534
Author
Magalhaes E.; Wanono R.; Smonig R.; Lermuzeaux M.; Lebut J.; Olivier A.;
Dupuis C.; Radjou A.; Mourvillier B.; Neuville M.; PiaDortho M.; Bouadma
L.; Rouvel-Tallec A.; Timsit J.-F.; Sonneville R.
Institution
(Magalhaes, Smonig, Lermuzeaux, Lebut, Olivier, Dupuis, Radjou,
Mourvillier, Neuville, Bouadma, Timsit, Sonneville) Department of
Intensive Care Medicine and Infectious Diseases, Hopital Bichat-Claude
Bernard-APHP, Paris, France
(Wanono, PiaDortho, Rouvel-Tallec) Physiology, Hopital Bichat-Claude
Bernard-AP-HP, Paris, France
Title
Prognostic value of early intermittent electroencephalography in patients
supported by venoarterial ECMO.
Source
Annals of Intensive Care. Conference: French Intensive Care Society,
International Congress - Reanimation 2017. France. Conference Start:
20170111. Conference End: 20170113. 7 (1 Supplement 1) (pp 162-163), 2017.
Date of Publication: January 2017.
Publisher
Springer Verlag
Abstract
Introduction Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is
increasingly used to treat refractory cardiogenic shock or cardiac arrest.
Acute brain injury (i.e. ischemic stroke, haemorrhage and/or failure to
awaken because of diffuse brain injury) may occur in up to 15% of patients
on VA-ECMO and is associated with increased mortality and poor functional
outcome in survivors. However, early indicators of neurological outcome
are lacking in this population. We aimed to assess the prognostic value of
early electroencephalography (EEG) alterations during VA-ECMO. Patients
and methods We conducted a prospective single-center study in the medical
ICU of a university hospital on consecutive patients cannulated to
VA-ECMO. A standardized clinical neurological evaluation including the
RASS score, the GCS score, the Full Outline of UnResponsiveness (FOUR)
score and brainstem reffexes was coupled to an intermittent EEG. EEG was
recorded as soon as possible within the frst 72 h after VA-ECMO
cannulation. EEG characteristics were analyzed by a neurophysiologist who
was blinded to the patient's condition. A severely altered EEG pattern was
defned as a predominant delta frequency, discontinuous, unreactive and/or
an isoelectric background. The primary endpoint was poor neurological
outcome, defned as the composite of death or acute brain injury on
neuroimaging within 28 days. Data are presented as median (interquartile
range) or number (percentage). False-positive rates (FPRs, corresponding
to 1-specifcity) of poor neurological outcome were calculated for each
signifcant predictor, using an exact binomial 95% confdence interval (CI).
Results Sixty-nine (age 58 (50-67) years) patients with a SOFA score of 14
(13-17) were included. Main indications for ECMO were: post cardiac
surgery (n = 25, 36%), terminal dilated cardiomyopathy (n = 12, 17%), and
acute myocardial infarction (n = 11, 16%). Cardiac arrest before ECMO
cannulation was noted in 20 (29%) patients. EEG was recorded 1 (1-2) days
after VA-ECMO cannulation and 62 (90%) patients were sedated at time of
EEG. At day 28, 46 (67%) had a poor outcome (n = 37 deaths and n = 9
patients alive with acute brain injury). In univariate analysis, a lower
RASS score (p = 0.003), a lower FOUR score (p = 0.001), a lower score on
the motor component of the Glasgow coma scale (p = 0.001), and a lack of
cough reffex (p = 0.033) at the time of EEG were signifcantly associated
with a poor outcome. A severely impaired EEG pattern or presence of a
discontinuous background activity were also associated with a poor outcome
(p = 0.015 and p = 0.002, respectively). Indicators of poor neurologic
outcome are presented in the Table 19. Among all parameters, a
discontinuous background activity was the only variable that constantly
predicted poor outcome (false-positive poor outcome prediction rate of 0%,
95% CI 0-15%). Conclusion Early intermittent EEG has a strong prognostic
value for sedated patients on VA-ECMO. Presence of a discontinuous EEG
background activity seems to be more accurate than clinical alterations to
predict a bad neurologic outcome at 28 days. [TABLE PRASENTED].

<21>
Accession Number
614161806
Author
Schafer U.; Deuschl F.; Schofer N.; Frerker C.; Reichart D.; Schirmer J.;
Schmidt T.; Kuck K.-H.; Kreidel F.; Mizote I.; Reichenspurner H.;
Blankenberg S.; Conradi L.
Institution
(Schafer) Universitaeres Herzzentrum Hamburg, Hamburg, Germany
(Deuschl) University Hospital Hamburg Eppendorf, Hamburg, Germany
(Schofer, Reichart, Mizote, Reichenspurner, Conradi) University Heart
Center Hamburg, Hamburg 20246, Germany
(Frerker, Schmidt, Kuck, Kreidel) Asklepiosklinikum St. Georg, Hamburg,
Germany
(Schirmer) HamburgGermany
(Blankenberg) Universitares Herzzentrum Hamburg, Hamburg, Germany
Title
Safety and efficacy of the percutaneous transaxillary access for
transcatheter aortic valve implantation using various transcatheter heart
valves in 100 consecutive patients.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B287), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter Aortic Valve Implantation (TAVI) is an
established treatment alternative for patients at high risk for
conventional aortic valve replacement. Nowadays, the transfemoral approach
is the most commonly used access for TAVI. Nevertheless, in a significant
number of patients the transfemoral access is not suitable due to
peripheral vascular disease. In these cases the transaxillar approach can
serve as an alternative implantation route. METHODS We analyzed the
outcome of 100 consecutive cases being implanted by a percutaneous
transaxillary approach at two different hospitals in Germany. Data were
retrospectively analyzed by means of procedural, hemodynamic and clinical
outcome. In addition, 1st versus 2nd generation devices were analyzed.
RESULTS Mean age was 78.2+/-2.1 years and the logEuroSCORE I was
23.9+/-3.4%. Device success was achieved in 95%. No patient experienced a
major and 11 patients a minor access site complication. In general, there
was a clear learning curve (see figure). There was one procedural death
(annular rupture) and one peri-procedural TIA. 23% of the patients were in
need for a new pacemaker. At discharge, mean effective orifice area was
1.94+/-0.16 cm² and the mean aortic gradient was 6.8+/-2.1
mmHg. Moderate aortic regurgitation/ paravalvular leakage was documented
in two patients. Mortality rates at 30 days and one year were 6% and
14.8%. Last but not least, 2nd generation devices showed a trend of
improved procedural outcomes. CONCLUSION The percutaneous transaxillary
access for TAVI is technically feasible and safe thereby yielding
excellent clinical results.

<22>
Accession Number
614161761
Author
Manoharan G.; Linke A.; Worthley S.; Mollmann H.; Holzhey D.M.; Walther T.
Institution
(Manoharan) Royal Victoria Hospital, Belfast, United Kingdom
(Linke) University of Leipzig Heart Center, Leipzig, Germany
(Worthley) Royal Adelaide Hospital, Adelaide, SA, Australia
(Mollmann) St Johannes Hospital, Dortmund, Germany
(Holzhey) Herzzentrum Leipzig, Leipzig, Germany
(Walther) Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany
Title
One year outcome of a multicenter clinical study evaluating a novel
self-expanding and resheathable transcatheter aortic valve system.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B17), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become
clinical routine for high risk patients with aortic stenosis. However,
limitations due to the lack of repositioning still exist for some TAVI
systems. We evaluated the multicenter outcomes of the self-expanding,
resheathable PorticoTM (St. Jude Medical) TAVI system at up to one year
follow-up, the final analysis point for the trial. METHODS Between March
2012 and September 2015, 222 patients were enrolled and 220 received the
18F and 19F Portico systems (23mm, 25mm, 27mm or 29mm valves) at 12 sites
in the United Kingdom, Germany, Netherlands, Denmark and Australia.
Adverse events were categorized by VARC I definitions and adjudicated by
an independent events committee. Echocardiography was evaluated by an
independent laboratory. RESULTS The PorticoTM TAVI system was successfully
implanted in 220 patients (74.0% Female; Mean age=83+/-4.6; STS
Score=5.8+/-3.3, Aortic valve area 0.7+/-0.2cm2). Resheathing and
repositioning was performed in 33% of the procedures and was successful in
all instances. Average depth of implant into LVOT was 6.1+/-2.2mm. At one
year mean aortic valve area increased from 0.7+/-0.2 at baseline to
1.9+/-0.5 cm2 at 30 days and 1.7+/-0.5 cm2 at one year, mean gradient
decreased from 43.3+/-14.6 at baseline to 8.3+/-3.8 at 30 days and
8.6+/-3.6 mmHg at one year. Paravalvular aortic regurgitation was absent/
trace in 46.8%, mild in 46.9%, moderate in 5.5% and severe in 0.8%,
respectively. NYHA functional status had significantly improved at one
year versus baseline (p<.0001). All-cause mortality was 3.6 % and 13.1% at
30 days and one year, respectively. Cardiovascular mortality was 3.6% and
9.0% at 30 days and one year respectively. Disabling stroke was observed
in 3.2% (30 days) and 5.4% (one year) of patients. Thirty patients (13.5%)
required new onset pacemaker implantation at 30 days with three additional
patients receiving a pacemaker through one year (14.9%). CONCLUSION The
self-expanding PorticoTM TAVI system allows for safe resheathing,
repositioning and optimization of the device position in elderly and high
risk patients. The functional and symptomatic outcomes appear to support
the efficacy and safety of the device at one year.

<23>
Accession Number
614161726
Author
Ansari M.; Garcia D.
Institution
(Ansari) Lenox Hill Heart And Vascular Institute, Wyoming, MI, United
States
(Garcia) University of Miami, Miami, LA, United States
Title
Should moderate to severe ischemic mitral regurgitation be repaired:
Meta-analysis of rct's.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B101-B102), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Functional mitral regurgitation repair has been well
established. Current clinical evidence for ischemicmitral regurgitation
repair is scarce despite currently available advanced therapies. We aimed
to evaluate the role of ischemic moderate mitral valve regurgitation (MVR)
repair in patients undergoing concomitant CABG surgery. METHODS Pub Med,
Cochrane and Embase were systematically searched up to June 2016 for all
RCT's that directly compared CABG + MVR to CABG alone for moderate to
severe ischemic mitral regurgitation. Primary outcomes included 30 days
mortality and long-term mortality. Secondary outcomes included stroke,
IABP requirement, NYHA class > 2, moderate to severe mitral regurgitation
and LVEF. We used Fixed or Random Effect analysis using the Cochrane
Handbook of Systematic Reviews and RevMan 5.2 for statistical analysis.
RESULTS Five RCT's provided a total of 598 patients, 302 in the CABG only
group and 296 in the CABG + MVR group. There was a trend towards less 30
days mortality in the CABG + MVR group (20% vs. 40%, p=0.1). There was a
significant less mortality at long-term follow up in the CABG + MVR group
(7.4% vs. 13%, p <0.05). Secondary outcomes analysis showed no difference
on stroke rates, NYHA class > 2 and LVEF. There was a trend towards less
IABP use in the CABG group (14% vs. 22%, p=0.1). There was significant
less moderate to severe MR in the CABG+MVR group (7.7% vs. 10%, p<0.01).
CONCLUSION Our analysis suggested that MVR at the time of CABG can lead to
better short and long-term survival given less residual moderate to severe
mitral regurgitation. The procedure might be associated with increased
mechanical support requirements. Further randomized studies. (Table
Presented).

<24>
Accession Number
614161725
Author
Giustino G.; Mehran R.; Veltkamp R.; Faggioni M.; Danias G.; Baber U.;
Dangas G.
Institution
(Giustino) Icahn School of Medicine, Mount Sinai Hospital, New York City,
NY, United States
(Mehran) Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai
School of Medicine, New York, NY, United States
(Veltkamp) Imperial College, London, United Kingdom
(Faggioni, Baber, Dangas) Mount Sinai Medical Center, New York, NY, United
States
(Danias) TEST, United States
Title
Neurologic outcomes with embolic protection devices in patients undergoing
transcatheter aortic valve replacement: A systematic review and
meta-analysis of randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B266-B267), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Cerebral embolization is a relatively frequent complication of
TAVR. Randomized controlled trials (RCTs) investigating the efficacy of
embolic protection devices during TAVR were relatively underpowered to
detect meaningful differences in imaging and clinical endpoints. METHODS
We performed a systematic review and study-level metaanalysis of RCTs that
tested the efficacy and safety of EP during TAVR. RCTs using any type of
EP and TAVR vascular access were included. Primary imaging efficacy
endpoints were total lesion volume (TLV; in mm³) and number of
new ischemic lesions. Primary clinical efficacy endpoints were any
deterioration in National Institute of Health Stroke Scale (NIHSS) and
Montreal Cognitive Assessment (MoCA) score at hospital discharge. Primary
analyses were performed with the intention-to-treat approach. RESULTS A
total of 4 RCTs (total n=252) have been included. Use of EP was associated
with lower TLV (Figure; standardized mean difference [SMD]: -0.65; 95%
confidence interval [CI]: -1.06 to -0.25; p=0.002) and lower number of new
ischemic lesions (Figure; SMD: -1.27; 95% CI: -2.45 to -0.09; p=0.03). EP
was associated with a trend to lower risk of deterioration in NIHSS at
discharge (RR: 0.55; 95% CI: 0.27 to 1.09; p=0.09) and higher MoCA score
(SMD: +0.40; 95% CI: +0.04 to +0.76; p=0.03). Risk of overt stroke and
all-cause mortality were non-significantly lower in the EP group.
CONCLUSION EP use seems to be associated with reduction of imaging markers
of cerebral infarction and early clinical neurologic effectiveness in
patients undergoing TAVR. (Figure Presented).

<25>
Accession Number
614161720
Author
Galassi A.; Boukhris M.; Belhadj Z.; Laaroussi L.; Ghanem I.; Tomasello
D.; Toma A.; Gaemperli O.; Luscher T.; Mashayekhi K.
Institution
(Galassi, Tomasello) Cannizzaro Hospital, Catania, Italy
(Boukhris) Abderrahmen Mami Hospital, Ben Arous, Tunisia
(Belhadj) Abderrahmen Mami Hospital, Ariana, Tunisia
(Laaroussi) Silesian. Center for Heart Diseases, Catania, Italy
(Ghanem) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Catania, Italy
(Toma) University Freiburg-Bad Krozingen, Staufen, Germany
(Gaemperli) University Hospital Zurich, Zurich, Switzerland
(Luscher) CardiologyUniversity Heart Center, Zurich, Switzerland
(Mashayekhi) University Heartcenter Bad Krozingen, Bad Krozingen, Germany
Title
Percutaneous coronary intervention of chronic total occlusions in patients
with low left ventricular ejection fraction.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B121-B122), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND The prognostic value of left ventricular ejection fraction
(LVEF) is well established in patients with coronary artery disease. Data
regarding patients with low EF affected by chronic total occlusions (CTOs)
are scarcely reported. METHODS We performed a multicenter prospective
study enrolling 839 CTO patients attempted percutaneously between January
2013 and December 2015. Patients were subdivided into 3 groups according
to LVEF : group 1 (LVEF>50%), group 2 (LVEF 35-50%) and group 3
(LVEF<35%). Baseline clinical and angiographic characteristics, procedural
details, success rate and in-hospital outcome were compared between
groups. J-CTO score was used to assess CTO lesion complexity. In CTO
patients with LVEF<35% successfully revascularized, clinical follow-up was
performed. Major adverse cardiac and cardiovascular events (MACCE) were
defined as the composite of cardiac death, myocardial infarction (MI) and
target vessel revascularization. Angiographic follow-up was performed
either systematically or driven by ischemia. RESULTS The mean age was
64.6+/-10.5 years and 87.7% were males. According to LVEF, patients were
subdivided as follows: group 1 (n=552 [65.8%]), group 2 (n=215 [25.6%])
and group 3 (n=72 [8.6%]). Group 3 patients were older, had more
comorbidies (diabetes, dyslipidemia, peripheral artery disease and chronic
kidney disease), and showed more often three-vessel disease (58.3% vs.
38.2%; p=0.007). As compared to group 2, group 3 patients were more often
diabetic with less prior PCI (23.6% vs. 33.7%; p=0.022). No difference in
J-CTO score was observed between the three groups. Similar success rates
were obtained in the three groups (93.5% vs. 94.4% vs. 91.7%,
respectively). Lower contrast load was used in group 3 in comparison with
group 1 and group 2 (295.6+/-159 ml vs. 369.9+/-213.9 ml [p=0.005] and vs.
349.1+/-197.7 ml [p=0.038]). The in-hospital outcome was similar between
groups, and no death, MI or emergency need for cardiac surgery was
observed in patients with LVEF<35%. Among patients with LVEF<35%
successfully revascularized, a mean followup period of 17.6+/-10.2 months
was performed. A significant improvement in LVEF (+11.5+/-7.3%; p<0.001)
was observed. At 2 years, MACCE free survival was 77.9%. Angiographic
follow-up was performed in 49 (74.2%) patients with LVEF <35%: target CTO
vessel restenosis was found in 4 patients (8.2%) (focal in all cases),
while no reocclusion was observed. CONCLUSION Our results showed that PCI
represents a safe and efficient management strategy in CTO patients with
low LVEF(<35%) able to ensure good immediate and long-term outcome.

<26>
Accession Number
614161718
Author
Turagam M.; Velagapudi P.; Agrawal H.; Mittal M.; Katta N.; Abbott J.D.;
Aggarwal K.
Institution
(Turagam) University of Missouri, Columbia, MD, United States
(Velagapudi) Brown University, Alpert School of Medicine, Columbia, MD,
United States
(Agrawal) Texas Tech University, EL Paso, TX, United States
(Mittal) Institute of Panvascular Medicine, Fudan University, Shanghai,
China
(Katta) University of Missouri, School of Medicine, Columbia, MD, United
States
(Abbott) Brown Medical School, Providence, RI, United States
(Aggarwal) ColumbiaMDUnited States
Title
Pacemaker implantation in transcatheter aortic valve replacement vs.
Sutureless surgical aortic valve replacement: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B101), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Several studies comparing transcatheter aortic valve
replacement (TAVR) with sutureless surgical aortic valve replacement
(SU-AVR) have reported varying results on post procedural complications
including permanent pacemaker (PPM) implantation in high risk aortic
stenosis (AS). We performed a meta-analysis including studies comparing
SU-AVR versus TAVR on post-procedural PPM implantation. METHODS A
comprehensive literature search comparing SU-AVR versus TAVR in high risk
AS patients was performed using Pubmed, Ebsco and google scholar
databases. PPM implantation rates between SU-AVR and TAVR were compared
using Mantel-Haenszel statistical method with random-effects model.
RESULTS Nine eligible studies [all prospective observational] consisting
of 1,358 patients (SU-AVR - 621 patients and TAVR - 737) were included.
TAVR patients were significantly older, had higher Euroscores, and higher
rates of previous cardiac surgeries compared to SU-AVR (p<0.05). There was
no significant difference in PPM implantation rates between SU-AVR and
TAVR (Figure). There was no difference in mortality between groups on
follow up. CONCLUSION In our meta-analysis there was no difference in
postprocedural PPM implantation or mortality between SU-AVR vs. TAVR.
(Figure Presented).

<27>
Accession Number
614161717
Author
Sinclair K.; Bamira D.; Girard E.; Szucs M.; Spilker R.; Elmariah S.;
Passeri J.; Inglessis I.
Institution
(Sinclair, Elmariah) Massachusetts General Hospital, Boston, MA, United
States
(Bamira) Sanford Medical Center, Brookline, MA, United States
(Girard) PrincetonNJUnited States
(Szucs) Siemens, Issaquah, WA, United States
(Spilker) Siemens Healthineers, Hoffman Estates, IL, United States
(Passeri) University of South Dakota, MA GRB 820, United States
(Inglessis) Massachusetts General Hospital, MA GRB 820, United States
Title
Feasibility of a Novel Echo/X-Ray fusion software to determine implant
angulation during transcatheter aortic valve replacement.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B203), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND The use of pre-procedural computed tomography (CT) is
considered the paradigm to determine a working C-arm angle during
transcatheter aortic valve replacement (TAVR). We evaluated whether C-arm
angulations derived from landmarks overlaid using a novel Echo/X-Ray
Fusion (EXF) prototype (Siemens Healthcare, Forchheim, Germany) were
clinically acceptable at a similar frequency to those derived using
pre-procedural CT. METHODS The EXF system requires parallel imaging using
transesophageal echocardiography (TEE) and fluoroscopy. On TEE, the aortic
valve leaflet hinge points were marked and a circle drawn to intersect all
3 points identifying the plane of the aortic valve annulus (Fig. 1A). The
volume was then rotated to determine an optimal perpendicular implant
angle using the landmarks as a guide (Fig. 1B). Angiography was performed
at the CT and/or EXF-derived angle (Fig. 1C). An experienced
interventional cardiologist was presented with modality-blinded (CT or EXF
derived) aortograms and asked to grade if the angle was clinically
acceptable for deployment. RESULTS Twelve patients at our center underwent
TAVR with Sapien S3 (n=7, Edwards, Irvine, CA) or Evolut R (n= 5,
Medtronic, Fridley, MN) using the EXF system. All 8 aortograms based on CT
angles were considered satisfactory to proceed with TAVR. Of the 12
EXF-based aortograms, 10 were considered satisfactory. Barnard's test
shows no significant difference at a cutoff of p=0.05. CONCLUSION
Preliminary data suggests that, when compared to CTderived deployment
angles, the EXF prototype presents a clinically acceptable alternative in
TAVR patients. (Figure presented).

<28>
Accession Number
614161716
Author
Sardar P.; Kundu A.; Chatterjee S.; Feldman D.; Owan T.; Nairooz R.;
Feldman T.; Abbott J.D.; Elmariah S.
Institution
(Sardar) University of Utah, Health Science Center, Salt Lake City, UT,
United States
(Kundu) Keimyung University, Dongsan Medical Center, New York, United
States
(Chatterjee) Mount Sinai St Lukes-Roosevelt Hospital, New York, United
States
(Feldman) New York- Presbyterian Cornell Hospital, New York, NY, United
States
(Owan) University of Utah, Salt Lake City, UT, United States
(Nairooz) UAMS, Little Rock, AR, United States
(Feldman) Evanston Hospital, Evanston, IL, United States
(Abbott) Brown Medical School, Providence, RI, United States
(Elmariah) Massachusetts General Hospital, Boston, MA, United States
Title
Transcatheter versus surgical aortic-valve replacement in
intermediate-risk patients: Evidence from a meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B305), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an established
treatment option in high-risk patients with severe aortic valve stenosis
(AS). We performed a meta-analysis to evaluate the efficacy and safety of
TAVR in comparison to surgical aortic valve replacement (SAVR) in
intermediate-risk patients. METHODS Databases were searched through April
30th, 2016 for studies that compared TAVR with SAVR for the treatment of
intermediate-risk patients with severe AS. We calculated summary risk
ratios (RRs) and 95% confidence intervals (CIs) with the random-effects
model. RESULTS The analysis included 4,601 patients from 7 studies (2
randomized and 5 observational). There was no significant difference in
allcause mortality between the two groups after mean follow up of 1.15
years [14.7% with TAVR vs. 15.4% with SAVR; RR 0.93; 95% CI 0.77-1.12].
TAVR resulted in lower rates of acute kidney injury [number needed to
treat (NNT)= 26], major bleeding [NNT=4] and new-onset atrial fibrillation
[NNT=6], but higher rates of major vascular complications [number needed
to harm (NNH)= 18], and moderate/severe aortic regurgitation [NNH=13]. The
rate of permanent pacemaker implantation was significantly higher with
TAVR in observational studies [RR 2.31; 95% CI 1.22- 2.81], but not in
RCTs [RR 1.21; 95% CI 0.93-1.56]. No significant difference in the rate of
stroke or myocardial infarction was observed. CONCLUSION Our analysis
showed that TAVR has similar clinical efficacy to SAVR in
intermediate-risk patients with severe AS, and can be a suitable
alternative to surgical valve replacement. (Figure Presented).

<29>
Accession Number
614161713
Author
Pibarot P.; Hahn R.; Weissman N.; Arsenault M.; Beaudoin J.; Bernier M.;
Dahou A.; Khalique O.; Asch F.; Toubal O.; Leipsic J.; Blanke P.; Zhang
F.; Parvataneni R.; Herrmann H.; Leon M.; Thourani V.; Kodali S.
Institution
(Pibarot, Bernier) Quebec Heart and Lung Institute, Quebec City, QC,
Canada
(Hahn) New York-Presbyterian Hospital, Columbia University Medical Center,
New York, NY, United States
(Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Arsenault, Beaudoin, Dahou, Toubal) Korea University Guro Hospital,
Vancouver, BC, Canada
(Khalique) Columbia University Medical Center, Vancouver, BC, Canada
(Asch) MedStar Health Research Institute, Washington Hospital Center,
Vancouver, BC, Canada
(Leipsic, Blanke) St. Paul's Hospital, Vancouver, BC, Canada
(Zhang, Parvataneni) CRF, New York, NY, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Leon, Kodali) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Thourani) Emory University Hospital Midtown, Atlanta, GA, United States
Title
Paravalvular regurgitation regression and impact on 1-year outcomes after
transcatheter aortic valve replacement with the SAPIEN 3 transcatheter
valve.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B16), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Most guidelines grade paravalvular regurgitation (PVR) in a
3-class scheme (i.e., mild, moderate and severe). Moderate/severe and even
mild PVR are associated with increased mortality following transcatheter
aortic valve replacement (TAVR). The SAPIEN 3 valve has been shown to have
less PVR compared to previous generations of SAPIEN valves. The objectives
of this study were: i) to examine the impact of PVR using a 5-class
grading scheme on 1-year mortality and heart failure re-hospitalization
and ii) to assess the change in PVR severity from 30 days to 1 year in a
large, multi-center registry of patients undergoing TAVR with the SAPIEN 3
transcatheter heart valve. METHODS Patients with severe, symptomatic
aortic stenosis (583 high surgical risk or inoperable and 1,078
intermediate risk) were enrolled in a multicenter, non-randomized registry
at 57 sites in the USA and Canada. PVR was assessed at 30 days and 1 year
according to a 5-class scheme: 0- None or Trace, 1- Mild (mild in 3-class
guidelines scheme), 2- mild-to-moderate (mild in 3-class scheme), 3-
moderate (moderate in 3-class scheme), 4- moderate-to-severe (moderate in
3- class scheme), and 5- severe. RESULTS 892 patients (55.9%) had
none-trace PVR, 519 (32.5%) mild, 131 (8.2%) mild-to-moderate, and 47
(3.4%) > moderate PVR at 30 days. At 1 year, 146 patients (9.3%) had died
and 203 (13.1%) had been rehospitalized. Only patients with > moderate PVR
had higher 1-year mortality (Hazard ratio [HR]: 2.42; p=0.005) and
composite of mortality/re-hospitalization (HR: 2.59, p<0.0001). After
adjustment for preoperative risk factors, > moderate PVR was independently
associated with increased risk of mortality (HR: 2.36, p=0.007) and
mortality/re-hospitalization (HR: 2.26, p=0.0004). In a paired comparison
including 1,218 patients, 71% of the patients with > moderate PVR at 30
days showed a reduction in PVR severity of at least one PVR class at 1
year; whereas only 1% of those with < moderate PVR at 30 days had a
worsening of PVR. CONCLUSION In this series of patients undergoing TAVR
with the SAPIEN 3, > moderate PVR was rare, but associated with increased
risk of death and heart failure re-hospitalization at 1 year. Even the
upper range of the mild class in the 3-class grading scheme (i.e., mildto-
moderate in the 5-class scheme) had no significant impact on shortterm
outcomes. The majority of the patients with > moderate PVR at 30 days
showed a decrease of PVR severity grade at 1 year.

<30>
Accession Number
614161701
Author
Meneguz-Moreno R.A.; Neto A.N.F.; Ramos A.; Siqueira D.; Le Bihan D.;
Barretto R.; Moreira A.; Abizaid A.; Sousa A.; Sousa J.E.
Institution
(Meneguz-Moreno) Dante Pazzanese Institute of Cardiology, Sao Paulo,
Brazil
(Neto, Ramos) Instituto Dante Pazzanese De Cardiologia, Sao Paulo, Brazil
(Siqueira, Moreira, Sousa) Instituto Dante Pazzanese of Cardiology, Sao
Paulo, Brazil
(Le Bihan) Fondazione Policlinico Gemelli, Rome, Italy
(Barretto) Medical Imaging Technologies, Siemens Healthcare, Sao Paulo,
Brazil
(Abizaid) Hospital do Coracao, Sao Paulo, Brazil
(Sousa) Uknown, Sao Paulo, Brazil
Title
Comparison of clinical profile and outcomes after transcatheter aortic
valve replacement in nonagenarians versus younger patients.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B305), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is the current
standard treatment for high-risk surgical and non-operable patients with
severe aortic stenosis, including those of advanced age. However, the
clinical profile and outcomes of nonagenarians undergoing TAVR have not
been thoroughly reported. METHODS We prospectively evaluated data from 279
patients with severe aortic stenosis undergoing TAVR between Jan-2009 and
Nov- 2015 at two centers conducted by the same Heart Team. Outcomes at
30-days and 1-year were compared between patients +/- 90 vs. < 90 years of
age following Valve Academic Research Consortium (VARC)-2 endpoints and
using cumulative incidence curves. RESULTS Among all patients analyzed, 30
(10.7%) were aged at least 90 years at the time of TAVR (mean age 91.8 +/-
2.0 years) and there were 249 younger patients (mean age 80.5 +/- 7.5
years). Nonagenarians had a higher STS score (10.7 +/- 13.8% vs. 8.6 +/-
4.0%, p = 0.002), a higher EuroSCORE II (25.5% +/- 10.3% vs. 20.9% +/-
12.2%, p=0.04) and the levels of glomerular filtration rate were lower
(38.5 +/- 21.1 mL.min vs. 58.3 +/- 12.6 mL.min, p=0.01). Furthermore, the
prevalence of diabetes mellitus-2 (42.9% vs. 38.1%, p=0.01), coronary
artery disease > 50% (60.0% vs. 58.2%, p=0.07) and previous coronary
artery by-pass graft (42.9% vs. 24.9%, p=0.002) was significantly higher
in these patients. In contrast, dyslipidemia (46.7% vs. 70.3%, p=0.009)
and hypertension (66.7% vs. 85.9%, p=0.06) were less prevalent in this
group. No differences were observed in rates of procedural success (96%
vs. 94%, p=0.320). The 30-day (13.3% vs. 9.2%, p=0.561) and 1- year
all-cause (16.6% vs. 12.8%, p=0.561) was not significantly higher among
patients > 90 years old. No differences in stroke rate, vascular or
hemorragic complications, aortic valve reintervention, heart failure
readmission or myocardial infarction were seen after 30 days or 1 year.
CONCLUSION In conclusion, performing TAVR in nonagenarians is feasible and
offers clinical benefit comparable to patients aged <90 years. TAVR
remains a suitable option for the treatment of severe symptomatic aortic
stenosis for very elderly patients regardless of their age.

<31>
Accession Number
614161677
Author
Tchetche D.; Denti P.; Juliard J.M.; Latib A.; Maisano F.
Institution
(Tchetche) Clinique Pasteur, Toulouse, France
(Denti) San Raffaele University Hospital, Opera (MI), Italy
(Juliard) Hospital Alvaro Cunqueiro, Milan, Italy
(Latib) Emo-gvm Centro Cuore Columbus, Milan, Italy
(Maisano) UniversitatsSpital Zurich, Zurich, Switzerland
Title
Innovative transcatheter tricuspid valve repair system. Initial outcomes
from the first in human multi-centre study.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B36), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a frequent finding in elderly
patients, due to annular dilatation and leaflet tethering as response to
right ventricular remodeling. It is common after mitral valve treatment in
rheumatic or ischemic mitral regurgitation, if left untreated at the time
of mitral surgery. Novel transcatheter therapies are emerging for the
treatment of significant TR such patients. METHODS The TriCinch system
(4Tech Cardio Ltd, Galway, Ireland) is a percutaneous device developed for
TV remodeling. It comprises of two components: 1) A transfemoral corkscrew
implant, to be placed in the anterior annulus of the TV, close to the
antero-posterior commissure (APC); 2) A self-expanding stent deployed in
the inferior vena cava (IVC). Once the corkscrew is implanted, the system
is tensioned by means of pulling and the applied remodeling is maintained
by deploying the stent -connected to the corkscrew- in the IVC. RESULTS
The first in human feasibility trial (PREVENT study) is actually ongoing
in several European sites and the experience is expanding with more than
12 procedures performed overall. Procedural refinements and patient
selection are currently improving, to target the proper TR population and
to consider tricuspid valve repair also in combination of other
percutaneous solutions (eg. mitral valve repair or left atrial appendage
occlusion) (Figure A). CONCLUSION The early reuslts of PREVENT study are
demonstrating the feasibility of percutaneous tricuspid valve treatment
with the TriCinch device, suggesting good clinical outcomes (case example
in Figure B, C) with encouraging QoL improvement. (Figure Presented).

<32>
Accession Number
614161676
Author
Anonymous
Title
28th Annual Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
The proceedings contain 838 papers. The topics discussed include: outcomes
of chronic total occlusion percutaneous coronary intervention according to
dissection/re-entry versus wire escalation techniques; specialist chronic
total occlusion (CTO) programmes and outcomes after CTO percutaneous
coronary interventions: an observational study of 5,496 patients from the
pan-London CTO cohort; LEADERS FREE OAC: biolimus A9 coated versus bare
metal stents in patients requiring oral anticoagulation: a pre-specified
subgroup analysis of the leaders free trial; thromboembolic event rate is
elevated with lower adherence to warfarin and NOACs; validation of Paris
risk scores in a large multi-ethnic PCI cohort: results from a large
single-center registry; temporal change of in-stent thrombus immediately
after percutaneous coronary intervention within 5 minutes using optical
coherence tomography; qualitative and quantitative evaluation of dynamic
changes in non-culprit coronary atherosclerotic lesion morphology by
optical coherence tomography; outcomes of transcatheter aortic valve
replacement without predilation of the aortic valve: insights from 1942
patients included in the source 3 registry; and prospective, multi-center
evaluation of the desolve novolimus-eluting bioresorbable coronary
scaffold: imaging outcomes and 4-year clinical and imaging results.

<33>
Accession Number
614161666
Author
Green P.; Russo M.; Arnold S.; Doshi D.; Pichard A.; Szeto W.; Makkar R.;
Babaliaros V.; Fearon W.; Svensson L.; Webb J.; Nazif T.; Zajarias A.;
Quader N.; Parvataneni R.; Kirtane A.; Cohen D.; Mack M.; Leon M.
Institution
(Green, Doshi, Nazif) Columbia University Medical Center, New York, NY,
United States
(Russo) RWJBarnabas Health, Green Village, NJ, United States
(Arnold) Saint Luke's Hospital, Kansas City, MO, United States
(Pichard) Washington Hospital Center, Washington, DC, United States
(Szeto) University of Pennsylvania Medical Center, Philadelphia, PA,
United States
(Makkar) Cedars-SinaiMedicalCenter, LosAngeles, CA, United States
(Babaliaros) Emory University, School of Medicine, Atlanta, GA, United
States
(Fearon) Stanford University Medical Center, Stanford, CA, United States
(Svensson) Clevel and Clinic Foundation, Cleveland, OH, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Zajarias) Barnes Jewish Hospital, St. Louis, MO, United States
(Quader) Sejong General Hospital, New York, NY, United States
(Parvataneni) CRF, New York, NY, United States
(Kirtane) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Mack) Heart Hospital Baylor Plano, Plano, TX, United States
(Leon) NewYork- Presbyterian Hospital, Columbia UniversityMedical Center,
NewYork, NY, United States
Title
Frailty in intermediate risk patients undergoing transcatheter or surgical
aortic valve replacement, cut points and relationship with outcomes: An
analysis of the placement of aortic transcatheter valves (PARTNER) 2
cohort a randomized trial.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B15), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Frailty is associated with adverse outcomes after transcatheter
(TAVR) and surgical aortic valve replacement (SAVR) in highrisk older
adults. The relationship between frailty and outcomes and optimal frailty
cut points in intermediate risk patients remains unknown. METHODS Frailty
was assessed at baseline in the Placement of Aortic Transcatheter Valves
(PARTNER) 2 cohort A randomized trial. Optimal cut-points for each
component of frailty were identified using receiver operating
characteristic (ROC) curves: gait speed <0.66 m/s, grip strength <12 kg
(female), <26 kg (male), dependent in any activity of daily living (ADL),
and serum albumin <3.8 g/dL. Abnormality in 2 or more frailty components
was considered frail. Multivariable cox proportional hazards models were
used to assess the relationship between frailty and death or disabling
stroke at 2 years. RESULTS Among 1998 participants (mean age 82+/-7, 45%
female, mean STS 6+/-2), 958 (48%) were frail as assessed by a composite
of gait speed, grip strength, ADL, and albumin. In multivariable models
following adjustment for STS score, treatment assignment (SAVR versus
TAVR) and important clinical and demographic characteristics, frailty
status was independently associated with death or disabling stroke at 2
years (HR 1.26, 95% CI 1.03-1.54). Frailty was associated with 2 year all
cause death: 20% vs. 15% (unadjusted HR 1.40, 95% CI 1.13-1.74, p=0.002).
Results were consistent after multivariable adjustment (HR 1.3, 95% CI
1.02-1.6, p=0.03). No interaction was identified between frailty and
treatment assignment upon clinical outcomes. CONCLUSION Empirically
derived cut points for frailty components in intermediate risk patients
demonstrated a high prevalence of frailty. Even in this lower risk
population, frailty is an important predictor of adverse events after TAVR
and SAVR. (Figure Presented).

<34>
Accession Number
614161652
Author
Amat-Santos I.; Cortes C.; Munoz A.; De Lezo J.S.; Nombela-Franco L.;
Gutierrez E.; Moreno R.; Serra V.; De La Torre Hernandez J.M.; Castrodeza
J.; Tobar J.; San Roman J.A.
Institution
(Amat-Santos) Institute of Heart Science, Valladolid, Spain
(Cortes) Hospital Clinico Universitario De Valladolid, Madrid, Spain
(Munoz) MalagaSpain
(De Lezo) Hospital Universitario Reina Sofia, Cordoba, Spain
(Nombela-Franco) Quebec CityQCCanada
(Gutierrez) Hospital Universitario Gregorio Maranon, Madrid, Spain
(Moreno) University Hospital La Paz, Madrid, Spain
(Serra) H. Vall d'Hebron, Sant Cugat Del Valles, Spain
(De La Torre Hernandez) Hospital Universitario Marques De Valdecilla,
Santander, Spain
(Castrodeza, Tobar, San Roman) Hospital Clinico Universitario De
Valladolid, Spain
Title
Transcatheter aortic valve replacement in patients with previous mitral
surgery-a multicentre study.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B304), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) in patients with
previous mitral prostheses (PMP) has been used despite the scarce data
concerning their outcomes. We aimed to compare acute and late outcomes of
patients undergoing TAVR according to the presence of PMP. METHODS All
patients with severe aortic stenosis who underwent TAVR in 10 centers were
prospectively collected, including all baseline, procedural and follow-up
outcomes. Also, a detailed search for the clinical and imaging
characteristics of patients with PMP within this population were
retrospectively searched, including type/size of prostheses, prosthetic
function, antithombotic regimes, and all relevant procedural aspects
related to the presence of PMP. RESULTS A total of 2491 patients receiving
TAVR were included. Mean age was 80 +/- 6 years and mean Logistic
EuroSCORE 17.3 +/- 8.1%. Of them, 73 patients (2.9%) had received either a
mechanical (63%) or a biological (27%) PMP, and 10% received a mitral ring
at a mean time of 9 +/- 4 years before the TAVR procedure. No differences
were found when compared to patients without PMP in terms of left
ventricular ejection fraction, NYHA class, valve type (self- vs.
balloon-expandable), or the approach. However, patients with PMP were
younger (78 +/- 7 vs. 81 +/- 5, p=0.03) and with higher Logistic EuroSCORE
(16.2 +/- 4.1 vs. 17.3 +/- 8.2, p=0.04). Also, the use of chronic oral
anticoagulation was higher in patients with PMP (64.4 vs. 16.7, p<0.001).
Concerning the procedure, those without PMP presented a higher rate of
procedural success (95.8 vs. 86.3%, p=0.001) due to lower rate of
procedural complications that included valve embolization (1 vs. 5.5 % in
those with PMP, P=0.007). Indeed, the presence of PMP was an independent
predictor of unsuccessful procedure according to VARC-2 criteria (HR=3.02,
95%CI=1.07-6.93, p=0.006). To remark, patients with PMP also had a higher
rate of in-hospital vascular complications (19.2 vs. 11.4%, p=0.042). At
discharge the rate of patients under triple antithrombotic regime was
higher (41.1 vs. 9.8%, p<0.001). No differences in the rate of inhospital
and follow-up mortality were found. CONCLUSION The rate of TAVR receptors
with PMP remains low. Despite their higher surgical risk, mortality rate
was similar at short- and mid-term but with lower procedural success and
higher rate of vascular complications, probably in relation with a more
aggressive antithrombotic regime. This suggests that careful procedural
planning and further research on optimal antithrombotics is still needed.

<35>
Accession Number
614161651
Author
Mack M.; Manian U.; Dieste M.; McLellan A.; Garg P.
Institution
(Mack) Heart Hospital Baylor Plano, London, ON, Canada
(Manian) 1st Dpt of Cardiology, Medical School, UOA, Canada
(Dieste) Centro Cardiologico Americano, Brazil
(McLellan) ICBA, United Arab Emirates
(Garg) Hospital Central Dr. Ignacio Morones Prieto, Mexico
Title
Use of a Novel Lead-based Arm-Board to Reduce Radiation Exposure to
Operators During Invasive Cardiac Procedures.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B345), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Cardiac catheterization is associated with significant
radiation exposure to the operator. Radiation safety employing the As Low
As Reasonably Achievable (ALARA) principle includes use of lead shielding
to reduce operator exposure. Furthermore, radial approach is now preferred
and may be associated with more radiation exposure compared with femoral
approach. We sought to evaluate whether use of a novel lead-based
arm-board will result in lower radiation exposure to the operator versus
usual practice. METHODS In this proof-of-concept pilot study we evaluated
radiation exposure to the primary operator in 72 patients undergoing
cardiac catheterization and/or percutaneous coronary intervention (PCI)
with or without the lead-based arm-board. Radiation was measured using a
personal dosimeter at the level of the chest and left arm. The primary
outcome was the radiation dose to operator at the chest and arm level,
external to worn lead. Secondary outcomes included radiation dose to the
patient, number of cine acquisitions and total fluoroscopy time. RESULTS
We analyzed radiation data to operator and patient during 72 procedures
(37 investigation; 35 control). The mean age of patients was 64 and most
were male (75%). The majority of procedures were by radial approach (82%)
and 40% had PCI. There were no significant differences in measured
baseline or procedural characteristics between the two groups. The
lead-based arm-board significantly reduced the radiation dose to operator
at the chest level (1.1 vs. 2.1 mrem, p=0.0015) with a trend towards
reduction at the arm level (2.6 vs. 4.7 mrem, p=0.06). There was no
significant difference in the patient dose (8841 vs. 6762, p=0.14).
CONCLUSION In this pilot study, radiation dose to primary operator was
significantly reduced with a lead-based arm-board. A larger, randomized
trial is underway to evaluate this further.

<36>
Accession Number
614161637
Author
Yzeiraj E.; Sievert H.; Nickenig G.; Latib A.; Hahn R.; Schofer J.
Institution
(Yzeiraj) Schofer Medizinisches Versorgungszentrum, Hamburg, Germany
(Sievert) CardioVascular Center Frankfurt CVC, Sankt Katharinen,
Frankfurt, Germany
(Nickenig) University of Bonn, Bonn, Germany
(Latib) Emo-gvm Centro Cuore Columbus, Milan, Italy
(Hahn) New York- Presbyterian Hospital, New York, NY, United States
(Schofer) Hamburg University Cardiovascular Center, Department for
percutaneous treatment of structural hea, Hamburg, Germany
Title
Early experience with the trialign system for transcatheter tricuspid
valve repair: A multicenter experience.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B35), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND There is increasing evidence that severe tricuspid
regurgitation (TR) is associated with poor prognosis. Transcatheter
tricuspid valve (TV) repair technologies are emerging as alternative
therapeutic options for high surgical risk patients. We aimed to show the
feasibility and efficacy of a transcatheter tricuspid annular repair.
METHODS Eight patients with severe TR underwent tricuspid valve repair
with Mitralign system (Mitralign, Massachusetts) as a compassionate- use
using trans-jugular venous access. Two pledgets were placed at the
antero-posterior and septo-posterior commissures and than cinched together
bicuspidizing the TV. RESULTS Mean age was 69+/-12 yrs and mean log
EuroScore 14+/-13%. Acute procedural success was achieved in all patients
with significant improvement in valvular dimensions and regurgitation. The
average reduction of vena contracta (VC) was -40.5% and of the effective
regurgitant orifice area (EROA) -52%. TV annular area was also reduced,
average -27% (Figure). CONCLUSION Transcatheter TV repair with Mitralign
system is feasible, safe, and shows promising results, which have to be
confirmed by a larger study. (Figure Presented).

<37>
Accession Number
614161609
Author
Al-Bawardy R.; Gonzalez M.; Munoz Mendoza J.; Alvarez M.; Pu D.; Shah A.;
Fard A.; Mohananey D.; Ramakrishna H.; Villablanca P.
Institution
(Al-Bawardy) Massachusetts General Hospital, Harvard Medical School,
Boston, MA, United States
(Gonzalez, Munoz Mendoza, Pu, Shah) Montefiore Medical Center, Bronx, NY,
United States
(Alvarez) Hospital of the Sisters of Charity (Krankenhaus Barmherzige
Schwestern) Linz, Department of Cardiology, Bronx, NY, United States
(Fard) Tangshan Worker's Hospital, Tangshan, China
(Mohananey) John H Stroger, Jr. Hospital of Cook County, Chicago, IL,
United States
(Ramakrishna) Mayo Clinic, Phoenix, AZ, United States
(Villablanca) Montefiore Medical Center, New York, NY, United States
Title
Bivalirudin versus heparin anticoagulation in transcatheter aortic valve
interventions. A systematic review and a meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B303), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Bivalirudin may be an effective anticoagulation alternative to
heparin in transcatheter aortic valve interventions. There is no clear
superiority of one agent and there is a scarcity of data directly
comparing heparin and bivalirudin for these procedures. We aimed to
compare the safety and efficacy of bivalirudin versus heparin as the
procedural anticoagulant agent in patients undergoing transcatheter aortic
valve interventions. METHODS We conducted an electronic database search of
all published data. The primary efficacy endpoints were all-cause
mortality, cardiovascular mortality, myocardial infarction, and stroke
within 30 days. Safety end-points include major and life-threatening bleed
according to VARC and BARC bleeding >3 within 48-72 hours, the need for
blood transfusion, vascular complications within 30 days and acute kidney
injury within 30 days. Odds ratios (OR) and 95% confidence intervals (CI)
computed using the Mantel-Haenszel method. Fixed-effect model was used; if
heterogeneity (I2)>40, effects were obtained using a random model. RESULTS
Three studies (n=1,690 patients) were included, which included one
randomized trial and two observational studies. There was a significance
difference favoring bivalirudin over heparin for myocardial infarction (OR
0.41, 95% CI 0.20-0.87). There was no statistically significant difference
in all-cause mortality at 30 days (OR 0.97, 95% CI 0.62-1.52),
cardiovascular mortality (OR 1.03, 95% CI 0.52- 2.05), stroke (OR 1.23,
95% CI 0.62-2.46), vascular complications (OR 0.96, 95% CI 0.70-1.32),
acute kidney injury (OR 1.03, 95% CI 0.53- 2.00), the need for blood
transfusion (OR 0.67, 95% CI 0.45-1.01), major and life threatening bleed
(VARC) (OR 0.74, 95% CI 0.37-1.49) and BARC bleeding >3 (OR 0.52, 95% CI
0.23-1.18). CONCLUSION In patients undergoing aortic valve interventions,
no statistically significant difference was seen between bivalirudin and
heparin use, except for a significant lower myocardial infarction events
with bivalirudin compared to heparin. Furthermore, large randomized
controlled trials are needed to assess which anticoagulation agent is
safer and efficacious in patients undergoing transcatheter aortic valve
interventions.

<38>
Accession Number
614161601
Author
Harvey J.; Clancy S.; Rutkin B.
Institution
(Harvey) WellSpan Health, York, PA, United States
(Clancy) Edwards Lifesciences, Whittier, CA, United States
(Rutkin) Northwell Health, Manhasset, NY, United States
Title
Predictors of hospital readmissions after transcatheter aortic valve
replacement.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B13-B14), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Reducing hospital readmissions can improve health care quality
and lower cost. For patients undergoing TAVR, 30 day readmissions have
been reported as 10-20% in several state and non-US analyses. Little is
known about the predictors of readmission at a national level in the
United States. The purpose of this study was to identify the predictors of
30 day hospital readmissions after TAVR among Medicare beneficiaries.
METHODS This retrospective analysis used the 100% Medicare Inpatient
Standard Analytic File for patients undergoing TAVR procedures discharged
alive in 2014. Procedures were identified by having an ICD- 9 procedure
code of 35.05. Multivariate analysis was performed by logistic regression
to predict likelihood of any readmission. RESULTS A total of 8,073
TAVRpatients met the inclusion criteria; 17%were readmitted within 30
days. After multivariate adjustment, the factors associated with
readmission included 2 prior admissions in the year before TAVR (P<0.01,
odds ratio [OR]= 2.33, 95% confidence interval [95% CI] = 2.02-2.7),
historyofdialysis (P<0.01,OR=1.78,95%CI=1.26-2.51), stroke (P<0.01,OR=
1.76, 95% CI = 1.24-2.49), blood loss (P=0.01, OR = 1.73, 95% CI =
1.14-2.61), new onset atrial fibrillation (P<0.01, OR = 1.70, 95% CI =
1.35-2.15), 1 prior admission in the year before TAVR (P<0.01, OR = 1.65,
95% CI = 1.41-1.92), acute kidney injury (P<0.01, OR = 1.62, 95% CI =
1.36-1.94), baseline atrial fibrillation (P<0.01, OR = 1.46, 95% CI =
1.29-1.66), paroxysmal tachycardia (P=0.013, OR = 1.38, 95% CI =
1.07-1.77), discharge to skilled nursing facility (P<0.01, OR = 1.3, 95%
CI = 1.10-1.53), respiratory failure (P=0.04, OR = 1.25, 95% CI =
1.01-1.55), and COPD (P=0.018, OR = 1.18, 95% CI = 1.03-1.34). CONCLUSION
In this large series of TAVR patients, 30 day readmissions were comparable
to that of the overall Medicare population despite advanced age and
significant comorbidities. Prominent noncardiac predictors of readmission
included renal insufficiency, anemia at the time of discharge, respiratory
insufficiency, neurologic dysfunction, and prior hospitalization. The most
prominent cardiac predictor was the presence of arrhythmia. These data
suggest that efforts to reduce readmissions should focus on optimizing
pre-existing non-cardiac comorbidities and managing post-operative
complications.

<39>
Accession Number
614161545
Author
Anwaruddin S.; Kirtane A.; Thourani V.; Vemulapalli S.; Manandhar P.;
Herrmann H.; Bavaria J.; Giri J.; Vallabhajosyula P.; Andersen B.K.; Szeto
W.
Institution
(Anwaruddin) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Kirtane) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Thourani) Emory University Hospital Midtown, Atlanta, GA, United States
(Vemulapalli) Duke University Medical Center, Philadelphia, PA, United
States
(Manandhar) UMHALT, Philadelphia, PA, United States
(Herrmann) University of Pennsylvania, Philadelphia, PA, United States
(Bavaria) PhiladelphiaPAUnited States
(Giri) U Penn, Philadelphia, PA, United States
(Vallabhajosyula) National Research Center for Preventive Medicine,
Moscow, Russian Federation
(Andersen) Aarhus University Hospital, Philadelphia, PA, United States
(Szeto) University of Pennsylvania Medical Center, Philadelphia, PA,
United States
Title
Characterizing the incidence and predictors of paravalvular regurgitation
after transcatheter aortic valve replacement (TAVR) and its impact on
outcomes: A study of the society of thoracic surgeons/american college of
cardiology transcatheter valve therapies (STS/ACC TVT) registry.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B33), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become the
standard of care for high risk and inoperable patients with severe
symptomatic aortic stenosis. We sought to assess rates of paravalvular
regurgitation (PVR) following TAVR in a large cohort of patients having
undergone TAVR post approval as part of the STS/ACC TVT Registry. METHODS
All patients from the STS/ACC TVT Registry undergoing commercial TAVR in
the United States (November 2011-March 2015) who underwent pre-discharge
echocardiogram with site-based reporting of PVR by echocardiography were
included. The incidence and impact of post TAVR PVR severity upon outcomes
of all-cause mortality and heart failure (HF) readmissions was analyzed.
RESULTS 9446 patients met criteria for this analysis. Of these, 38.1% were
noted to have no PVR post procedure. 52.9% were noted to have mild PVR
post procedure and 9% were noted to have moderate/severe PVR. The majority
received a balloon-expandable prosthesis (n=7575, 80%). Body surface area
(OR 0.87, p=0.002), moderate/severe aortic insufficiency (OR 1.36,
p=0.001), female sex (OR 0.7, p<0.001), moderate to severe mitral
insufficiency (OR 1.25, p<0.0021), and alternative access (OR 0.7,
p<0.0001) were all associated with PVR following TAVR. The presence of
moderate/severe PVR, but not mild PVR, post TAVR was associated with
increased 30 day (HR 1.94 [1.45-2.58], p<0.0001) and 1-year mortality (HR
1.63 [1.38-1.92], p<0.0001). Mild PVR was associated with higher rates of
HF readmissions at 1 year (HR 1.2, [1.04-1.33], p=0.003). CONCLUSION In
this largest single series of patients in a post approval registry, rates
of mild PVR were higher than those reported in large randomized clinical
trials. Moderate/severe PVR, but not mild PVR, post TAVR was associated
with increased 30-day or 1 year mortality. The presence of mild PVR was
associated with increased risk of HF readmissions.

<40>
Accession Number
614161519
Author
Lebehn M.; Hunter T.; Clancy S.; Spies C.
Institution
(Lebehn) University Hospital Limerick, Honolulu, HI, United States
(Hunter) CTI Clinical Trial and Consulting, Cincinnati, OH, United States
(Clancy) Edwards Lifesciences, Whittier, CA, United States
(Spies) Queen's Medical Center, Honolulu, HI, United States
Title
Effects of anesthesia on cost and length of stay in patients undergoing
transcatheter aortic valve replacement (TAVR)-results from a cohort study.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B278), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter Aortic Valve Replacement (TAVR) is an established
therapy in select patients. Recent efforts to optimize the procedure
focused on mode of anesthesia and usefulness of the "minimalist approach".
Reports suggested conscious sedation (CS), as opposed to general
anesthesia (GA) results in shorter length of stay (LOS) leading to reduced
resource utilization, though these reports were confounded by other
components of the "minimalist approach". The goal of this study was to
identify the isolated effect of CS on LOS and procedural costs. METHODS
This is a retrospective cohort study using the Premier Database.
Endovascular TAVR cases were identified based on ICD-9 procedure code
35.05, endovascular replacement of aortic valve between October 2011 and
December 2014. Generalized linear models with gamma distributions and log
links were developed to assess the impact of anesthesia cohorts on index
hospitalization cost and LOS endpoints after controlling for patient and
hospital characteristics. RESULTS A total of 3,267 TAVR visits met the
inclusion criteria for this study including 143 CS visits at 7 hospitals
and 3,124 GA visits at 96 hospitals. After adjusting for comorbidities and
hospital characteristics, LOS did not differ depending on the mode of
anesthesia (7.7 days CS vs. 7.1 days GA, p=0.09). The CS cohort had a
lower total hospital cost of $50,492 vs. $60,533 for the GA cohort (p=
0.0001). The difference in cost was primarily driven by procedure location
(cath lab versus operating room) as well as reductions in ICU, room time
and ancillary costs. There was no difference in safety characteristics
amongst the two anesthesia modalities (in-hospital mortality 3.5% CS vs.
3.8% GA). CONCLUSION We found that while CS in TAVR results in significant
cost savings, there is no significant effect on overall LOS. The present
study is the only multicenter study to date controlling for confounders of
LOS and identifying the procedural area and post-procedural resource
utilization as sources of potential cost saving, rather than LOS in
itself.

<41>
Accession Number
614161517
Author
Ruile P.; Jander N.; Blanke P.; Schoechlin S.; Reinohl J.; Gick M.; Langer
M.; Leipsic J.; Buettner H.J.; Neumann F.-J.; Pache G.
Institution
(Ruile) University Heart Center Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Jander) Medical University of Silesia, Department of Epidemiology,
Vancouver, BC, Canada
(Blanke) St. Paul's Hospital, Vancouver, BC, Canada
(Schoechlin) Lumen Foundation, Freiburg, Germany
(Reinohl) Heart Center Freiburg University, Freiburg, Germany
(Gick) UHZ Freiburg- Bad Krozingen, Bad Krozingen, Germany
(Langer) Stem Cell Institute, James Graham Brown Cancer Center, University
of Louisville, Vancouver, BC, Canada
(Leipsic) St. Paul's Hospitals, Vancouver, BC, Canada
(Buettner) Universitaets-Herzzentrum Freiburg-Bad Krozingen, Bad
Krozingen, Germany
(Neumann) Universitats-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Pache) Universitaets Herzzentrum Freiburg - Bad Krozingen, Bad Krozingen,
United States
Title
Course of early subclinical leaflet thrombosis after transcatheter aortic
valve replacement with or without oral anticoagulation.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B32-B33), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Subclinical early leaflet thrombosis (LT) has recently been
described on computed tomography angiography (CTA) in patients after
transcatheter aortic valve replacement (TAVR). We sought to investigate
the course of LT in patients with and without anticoagulation. METHODS Out
of 528 patients undergoing CTA at 5 days post TAVI, 51 (9.7%) with LT were
included in this prospective observational study. In addition to
clopidogrel, 29 patients received phenprocoumon and 22 received aspirin,
based on timing of inclusion or indication for anticoagulation. We also
analyzed 10 patients on dual antiplatelet therapy (DAPT) after
discontinuation of anticoagulation. After a median of 86 days, we obtained
follow-up CTAs in 22 patients on anticoagulation and in 26 patients on
DAPT. CTAs were evaluated by an independent, blinded reader for the
presence of LT defined as hypoattenuated leaflet thickening with or
without leaflet restriction (LR). LR was classified according to a 4-point
grading scale as none, mild (<50%), severe (>50%) or as almost complete.
RESULTS We found significant (P<0.001) differences between the 2 groups:
Under anticoagulation, the LR score decreased by amedian of 1 (quartiles
1.2, P=0.001), whereas on DAPT it increased by 1 (1, 1.5; P=0.01). The
change in maximum leaflet thickness was -2.6+/-1.5mm (P<0.001) on
anticoagulation, but +1.37+/-1.67mm (P=0.005) on DAPT. LT regressed in all
patients with anticoagulation, whereas it progressed in 17 patients on
DAPT (P<0.001). Changes in LR correlated significantly with changes in
transvalvular pressure gradients (r=0.511, P<0.001). LT was not associated
with clinical symptoms or downstream events. CONCLUSION The course of LT
was fundamentally different depending on the presence or absence of
anticoagulation, with consistent regression under phenprocoumon, but
mostly progression under antiplatelet therapy alone. Changes in LT were
associated with changes in transvalvular pressure gradients.

<42>
Accession Number
614161482
Author
Yadav P.; Singh V.; Eng M.; MacEdo F.; Silva G.; Rassi A.; Mendirichaga
R.; Alfonso C.; Cohen M.; Palacios I.; O'Neill W.
Institution
(Yadav) Penn State University, Hershey, PA, United States
(Singh) Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Eng) University Clinic of Munich, Germany
(MacEdo) Universitatsklinikum Jena, Germany
(Silva) Texas Heart Institute, Houston, TX, United States
(Rassi) Kaiser Permanente San Francisco Medical Center, San Francisco, CA,
United States
(Mendirichaga) University of Miami, Miller School of Medicine, Miami, FL,
United States
(Alfonso) University of Miamis, Miami, FL, United States
(Cohen) University of Miami Hospital, Miami, FL, United States
(Palacios) Massachusetts General Hospital, Boston, MA, United States
(O'Neill) Henry Ford Hospital, Detroit, MI, United States
Title
Outcomes of hemodynamic support with impella in very high-risk patients
undergoing balloon aortic aortic valvuloplasty: Results from the global
cVAD registry.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B55), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Severe aortic stenosis (AS) with left ventricular dysfunction
patients are at risk of adverse events when undergoing balloon aortic
valvuloplasty (BAV). Hemodynamic support is often used as a "bailout"
after the BAV; however, smaller single center reports have suggested its
role on elective basis. The aim of this study is to compare outcomes in
patients with severe AS and severe LV dysfunction who underwent BAV +/-
PCI with use of Impella (Abiomed, Danvers, MA) as elective (upfront) vs
emergent (bailout) strategy. METHODS Patients were identified from cVAD
registry an on-going multicenter voluntary registry open to all sites in
the North America and Europe that have used the Impella device for all
indications in more than 10 patients. RESULTS Of total 118 patients (mean
age 80.58+/-9.06 years), majority (73%) had Impella placed electively
prior to BAV, while 27% required Impella emergently after BAV. The two
groups were similar except the elective group more commonly had coronary
artery disease (82.7% vs 63.3%, p = 0.041), had lower LV ejection fraction
(24.8% vs 33.0 %, p = 0.020). The emergent group had higher STS mortality
score (31.8% vs 14.8%, p = 0.004). Elective placement of Impella was
associated with significantly better 1-year survival when compared to
emergency placement of the device (58% vs 30%, p=0.003) (figure 1),
primarily driven by better early survival. CONCLUSION This largest series
suggests high risk AS patients with concomitant LV dysfunction undergoing
BAV have significantly better survival when hemodynamic support is used
upfront, electively (rather than emergent, bailout). (Figure Presented).

<43>
Accession Number
614161447
Author
Sievert H.; Goldberg S.; Siminiak T.; Degen H.; Lipiecki J.; Haude M.
Institution
(Sievert) CardioVascular Center Frankfurt CVC, Sankt Katharinen,
Frankfurt, Germany
(Goldberg) Kalispell Regional Medical Center, Whitefish, MT, United States
(Siminiak) Poznan University of Medical Sciences, Poznan, Poland
(Degen) NeussGermany
(Lipiecki) Clinique Des Domes-Pole Sante Republique, Clermont-Ferrand,
France
(Haude) Lukaskrankenhaus Neuss, Neuss, Germany
Title
Percutaneous mitral valve annuloplasty patients with minimal acute
reduction in mitral regurgitation improve long term (from the TITAN II
trial).
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B260), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND The Carillona Mitral Contour Systema (Cardiac Dimensions,
Kirkland, Washington) treats patients with functional mitral regurgitation
(FMR). The TITAN and TITAN II studies evaluated the Carillon device in
patients with symptomatic heart failure, 2+ - 4+ Grade MR, reduced left
ventricular function (EF <40%) and dilated ventricles (left ventricular
end diastolic diameter >55 mm). The TITAN protocol required a >1+ grade
reduction for permanent implantation, otherwise the device was recaptured.
85% of patients demonstrated acute improvement >1 grade (45 of 53).
Patients exhibited further MR reduction and reverse remodeling during the
12-month follow-up. This led investigators to evaluate the long-term
effect of device implantation in patients with <1+ grade acute reduction
in the TITAN II study. This study evaluates whether patients with minimal
acute improvement in MR with Carillon may have had long-term reduction in
MR. METHODS In TITAN II, patients received permanent implantation of the
Carillon device irrespective of the acute reduction in MR. Baseline and
follow-up echocardiographs (at 1, 6, and 12 months) were evaluated by a
core laboratory; procedural echocardiographs (TTE or TEE) were interpreted
by the sites. Patients with <1 grade reduction in MR at the time of the
implant were compared with patients with >1 grade reduction. RESULTS See
attached Tables. Patients with < 1 grade acute MR recution had slightly
less favorable baseline characteristics with more severe baseline MR, and
larger ventricles than those patients with more obvious acute reduction in
MR at the time of Carillon implantation. However, there were similar
improvements in echocardiographic and clinical parameters with follow-up.
Both groups showed improvement in MR over time, as well as left
ventricular remodeling. CONCLUSION Patients with <1 grade MR reduction at
implant had slightly less favorable baseline characteristics (worsened MR,
larger LV volumes) but demonstrated similar improvements in all
parameters, compared patients with >1+ grade improvement. This data
suggests that patients with <1 grade acute improvement will improve over
time and therefore permanent implantation of the Carillon device is
reasonable. The double-blind, randomized REDUCE FMR study will further
evaluate this observation.

<44>
Accession Number
614161441
Author
Treede H.; Conradi L.; Walther T.; Kempfert J.; Bleiziffer S.; Eichinger
W.; Heyn O.; Reichenspurner H.; Cocchieri R.; Lange R.
Institution
(Treede) University Hospital Halle, Halle, Germany
(Conradi, Reichenspurner) University Heart Center Hamburg, Hamburg,
Germany
(Walther) Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany
(Kempfert) Kerckhoff Clinic, Bad Nauheim, Germany
(Bleiziffer, Lange) German Heart Center Munich, Munich, Germany
(Eichinger) Klinikum Muenchen Bogenhausen, Munich, Germany
(Heyn) LMU, Munich, Germany
(Cocchieri) Department of Cardiology, Ehime Prefectural Central Hospital,
Munich, Germany
Title
Twelve-month follow-up results of the STASIS trial: A multi-center study
on a novel apical closure device for transapical transcatheter aortic
valve implantation.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B299), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND TA access for TAVI has seen little standardization due to the
absence of automated preclosure and carries a risk for bleeding and
increased morbidity compared to TF TAVI. Here we report the 12-month
follow-up of patients after use of a novel device to facilitate safe and
reliable, automated access and closure during TA TAVI. METHODS 34 patients
at 5 EU centers underwent TA TAVI through mini-thoracotomies using the
Permaseal closure device (STASIS trial). All patients received Edwards
Sapien 3 or Sapien XT valves. The closure device consists of 8
polypropylene anchors connected by a braided polyester pre-tied suture
allowing for the passage of sheaths up to 30F. Anchors are mechanically
deployed into myocardial tissue near the apex over a guidewire. After
removal of the TAVI sheath, hemostasis is achieved by advancement of the
pre-tied suture and approximation of the anchors without fast pacing. All
patients were prospectively followed for 1, 3 and 12 months. RESULTS The
Permaseal device was successfully deployed in all patients. Hemostasis was
achieved with no or only 1 additional pledgeted suture after sheath
removal and anchor approximation by closing of the pre-tied suture in
94.1% of patients. Additional sutures had to be applied in 2 patients to
resolve ongoing bleeding from the access site. 3 patients (8.8%) required
transfusion of more than 2 units periprocedurally or prior to discharge.
Mean operation time was 86 +/- 22.5 min. Pulsatile bleeding was not
reported and re-intervention was not required for any patient following
the procedure or during follow-up. No patients died during 30-day
follow-up; 1 patient died on day 37 from complications related to hip
replacement surgery. No patients suffered strokes or myocardial
infarctions during the 12-month follow-up period. CONCLUSION The Permaseal
device allows for minimally invasive reproducible access and closure of
the left ventricular apex for TA TAVI. The device can be used without rib
spreading, complies with the beating heart, and shows no interference with
wall motion while leaving only little foreign material behind. This access
and closure approach may help to reduce OR time, abate blood loss, and
reduce morbidity for TA-TAVI.

<45>
Accession Number
614161438
Author
Villablanca P.; Makkiya M.; Mathew V.; Thourani V.; Rodes-Cabau J.;
Bangalore S.; Vlismas P.; Briceno D.; Slovut D.; Taub C.; McCarthy P.;
Augoustides J.; Ramakrishna H.
Institution
(Villablanca) Montefiore Medical Center, New York, NY, United States
(Makkiya) Montefiore, Bronx, NY, United States
(Mathew) Mayo Clinic, Rochester, MN, United States
(Thourani) Emory University Hospital Midtown, Atlanta, GA, United States
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec,
QC, Canada
(Bangalore) New York University, School of Medicine, New York, NY, United
States
(Vlismas) Sunnybrook Health Sciences Centre, Bronx, NY, United States
(Briceno) Montefiore Medical Center, Albert Einstein College of Medicine,
Bronx, NY, United States
(Slovut) Montefiore Medical Center, New Rochelle, NY, United States
(Taub) Department of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
(McCarthy) Northwestern University, Palermo, Italy
(Augoustides) Interventional Cardiology Unit, University of Palermo,
Palermo, Italy
(Ramakrishna) Mayo Clinic, Phoenix, AZ, United States
Title
A meta-analysis and meta-regression of long-term outcomes of transcatheter
versus surgical aortic valve replacement for severe aortic stenosis.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B276-B277), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as an
alternative to surgical aortic-valve replacement (SAVR) for patients with
severe symptomatic aortic stenosis (AS) who are at high operative risk. We
sought to determine the long-term (>1 year follow-up) safety and efficacy
TAVR compared with SAVR in patients with severe AS. METHODS We conducted
electronic datebase search. Primary endpoint was all cause mortality.
Secondary endpoints included myocardial infarction (MI), stroke, major
bleeding, vascular complications, aortic regurgitation (AR), acute kidney
injury (AKI) and permanent pacemaker implantation (PPM). Mantel-Haenszel
(MH) method for odds ratios (OR) and 95% confidence intervals (CI) were
computed. Fixed-effect model was used; if heterogeneity (I2)>25, effects
were obtained using a random model. RESULTS 4 RCTs (n= 3,806) and 33
cohorts (n= 40,441) enrolled a total of 44,247 patientsmet the inclusion
criteria. The mean duration followup was 21.4 months. No difference was
found in long-term all-cause mortality (Risk ratios (RR), 1.06;
95%confidence interval (Cl) 0.91-1.22). There was a significant difference
favoring TAVR in the incidence of stroke (RR, 0.82; 95% Cl 0.71-0.94),
atrial fibrillation (RR, 0.43; 95% Cl 0.33-0.54), acute kidney injury (RR,
0.70; 95% Cl 0.53-0.92), and major bleeding (RR, 0.57; 95% Cl 0.40-0.81).
TAVR had significant higher incidence of vascular complications (RR, 2.90;
95% Cl 1.87-4.49), aortic regurgitation (RR, 7.00; 95% Cl 5.27-9.30), and
pacemaker implantation (PPM) (RR, 2.02; 95% Cl 1.51-2.68). TAVR
demonstrated significantly lower stroke risk compared to SAVR in high-risk
patients (RR, 1.49; 95% Cl 1.06-2.10); no differences in PPM implantation
was observed in intermediate- risk patients (RR, 1.68; 95% Cl 0.94-3.00).
In a meta- regression analysis, the effect of TAVR baseline clinical
features did not affect the long-term all-cause mortality outcome.
CONCLUSION Our meta-analysis showed that TAVR is as effective as SAVR in
high-risk patients with AS for the endpoint of long-term survival; each
intervention confers its own significant complications. There is early
evidence that TAVR may be superior to SAVR in intermediate- risk patients.

<46>
Accession Number
614161387
Author
Leurent G.; Garlantezec R.; Auffret V.; Filippi E.; Gilard M.; Saouli D.;
Hacot J.-P.; Rouault G.; Delaunay R.; Boulmier D.; Bedossa M.; Le Breton
H.
Institution
(Leurent) Hopital Pontchaillou - Chu, Rennes Cedex, France
(Garlantezec, Boulmier) University Hospital of Rennes, Rennes, France
(Auffret) CHU Rennes Pontchaillou, Rennes, France
(Filippi) CHBA, Vannes, France
(Gilard) Brest University, Brest, France
(Saouli) Centre Hospitalier Broussais, Saint Malo, France
(Hacot) Ch Bretagne Sud, Lorient, France
(Rouault) Ch Cornouaille, Quimper, France
(Delaunay) Centre Hospitalier Yves le Fol, Rennes, France
(Bedossa) Dpt of Cardiology University Hospital Rennes France, Rennes,
France
(Le Breton) Hopital Pontchaillou, Rennes, France
Title
Complete myocardial revascularisation is not associated with a better
prognosis in cardiogenic shock complicating ST-elevation myocardial
infarction. Insight from the multicenter prospective ORBI registry.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B52-B53), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Guidelines recommend a complete myocardial revascularisation in
Cardiogenic shock (CS) complicating ST-segment elevation myocardial
infarction (STEMI). However, the impact on the prognosis of residuals
stenosis of the coronary arteries is still unclear. We aimed to determine
if a complete myocardial revascularisation by percutaneous coronary
intervention (PCI) influence the intra hospital mortality of CS
complicating STEMI, in a contemporary management of those patients,
including a systematic reperfusion strategy by primary PCI. METHODS We
analysed data collected in the Regional Acute Myocardial Infarction
Registry of Brittany (ORBI), an 8 years prospective and systematic
registry of 8500 patients admitted for management of STEMI. We focused on
patients managed by primary PCI, presenting a CS at admission. "Complete
revascularisation" was defined by PCI of all the critically stenosed
coronary arteries. We performed a Cox model in order to identify
independent factors of intra hospital mortality. RESULTS 239 patients were
in CS managed by primary PCI at admission: mean age was 68 +/-13 years,
157 patients were male (65%). Sudden death was the 1st symptom in 57
patients (23%). STEMI occurred in the anterior area in 113 patients (43%).
Median delay between occurring of symptom and primary PCI was 204 minutes.
135 patients (56%) had pluri-truncular lesions, 107 (44%) had complete
revascularisation. Culprit lesion was left main trunk in 36 patient (15%).
103 patients (43%) were treated with mechanical circulatory assistance,
110 (46%) with mechanical ventilation, 164 (68%) with catecholamines. Post
PCI TIMI flow was 3 in 194 patients (82%). Last, 25 patients (10%)
presented mechanical complications. 113 patients (47%) died during the
intra hospital follow-up. Multivariate analysis identified 3 independent
factors significantly associated with mortality: age [HR: 1.03; 95% CI
1.01-1.05], post PCI TIMI flow = 3 (versus <3) [HR: 0.447; 95% CI
0.26-0.74], and mechanical ventilation [HR: 1.97; 95% CI 1.23-3.16].
CONCLUSION Despite a systematic reperfusion strategy by primary PCI,
patients admitted for CS in the acute phase of STEMI still have a dreadful
prognosis. However, in our study, residuals stenosis of the coronary
arteries are not associated with the intra hospital prognosis.

<47>
Accession Number
614161382
Author
Shin H.; Jang J.-S.; Jin H.-Y.; Seo J.-S.; Yang T.-H.; Kim D.-S.; Song
Y.S.; Song P.S.; Kim D.-K.; Kim D.-I.
Institution
(Shin) Inje University Pusan Paik Hospital, Pusan, South Korea
(Jang) Saint- Luke's Hospital, Kansas City, United States
(Jin) Busan Paik Hospital, Busan, South Korea
(Seo) SeoulSouth Korea
(Yang) St. Paul Hospital, University of British Colu, Vancouver, BC,
Canada
(Kim, Kim) Busan Paik Hospital, Inje University, College of Medicine,
Busan, South Korea
(Song) Haeundae Paik Hospital, Busan, South Korea
(Song) INJE, Busan, South Korea
(Kim) Inje University, Haeundae Paik Hospital, Busan, South Korea
(Kim) Inje University, Haeundae Paik Hospital, South Korea
Title
Impact of successful recanalization of chronic total occlusions using
coronary stents on long-term clinical outcomes: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B114), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Although coronary stent implantation dramatically reduced the
occurrences of restenosis and the needs for repeat revascularization,
there is still uncertainty as to the prognostic impact of successful
recanalization of chronic total occlusion (CTO) lesion. METHODS Databases
were searched for clinical studies that compared outcomes after successful
recanalization of CTO lesions using coronary stent deployment with those
of unsuccessful recanalization from January 2003 to March 2016. The end
points of this study were mortality; myocardial infarction (MI); major
adverse cardiac events (MACE); the need for coronary artery bypass graft
surgery (CABG); and angina relief at the longest follow-up. RESULTS We
identified 19 studies encompassing 12,598 patients with a median follow-up
period of 12-60 months after successful vs. unsuccessful CTO
recanalization using coronary stent. There were 455 (5.0%) deaths of 9,041
patients after successful recanalization compared to 339 (10.3%) among
3,280 patients after unsuccessful recanalization (odds ratio [OR] 0.48,
95% confidence interval [CI] 0.38 to 0.61) (Figure). Successful CTO
recanalization significantly reduced the incidence of MI (OR 0.67, 95% CI
0.46 to 0.97) and MACE (OR 0.55, 95% CI 0.42 to 0.73). Successful CTO
recanalization was associated with a lower need for subsequent CABG and
higher angina relief. CONCLUSION Successful recanalization of CTO lesions
using coronary stents deployment appears to be associated with improvement
in mortality and reduced needs for CABG as compared with unsuccessful PCI.

<48>
Accession Number
614161350
Author
Lindman B.; Abramowitz Y.; Pibarot P.; Quader N.; Maniar H.; Zajarias A.;
Arnold S.; Hahn R.; Elmariah S.; Suri R.; Vahl T.; Svensson L.; Thourani
V.; Litherland C.; Alu M.; Leon M.; Makkar R.
Institution
(Lindman) Aurora St. Luke's Hospital, Los Angeles, CA, United States
(Abramowitz, Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Pibarot) Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Quader) Sejong General Hospital, St. Louis, MO, United States
(Maniar) Washington University, School of Medicine, St. Louis, MO, United
States
(Zajarias) Barnes Jewish Hospital, St. Louis, MO, United States
(Arnold) Saint Luke's Hospital, Kansas City, MO, United States
(Hahn) New York-Presbyterian Hospital, New York, NY, United States
(Elmariah) Massachusetts General Hospital, Boston, MA, United States
(Suri) Cleveland Clinic, New York, NY, United States
(Vahl) Columbia University Medical Center, New York, NY, United States
(Svensson) Cleveland Clinic Foundation, Cleveland, OH, United States
(Thourani) Emory University Hospital Midtown, Atlanta, GA, United States
(Litherland) Cardiovascular Research Foundation, Wilson, NC, United States
(Alu) Columbia University Medical Center, Wilson, NC, United States
(Leon) New York-Presbyterian Hospital, Columbia University Medical Center,
New York, NY, United States
Title
Diabetes and clinical outcomes in intermediate risk patients randomized to
transcatheter versus surgical aortic valve replacement: An analysis of the
PARTNER 2A trial.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B275), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND In the PARTNER IA trial with high-risk patients, a posthoc
analysis demonstrated that diabetics had lower 1-year all-cause mortality
when treated with TAVR compared to SAVR. Our objective was to
examinewhether diabetes altered outcomes based on treatment group in the
PARTNER 2A intermediate risk trial, which demonstrated similar 1- and
2-year all-cause mortality after TAVR or SAVR. METHODS Among patients with
severe symptomatic aortic stenosis at intermediate risk for surgery in the
PARTNER 2A trial, we evaluated whether there was an interaction between
diabetes status and treatment group with respect to all-cause mortality in
Cox proportional hazards models. We also tested for an interaction with
respect to 2- year left ventricular (LV) mass index and LV ejection
fraction. RESULTS Among 1938 patients in PARTNER 2A, 703 patients (36%)
were diabetic, including 215 (11%) that were insulin dependent. There was
no interaction between diabetes and treatment group (TAVR or SAVR) with
respect to 1- or 2-year all-cause mortality (interaction p>0.05). The
rates of all-cause death at 1 and 2 years were similar in the TAVR and
SAVR treatment groups, respectively, among patients with insulin-dependent
diabetes (1 year: 11.2% and 13.4%, p=0.63; 2 years: 15.0% and 16.9%,
p=0.67), non-insulin-dependent diabetes (1 year: 11.6% and 8.5%, p=0.25; 2
years: 14.7% and 15.0%, p=0.97), and no diabetes (1 year: 11.9% and 14.6%,
p=0.12; 2 years: 16.8% and 19.1%, p=0.24). Among those in the
transfemoral- access cohort (n=1482), these relationships were similar. In
separate models, after adjustment for (1) baseline LV mass index or (2)
baseline LV ejection fraction, SAVR was associated with lower LV mass
index and higher LV ejection fraction at 2 years. Neither of these
relationships was altered by diabetes status (interaction p>0.05).
CONCLUSION Among intermediate risk patients, all-cause mortality was
similar after TAVR or SAVR regardless of diabetes status. Diabetes also
did not alter the association between SAVR and more favorable LV
remodeling and function after valve replacement.

<49>
Accession Number
614161330
Author
Kapur N.; Breton C.; O'Kelly R.; Esposito M.; Rheude T.; Mullin A.;
Annamalai S.; Grise M.; Kiernan M.; Pham D.T.; Anderson M.; Morris D.L.
Institution
(Kapur) Tufts Medical Center, Boston, MA, United States
(Breton) General University Hospital, Institute of Pathology, Prague,
Czech Republic
(O'Kelly) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
(Esposito) Hospital U. Central De La Defensa "Gomez Ulla", Boston, MA,
United States
(Rheude) Deutsches Herzzentrum Munchen, Bochum, Germany
(Mullin) UNC School of Medicine, Bochum, Germany
(Annamalai) Departmenf of Cardiac and Thoracic Surgery, BG University
Hospital Bergmannsheil, Bochum, Germany
(Grise) Sacred heart hospital, Pensacola, FL, United States
(Kiernan) Hospital U. Central De La Defensa "Gomez Ulla", Chicago, IL,
United States
(Pham) Northwestern University, Chicago, IL, United States
(Anderson) Einstein Healthcare Network, Philadelphia, PA, United States
(Morris) Einstein Medical Center Philadelphia, Philadelphia, PA, United
States
Title
Simultaneous, not staged, deployment of biventricular micro-axial flow
impella catheters (BiPella) is associated with improved survival for
cardiogenic shock involving biventricular failure.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B51), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Cardiogenic shock involving biventricular failure (BiVF) is
associated with increased in-hospital mortality. This study explored the
clinical utility of employing two micro-axial flow Impella catheters for
biventricular support (BiPella) in the setting of BiVF. METHODS We
retrospectively reviewed data from 14 patients receiving BiPella support
for BiVF from 3 tertiary-care hospitals in the United States. Medical
records were reviewed for demographics, hemodynamics, laboratory data, and
BiPella implant details. RESULTS BiVF was due to acute myocardial
infarction (n=6), advanced heart failure (n=4), cardiac surgery (n=2), and
myocarditis (n=2). Mean ejection fraction was 22+11%. BiPella patients had
moderate or severe systolic dysfunction (100%), elevated right atrial (RA)
pressure (21+/-4), elevated RA: wedge ratio (0.9+/-0.2), a low pulmonary
artery (PA) pulsatility index (0.9+/-0.7). The duration of LV and RV
support was 4+/-3 and 4+/-2 days with mean LV and RV flows of 3.2+/-0.9
and 3.4+/-0.5 liters/minute respectively. RA pressure and PA saturation
improved after BiPella activation. In-hospital mortality was 50%. No
intra-procedural mortality was observed. Complications included limb
ischemia (n=1), bleeding requiring a transfusion (n=7), and hemolysis
(n=5). Among survivors, 2 bridged to LVAD before discharge. No patients
were bridged to ECMO, BiVAD, or transplant. Survivors were younger, had
higher vasopressor use, lower mean PA pressures, and lower glomerular
filtration rates. All survivors received RV support at the same time as LV
support (Simultaneous), whereas 57% of non-survivors received delayed RV
support (Staged). CONCLUSION This is the largest multicenter report
describing the clinical utility of BiPella support in BiVF. BiPella is
feasible and associated with improved hemodynamics. Simultaneous, not
staged, LV and RV support is associated with improved survival. (Table
Presented).

<50>
Accession Number
614161310
Author
Cavalcante R.; Sotomi Y.; Suwannasom P.; Lee C.W.; Ahn J.-M.; Tenekecioglu
E.; Zeng Y.; Collet C.; Miyazaki Y.; Onuma Y.; Park S.-J.; Serruys P.
Institution
(Cavalcante) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Sotomi) EMC, Rotterdam, Netherlands
(Suwannasom, Miyazaki) Erasmus MCs, Rotterdam, Netherlands
(Lee) Asans Medical Center, Seoul, South Korea
(Ahn) Asan Medical Centers, Seoul, South Korea
(Tenekecioglu) Erasmus MC, Rotterdam, Netherlands
(Zeng) Centro Cardiologico Monzino, Rotterdam, Netherlands
(Collet) Clinica El Avila, Caracas, Venezuela
(Onuma) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Park) Asan Medical Center, Seoul, South Korea
(Serruys) Imperial College, London/Thoraxcenter of Erasmus University,
Rotterdam, Netherlands
Title
Impact of the Syntax score in patients with diabetes and left-main and/or
multivessel coronary disease: A pooled analysis of individual patient
level data from the Syntax, Precombat and BEST trials.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B27-B28), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Recent guidelines recommend coronary bypass surgery (CABG) over
percutaneous coronary intervention (PCI) for diabetic patients with
multivessel coronary disease (MVD). The impact of the SYNTAX score in this
subset of patients is unclear. The objective of the present study was to
assess the impact of the SYNTAX score in outcomes after PCI and CABG for
diabetic patients withMVD and to compare the performance of the SYNTAX
score II in diabetics vs. non-diabetics. METHODS We performed a
patient-level pooled analysis of the diabetes subset from three large
randomized trials of PCI vs. CABG for patients with MVD. Outcomes were
assessed according to SYNTAX score terciles. The primary endpoint was the
composite of all-cause death, myocardial infarction (MI) or stroke over a
median follow-up of 5 years. We also compared the performance of the new
SYNTAX II score in diabetics vs. non-diabetics. RESULTS From the 3280
patients enrolled in the three trials, a total of 1068 had diabetes and
were randomized to either CABG (531) or PCI (537). Overall, mean age was
64.7 +/- 8.9 years, 71.7% were male, 22.4% were treated with insulin and
mean SYNTAX score was 27.5 +/- 10.0. The primary endpoint occurred in 94
(17.5%) patients in the PCI arm and 77 (14.5%) patients in the CABG arm
(HR 1.19, 95%CI 0.88-1.6; p=0.27). No difference in the rates of the
primary endpoint in the PCI and CABG arms was observed for patients with
low-intermediate (0-32) SYNTAX scores (15.1% vs. 14.9%, respectively;
p=0.93). In patients with high (>33) SYNTAX scores, PCI had a
significantly higher rate of death, MI or stroke as compared to CABG
(24.5% vs. 13.2%, respectively; p=0.018). The SYNTAX score II showed good
calibration and discrimination in both diabetics (cindex = 0.73) and
non-diabetics (c-index = 0.73). CONCLUSION At 5 years of follow-up, CABG
and PCI are associated with similar rates of death, MI and stroke in
diabetic patients with MVD and low-intermediate (0-32) SYNTAX scores. CABG
is safer than PCI in patients with high SYNTAX scores (>33). The SYNTAX
score II shows good discrimination ability for long-term mortality
prediction after PCI and CABG, regardless of the diabetes status.

<51>
Accession Number
614161302
Author
Ribeiro H.; Rodes-Cabau J.; Park J.K.; Blanke P.; Leipsic J.; Bapat V.;
Makkar R.; Dos Santos M.S.; Barbanti M.; Schofer J.; Bleiziffer S.; Latib
A.; Hildick-Smith D.; Presbitero P.; Windecker S.; Napodano M.; Cerillo
A.; Abdel-Wahab M.; Tchetche D.; Fiorina C.; Cohen M.; Guerrero M.;
Whisenant B.; Nietlispach F.; Franco L.N.; Brito F.; Lemos P.; Webb J.;
Dvir D.
Institution
(Ribeiro) Hopital Laval, Quebec City, QC, Canada
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec,
QC, Canada
(Park) National Health Insurance Service, Ilsan Hospital, Goyang, South
Korea
(Blanke, Leipsic, Webb, Dvir) St. Paul's Hospital, Vancouver, BC, Canada
(Bapat) Guy's and St. Thomas', London, United Kingdom
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Dos Santos) Federal University of Sao Paulo, Brazil
(Barbanti) Ferrarotto Hospital, University of Catania, Catania, Italy
(Schofer) Hamburg University, Cardiovascular Center, Department for
Percutaneous Treatment of Structural Hea, Hamburg, Germany
(Bleiziffer) German Heart Center Munich, Munich, Germany
(Latib) EMO-GVM Centro Cuore Columbus, Milan, Italy
(Hildick-Smith) Sussex Cardiac Centre, Brighton, United Kingdom
(Presbitero) Istituto Clinico Humanitas, Rozzano-Milan, Italy
(Windecker) Swiss Cardiovascular Center Bern, Bern, Switzerland
(Napodano) Padova University Hospital, Padova, Italy
(Cerillo) Fondazione Toscana G. Monasterio, Massa, Massa and Carrara,
Italy
(Abdel-Wahab) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Tchetche) Clinique Pasteur, Toulouse, France
(Fiorina) BresciaItaly
(Cohen) University of Miami Hospital, Miami, FL, United States
(Guerrero) Evanston Hospital, Evanston, IL, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Nietlispach) University Hospital Zurich, Madrid, Spain
(Franco) Hospital Clinico San Carlos, Madrid, Spain
(Brito) University of Texas, Health Science Center at San Antonio, Sao
Paulo, Brazil
(Lemos) University of Sao Paulo Medical School, Sao Paulo, Brazil
Title
Incidence, predictors and clinical outcomes of coronary obstruction
following transcatheter aortic valve implantation for degenerative
bioprosthetic surgical valves: Insights from the VIVID registry.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B274-B275), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND There are limited data on coronary obstruction (CO) following
transcatheter valve-in-valve (ViV) implantation inside failed aortic
bioprostheses. The present study includes a large cohort of patients
undergoing ViV suffering this complication. METHODS A total of 34 patients
with symptomatic CO following 1,508 aortic procedures from the
Valve-in-Valve International Data (VIVID) registry were included
(incidence of 2.25%). Pre-TAVI computed tomography (CT) data was available
in 20 CO patients and in 90 controls, and data was subject to centralized
blinded CoreLab analysis. The distance between a virtual transcatheter
ring similar in size to the implanted device at the level of each coronary
ostium (VTC) was determined. RESULTS Baseline clinical characteristics in
the CO patients were similar to controls. CO was more common in stentless
or stented bioprostheses with externally mounted leaflets than in stented
bioprostheses with internally mounted leaflets (6.1% vs. 3.7% vs. 0.8%,
respectively; p<0.001). Balloon post-dilation was more frequently
performed in CO group (24.2% vs. 12.7%, p=0.05, respectively), and 30-day
mortality was 52.9% vs. 3.9%, respectively (p<0.001). VTC distance was
shorter in CO patients in relation to controls (3.24+/-2.22 vs.
6.30+/-2.34, respectively; p<0.001). Using multivariable analysis, the use
of a stentless (OR 8.76, 95% CI: 3.52- 21.8, p<0.001) or stented
bioprosthesis with externally mounted leaflets (Mitroflow [Sorin];
Trifecta [St. Jude Medical], OR 4.95, 95% CI: 1.88-13.1, p=0.001) were
independent predictors of CO. In addition, shorter VTC distance was
independently associated with CO (p<0.01), with an optimal cutoff level of
4mm (AUC 0.895; p<0.001). CONCLUSION Coronary obstruction following aortic
ViV procedures is a life-threatening complication that occurred more
frequently in patients with prior stentless or stented bioprostheses with
externally mounted leaflets and those with shorter VTC distance.

<52>
Accession Number
614161283
Author
Hall S.; Uriel N.; Carey S.; Edens M.; Esposito M.; O'Kelly R.; Annamalai
S.; Aghili N.; Adatya S.; Kapur N.
Institution
(Hall) Brigham and Women's Hospital, Dallas, TX, United States
(Uriel) University of Chicago Medical Center, Chicago, IL, United States
(Carey) Stony Brook University Hospital, Boston, MA, United States
(Edens) University Hospitals Case Medical Center, Boston, MA, United
States
(Esposito) Hospital U. Central De La Defensa "Gomez Ulla", Boston, MA,
United States
(O'Kelly) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr- University Bochum, Bad Oeynhausen, Germany
(Annamalai) Departmenf of Cardiac and Thoracic Surgery, BG University
Hospital Bergmannsheil, Bochum, Germany
(Aghili, Kapur) Tufts Medical Center, Boston, MA, United States
(Adatya) Vivantes Klinikum Neukoelln, Boston, MA, United States
Title
Use of the Impella 5.0 circulatory support device for bridge to decision
during acute decompensation of advanced heart failure.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B49), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Prognosis is poor for patients with acutely decompensated
advanced heart failure (HF) refractory to medical therapy. Evaluating
candidacy for durable mechanical circulatory support (MCS), cardiac
transplantation, or palliative care is complex. The Impella 5.0 is a
minimally invasive axial-flow catheter capable of providing full
hemodynamic support. We report a multicenter series on the use of this
device for bridge to decision (BTD) in decompensated advanced HF patients.
METHODS We performed a multicenter, retrospective analysis for patients
with advanced HF who acutely decompensated and received the Impella 5.0
for BTD. Demographics, procedural characteristics, inhospital and
intermediate term outcomes, and in-hospital complications were analyzed.
RESULTS Fifty-eight patients met inclusion criteria from 2010-2015. All
were inotrope-dependent; median ejection fraction was 10% (IQR 10- 15),
median age was 59 years (IQR 48-64). Mean duration of support was 7 days
(range 0-22). Thirty-nine patients survived to next therapy (67%), with
most receiving durable MCS (N=20) or heart transplantation (N=15).
In-hospital complications included bleeding (N=9) and hemolysis (N=4). Of
the patients who survived to next therapy, survival at one year was 62%
for those who received durable MCS, 86% for those transplanted, and 75%
for those who were stabilized and weaned. CONCLUSION The Impella 5.0 is an
important part of a BTD strategy for patients with advanced heart failure
and acute hemodynamic instability. Prospective studies are needed to
evaluate safety and effectiveness in this patient population. (Figure
Presented).

<53>
Accession Number
614161281
Author
Garg A.; Sharma A.; Agrawal S.; Virmani D.; Kostis J.; Singal D.
Institution
(Garg) Saint Peter's University Hospital, New Brunswick, NJ, United States
(Sharma) SUNY Downstate Medical Center, Brooklyn, NY, United States
(Agrawal) St Luke's University Hospital, Bethlehem, PA, United States
(Virmani) Albert Einstein College of Medicine, Bronx, NY, United States
(Kostis) New BrunswickNJUnited States
(Singal) RWJ Univ Hospital, Somerset, NJ, United States
Title
Transcatheter aortic valve replacement versus surgical valve replacement
for low to intermediate surgical-risk patients: A metaanalysis of 5,346
patients.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B295-B296), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter Aortic Valve Replacement (TAVR) has shown
comparable results to surgical valve replacement (SVR) in patients with
severe aortic stenosis (AS) who are at high risk for surgery. We conducted
a meta-analysis to evaluate the safety and efficacy of TAVR versus SVR in
low-intermediate risk patients. METHODS A systematic review was conducted
of randomized control trials (RCTs) and observational studies comparing
TAVR versus SVR in low-intermediate risk patients included in MEDLINE,
EMBASE, CINAHL and Cochrane databases. The outcomes of interest were
allcause mortality, cardiovascular mortality (CVM), myocardial infarction
(MI), stroke, major bleeding, acute kidney injury (AKI), new atrial
fibrillation, major vascular complications, moderate-severe paravalvular
regurgitation (PVR) and new permanent pacemaker (PPM) implantation. Pooled
analyses were performed using random-effects model and treatment effects
were reported as risk ratios (RR) with 95% confidence intervals (CI).
RESULTS Ten studies comprising three RCTs and seven observational studies,
with a total of 5,346 patients were included. There were no significant
differences between TAVR and SVR in terms of mortality [RR 0.90; 95% CI
0.69-1.18, RR 1.02; 95% CI 0.89-1.17], CVM [RR 0.89; 95% CI 0.50-1.59, RR
0.90; 95% CI 0.70-1.15], stroke [RR 0.88; 95% CI 0.65-1.20, RR 1.09; 95%
CI 0.86-1.38] at 30 days or medium-long term follow up respectively, and
major bleeds [RR 0.57, 95% CI 0.27-1.20]. TAVR was associated with
significantly lower rates of 30 days MI [RR 0.52, 95% CI 0.31-0.87], AKI
[RR 0.46, 95% CI 0.32-0.65] and new atrial fibrillation [RR 0.33, 95% CI
0.27-0.40]. On the contrary, the risks of major vascular complication [RR
8.02, 95% CI 2.31-27.86], new PPM implantation [RR 3.74, 95% CI 1.92-7.28]
and moderate-severe PVR [RR 5.77, 95% CI 3.59-9.27] were significantly
increased with TAVR. On sub-analysis, higher rates of major vascular
complication and new PPM implantation reached statistical significance for
only the selfexpanding but not the balloon-expandable TAVR prosthesis.
CONCLUSION TAVR is an acceptable option for low-intermediate risk patients
with severe AS with similar risk ofmortality compared to SVR.

<54>
Accession Number
614161279
Author
Xu B.; Guan C.; Jing Q.; Xu K.; Yang Y.; Han Y.
Institution
(Xu) Fu Wai Hospital, Beijing, China
(Guan) Fu Wai Hospital, National Center for Cardiovascular Diseases,
Beijing, China
(Jing) Division of Cardiology, Department of Internal Medicine, Chiang Mai
University, Beijing, China
(Xu) Chinese Medical Association, Beijing, China
(Yang) Cardiovascular Institute, Fu Wai Hospital, Beijing, China
(Han) Shenyang, LiaoningChina
Title
A Randomized comparison of novel biodegradable polymer-and durable
polymer-coated cobalt-chromium sirolimus-eluting stents: Three-year
outcomes of the I-LOVE-IT 2 trial.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B191), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Previous report of the I-LOVE-IT 2 trial has demonstrated that
the novel biodegradable polymer (BP)-coated cobaltchromium (CoCr)
sirolimus-eluting stent (SES) (Tivoli, Essen Technology, Beijing, China)
was noninferior to the durable polymer (DP)- coated CoCr SES (Firebird 2,
MicroPort, Shanghai, China) for the primary endpoint of 1-year target
lesion failure (TLF). We sought to compare the long-term safety and
effectiveness of the BP-SES with DP-SES. METHODS In the real-world,
randomized trial conducted at 32 Chinese sites, a total of 2,737 patients
eligible for coronary stenting were treated with BP- or DP-SES in a 2:1
ratio. The primary endpoint of 1- year TLF was defined as the composite of
cardiac death, target vessel myocardial infarction (MI), or ischemia
driven (ID) target lesion revascularization (TLR). Secondary endpoints
included the patientoriented composite endpoint (PoCE), a composite of
all-cause death, all MI, or any revascularization, TLF and PoCE
components, and definite/probable stent thrombosis (ST). Long-term
clinical follow-up was scheduled annually up to 5 years for all enrolled
patients. RESULTS Three-year follow-up data was available in 2,663 (97.3%)
patients. There were no significant differences in 3-year rates of TLF
(8.7% vs. 8.4%, p = 0.82), PoCE (15.0% vs.14.0%, p = 0.48), and their
individual components between BP-SES and DP-SES group. The incidences of
definite/probable ST were low and similar between the 2 groups at 3 years
(0.8% vs. 1.0%, p = 0.64). Landmark analysis at 1 year showed that the TLF
(2.7% vs. 2.6%, p = 0.81), PoCE (6.2% vs. 5.2%, p = 0.28), and
definite/probable ST (0.4% vs. 0.5%, p = 1.0) were comparable between the
2 treatments. Three-year clinical outcomes were shown in the Table.
CONCLUSION In the large-scale real-word I-LOVE-IT 2 trial, the novel
BP-SES had similar safety and efficacy outcomes as compared to the DP-SES
through 3 years. (Table presented).

<55>
Accession Number
614161277
Author
Kalra S.; Sapontis J.; Riley R.; Qintar M.; Jones P.; Kirtane A.; Parikh
M.; Moses J.; Ali Z.; Lombardi W.; Nicholson W.; Grantham J.A.;
Karmpaliotis D.
Institution
(Kalra) CIVT, Columbia University Medical Center, New York, NY, United
States
(Sapontis) MonashHeart, VIC, Australia
(Riley) University of Washington, Seattle, WA, United States
(Qintar) Saint Lukes Mid America Heart Institute, Overland Park, KS,
United States
(Jones) Interventional Cardiology Unit, University of Palermo, New York,
NY, United States
(Kirtane, Parikh, Moses) New York-Presbyterian Hospital, Columbia
University Medical Center, New York, NY, United States
(Ali, Karmpaliotis) Columbia University Medical Center, New York, NY,
United States
(Lombardi) University of Washington Medical Center, Seattle, WA, United
States
(Nicholson) York Hospital - Wellspan Health, York, PA, United States
(Grantham) University of Missouri Kansas City, Mid America Heart
Institute, Kansas City, MO, United States
Title
Patient and procedural characteristics and in-hospital outcomes associated
with the use of retrograde recanalization techniques for chronic total
occlusion PCI: A report from the open CTO registry.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B7), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Since the introduction of the Hybrid Algorithm for Chronic
Total Occlusion (CTO) PCI, the use of retrograde recanalization techniques
has become more common. We sought to identify patient and procedural
characteristics necessitating use of retrograde CTO techniques using a
multicenter, adjudicated, prospective CTO PCI registry. METHODS We
analyzed baseline patient and procedural characteristics and in-hospital
outcomes from 881 patients in a contemporary, multicenter US CTO PCI
registry. Data on patient demographics, risk factor prevalence, anatomic
lesion characteristics and in-hospital outcomes of all patients were
collected and analyzed using t-tests or Fisher's exact tests. RESULTS The
mean age of all patients was 65 years, of whom 80% were male. In this
group of 881 patients (428 antegrade-only and 453 any retrograde),
procedural success was achieved more often in the antegrade-only group
than in the retrograde group (396 patients, 92.5% versus 352 patients,
77.7%; p<0.001). Patients in the retrograde group had a significantly
higher prevalence of diabetes mellitus (45.5% vs 36.2%, p=0.005) and were
more frequently post coronary bypass surgery (42.5% vs 24%, p<0.001).
Retrograde group patients more often had a bypass graft to the target
vessel (12.6% vs 5.1%, p<0.001). Lesions in the retrograde group were
longer overall (68.8 mm vs 54.4 mm, p<0.001) and more complex, with higher
average J-CTO scores (2.7 vs 1.9, p<0.001). Procedures in the retrograde
group were longer, with both higher use of radiation (3.02 Gy vs 1.86 Gy,
p<0.001) and contrast (278cc vs 235cc, p<0.001) than those in the
antegrade-only group. CONCLUSION Retrograde CTO PCI strategies appear to
be required more often for the treatment of challenging lesion subsets and
are important to achieving procedural success. Given the higher MACCE
rates, operators should keep a high threshold for the use of these
techniques and patients should be appropriately counseled about the higher
risks involved. (Table Presented).

<56>
Accession Number
614161276
Author
Hwang D.; Myung Lee J.; Rhee T.-M.; Park J.; Park K.W.; Hong M.-K.; Jang
Y.; Valgimigli M.; Colombo A.; Gilard M.; Palmerini T.; Stone G.; Kim
H.-S.
Institution
(Hwang, Myung Lee, Rhee, Park, Park, Kim) Seoul National University
Hospital, Seoul, South Korea
(Hong) Yonsei University, College of Medicine, Seoul, South Korea
(Jang) BernSwitzerland
(Valgimigli) Thoraxcenter, Bern, Switzerland
(Colombo) San Raffaele Scientific Institute, Milan, Italy
(Gilard) Brest University, Brest, France
(Palmerini) Policlinico S. Orsola, Bologna, Italy
(Stone) Columbia University Medical Center, New York-Presbyterian
Hospital, New York, NY, United States
Title
Clinical outcomes of dual antiplatelet therapy after coronary stenting in
patients with chronic kidney disease: Patient-level meta-analysis of 4
randomized clinical trials.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B90-B91), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) for 6 months to 12 months is
recommended after coronary stenting with drug-eluting stent (DES).
However, DAPT in patients with chronic kidney disease (CKD) has not been
thoroughly investigated. METHODS Patient-level pooled analysis was
performed with 5,843 patients from 4 randomized controlled trials (RESET,
PRODIGY, ITALIC, and SECURITY), which evaluated DAPT in patients who
underwent coronary stenting with DES. The 1-year clinical outcomes were
compared between short-term DAPT group (+/-6-month) and long-term DAPT
group (>6-month), stratified by the presence of CKD. Patient-oriented
composite outcome (POCO, a composite of all cause death, any myocardial
infarction [MI], stroke and TIMI major bleeding) was the primary endpoint.
RESULTS Among the total patients, 816 patients had CKD (eGFR by CKD-EPI
<60ml/min/m²), while 5,027 patients had normal renal function.
Most patients (88.9%) were treated by 2nd generation DES. In the CKD
population, the rates of POCO at 1 year were 8.0% in the short-term DAPT
group and 9.0% in the long-term DAPT group (HR 1.22, 95% CI 0.75-1.99,
p=0.430). In the non-CKD population, this rate was lower and did not
differ significantly by DAPT duration (2.7% vs. 3.2%, HR 1.15, CI
0.82-1.60, p=0.416). The incidence of thrombotic events (any MI and and
definite/probable stent thrombosis) did not differ between short-term and
long-term DAPT in either CKD or non- CKD population. TIMI major bleeding,
however, were more frequent in the long-term than the short-term DAPT
group, which did not reach the statistical significance in smaller CKD
population (1.3% vs. 0.3%, HR 5.05, CI 0.59-43.2, p=0.139) but reached
significance in larger non- CKD population (1.8% vs. 0.3%, HR 2.80, CI
1.19-6.63, p=0.019). CONCLUSION Duration of DAPT after coronary stenting
with 2nd generation DES did not affect POCO and thrombotic events in CKD.
population aswell as in non-CKD one. But long-term DAPTmay increase the
incidence of TIMI major bleeding, which reached statistical significance
in the larger non-CKD populationwhile did not in the smaller CKD one.

<57>
Accession Number
614161268
Author
Ahn J.-M.; Cho M.S.; Kang S.H.; Park D.-W.; Lee C.W.; Chang M.; Cavalcante
R.; Sotomi Y.; Onuma Y.; Tenekecioglu E.; Lee P.H.; Kang S.-J.; Lee S.-W.;
Kim Y.-H.; Park S.-W.; Serruys P.; Park S.-J.
Institution
(Ahn, Cho, Kang, Park, Lee, Chang, Kang, Lee, Kim, Park, Park) Asan
Medical Center, Seoul, South Korea
(Cavalcante) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
(Sotomi) EMC, Rotterdam, Netherlands
(Onuma) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Tenekecioglu) ERASMUS MC, Rotterdam, Netherlands
(Lee) Columbia University Medical Center, Seoul, South Korea
(Serruys) Imperial College, London/Thoraxcenter of Erasmus University,
Rotterdam, Netherlands
Title
Mortality of stenting versus bypass surgery according to completeness of
revascularization in severe coronary artery disease: Patient-level pooled
analysis of SYNTAX, PRECOMBAT, and BEST Trials.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B134), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND We compare the long-term survival of patients undergoing
coronary artery bypass surgery (CABG) with those undergoing percutaneous
coronary intervention (PCI) achieving complete revascularization (CR) or
incomplete revascularization (IR) in severe coronary artery disease.
METHODS Data were pooled from the SYNTAX, PRECOMBAT, and BEST trials. The
primary outcome was death from any causes and was compared by as treated
analysis. RESULTS During a median of 4.9 year follow-up (interquartile
range; 4.5 years to 5.0 years), death from any cause occurred in 306
patients (9.5%), and cardiac death occurred in 182 patients (5.7%).
Compared with patients undergoing CABG, patients undergoing PCI with IR
had higher risk of death from any cause (adjusted hazard ratio [aHR],
1.36; 95% confidence interval [CI], 1.03-1.79; P=0.032), and cardiac death
(aHR, 1.61; 95% CI, 1.12-2.31; P=0.01). However, there was no significant
difference between patients undergoing CABG and PCI with CR regarding the
risk of death from any cause (aHR, 1.13; 95% CI 0.85- 1.50; P=0.40), and
cardiac death (aHR, 1.32; 95% CI 0.91-1.90; P=0.14). Subgroup analysis of
multivessel coronary disease, high SYNTAX score (>32), and diabetes showed
consistent findings. CONCLUSION For the treatment of left main or
multivessel coronary artery disease, patients undergoing PCI achieving CR
showed similar long-term survival rate to those undergoing CABG.
Therefore, when the coronary anatomy was suitable for CR, PCI with
drug-eluting stents could be considered as a less invasive alternative to
CABG.

<58>
Accession Number
614161261
Author
Pellegrini C.; Husser O.; Kim W.; Holzamer A.; Walther T.; Rheude T.;
Trenkwalder T.; Michel J.; Kastrati A.; Schunkert H.; Burgdorf C.; Hilker
M.; Mollmann H.; Hengstenberg C.
Institution
(Pellegrini, Hengstenberg) Deutsches Herzzentrum Munchen, Munich, Germany
(Husser, Kastrati) MunichGermany
(Kim) Symetis, Edublens Vd, Switzerland
(Holzamer) University Hospital Regensburg, Regensburg, Germany
(Walther) Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany
(Rheude) LSUHSC-Shreveport, Munich, Germany
(Trenkwalder) ASCARDIO, Munich, Germany
(Michel) Deutsches Herzzentrum Munich, Munich, Germany
(Schunkert) Royal Adelaide Hospital, Bad Bevensen, Germany
(Burgdorf) Herz- und Gefaszentrum Bad Bevensen, Bad Bevensen, Germany
(Hilker) Uniklinik Regensburg, Lappersdorf, Germany
(Mollmann) St Johannes Hospital, Dortmund, Germany
Title
A multicenter analysis of incidence and predictors for permanent pacemaker
implantations and new conduction abnormalities with a novel
self-expandable transcatheter heart valve.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B295), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Preliminary reports show a low rate of permanent pacemaker
implantation (PPI) in patients undergoing transcatheter aortic valve
implantation (TAVI) with the novel self-expanding transcatheter heart
valve ACURATE neo (NEO) (SYMETIS SA, Eclubens, Switzerland). However, the
incidence of PPI and new-onset conduction abnormalities (CA) has not been
studied in large populations. Further, PPI rate is largely influenced by
parameters, such as prosthesis oversizing and implantation depth. Thus, we
analyzed its influence on PPI and on the composite endpoint "PPI and
new-onset CA" (PPI/new-onset CA). METHODS Between January 2014 and January
2016, 312 patients underwent TAVR with NEO in three German TAVI centers.
Of these, 276 consecutive patients without prior pacemaker and 189
patients without baseline CA were studied. Core lab evaluation of the
final aortic angiogram showing the prosthesis in an orthogonal view was
performed to thoroughly assess implantation depth in the left ventricular
outflow tract and CT was used for sizing. ECGs before and after TAVI were
evaluated for new-onset CA. RESULTS New PPI occurred in 9.8% (27/276).
Patients requiring PPI had a higher BMI (27+/-5kg/m² vs.
30+/-6kg/m²; p=0.024), increased prevalence of complete right
bundle branch block (22% vs. 6%; p=0.004) and bradycardia (<60bpm, 30% vs.
13%; p=0.037). PPI/ new- onset CA occurred in 27% (51/189) of patients
having a higher logistic EuroSCORE of 19+/-12% vs. 16+/-9%; p=0.030.
Neither prosthesis oversizing by area nor implantation depth influenced
the rate of PPI or PPI/new-onset CA (see Table). Throughout quartiles of
consecutive patients treated with NEO, there was no sign of a learning
curve on the incidence of PPI (p= 0.70) and PPI/newonset CA (p= 0.62).
CONCLUSION In this multicenter study with the novel self-expandable NEO,
we found a low rate of new PPI and new-onset CA. Degree of prosthesis
oversizing by aortic annular area or implantation depth was not associated
with an increase in both, PPI alone or PPI/new-onset CA. (Table
Presented).

<59>
Accession Number
614161259
Author
Chandrasekhar J.; Redfors B.; Genereux P.; Kirtane A.; Parvataneni R.;
Mehran R.; Stone G.
Institution
(Chandrasekhar) Mount Sinai Hospital, New York, NY, United States
(Redfors) CRF, New York, NY, United States
(Genereux) Columbia University Medical Center, Hopital du Sacre-Coeur De
Montreal, New York, NY, United States
(Kirtane, Stone) New York-Presbyterian Hospital, Columbia University
Medical Center, New York, NY, United States
(Parvataneni) CRFs, New York, NY, United States
(Mehran) Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai
School of Medicine, New York, NY, United States
Title
Comparative efficacy and safety of coronary stents in diabetic patients
with and without insulin treatment: A pooled patient level analysis from
17 randomized trials.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B27), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Patients with diabetes mellitus (DM) have worse cardiovascular
outcomes compared to non-DM patients. Whether DM patients treated with
insulin (ITDM) have worse prognosis is unknown. METHODS In a pooled
patient level analysis from 17 randomized PCI trials (n 21,830), we
compared the 5-yr incidence of mortality, myocardial infarction (MI),
stent thrombosis (ST) and target lesion revascularization (TLR) between
ITDM and non-ITDM groups. Adjusted outcomes and multivariable predictors
of 5-yr mortality were determined using study stratified Cox regression
analysis. RESULTS The study population included 5281 patients (17.8%) with
DM, of which 72.0% (3804) were non-ITDM and 28.0% were (1477) ITDM
patients. ITDM patients were more likely to have prior revascularization
and MI, and lower left ventricular ejection fraction than non-ITDM
patients. ITDM patients had lesions with smaller reference vessel and
final minimum lesion diameters than non-ITDM patients. The 5-yr adjusted
risk of mortality was significantly higher in ITDM vs non-ITDM patients
(Figure). The independent predictors of 5-yr mortality were age (HR 2.01
[1.76, 2.28]), current smoking (HR 2.28 [1.69, 3.07] per 10yr increase)
and ITDM (HR 1.67 [1.32, 2.11]). CONCLUSION Among DM patients undergoing
coronary stenting, insulin treatment is associated with significantly
greater 5-yr mortality, but not MI, ST or TLR. (Figure Presented).

<60>
Accession Number
614161255
Author
Salizzoni S.; D'Errigo P.; Barbero C.; Ferrigno L.; Rosato S.; Barbanti
M.; Tamburino C.; Rinaldi M.; Seccareccia F.
Institution
(Salizzoni) Citta Della Salute E Della Scienza - Molinette, Turin, Torino,
Italy
(D'Errigo, Ferrigno, Rosato, Barbanti, Seccareccia) Istituto Superiore Di
Sanita, Rome, Italy
(Barbero) Cardiothoracic Department, Turin, Italy
(Tamburino) Ferrarotto Hospital, Catania, Italy
(Rinaldi) Biosensors, Italy
Title
Futility in transcatheter aortic valve implantation: Result from the
Italian multicenter OBSERVANT Study.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B273), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter Aortic Valve Implantation (TAVI) is a valid
treatment in high-risk patients with severe aortic valve stenosis. Recent
trials demonstrated similar short-term outcomes compared to surgery also
in low-risk patients. To date, there is no agreement regarding the profile
of patient in whom TAVI is likely to be beneficial, especially in
compromised and so called "inoperable" patients. Objective of the study is
to identify those patients who do not benefit from TAVI, regardless by the
excellent periprocedural-result (and we defined as "futile" procedure).
METHODS All patients that underwent TAVI between December 2010 and June
2012 and were enrolled in the OBservational Study of Effectiveness of
AVR-TAVI procedures for severe Aortic steNosis Treatment (OBSERVANT) were
included in the analysis. Futility was defined as 1-year mortality in
patients survived at 30 days. Multivariable analysis was performed to
assess pre-operative independent predictors of futility. RESULTS A total
of 1911 patients that underwent TAVI were enrolled in the OBSERVANT. Only
the data from 1728 patients that survive 30 days after TAVI were analyzed.
One-year mortality was 13.5% (233 patients). The independent pre-operative
predictors of futility, corrected for major post-procedural complications,
were: male gender (HR 1.38; 95% CI 1.00-1.90); serum creatinine (every 1
mg/dL increase of HR 1.18; 95% CI 1.03-1.35); frailty score (grade 1: HR
1.94; 95% CI 1.34-2.79; grade 2:HR 1.72; 95% CI 1.17-2.52; grade 3:HR
6.28; 95% CI 3.54-11.14); previous procedures on the aorta (HR 1.89; 95%
CI 1.15- 3.09); percutaneous transluminal coronary angioplasty (PTCA) at
the time of TAVI (HR 1.98; 95% CI 1.07-3.63). CONCLUSION Male gender,
kidney dysfunction, low- and mid-grade of frailty, previous procedures on
the aorta and PTCA concomitant with TAVI are independent predictors of
one-year mortality in patients undergoing successful TAVI. In these
subgroups a proper and careful patient selection is needed to avoid
"futile" procedures. For sure patients with high grade of frailty
(dementia, patient totally dependent in shifts or day-by-day activities)
should be excluded from a TAVI program.

<61>
Accession Number
614161241
Author
Stone G.; Abraham W.; Lindenfeld J.A.; Weissman N.; Marx S.; Ellis J.;
Crosson L.A.; Mack M.
Institution
(Stone) Columbia University Medical Center, New York-Presbyterian
Hospital, New York, NY, United States
(Abraham) Ohio State University, Columbus, OH, United States
(Lindenfeld) Vanderbilt University Medical Center, Washington, DC, United
States
(Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Marx) Columbia University Medical Center, Menlo Park, CA, United States
(Ellis) Abbott Vascular, Santa Clara, CA, United States
(Crosson) Abbott Vascular, Menlo Park, CA, United States
(Mack) Heart Hospital Baylor Plano, Plano, TX, United States
Title
Cardiovascular outcomes assessment of MitraClip therapy in heart failure
patients with functional mitral regurgitation (The COAPT Trial): Baseline
characteristics and preliminary 30-day and 1-year outcomes of the roll-in
cohort.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B255), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Pts with functional mitral regurgitation (FMR) and heart
failure (HF) have a poor prognosis. The COAPT Trial was designed to
determine whether transcatheter mitral valve (MV) repair with the
MitraClip is safe and effective for reducing recurrent HF hospitalizations
in pts with FMR. Herein we describe demographics and 30-day outcomes from
the COAPT roll-in cohort, performed at sites with little or no MitraClip
experience. METHODS Pts enrolled in COAPT have >3+ FMR, are symptomatic
despite maximally tolerated guideline-directed medical therapy, and have
LVESD <70 mm and LVEF >20% - <50%. A Central Eligibility Committee
confirms that each pt has been optimally medically treated and will not
undergo MV surgery. Endpoints include NYHA Class, Six Minute Walk Distance
(6MWD) and echo measures analyzed by an independent core lab. RESULTS 49
roll-in pts (mean age 75 yrs, 61% male) at 34 US centers underwent the
MitraClip procedure. Baseline co-morbidities included CAD (82%), renal
disease (63%), prior CABG (53%) and COPD (43%). Mean STS score was
11+/-7%, and 69% were NYHA class III/IV. Baseline 3+/4+ FMR was present by
core lab analysis in 55%/45% of patients (63% due to ischemic
cardiomyopathy (CM), 37% idiopathic CM). LVEF was 37+/-11% and mean 6MWD
was 234m. The Clip implant rate was 94% (mean 1.4 Clips), and MR was
reduced to <2+ MR in 38/45 pts (84%) post procedure. Adverse events and
functional measures were assessed at 30 days and 1 year (Table).
CONCLUSION In the COAPT roll-in experience, among high-risk symptomatic HF
pts with severe FMR, the MitraClip safely reduced MR and improved symptoms
at 30 days and 1 year. Results from the ongoing randomized COAPT trial
will determine whether reducing FMR in optimally treated patients with HF
improves prognosis. (Table Presented).

<62>
Accession Number
614161236
Author
Mina G.; Gill P.; Soliman D.; Reddy P.; Dominic P.
Institution
(Mina, Gill) LSUHSC-Shreveport, Shreveport, LA, United States
(Soliman) National Helicopter Emergency Medical Service, Denmark
(Reddy) Universitatsklinikum Jena, Germany
(Dominic) Central Denmark Region Emergency Medical Service, Shreveport,
LA, United States
Title
Impact of diabetes mellitus on outcomes of transcatheter aortic valve
replacement: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B294-B295), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with adverse outcomes
after surgical aortic valve replacement. However, data on the impact of DM
on outcomes of transcatheter aortic valve replacement (TAVR) are
conflicting. METHODS We searched Pubmed/Medline and Cochrane Central
Register of Controlled Trials for all studies that evaluated outcomes
after TAVR and stratified at least one of the studied endpoints by DM
status. Primary end point was all-cause mortality at one year. Secondary
end points were early (up to 30 days) mortality, acute kidney injury
(AKI), cerebrovascular accidents (CVAs), major bleeding and major vascular
complications. Pooled odds ratio (OR) and 95% confidence intervals (CI)
were calculated using random effect models. RESULTS The present
meta-analysis included 64 studies with a total of 38,686 patients. DM was
present in 29% of those patients. Patients with DM had significantly
higher one year mortality (OR 1.14, CI 1.04- 1.26, p=0.008) and
periprocedural AKI (OR: 1.28, CI: 1.08-1.52, p=0.005) when compared to
patients without DM. On the other hand, there were no significant
differences between diabetics and nondiabetics in early mortality (OR
1.00, CI 0.86-1.16, p=0.99), CVAs (OR 1.01, CI 0.63-1.64, p=0.95), major
bleeding (OR 1.03, CI 0.84-1.25, p=0.79) or major vascular complications
(OR 0.89, CI 0.65-1.22, p=0.47). CONCLUSION In patients undergoing TAVR,
DM is associated with increased one-year mortality and periprocedural AKI,
and therefore, DM should be considered one of the predictors of adverse
outcomes in those patients.

<63>
Accession Number
614161234
Author
Yadav M.; Genereux P.; Redfors B.; Madhavan M.; Kirtane A.; Parvataneni
R.; Stone G.
Institution
(Yadav) CRF, South Richmond Hill, NY, United States
(Genereux) Columbia University Medical Center, Hopital du Sacre-Coeur De
Montreal, New York, NY, United States
(Redfors, Parvataneni) CRF, New York, NY, United States
(Madhavan) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Kirtane, Stone) New York-Presbyterian Hospital, Columbia University
Medical Center, New York, NY, United States
Title
The smoker's paradox revisited: A 5-year patient-level pooled analysis of
17 randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B133), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Studies on the effects of smoking and outcomes among patients
undergoing percutaneous coronary intervention (PCI) have reported
conflicting results. We sought to examine this relationship from a large
pooled patient-level study. METHODS Patient-level data from 17
prospective, randomized trials (RAVEL, E-SIRIUS, SIRIUS, C-SIRIUS, TAXUS
II, TAXUS IV-V, ENDEAVOR II-IV, SPIRIT II-IV, HORIZONS-AMI and COMPARE
I-II, PLATINUM) were pooled. Patients were stratified by smoking status at
time of enrollment. Study stratified Kaplan Meier event rates and Cox
regression analysis modeled time to event outcomes. Five year ischemic
outcomes were compared between the two groups. RESULTS Among 21,549
patients, 6,038 (28.01%) were current smokers. Smokers were younger and
less likely to have diabetes, hypertension, hyperlipidemia, or prior
myocardial infarction (MI), PCI, or coronary artery bypass grafting.
Angiographically, smokers had longer lesions but less calcification. At 5
years, smokers had similar unadjusted rates of death and cardiac death but
higher rates of MI and stent thrombosis than nonsmokers; however, after
multivariable adjustment for potential confounders, smoking was a strong
independent predictor of all-cause death, cardiac death, MI, and stent
thrombosis (Table). (Table Presented) CONCLUSION The present large
patient-level pooled analysis with 5- year follow-up clearly demonstrates
that smoking remains an important predictor of poor outcomes after PCI and
should be strongly discouraged.

<64>
Accession Number
614161226
Author
Wang D.D.; Eng M.; Greenbaum A.; Guerrero M.; O'Neill W.
Institution
(Wang, Greenbaum, O'Neill) Henry Ford Hospital, Detroit, MI, United States
(Eng) University Clinic of Munich, Evanston, IL, United States
(Guerrero) Evanston Hospital, Evanston, IL, United States
Title
Validating a prediction modeling tool for LVOT obstruction after
transcatheter mitral valve replacement.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B254-B255), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Left ventricular outflow tract (LVOT) obstruction is a fatal
consequence of transcatheter mitral valve replacement (TMVR). Despite
advancements in transcather aortic valve replacement therapies, there
currently exists no LVOT prediction model to optimize patient procedural
safety in TMVR. METHODS From 2013 to May 2016, 30 patients in 5 centers
underwent TMVR with compassionate use of balloon-expandable valves for
severe mitral valve dysfunction secondary to degenerative surgical mitral
ring, bioprosthesis, or severe mitral stenosis secondary to severe mitral
annular calcification. We performed a multi-center retrospective review of
all thirty patients who underwent transcatheter mitral valve replacement.
All patients had pre-procedural CT scans performed for LVOT prediction
modeling, intraprocedural TEE and cardiac catheterization hemodynamics
performed. Pre-procedural prediction modeling was performed utilizing
computer-aided-design (CAD) modeling of the neo-LVOT post-TMVR. RESULTS
All patients underwent successful transcatheter mitral valve replacement
without device embolization. Five of the thirty patients experienced an
increase of > 10mmHg in their LVOT peak gradient post-TMVR from their
resting LVOT gradient. Utilizing an ROC curve comparing difference in LVOT
peak gradient pre-and post- TMVR compared to predicted neo-LVOT surface
area post-TMVR, a predicted neo-LVOT surface area of 252.2 mm²
(93.1% classification rate) was identified as the cutoff neo-LVOT surface
area necessary for successful TMVR without an associated significant
increase in LVOT peak gradients. CONCLUSION The novel clinical application
of CAD design, and CT post-processing in predicting LVOT obstruction may
be invaluable for optimal mitral valve annulus sizing, and determination
of the desired deployment angulation and landing height. The use of this
technology may improve the technical success of TMVR and aid in the first
steps towards personalized medicine in transcatheter heart valve
therapies.

<65>
Accession Number
614161205
Author
Lebehn M.; Hunter T.; Clancy S.; Spies C.
Institution
(Lebehn) University Hospital Limerick, Honolulu, HI, United States
(Hunter) CTI Clinical Trial and Consulting, Cincinnati, OH, United States
(Clancy) Edwards Lifesciences, Whittier, CA, United States
(Spies) Queen's Medical Center, Honolulu, HI, United States
Title
A comparison of the effects on length of stay and cost with percutaneous
versus surgical cutdown femoral artery access in patients undergoing
Transcatheter Aortic Valve Replacement-Results from a Cohort Study.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B152), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Single center studies documented a shorter length of stay (LOS)
and lower cost in patients undergoing percutaneous access (PA) as opposed
to surgical cutdown (SC) in transfemoral Transcatheter Aortic Valve
Replacement (TAVR). Nevertheless, according to the most recent TVT
database analysis, approximately one quarter of patients undergoing
transfemoral TAVR still receive SC. The goal of this study was to identify
the effect of PA on LOS and procedural costs. METHODS This is a
retrospective cohort study using the Premier Database. Transfemoral TAVR
cases were identified based on Current Procedural Terminology (CPT) codes
33361 and 33362 between October 2011 and December 2014. Cost and LOS
models were developed to compare the PA versus SC cohorts. Generalized
linear models with gamma distributions and log links were developed to
assess the impact of approach on LOS and total visit cost after
controlling for patient and hospital characteristics. RESULTS A total of
51 procedures performed via SC at 7 hospitals and 146 procedures performed
via PA at 10 hospitals were included in the analysis. PA was associated
with a shorter adjusted LOS (4.8 days PA vs. 5.8 days SC, p=0.03) and
lower total hospital cost of $4,096 per case. PA did not have higher
adverse event rates and in hospital mortality as compared to SC.
CONCLUSION This study demonstrates that PA safely results in a shorter LOS
and less cost compared to SC. This is the first comprehensive analysis of
PA in TAVR derived from a multicenter cohort study. Further efforts should
focus on wider dissemination of PA amongst all TAVR centers.

<66>
Accession Number
614161166
Author
Rudenko B.; Shanoian A.; Boytsov S.; Drapkina O.; Beregovskaya S.;
Akhadova A.; Feshchenko D.; Vlasov V.; Shukurov F.; Koltunov A.;
Dzemeshkevich S.; Frolova Y.
Institution
(Rudenko) MoscowRussian Federation
(Shanoian) Nat. Rsrch Ctr for Preventive Med., Moscow, Russian Federation
(Boytsov, Drapkina, Beregovskaya, Akhadova, Feshchenko, Vlasov, Shukurov)
National Center for Preventive Medicine, Russian Federation
(Koltunov) Central Military Hospital, Russian Federation
(Dzemeshkevich, Frolova) National Center for Surgery, Russian Federation
Title
Simplicity Denervation System for Pulmonary Artery Denervation in Patients
with Chronic Thrombembolic Pulmonary Hypertension (first-in-man study).
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B334), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND The goal of our study was to evaluate the safety and
effectivenessofSimplicitydenervationsysteminloweringpulmonaryartery
pressure in patients with chronic thromboembolicpulmonaryhypertension.
METHODS Patients with the chronic thromboembolic pulmonary hypertension
(defined as mean pulmonary artery pressure > 25) were eligible for the
study. A total of 12 patients were included. All patients were on the
multidrug theraphy, including sildenafil. Functional capacity was
determined by the 6MWT performed 1 week prior and 3 months following the
PADN procedure. The right heart catheterization, hemodynamic measurements
and blood oxygen saturation data from the RA, RV, and PA were done before
the PADN procedure. The PVR [PVR = (mean PAP d PAOP)/CO] was calculated.
The PADN procedure was made by Simplicity 6 Fr-compatible radiofrequency
ablation catheter inserted through the coronary guiding catheter. Ablation
was perfored at the bifurcation level of the main PA and at the ostium of
the left and right PA. Procedural success was defined as a reduction in
the mean PAP >10 mm Hg (as measured by guiding catheter at the end of
ablation), and there were no complications. The primary endpoints were
improvement of functional capacity by the 6MWT and mean PAP at 3 months.
RESULTS During and immediately following the PADN procedure, no
complications (death, arrhythmias, PA perforation, acute thrombus
formation in the PA or in the femoral vein, bleeding) were recorded.
During 3-months of follow-up no rehospitalization was required. All
patients reported no deterioration of the symptoms and no complications
were registered. 9 patients noticed significant improvements in dyspnea
and fatigue, in all patients sildenafil was discontinued. After 3 months
all patients underwent right heart catheterization and functional capacity
measurements. At 3 months follow-up the reduction of mean pulmonary artery
pressure was 25 mm Hg (from 58 +/- 6 to 33 +/- 4 mm Hg) (p < 0.01) and
improvement of the 6 minutes walking test from 321 +/- 19 m to 487 +/- 29
m (p < 0.01) was observed. CONCLUSION The Simplicity denervation system is
proven to be safe and effective for pulmonary artery denervation. Further
randomized study is needed to confirm the clinical benefit of this
procedures in patients with pulmonary hypertension.

<67>
Accession Number
614161084
Author
Muranishi H.; Yamaji K.; Yamaji Y.; Ando K.; Kadota K.; Higami H.; Kawai
K.; Tamura T.; Sakamoto H.; Toyofuku M.; Morimoto T.; Kimura T.
Institution
(Muranishi) Kokura Memorial Hospital, Kokura City, Japan
(Yamaji) KitakyushuJapan
(Yamaji, Ando) Kokura Memorial Hosiptal, Kurashiki, Japan
(Kadota) Kurashiki Central Hospital, Kurashiki, Japan
(Higami) Otsu Red Cross, Otsu, Japan
(Kawai) Chikamori Hospital, Kochi, Japan
(Tamura) Japanese Red Cross Society Wakayama Medical Center, Shizuoka,
Japan
(Sakamoto) Shizuoka General Hospital, Shizuoka, Japan
(Toyofuku) Wakayama Medical Center, Wakayama, Japan
(Morimoto) Hyogo College of Medicine, Nishinomiya, Japan
(Kimura) Kyoto University Hospital, Kyoto, Japan
Title
Optimal duration of dual antiplatelet therapy after left main coronary
artery stenting: A retrospective multicenter AOI LMCA stenting registry.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B85), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Several studies suggested that prolonged dual antiplatelet
therapy (DAPT) reduced the risks of ischemic events, but increased the
risk of bleeding. Optimal duration of DAPT after left main coronary artery
(LMCA) stenting remains unclear. METHODS From Nov. 2004 to Dec. 2012, we
enrolled consecutive 1809 patients who underwent LMCA stenting in 6
Japanese centers. We compared 5-year clinical outcomes after LMCA stenting
between patients with and without DAPT at 1 year. RESULTS Mean follow-up
period was 44 +/- 27 months. A total of 1219 patients survived neither
with any bleeding events nor with any coronary revascularization at 1 year
(on-DAPT at 1 year: N=1092 [89.6%], off-DAPT at 1 year: N=123 [10.1%], and
DAPT status unknown: N=4 [0.3%]). The cumulative 5-year incidence of
myocardial infarction (2.5% vs 3.2%, p=0.87; adjusted HR 1.75 [95% CI.
0.43-12.1], p=0.47) and major bleeding events (7.7% vs 7.0%, p=0.64;
adjusted HR 1.09 [95% CI. 0.53-2.60], p=0.82) were similar between
patients with and without DAPT, respectively. Very late stent thrombosis
(VLST, >1 year) occurred in only one patient in the off-DAPT group. While
VLST in the LMCA lesion might lead a catastrophic outcome, the adjusted
5-year risks of all-cause death (17.9% vs 25.0%, p=0.22; adjusted HR 0.70
[95% CI. 0.45-1.11], p=0.12) and cardiac death (6.0% vs 5.9%, p=0.62;
adjusted HR 0.97 [95% CI. 0.41-2.75], p=0.96) were also similar between
the two groups. The cumulative 5-year incidence of target lesion
revascularization was significantly higher in patients in the on-DAPT
group than in the off-DAPT group (8.1% vs 2.5%; p=0.02; adjusted HR 4.07
[95%CI 1.21-25.3], p=0.02). CONCLUSION In the real-world clinical
practice, 90% of patients continued to receive DAPT beyond 1 year after
the LMCA stenting. Given that there were no significant differences in the
ischemic and bleeding outcomes between patients with and without DAPT at 1
year, patients safely stop DAPT within 1 year after LMCA stenting.

<68>
Accession Number
614161072
Author
Van Gils L.; Clavel M.-A.; Vollema M.; Delgado V.; Nazif T.; Spitzer E.;
Hahn R.; Bax J.; Leon M.; Pibarot P.; Van Mieghem N.
Institution
(Van Gils) Erasmus MC, Rotterdam, Netherlands
(Clavel) Quebec Heart Institute, Quebec City, QC, Canada
(Vollema) LUMC, Canada
(Delgado) Leiden University Medical Cent, Leiden, Netherlands
(Nazif) Columbia University Medical Center, New York, United States
(Spitzer) Cardialysis, Rotterdam, Netherlands
(Hahn) New York-Presbyterian Hospital, New York, United States
(Bax) Leiden University Medical Center, Leiden, Netherlands
(Leon) NewYork- Presbyterian Hospital, Columbia University Medical Center,
New York, United States
(Pibarot) Quebec Heart and Lung Institute, QC, Canada
(Van Mieghem) Erasmus Medical Center, Rotterdam, Netherlands
Title
Clinical outcome in patients with heart failure and moderate aortic
stenosis.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B331-B332), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Frequency of heart failure (HF) and moderate aortic stenosis
(AS) increases with age and often coincides. Afterload reduction is the
mainstay of HF treatment. Aortic valve replacement (AVR) is only formally
indicated for symptomatic severe AS. We aimed to evaluate the event rate
in patients with depressed LV function and proven moderate AS. METHODS We
created a multi-center retrospective database including all patients with
depressed LV function (ejection fraction < 50%) and moderate AS (AVA 1.0 -
1.5 cm2) between 2010 and 2015. Endpoints were all-cause mortality,
progression to severe AS requiring AVR and need for hospitalization for
decompensated HF. RESULTS The study enrolled 310 patients with a mean age
of 73 years and 75% were male. The majority was symptomatic (NYHA II: 41%;
NYHA III: 29%; NYHA IV: 4%). Ischemic cardiomyopathy was present in 48% of
patients and 12% had cardiac resynchronization therapy. Overall 72% of
patients received beta-blocking agents, 48% ACE-inhibitors, 28%
angiotensin receptor antagonists and 21% mineralocorticoid receptor
antagonists. Half of the patients (44%) received oral anticoagulants.
Median follow-up time was 688 days [IQR 304-1171]. All-cause mortality at
1 and 2 years were 10% and 20%, respectively. Hospitalizations for HF at 1
and 2 years occurred in 16% and 23%, respectively, with multiple
admissions in one third. AVR was performed in 14% at 1 year and in 19% at
2 years, in two thirds surgical (SAVR) and in one third transcatheter
(TAVR). CONCLUSION Patients with both HF and moderate AS are at high risk
for mortality, hospitalization for decompensated HF and/or progression to
severe aortic stenosis. Early valve replacement in these vulnerable
patients may provide additional afterload reduction and impact clinical
outcome. This hypothesis will be studied in the randomized Transcatheter
Aortic Valve Replacement to UNload the Left ventricle in patients with
ADvanced heart failure (TAVR UNLOAD) trial.

<69>
Accession Number
614161071
Author
Garcia E.; Hong S.; Cho S.-A.; Cho J.Y.; Lee S.H.; Joo H.J.; Park J.H.; Yu
C.W.; Lim D.S.
Institution
(Garcia) Hospital Universitario Madrid Monteprincipe, Seoul, South Korea
(Hong) Korea University, College for Medicine, Seoul, South Korea
(Cho) Hospital Universitario Madrid, Seoul, South Korea
(Cho) Korea University Cardiovascular Center, Seoul, South Korea
(Lee) Anam Hospital, Korea University Medical Center., Seoul, South Korea
(Joo, Park, Lim) Korea University, Anam Hospital, Seoul, South Korea
(Yu) Korean University, Anam Hospital, Seoul, South Korea
Title
Comparison of ticagrelor versus prasugrel on inflammation, vascular
function, and circulating endothelial progenitor cells in diabetic
patients with non-ST elevation acute coronary syndrome (NSTE-ACS)
requiring coronary stenting: Prospective, randomized, cross-over design.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B43), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Although both ticagrelor and prasugrel have shown potent
anti-platelet effects, only ticagrelor inhibits cellular uptake of
adenosine. We therefore compared adenosine associated pleiotropic effects
such as systemic inflammation, vascular function, and circulating
endothelial progenitor cells between two adenosine diphosphate receptor
inhibitors. METHODS Using a randomized, cross-over, 10-weeks follow-up
design, ticagrelor or prasugrel was administered in type 2 diabetic
patients with non-ST elevation acute coronary syndrome (ACS) requiring
stent implantation. Brachial artery flow mediated dilation (baFMD),
inflammatory markers, circulating number of endothelial progenitor cells,
and arterial stiffness were compared during the follow-up. RESULTS
Improvement in baFMD was significantly greater in the ticagrelor group
(0.015 +/- 0.019 vs. -0.003 +/- 0.018 %, p<0.001). Ticagrelor
significantly decreased inflammatory cytokines such as IL-6 (-0.58 +/-
0.43 vs. -0.05 +/- 0.24 pg/mL, p<0.001), TNF-alpha (-5.62 +/- 4.40 vs.
-0.42 +/- 2.64 pg/mL, p<0.001), and increased adiponectin (2.31 +/- 2.00
vs. 0.08 +/- 1.50 mg/mL, p<0.001) during the 10-week follow-up. Ticagrelor
also showed significant increases in absolute numbers of circulating
endothelial progenitor cells such as CD34/KDR (42.5 +/- 37.8 vs. -28.2 +/-
23.7/mL, p<0.001), CD34/CD117 (51.9 +/- 77.2 vs. -66.3 +/- 45.2/ mL,
p<0.001), and CD34/CD133 (55.2 +/- 69.2 vs. -28.0 +/- 34.1/mL, p<0.001).
CONCLUSION Ticagrelor, in comparison to prasugrel, significantly decreased
inflammatory cytokines and increased circulating endothelial progenitor
cells, thereby contributing to the improvement in arterial endothelial
function in diabetic non ST-elevation ASC patients. The pleiotropic
effects of ticagrelor beyond its potent antiplatelet effects may
contribute to additional clinical benefits.

<70>
Accession Number
614161054
Author
Ebrahimi R.; Mehran R.; Ben-Yehuda O.; Parvataneni R.; Stone G.
Institution
(Ebrahimi) Ramin Ebrahimi, Los Angeles, CA, United States
(Mehran) Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai
School of Medicine, New York, NY, United States
(Ben-Yehuda) Cardiovascular Research Foundation, New York, NY, United
States
(Parvataneni) CRF, New York, NY, United States
(Stone) Columbia University Medical Center, New York-Presbyterian
Hospital, New York, NY, United States
Title
Risks and benefits of dual antiplatelet therapy after coronary artery
bypass graft surgery: Insights from the ACUITY trial.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B2), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND The role of dual antiplatelet therapy (DAPT) after coronary
artery bypass graft (CABG) surgery remains controversial. We investigated
the impact of treatment with DAPT (aspirin [ASA] plus clopidogrel) vs. ASA
alone at discharge after CABG on 30-day and 1-year clinical outcomes from
the multicenter Acute Catheterization and Urgent Intervention Triage
strategy (ACUITY) trial. METHODS In ACUITY 13,819 patients with
non-ST-segment elevation acute coronary syndromes (NSTEACS) underwent
urgent angiography followed by revascularization as appropriate. ASA was
continued indefinitely in all patients. Use of clopidogrel after CABG was
left to the discretion of the physician. The present analysis excluded
CABG patients who died or had a post-CABG in-hospital myocardial
infarction (MI) and those discharged on ticlopidine. The primary endpoint
was major adverse cardiac events (MACE), a composite of death, MI or
unplanned revascularization for ischemia. Kaplan-Meier estimated event
rates were determined. Propensity matched Cox regression models were used
to determine the independent effects of DAPT utilization at discharge on
30-day and 1-year outcomes. RESULTS Of 1539 pts undergoing CABG, 161 had
MI or death before discharge and 7 were discharged on ticlopidine. Of the
remaining 1371 pts, 576 (42.0%) were discharged on DAPT, and the remainder
on ASA alone. There were no significant differences in baseline
characteristics between the DAPT and ASA groups. 30-day post-discharge
CABGmajor bleeding was higher in the DAPT vs the ASA group (24.2% vs
12.5%, adjusted HR=1.55, 95% CI 1.07-2.25, P=0.02). Post-discharge 30-day
MACE (4.9%vs 4.5%, adjusted HR =0.99, 95% CI 0.55-1.83, p=0.99) and
post-discharge 1-year MACE (11.5% vs 9.6%, adjusted HR = 1.32 95% CI
0.88-1.97, p=0.17) were not significantly different between the DAPT and
the ASA groups respectively. Nor did the component rates of the MACE
endpoint vary according to antiplatelet regimen. CONCLUSION Among pts with
NSTEACS undergoing CABG in the large ACUITY trial, post-discharge use of
DAPT was associated with increased major bleeding without reductions in
30-day or 1-year MACE.

<71>
Accession Number
614161032
Author
Yzeiraj E.; Bijuklic K.; Haselbach T.; Krause K.; Witt J.; Hansen L.;
Riess F.-C.; Schofer J.
Institution
(Yzeiraj) Prof. Schofer Medizinisches Versorgungszentrum, Hamburg, Germany
(Bijuklic) TCTMD.com, Hamburg, Germany
(Haselbach, Krause, Witt, Hansen) Albertinen Krankenhaus, Hamburg, Germany
(Riess) Heart Hospital Baylor Plano, Hamburg, Germany
(Schofer) Hamburg University Cardiovascular Center, Hamburg, Germany
Title
A DW-MRI and MSCT-Study to assess predictors of cerebral embolism during
transcatheter aortic valve implantation.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B290), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is known to be
associated with the risk of cerebral infarcts (CI). Cerebral embolic
protection devices are under clinical evaluation but the indication for
their use has not yet been defined. We aimed to identify predictive risk
factors for the occurrence of CI in patients undergoing TAVI. METHODS 247
TAVI patients who underwent cerebral DW-MRI 3-5 days after the procedure
were enrolled. 176 patients (71%) received SAPIEN valve (Edwards
Lifesciences, California) (ES) and 71 patients (29%) a Direct Flow Medical
valve (Direct Flow Medical, California) (DFM). The access was transfemoral
in 97%, transaortic in 2% and transapical in 1% of cases. Cerebral DW-MRI
were analysed by a blinded physician to assess the incidence, number and
volume of new CI. Volumetric quantification of calcification of the aortic
valve complex (AVC) including left ventricular outflow tract and aortic
root (AR) were assessed from contrast-enhanced MSCT. RESULTS DFM patients
(mean age 82 +/- 5 yrs, EuroSCORE 20 +/- 10.5%) had a higher incidence of
CI respect ES patients (mean age 82 +/- 7 yrs, EuroSCORE 21.2 +/- 12.9%)
(86% versus 66%, p=0.002). Also mean lesion volume was bigger in DFM group
(379 +/- 79 versus 202 +/- 22 mm³, p=0.004). In the ES group
patients with CI were older (p=0.043), more often treated with a 29 mm
valve (p=0.036) and had a more calcified AVC, in particular AR (p=0.033).
Binary logistic regression analysis identified valve size (OR 2.620) and
AR calcification (OR 1.002) as independent predictors of CI in ES
patients. In the DFM group there were no significant differences between
patients with and without CI and no independent predictor for CI was
identified. CI were silent in 98% of cases. Stroke occurred in four
patients, not different in the two cohorts. CONCLUSION TAVI is associated
with a high rate of new CI and the majority of them are silent. Whereas
the risk of CI in ES patients increases with increasing valve size and
degree of aortic root calcification, no clinical, echocardiographic, MSCT
or procedural factor were found to be predictor of CI in the DFM patients.
These findings might help identifying patients who need a cerebral embolic
protection device for TAVI.

<72>
Accession Number
614161029
Author
Carrie D.; Menown I.B.A.; Oldroyd K.; Copt S.; Talwar S.; Maillard L.;
Morice M.-C.; Lim S.T.; Lang I.; Urban P.
Institution
(Carrie) Hopital Rangueil, Toulouse, France
(Menown) Craigavon Cardiac Centre, Craigavon, Northern Ireland, United
Kingdom
(Oldroyd) West of Scotland Regional Heart and Lung Centre, Glasgow, United
Kingdom
(Copt) Biosensors International Group, Morges, Switzerland
(Talwar) Royal Bournemouth Hospital, Bournemouth, United Kingdom
(Maillard) GCS ES Axium Rambot, Aix en Provence, France
(Morice) Institut Cardiovasculaire Paris Sud, Massy, France
(Lim) National Heart Centre Singapore, Singapore, Singapore
(Lang) Medizinische Universitat Wien, Wien, Austria
(Urban) La Tour Hospital, Geneva, Switzerland
Title
LEADERS FREE OAC: Biolimus A9 coated versus bare metal stents in patients
requiring oral anticoagulation: A pre-specified subgroup analysis of the
LEADERS FREE trial.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B22-B23), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND The optimal choice of stent and antithrombotic therapy for
patients (pts) at high bleeding risk (HBR) remains controversial because
of concerns regarding long-term dual antiplatelet therapy (DAPT).
Recently, the LEADERS FREE trial documented that a polymer- free Biolimus
A9- Drug Coated Stent (DCS) was superior to a baremetal stent (BMS) in HBR
pts when used with a 1-month course of dual antiplatelet therapy. The
present pre-specified subgroup analysis focuses on pts included in LEADERS
FREE for reason of concomitant (OAC) planned to continue after PCI.
METHODS Among 2466 pts randomized in the LEADERS FREE trial, we studied a
pre-specified sub-group of 879 pts (35.6%) for whom continued long term
OAC after the index PCI was planned. Adjudicated primary safety (cardiac
death, myocardial infarction, stent thrombosis) and efficacy endpoints
(clinically driven TLR) and bleeding events (BARC defined) during a 390
day follow-up period were evaluated. Of the 879 pts, 448 pts received DCS
and 431 pts BMS. The groups were comparable for baseline characteristics
including age, gender, diabetes, acute coronary syndrome, congestive heart
failure, atrial fibrillation, previous stroke or myocardial
revascularisation. Multi-vessel disease was present in 60% of patients,
20.8 % underwent multivessel procedures (with staging in 3.8%) and 12.2%
of target lesions were bifurcations. Radial access was used in 61.5% of
procedures. The mean number of stents implanted/pt was 1.8 +/- 1.1 with a
mean total stent length of 32.5 +/- 21.7 mm. Procedural success was 97.2%.
Of the 879 pts,775 were discharged on OAC as follows : 715 (92.3%) on
triple therapy, 56 (7.2%) on a vitamin K antagonist + clopidogrel (WOEST
regimen) and 4 (0.5%) on other combinations of OAC and APT. RESULTS Table
1 CONCLUSION The LEADERS FREE OAC sub-study suggests that the benefit seen
in the overall trial is preserved in pts planned for continuation of OAC.
(Table Presented).

<73>
Accession Number
614161017
Author
Villablanca P.; Makkiya M.; Nikolic K.; Wang K.; Lesniak-Sobelga A.;
Augoustides J.; Maldonato Y.; Ramakrishna H.
Institution
(Villablanca) Montefiore Medical Center, New York, NY, United States
(Makkiya) Montefiore, Bronx, NY, United States
(Nikolic) Mayo Clinic Arizona, United States
(Wang) St. Luke's Mid America Institute, Krakow, Poland
(Lesniak-Sobelga) Department of Cardiac and Vascular Diseases, John Paul
II Hospital, Krakow, Poland
(Augoustides) Interventional Cardiology Unit, University of Palermo,
Palermo, Italy
(Maldonato) Bristol Heart Institute, Phoenix, AZ, United States
(Ramakrishna) Mayo Clinic, Phoenix, AZ, United States
Title
Comparison of general versus local anesthesia in patients undergoing
transcatheter aortic valve replacement (TAVR): A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 28th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2016. United
States. Conference Start: 20161029. Conference End: 20161102. 68 (18
Supplement 1) (pp B269), 2016. Date of Publication: November 2016.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter Aortic Valve Replacement (TAVR) is typically
performed under general anesthesia with endotracheal intubation (GA).
There is growing data in the literature however, that this procedure can
be safely performed under local anesthesia (LA). METHODS We performed a
comprehensive search of EMBASE, PUBMED, and Web of Science databases. Odds
ratios (OR), difference of the mean (DM) and 95% confidence intervals (CI)
were computed using the Mantel-Haenszel method. Fixed-effect model was
used; if heterogeneity (I2)>40, effects were obtained using a random
model. Sensitivity and cumulative analysis was performed for each outcome.
RESULTS A total of 18 studies and 19 255 patients were included in
meta-analysis. The use of GA for TAVR was associated with an increased
overall 30- day mortality (RR 1.35, Cl 1.07-1.70), length of stay (DM
2.33, CI 1.28-3.38), ICU stay (DM 8.98, CI 1.47-16.50), procedural time
(DM 24.46, CI 16.52-32.41), use of vasopressors/ inotropes (RR 1.95, CI
1.58-2.40), vascular complications (RR 1.41, CI 1.05-1.89) and post
procedural intubation (RR 32.71, CI 18.18-58.88). TAVR with GA showed a
lower incidence of paravalvular leak (RR 0.8, CI 0.66-0.80). No difference
was observed between GA and LA for stroke (RR 1.15, Cl 0.91-1.45),
cardiovascular mortality (RR 1.32, Cl 0.83-2.10), permanent pacemaker
implantation (RR 1.32, Cl 0.83- 2.10),vascular complications (RR 1.11, Cl
0.84-1.46),major bleeding (RR 1.09, Cl 0.70-1.68), acute kidney injury
(RR1.07, CL 0.69-1.65), myocardial infarction (RR 0.72, Cl 0.39-1.33),
procedural success (RR 1.01, CL 0.96-1.06),conduction abnormalities (RR
0.83,Cl 0.64- 1.07),annular rupture (RR 0.73, Cl 0.27-1.99) and
fluoroscopy time (DM 1.77, Cl - 0.06-3.61). CONCLUSION Our meta- analysis
suggests that the use of LA in patients undergoing TAVR is associated with
decreased mortality, shorter hospital stay, reduced vascular complications
and procedural time. Further large randomized trials are needed to confirm
our findings.

<74>
Accession Number
614089666
Author
Smid M.C.
Institution
(Smid) University of North Carolina - Chapel Hill, Chapel Hill, NC, United
States
Title
Non-elective cesarean delivery and perioperative complications-does
maternal obesity increase complications?.
Source
American Journal of Obstetrics and Gynecology. Conference: 37th Annual
Meeting of the Society for Maternal-Fetal Medicine: The Pregnancy Meeting.
United States. Conference Start: 20170123. Conference End: 20170128. 216
(1 Supplement 1) (pp S518), 2017. Date of Publication: January 2017.
Publisher
Mosby Inc.
Abstract
OBJECTIVE: Maternal obesity increases post-cesarean infectious
complications however less is understood about immediate perioperative
complications. Our objective was to measure the association between
maternal obesity, perioperative cesarean delivery (CD) complications and
operative times. STUDY DESIGN: This is a secondary analysis of a
randomized controlled trial of azithromycin-based extended-spectrum
antibiotic prophylaxis at time of non-elective CD. Maternal BMI at
delivery was grouped as non-obese (BMI <30 kg/m²), Class I/II
obesity (BMI 30-39.9 kg/m²) or Class III obesity (BMI < 40
kg/m²). A super obese category (BMI < 50 kg/m²) was
included, with non-obese as the referent group. Our primary outcome was
defined as a composite of maternal perioperative complications including
one or more of the following: blood transfusion; atony requiring medical
or surgical intervention; hypotension requiring medical treatment, oxygen
saturation < 90%; unplanned procedure (hysterectomy, exploratory
laparotomy); anesthetic or cardiopulmonary complication (pulmonary edema,
ARDS, cardiac event, post-operative ventilator), coagulopathy; ICU
admission, and ileus. Our secondary outcomes were prolonged operative
and/or incision to delivery time, defined as > 90th percentile for cohort,
and length of hospital stay. Outcomes in BMI groups were compared using
chi-square, Mantel-Haenszel test of trend and ANOVA as applicable.
Multivariable logistic regression models estimated odds of perioperative
outcomes, adjusting for potential maternal confounders. RESULTS: 2009
women underwent CD; 336 (17%) had one or more perioperative complication.
There was no association between maternal BMI group and the primary
outcome (p=0.06). There was a significant association between BMI group,
prolonged operative times and hospital stay (p<0.001) (Table 1). Adjusted
OR for prolonged operative time increased as BMI group increased (Figure).
CONCLUSION: In this secondary analysis, maternal obesity was not
associated with increased perioperative cesarean complications. As BMI
increases, CD operative times are significantly longer. Future studies to
elucidate if longer operative time account for increased risk of
post-operative infections among obese women undergoing CD are warranted.
(Table Presented).

<75>
Accession Number
614089665
Author
D'Souza R.D.; Acuna S.; Zaffar N.; Bhagra C.; Ross H.; Silversides C.
Institution
(D'Souza, Zaffar) Mount Sinai Hospital, University of Toronto, Toronto,
ON, Canada
(D'Souza, Acuna) Institute of Health Policy Management and Evaluation,
University of Toronto, Toronto, ON, Canada
(Bhagra, Silversides) Mount Sinai Hospital, University Health Network,
University of Toronto, Canada, Toronto, ON, Canada
(Ross) Peter Munk Cardiac Centre, University Health Network, University of
Toronto, Toronto, ON, Canada
Title
Pregnancy outcomes of cardiothoracic transplant recipients: A systematic
review and meta-analysis.
Source
American Journal of Obstetrics and Gynecology. Conference: 37th Annual
Meeting of the Society for Maternal-Fetal Medicine: The Pregnancy Meeting.
United States. Conference Start: 20170123. Conference End: 20170128. 216
(1 Supplement 1) (pp S440), 2017. Date of Publication: January 2017.
Publisher
Mosby Inc.
Abstract
OBJECTIVE: To systematically review the literature reporting pregnancy
outcomes in cardiothoracic transplant recipients and to estimate the
incidence of maternal, fetal and neonatal complications in these women.
STUDY DESIGN: A search strategy was designed for MEDLINE, EMBASE, and
Cochrane Central from inception to July 2016 to identify studies reporting
outcomes in three or more pregnancies following cardiothoracic transplant.
Pooled incidence of maternal outcomes (maternal mortality, organ rejection
and preeclampsia) and fetal and neonatal outcomes (livebirth, fetal
anomalies, preterm births and fetal growth restriction) were calculated
using randomeffect meta-analysis and reported per 100 pregnancies with 95%
confidence intervals (CI). Risk of bias was determined using the Institute
of Health Economics' Quality Appraisal Tool for Uncontrolled Observational
Studies. Subgroup analysis was conducted based on transplanted organ and
sensitivity analysis based on the studies' risk of bias. RESULTS: A total
of 3,002 records were identified, 172 full texts reviewed and 19 studies
included. The included studies reported on a total of 406 pregnancies in
301 cardiothoracic transplant recipients (183 heart, 42 heart-lung, and 76
lung). Maternal mortality was 2.5%, (0.2-4.7%), organ rejection occurred
in 10.4% (6.4-14.4%) and preeclampsia in 16.3% (10.6-21.9%). Live births
were reported in 77.1% (69.8-84.9%) pregnancies of which 37.0%
(25.7-48.2%) resulted in preterm births. Compared with heart transplant
recipients, lung transplant recipients were more likely to experience
preterm births [50.3% (35.5-65.0) vs. 39.8% (30.7-49.0)] and organ
rejection [18.5% (7.8-29.3) vs. 8.5% (2.0-15.0)]. No other significant
differences in the pregnancy outcomes were observed in subgroup
meta-analyses by transplanted organ. CONCLUSION: With appropriate
multidisciplinary care, women with cardiothoracic transplants can have
successful pregnancies with high livebirth rates. Although maternal
mortality is rare, these women are at risk for organ rejection,
preeclampsia and preterm births.

<76>
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.

<77>
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.

<78>
Accession Number
613879945
Author
Popovic B.; Agrinier N.; Voilliot D.; Elfarra M.; Villemot J.P.; Maureir
P.
Institution
(Popovic, Voilliot) CHU Nancy, Departement de Cardiologie, Nancy, France
(Agrinier) CHU Nancy, Epidemiologie et Evaluation Cliniques, Nancy, France
(Elfarra, Villemot, Maureir) CHU Nancy, Service de Chirurgie des Maladies
Cardiovasculaires et Transplantations, Nancy, France
Title
Ventricular dysfunction in patients with acute coronary syndrome
undergoing coronary surgical revascularization: Prognostic impact on
long-term outcomes.
Source
PLoS ONE. 11 (12) (no pagination), 2016. Article Number: e0168634. Date of
Publication: December 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Patients with non-ST elevation acute coronary syndrome
complicated by left ventricular dysfunction (LVEF) are a poor prognosis
group. The aim of our study was to assess the short and long term LEVF
prognostic value in a cohort of NSTE-ACS patients undergoing surgical
revascularization. Methods We performed elective and isolated CABG on a
cohort of 206 consecutive patients with LVEF<0.40 complicating acute
coronary syndrome. The case cohort was compared with a cohort of controls
(LVEF>0.40) randomly selected (2:1) among patients who underwent the
procedure during this period. Results The Kaplan-Meier 5-year estimated
survival rates for patients in the low and normal LVEF groups were 70.8%
(95% confidence interval CI: 64.2-77.4) and 81.7% (95%CI: 77.8- 85.6),
respectively. A low LVEF was associated with both a higher all-cause (HR
[95%CI] = 1.84[1.18-2.86]) and a higher cardiovascular mortality (HR =
2.07 [1.27-3.38]) during the first 12 months of follow-up. After
adjustment for potential confounders, a low LVEF remained associated with
a higher cardiovascular mortality only (1.87[1.03-3.38]) during the first
12 months of follow-up. After 12 months of follow-up, a low LVEF was no
more associated with all-cause, nor cardiovascular mortality. Conclusion
Patients with low LVEF might require more intensive care than patients
with normal LVEF during the year after the surgical procedure, but once
the first postoperative year over, the initial low LVEF was no more
associated with long term mortality. Copyright &#xa9; 2016 Popovic et al.
This is an open access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source
are credited.

<79>
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.

<80>
Accession Number
614047586
Author
Bautista-Hernandez V.; Cal-Purrinos N.; Arribas-Leal J.M.; Carnero-Alcazar
M.; Gutierrez-Diez J.F.; Cuenca-Castillo J.J.
Institution
(Bautista-Hernandez, Cuenca-Castillo) Department of Cardiovascular
Surgery, Xerencia de Xestion Integrada A Coruna (XXIAC), A Coruna, Spain
(Bautista-Hernandez) Congenital and Structural Heart Disease, Instituto de
Investigacion Biomedica A Coruna (INIBIC), A Coruna, Spain
(Cal-Purrinos) Fundacion Profesor Novoa Santos, Xerencia de Xestion
Integrada A Coruna (XXIAC), A Coruna, Spain
(Arribas-Leal) Department of Cardiovascular Surgery, Hospital Virgen de la
Arrixaca, Murcia, Spain
(Carnero-Alcazar) Department of Cardiovascular Surgery, Hospital Clinico
de San Carlos, Madrid, Spain
(Gutierrez-Diez) Department of Cardiovascular Surgery, Hospital Marques de
Valdecilla, Santander, Spain
Title
Rapid Deployment Aortic Replacement (RADAR) Registry in Spain: A protocol.
Source
BMJ Open. 7 (1) (no pagination), 2017. Article Number: e011437. Date of
Publication: 01 Jan 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Rapid deployment valves (RDV) represent a newly introduced
approach to aortic valve replacement which facilitates surgical
implantation and minimally invasive techniques, shortens surgical times
and shows excellent haemodynamic performance. However, evidence on their
safety, efficacy and potential complications is mostly fitted with
small-volume and retrospective studies. Moreover, no current guidelines
exist. To improve our knowledge on this technology, The Rapid Deployment
Aortic Replacement (RADAR) Registry will be established across Spain with
the aim of assessing RDV outcomes in the real-world setting. Methods and
analysis The RADAR Registry is designed as a product registry that would
provide information on its use and outcomes in clinical practice. This
multicentre, prospective, national effort will initially involve 4 centres
in Spain. Any patient undergoing cardiac surgery for aortic valve
replacement and receiving an RDV as an isolated operation or in
combination with other cardiac procedures may be included. Participation
is voluntary. Data collection is equal to information obtained during
standard care and is prospectively entered by the participating physicians
perioperatively and during subsequent follow-up visits. The primary
outcome assessed is in-hospital and up to 5 years of follow-up, prosthetic
valve functioning and clinical status. Secondary outcomes are to perform
subgroup analysis, to compare outcomes with other existing approaches and
to develop future clinical guidelines. The follow-up assessments are timed
with routine clinical appointments. Dissociated data will be extracted and
collectively analysed. Initial target sample size for the registry is 500
participants entered with complete follow-up information. Different
substudies will be implemented within the registry to investigate specific
populations undergoing aortic valve replacement. Ethics and dissemination
The protocol is approved by all local institutional ethics committees.
Findings will be shared by the participant hospitals, policymakers and the
academic community to promote quality monitoring and efficient use of this
technology. Copyright &#xa9; 2016 Published by the BMJ Publishing Group
Limited.

<81>
Accession Number
614085660
Author
Friedberg M.K.; Schwartz S.M.; Zhang H.; Chiu-Man C.; Manlhiot C.; Ilina
M.V.; Arsdell G.V.; Kirsh J.A.; McCrindle B.W.; Stephenson E.A.
Institution
(Friedberg, Schwartz, Zhang, Chiu-Man, Manlhiot, Ilina, Arsdell, Kirsh,
McCrindle, Stephenson) Labatt Family Heart Center, The Hospital for Sick
Children, University of Toronto, Toronto, Ontario, Canada
Title
Hemodynamic effects of sustained postoperative cardiac resynchronization
therapy in infants after repair of congenital heart disease: Results of a
randomized clinical trial.
Source
Heart Rhythm. 14 (2) (pp 240-247), 2017. Date of Publication: 01 Feb 2017.
Publisher
Elsevier B.V.
Abstract
Background It is unknown whether continuous cardiac resynchronization
therapy (CRT) can lead to sustained improvement in hemodynamics after
surgery for congenital heart disease (CHD). Objective We investigated
whether CRT improves cardiac index (CI) and blood pressure in infants
after biventricular repair of CHD. Methods We randomized infants younger
than 4 months after biventricular CHD surgery to standard care or standard
care plus CRT for 48 hours or until extubation if sooner. Change in the
primary outcome of CI and blood pressure over time was compared between
groups. For subgroup analysis, QRS duration was considered prolonged if
greater than the 98th percentile. Results Forty-two patients were
randomized: 21 controls and 21 patients receiving CRT (median weight 4
kg). There were no identified adverse events from pacing. The change in CI
over time was not different between patients receiving CRT and controls,
but trended toward improvement in patients with wide QRS who received CRT
(n = 9) vs controls with wide QRS (n = 8) (+1.65 (0.86)
L/(min.m²); P = .06). Controls with wide QRS experienced the
smallest increase in CI (0.33 L/(min.m²)). Blood pressure was
significantly higher in infants with wide QRS who received CRT than in
controls (+7.14 (3.08) mm Hg; P = .02). Serum lactate level, catecholamine
use, ventilation time, and length of intensive care unit stay were similar
between the 2 groups. Conclusion CRT improved blood pressure and a trend
toward higher CI in infants after repair of biventricular CHD with
prolonged QRS duration. These findings warrant further study of CRT to
improve postoperative recovery in infants with electrical dyssynchrony.
Copyright &#xa9; 2016 Heart Rhythm Society

<82>
Accession Number
613644797
Author
Zhou C.; Jeon Y.; Meybohm P.; Zarbock A.; Li L.; Hausenloy D.J.
Institution
(Zhou, Li) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing 100037, China
(Jeon) Department of Anesthesiology and Pain Medicine, Seoul National
University Hospital, Daehakro 101, Seoul 110-744, South Korea
(Meybohm) Department of Anesthesiology, Intensive Care Medicine, and Pain
Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt
60590, Germany
(Zarbock) Department of Anesthesiology, Critical Care Medicine and Pain
Therapy, University Hospital Munster, Albert-Schweitzer-Campus 1, Gebaude
A1, Munster 148149, Germany
(Hausenloy) The Hatter Cardiovascular Institute, University College
London, 67 Chenies Mews, London WC1E 6HX, United Kingdom
(Hausenloy) The National Institute of Health Research University College
London Hospitals, Biomedical Research Centre, London, United Kingdom
(Hausenloy) National Heart Research Institute Singapore, National Heart
Centre Singapore, Singapore
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore
Title
Corrigendum to "Renoprotection by remote ischemic conditioning during
elective coronary revascularization: A systematic review and meta-analysis
of randomized controlled trials" (International Journal of Cardiology
(2016) 1(222) (295-302)(S016752731631573X)(10.1016/j.ijcard.2016.07.176)).
Source
International Journal of Cardiology. 226 (pp 141), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
The authors regret that they have to make a change to the authorship of
this paper. Dr. Paul Young has been removed as a co-author, as he did not
review or approve the submitted manuscript and, therefore, did not fulfil
the criteria for authorship. The authors would like to apologise for any
inconvenience caused. Copyright &#xa9; 2016

<83>
Accession Number
614064526
Author
AlKherayf F.; Xu Y.; Westwick H.; Moldovan I.D.; Wells P.S.
Institution
(AlKherayf, Moldovan) Division of Neurosurgery, Department of Surgery,
University of Ottawa, Ottawa, Canada
(Xu) School of Medicine, Queen's University, Kingston, Canada
(Westwick) Division of Neurosurgery, Department of Surgery, Hopital du
Sacre-Coeur de Montreal, Montreal, Canada
(Xu, Wells) Division of Hematology, Department of Medicine, Ottawa, Canada
(AlKherayf, Wells) The Ottawa Hospital Research Institute, Ottawa, Canada
Title
Timing of anticoagulant re-initiation following intracerebral hemorrhage
in mechanical heart valves: Survey of neurosurgeons and thrombosis
experts.
Source
Clinical Neurology and Neurosurgery. 154 (pp 23-27), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier B.V.
Abstract
Background While oral anticoagulation (OAC) is universally indicated for
patients with mechanical heart valves (MHVs), OAC resumption following
anticoagulant-associated intracerebral hemorrhage (ICH) is an area of
uncertainty. We sought to determine the practice preferences of North
American neurosurgeons and thrombosis experts on optimal timing of OAC
re-initiation. Methods A cross-sectional survey was disseminated to North
American members of the American Association of Neurological Surgeons and
the International Society for Thrombosis and Haemostasis. Demographic
factors, as well as a clinical scenario with 14 modifiable clinical risk
factors were included in the survey. Results 504 physicians completed our
survey (response rate 34.3%). Majority of participants were affiliated
with academic centres, and managed < 10 ICH patients with MHV per year.
There was wide distribution in response in optimal timing for OAC
resumption following an ICH: 59% and 60% preferred to re-start OAC between
3 and 14 days following the hemorrhagic event (median of 6-7 days).
Smaller hemorrhages (<30 cm²). CHADS<inf>2</inf> score >2,
concomitant venous thromboembolism, mitral valve prosthesis, caged-ball
valves and multiple valves prompted earlier OAC resumption. Conclusion
Wide variation in the current practice of neurosurgeons and thrombosis
specialists exist when they encounter patients with ICH and MHV, though
decisions were influenced by patient- and valve-related factors. As our
observed variation likely reflects the immense gap in current evidence,
prospective randomized trials in this population are therefore urgently
needed. Copyright &#xa9; 2017 Elsevier B.V.

<84>
Accession Number
614015633
Author
Bundhun P.K.; Soogund M.Z.S.; Huang W.-Q.
Institution
(Bundhun, Huang) Institute of Cardiovascular Diseases, First Affiliated
Hospital of Guangxi Medical University, Nanning, Guangxi, China
(Soogund) Guangxi Medical University, Nanning, Guangxi, China
Title
Same day discharge versus overnight stay in the hospital following
percutaneous coronary intervention in patients with stable coronary artery
disease: A systematic review and meta-analysis of randomized controlled
trials.
Source
PLoS ONE. 12 (1) (no pagination), 2017. Article Number: e0169807. Date of
Publication: January 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: New research in interventional cardiology has shown the demand
for percutaneous coronary interventions (PCI) to have increased
tremendously. Effective treatment with a lower hospital cost has been the
aim of several PCI capable centers. This study aimed to compare the
adverse clinical outcomes associated with same day discharge versus
overnight stay in the hospital following PCI in a population of randomized
patients with stable coronary artery disease (CAD). Methods: The National
Library of Medicine (MEDLINE/PubMed), the Cochrane Registry of Randomized
Controlled Trials and EMBASE databases were searched (from March to June
2016) for randomized trials comparing same-day discharge versus overnight
stay in the hospital following PCI. Main endpoints in this analysis
included adverse cardiovascular outcomes observed during a 30-day period.
Statistical analysis was carried out by the RevMan 5.3 software whereby
odds ratios (OR) and 95% confidence intervals (CIs) were calculated with
respect to a fixed or a random effects model. Results: Eight randomized
trials with a total number of 3081 patients (1598 patients who were
discharged on the same day and 1483 patients who stayed overnight in the
hospital) were included. Results of this analysis showed that mortality,
myocardial infarction (MI) and major adverse cardiac events (MACEs) were
not significantly different between same day discharge versus overnight
stay following PCI with OR: 0.22, 95% CI: 0.04-1.35; P = 0.10, OR: 0.68,
95% CI: 0.33-1.41; P = 0.30 and OR: 0.45, 95% CI: 0.20-1.02; P = 0.06
respectively. Blood transfusion and re-hospitalization were also not
significantly different between these two groups with OR: 0.64, 95% CI:
0.13-3.21; P = 0.59 and OR: 1.53, 95% CI: 0.88- 2.65; P = 0.13
respectively. Similarly, any adverse event, major bleeding and repeated
revascularization were also not significantly different between these two
groups of patients with stable CAD, with OR: 0.42, 95% CI: 0.05-3.97; P =
0.45, OR: 0.73, 95% CI: 0.15-3.54; P = 0.69 and OR: 0.67, 95% CI:
0.14-3.15; P = 0.61 respectively. Conclusion: In terms of adverse
cardiovascular outcomes, same day discharge was neither superior nor
inferior to overnight hospital stay following PCI in those patients with
stable CAD. However, future research will have to emphasize on the
long-term consequences. Copyright &#xa9; 2017 Bundhun et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<85>
Accession Number
614015575
Author
Hamo C.E.; Klem I.; Rao S.V.; Songco V.; Najjar S.; Lakatta E.G.; Raman
S.V.; Harrington R.A.; Heitner J.F.
Institution
(Hamo) Department of Medicine, Stony Brook University Hospital, Stony
Brook, NY, United States
(Klem, Rao) Duke Clinical Research Institute, Durham, NC, United States
(Songco, Heitner) Division of Cardiology, New York Methodist Hospital,
Brooklyn, NY, United States
(Najjar) MedStar Health Research Institute, Washington, DC, United States
(Najjar, Lakatta) Intramural Research Program, National Institute of
Aging, The, National Institute of Health, Baltimore, MD, United States
(Raman) Division of Cardiovascular Medicine, Ohio State University,
Columbus, OH, United States
(Harrington) Department of Medicine, Stanford University, Palo Alto, CA,
United States
Title
The Systematic Evaluation of Identifying the Infarct Related Artery
Utilizing Cardiac Magnetic Resonance in Patients Presenting with
ST-Elevation Myocardial Infarction.
Source
PLoS ONE. 12 (1) (no pagination), 2017. Article Number: e0169108. Date of
Publication: January 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Identification of the infarct-related artery (IRA) in patients
with STEMI using coronary angiography (CA) is often based on the ECG and
can be challenging in patients with severe multi-vessel disease. The
current study aimed to determine how often percutaneous intervention (PCI)
is performed in a coronary artery different from the artery supplying the
territory of acute infarction on cardiac magnetic resonance imaging (CMR).
Methods We evaluated 113 patients from the Reduction of infarct Expansion
and Ventricular remodeling with Erythropoetin After Large myocardial
infarction (REVEAL) trial, who underwent CMR within 4+/-2 days of
revascularization. Blinded reviewers interpreted CA to determine the IRA
and CMR to determine the location of infarction on a 17-segment model. In
patients with multiple infarcts on CMR, acuity was determined with
T2-weighted imaging and/or evidence of microvascular obstruction. Results
A total of 5 (4%) patients were found to have a mismatch between the IRA
identified on CMR and CA. In 4/5 cases, there were multiple infarcts noted
on CMR. Thirteen patients (11.5%) had multiple infarcts in separate
territories on CMR with 4 patients (3.5%) having multiple acute infarcts
and 9 patients (8%) having both acute and chronic infarcts. Conclusions In
this select population of patients, the identification of the IRA by CA
was incorrect in 4% of patients presenting with STEMI. Four patients with
a mismatch had an acute infarction in more than one coronary artery
territory on CMR. The role of CMR in patients presenting with STEMI with
multi-vessel disease on CA deserves further investigation.

<86>
Accession Number
614039652
Author
Roshanov P.S.; Walsh M.; Devereaux P.J.; MacNei S.D.; Lam N.; Hildebrand
A.M.; Acedillo R.R.; Mrkobrada M.; Chow C.K.; Lee V.W.; Thabane L.; Garg
A.X.
Institution
(Roshanov, MacNei, Acedillo) 1Lilibeth Caberto Kidney Clinical Research
Unit, London Health Sciences Centre, London, ON, Canada
(Roshanov, Walsh, Devereaux, Thabane) Department of Clinical Epidemiology
and Biostatistics, McMaster University, Hamilton, ON, Canada
(Walsh, Devereaux) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Walsh, Devereaux) Population Health Research Institute, Hamilton, ON,
Canada
(MacNei) Department of Otolaryngology Head and Neck Surgery and Department
of Oncology, Western University, London, ON, Canada
(MacNei, Garg) Institute for Clinical Evaluative Sciences, London, ON,
Canada
(Lam, Hildebrand) Division of Nephrology, University of Alberta, Edmonton,
AB, Canada
(Mrkobrada, Garg) Department of Medicine, Western University, London, ON,
Canada
(Chow) George Institute for Global Health, Sydney Medical School,
University of Sydney, Sydney, NSW, Australia
(Chow) Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
(Lee) Department of Renal Medicine, Westmead Hospital, Western Sydney
Local Health District, Sydney, NSW, Australia
(Lee) Centre for Transplant and Renal Research, Westmead Institute for
Medical Research, University of Sydney, Westmead, NSW, Australia
(Thabane) Centre for Evaluation of Medicines and Biostatistics Unit, St
Joseph's Healthcare, Hamilton, ON, Canada
(Thabane) Departments of Paediatrics and Anaesthesia, McMaster University,
Hamilton, ON, Canada
(Garg) Department of Epidemiology and Biostatistics, Western University,
London, ON, Canada
Title
External validation of the Revised Cardiac Risk Index and update of its
renal variable to predict 30-day risk of major cardiac complications after
non-cardiac surgery: Rationale and plan for analyses of the VISION study.
Source
BMJ Open. 7 (1) (no pagination), 2017. Article Number: e013510. Date of
Publication: 01 Jan 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: The Revised Cardiac Risk Index (RCRI) is a popular
classification system to estimate patients' risk of postoperative cardiac
complications based on preoperative risk factors. Renal impairment,
defined as serum creatinine >2.0 mg/dL (177 mumol/L), is a component of
the RCRI. The estimated glomerular filtration rate has become accepted as
a more accurateindicator of renal function. We will externally validate
the RCRI in a modern cohort of patients undergoing non-cardiac surgery and
update its renal component. Methods and analysis: The Vascular Events in
Noncardiac Surgery Patients Cohort Evaluation (VISION) study is an
international prospective cohort study. In this prespecified secondary
analysis of VISION, we will test the risk estimation performance of the
RCRI in 34 000 participants who underwent elective noncardiac surgery
between 2007 and 2013 from 29 hospitals in 15 countries. Using data from
the first 20 000 eligible participants (the derivation set), we will
derive an optimal threshold for dichotomising preoperative renal function
quantified using the Chronic Kidney Disease Epidemiology Collaboration
(CKD-Epi) glomerular filtration rate estimating equation in a manner that
preserves the original structure of the RCRI. We will also develop a
continuous risk estimating equation integrating age and CKD-Epi with
existing RCRI risk factors. In the remaining (approximately) 14 000
participants, we will compare the risk estimation for cardiac
complications of the original RCRI to this modified version. Cardiac
complications will include 30-day non-fatal myocardial infarction,
non-fatal cardiac arrest and death due to cardiac causes. We have examined
an early sample to estimate the number of events and the distribution of
predictors and missing data, but have not seen the validation data at the
time of writing. Ethics and dissemination: The research ethics board at
each site approved the VISION protocol prior.

<87>
Accession Number
614002790
Author
Shu A.; Liu X.; Wang Q.; Chen X.; Zhan L.
Institution
(Shu, Wang, Chen, Zhan) Department of Anesthesiology, Three Gorges
University People's Hospital, The First People's Hospital of Yichang,
Yichang, China
(Liu) Department of Anesthesiology, Changyang Tujia Autonomous County
People's Hospital, Yichang, China
Title
Study on cerebral protective effect of dexmedetomidine during anesthesia
in cardiac valve replacement surgery.
Source
International Journal of Clinical and Experimental Medicine. 10 (1) (pp
1066-1072), 2017. Article Number: IJCEM0035941. Date of Publication: 30
Jan 2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To evaluate the cerebral protection of Dexmedetomidine during
anesthesia of cardiac valve replacement surgery. Methods: 60 patients who
underwent elective cardiac valve replacement surgery under cardiopulmonary
bypass (CPB) in our hospital were randomly divided into Dexmedetomidine
group and control group (30 cases in each group); patients in
Dexmedetomidine group were injected with Dexmedetomidine 1.0 mug/kg
intravenously at 10 min before routine anesthesia induction, then injected
with 0.5 mug/kg/h till surgery finished; the control group received equal
volume of normal saline with the same infusion speed. Heart rate (HR) and
blood pressure were recorded at T1 (establish of CPB), T2 (end of CPB) and
T3 (end of surgery), in the meanwhile, the doses of vasoactive agents used
during operation were also recorded. Jugular venous oxygen saturation
(SjvO<inf>2</inf>), Arterial venous oxygen content difference
(Da-jvO<inf>2</inf>) and cerebral extraction of oxygen (CERO<inf>2</inf>)
at T1-T3 were monitored analyzed. Central venous blood was drawn at time
points of T1-T3 to detect the concentrations of plasma S-100beta protein,
TNF-alpha and serum neuronspecific enolase (NSE) by ELISA. Mini-Mental
State Examination (MMSE) and Delirium Rating Scale (DRS) were used to
assess postoperative cognitive function and postoperative delirium,
respectively. Results: Compared with the control group, the amount of
Phenylephrine, Dopamine, Adrenaline used in Dexmedetomidine group was
significantly reduced (94 mug vs. 185 mug; 24 mug vs. 44 mug; 6.3% vs.
21%), while the volume of Atropine was significantly increased (18% vs.
6.1%), the differences were statistically significant (all P < 0.05); the
SjvO<inf>2</inf> of two groups of patients at T2 was significantly higher
than that at T1 while Da-jvO<inf>2</inf> and CERO<inf>2</inf> were
significantly lower than those at T1. Moreover, by comparing with control
group, the SjvO<inf>2</inf> of Dexmedetomidine group at T2 and T3 was
significantly higher while Da-jvO<inf>2</inf> and CERO<inf>2</inf> were
significantly lower (all P < 0.05). The postoperative delirium score of
dexmedetomidine group (15.8+/-4.2) was significantly lower than that of
control group (18.6+/-6.2), the difference was statistically significant
(P < 0.05); there was a significant difference in MMSE score (P < 0.05)
between two groups at postoperative 1 week; the concentrations of
TNF-alpha, S-100beta protein and NSE level of both groups at T2 and T3
were significantly increased (P < 0.05) by comparing with the values at
T1, and the levels in dexmedetomidine group were significantly lower than
those of control group (P < 0.05) at T2 and T3. Conclusion:
Dexmedetomidine could improve brain oxygen metabolism and reduce
intraoperative cerebral ischemia and hypoxia during cardiac valve
replacement surgery under CPB; to a certain extent, Dexmedetomidine has
cerebral protective effect. Copyright &#xa9; 2017, E-Century Publishing
Corporation. All rights reserved.

<88>
Accession Number
613836011
Author
He P.; Wei H.; Wulasihan M.; Yang Y.C.; Liu Z.; Ma Y.; Mei C.; Zhang L.;
Liu T.; Wang S.; Li L.
Institution
(He, Wulasihan, Yang, Liu, Ma, Mei, Zhang, Liu, Wang, Li) Department of
Cardiology, First Affiliated Hospital of Xinjiang Medical University,
Urumqi, China
(Wei) Department of Cardiology, The First People's Hospital of Zhengzhou,
Zhengzhou, China
Title
Comparisons of effectiveness and safety between bivalirudin and heparin
with tirofiban in ST-segment elevation myocardial infarction treated with
percutaneous coronary intervention.
Source
International Journal of Clinical and Experimental Medicine. 9 (12) (pp
23472-23481), 2016. Article Number: IJCEM0029948. Date of Publication:
2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To compare the effectiveness and safety between bivalirudin and
heparin with tirofiban in patients with acute myocardial infarction by
percutaneous coronary intervention. Methods: A randomized controlled,
open-label experiment was performed. 260 cases of hospitalized patients
with acute ST-segment elevation myocardial infarction (STEMI) who accepted
emergency PCI were enrolled in the study. They were randomly divided into
bivalirudin group (129 cases), heparin plus tirofiban group (131 cases).
In Bivalirudin group, they were given intravenous injection 0.75 mg/kg for
the first dose. Then they were given 1.75 mg/(kg.h) continuous intravenous
infusion until PCI surgery was completed. 1.75 mg/(kg.h) intravenous
infusion was followed after the surgery and sustained with an average time
of 190 min. Patients were followed-up for 30 days. Results: A total of 259
patients completed 30 days of follow-up (99.6%). 14 cases (10.9%) in the
bivalirudin group and 32 cases (24.4%) in heparin plus tirofiban group
showed 30 days of net adverse clinical events (RR, 0.45; 95% CI,
0.19~0.75; P=0.004). Two major adverse cardiac and cerebrovascular events
(a given group bivalirudin 5.4%, heparin plus tirofiban 9.2%; P=0.25),
stent thrombosis (1.6% vs 3.1%; P=0.42), acquired platelet less disease
(0.8% vs 0; P=0.32) and the incidence of acute stent thrombosis (0 vs
0.8%; P=0.25) showed statistical significance. Conclusion: In emergency
PCI treated STEMI patients, compared with heparin combined
tirofibantreatment, bivalirudin (1.75 mg/kg/h) postoperative continuous
with the average of 190 min) can decrease the incidence of net adverse
clinical events in 30 days. Copyright &#xa9; 2016, E-Century Publishing
Corporation. All rights reserved.

<89>
Accession Number
613835786
Author
Zhang H.; Lei C.; Zhang T.; Hou L.; Wang Q.; Dong H.; Han J.; Xiong L.
Institution
(Zhang, Lei, Zhang, Hou, Wang, Dong, Xiong) Department of Anesthesiology,
Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi
Province 710032, China
(Han) Department of Anesthesiology, Tianjin Chest Hospital, Tianjin
300051, China
Title
Randomized controlled trial of TEAS with different acupoints combination
on opioids consumption in patients undergoing off-pump coronary artery
bypass grafting.
Source
International Journal of Clinical and Experimental Medicine. 9 (12) (pp
23060-23071), 2016. Article Number: IJCEM0031552. Date of Publication:
2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
We conducted this prospective, double-blinded, randomized controlled trial
to compare the opioid sparing effect of transcutaneous electric acupoint
stimulation (TEAS) on the distal-proximal acupoints combination and
regional acupoints combination. 186 adults scheduled for elective off-pump
coronary artery bypass grafting (OP-CABG) surgery were randomized to TEAS
with distal-proximal acupoints combination (LI4 and CV17), regional
acupoints combination (CV17 and CV14) and control (non-acupoints) groups.
The primary endpoint was intraoperative sufentanil consumption. Secondary
endpoints included perioperative hemodynamics, duration of mechanic
ventilation, length of cardiac care unit (CCU) and postoperative hospital
stay, incidence and the duration of re-intubation, re-admission to CCU,
placement of intra-aortic balloon counter pulsation (IABP) or ventricular
assisted device (VAD), postoperative cardiac function, incidence of
postoperative complications, and all cause mortality by day 30. The
cumulative consumption of sufentanil was significantly reduced in the
distal-proximal acupoints combination group when compared with those in
the regional acupoints combination and control groups (255.0 +/- 106.1
micro&#32;g vs 300.4 +/- 106.9 micro&#32;g and 305.9 +/- 119.1
micro&#32;g, P = 0.027). No significant differences among the three groups
were found as refer to all of the secondary endpoints. TEAS with
distal-proximal acupoints combination has better efficacy in reducing
intraoperative opioid consumption in patients undergoing OP-CABG surgery.
Copyright &#xa9; 2016, E-Century Publishing Corporation. All rights
reserved.

<90>
Accession Number
613835762
Author
Yang L.; He L.; Tang Y.; Lai G.; Guo Y.; Cao G.; Ni J.
Institution
(Yang, He, Tang, Lai, Guo, Cao, Ni) Department of Pain Management, Xuanwu
Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng
District, Beijing 100053, China
Title
Efficacy of coblation nucleoplasty under CT-guidance in lumber paracentral
disc herniation: Parasagittal interlaminar vs posterolateral
extrapedicular approach.
Source
International Journal of Clinical and Experimental Medicine. 9 (12) (pp
23267-23275), 2016. Article Number: IJCEM0022864. Date of Publication:
2016.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To compare the efficacy of coblation nucleoplasty under
computed tomography (CT) guidancein treating radicular pain related to
lumbar disc herniation using the parasagittal interlaminar versus the
posterolateral extrapedicular approach. Methods: This randomized,
prospective, observational study included fifty-six patients with
radicular pain who received coblation annuloplasty under CT guidance.
Patients were randomized into two groups according to the approach used:
the parasagittal interlaminar group (PIL group) or the posterolateral
extrapedicular group (PEL group). The primary clinical outcome was pain
assessed using the Visual Analog Scale (VAS). Secondary clinical outcomes
were functional status according to modified MacNab criteria, and numbers
of patients with significant pain relief (>50%) and significant reduction
(>50%) in anesthetic intake. All outcome assessments were recorded for 12
months postoperatively. Results: The VAS had significantly decreased to
2.0+/-1.1 in the PIL group and 2.0+/-1.4 in the PEL group at postoperative
12 months. There was no significant difference between the two groups in
VAS, modified MacNab criteria, or numbers of patients with significant
pain relief (>50%) or significant reduction (=50%) in anesthetic intake.
Five patients in the PIL group experienced cerebrospinal fluid leakage,
but there was no significant difference in complication rate between
groups. Conclusion: Under CTguidance, coblation nucleoplasty using either
the parasagittal interlaminar or the posterolateral extrapedicular
approach decreased pain intensity and improved modified MacNabcriteria in
patients with radicular pain related to lumbar disc herniation. Both
approaches were effective, safe, minimally invasive, and caused minimal
discomfort. Copyright &#xa9; 2016, E-Century Publishing Corporation. All
rights reserved.

<91>
Accession Number
614101023
Author
Micha G.; Tzimas P.; Zalonis J.; Kotsis K.; Papadopoulos G.; Arnaoutoglou
E.
Institution
(Micha, Tzimas, Papadopoulos, Arnaoutoglou) Department of Anesthesiology
and Postoperative Intensive Care Unit, Medical School, University of
Ioannina, 10 Kanari Street 17235, Greece
(Zalonis) Department of Neuropsychology, National and Kapodistrian
University of Athens, Medical School, Greece
(Kotsis) Department of Child and Adolescent Psychiatry, Thriasi Elefsina,
General Hospital, Greece
Title
Propofol vs Sevoflurane anaesthesia on postoperative cognitive dysfunction
in the elderly. A randomized controlled trial.
Source
Acta Anaesthesiologica Belgica. 67 (3) (pp 129-137), 2016. Date of
Publication: 2016.
Publisher
ARSMB-KVBMG (Avenue W. Churchill-laan 11/30, Brussels B-1180, Belgium)
Abstract
Background: Postoperative cognitive dysfunction is a topic of special
importance in the geriatric surgical population which primarily resolves
within the short term postoperative period, but it can become a long term
disorder with significant impact on patient's quality of life. This study
was designed to compare the short and long term postoperative cognitive
function after propofol and sevoflurane anaesthesia in the elderly and to
evaluate the role of the inflammatory process. Methods:: Patients, aged
60-74, scheduled for a non-cardiac operation of more than two-hour
duration were enrolled in this prospective randomized controlled trial and
allocated into two groups in order to receive propofol or sevoflurane
anaesthesia. Postoperative early cognitive function was assessed by means
of the Mini Mental State Examination test (MMSE) 48 hours postoperatively.
Late cognitive function was evaluated by means of 10 psychometric tests, 9
months postoperatively. The role of inflammation was estimated by the
incidence of SIRS and the levels of the inflammatory markers. Results::
Statistical significant decrease was observed in the postoperative MMSE
values in the sevoflurane group. Nine months postoperatively, there was a
decline in test performance in the same group and an increase in
postoperative values of inflammatory markers in both groups, which turned
non-significant in their between comparison (except CRP). Conclusion:
According to the neuropsychological test evaluation of cognition, there is
a negative influence of sevoflurane anaesthesia on the early and late
postoperative state. As far as the inflammatory markers are concerned,
they don't relate to the patient's cognitive status. Copyright &#xa9; Acta
Anaesthesiologica Belgica, 2016.

<92>
Accession Number
613898453
Author
Ilic I.; Stankovic I.; Ilisic B.; Cerovic M.; Aleksic A.; Nikolajevic I.;
Kafedzic S.; Cuellas Ramon C.; Sokolov M.; El Setecha M.; Putnikovic B.;
Neskovic A.N.
Institution
(Ilic, Stankovic, Ilisic, Cerovic, Aleksic, Nikolajevic, Kafedzic,
Putnikovic, Neskovic) Department of Cardiology, Clinical Hospital Centre
Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
(Cuellas Ramon) Cardiology, Hospital de Leon, Leon, Spain
(Sokolov) Cardiology, Ukrainian Institute of Cardiology, Kiev, Ukraine
(El Setecha) Cardiology, Om El-kora Cardiac Center, Gharbia, Egypt
Title
Favorable outcomes in octogenarians treated with bioresorbable polymer
drug-eluting stent.
Source
Geriatrics and Gerontology International. 16 (12) (pp 1246-1253), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Blackwell Publishing (E-mail: info@asia.blackpublishing.com.au)
Abstract
Aim: As a result of a higher prevalence of comorbidities, elderly adults
are often underrepresented in clinical trials, and more often experience
complications during percutaneous coronary intervention. Our aim was to
evaluate clinical outcomes of patients older than 80 years, compared with
their younger counterparts, when bioresorbable polymer biolimus A9
drug-eluting stent is used for their treatment. Methods: The prospective,
observational e-Nobori registry was created to validate the safety and
efficacy of bioresorbable polymer drug-eluting stent in unselected
patients. The primary end-point of the study was freedom from target
lesion failure defined as a composite of cardiac death, target
vessel-related myocardial infarction and clinically-driven target lesion
revascularization at 1 year. Results: There were 781 (7.8%) octogenarians,
they were less frequently male (62% vs 77%; P < 0.0001) and more often
presented as acute coronary syndrome (44% vs 39%; P = 0.0182). The index
percutaneous coronary intervention success was lower in the elderly
patients (98% vs 99%; P = 0.0398). One-year follow up was completed for
97% of the elderly patients and 99% of the younger patients. The
difference in target lesion failure (3.33% vs 2.83%; log-rank P = 0.0114)
was mainly driven by increased mortality in octogenarians (3.73% vs 1.47%;
P < 0.0001). Elderly patients had more bleeding and vascular complications
(2.67% vs 1.05%; P = 0.0001). Conclusions: Despite advanced age, multiple
comorbidities and complexity of treated lesions, clinical outcomes are
favorable in octogenarians treated by bioresorbable polymer biolimus A9
drug-eluting stent. Geriatr Gerontol Int 2016; 16: 1246-1253. Copyright
&#xa9; 2015 Japan Geriatrics Society

<93>
Accession Number
613890543
Author
Naber C.K.; Pyxaras S.A.; Ince H.; Frambach P.; Colombo A.; Butter C.;
Gatto F.; Hink U.; Nickenig G.; Bruschi G.; Brueren G.; Tchetche D.; Den
Heijer P.; Schillinger W.; Scholtz S.; Van Der Heyden J.; Lefevre T.;
Gilard M.; Kuck K.-H.; Schofer J.; Divchev D.; Baumgartner H.; Asch F.;
Wagner D.; Latib A.; De Marco F.; Kische S.
Institution
(Naber, Pyxaras) Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus
Essen, Klara-Kopp-Weg 1, Essen 45138, Germany
(Ince, Kische) Vivantes Klinikum im Friedrichshain und Am Urban, Berlin,
Germany
(Ince, Divchev, Kische) Universitatsklinikum Rostock, Rostock, Germany
(Frambach, Wagner) Institut de Chirurgie Cardiaque et de Cardiologie
Interventionnelle, Luxembourg
(Colombo, Latib) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Butter) Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
(Gatto) Herzzentrum Saar, Volklingen, Germany
(Hink) Universitatsklinikum Mainz, Mainz, Germany
(Nickenig) Universitatsklinikum Bonn, Bonn, Germany
(Bruschi, De Marco) Ospedale Niguarda Ca' Granda, Milan, Italy
(Brueren) Catharina Ziekenhuis, Eindhoven, Netherlands
(Tchetche) Clinique Pasteur, Toulouse, France
(Den Heijer) Amphia Ziekenhuis Hartcentrum - Cardiologie, Breda,
Netherlands
(Schillinger) Universitatsklinikum Gottingen, Gottingen, Germany
(Scholtz) Klinik fur Kardiologie Herz, Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Van Der Heyden) St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Lefevre) Hopital Prive Jacques Cartier, Massy, France
(Gilard) CHU Brest, Brest, France
(Kuck) Asklepios Klinik St. Georg, Hamburg, Germany
(Schofer) Albertinen Herzzentrum, Hamburg, Germany
(Baumgartner) Universitatsklinikum Munster, Munster, Germany
(Asch) MedStar Health Research Institute, Washington, DC, United States
Title
A multicentre European registry to evaluate the Direct Flow Medical
transcatheter aortic valve system for the treatment of patients with
severe aortic stenosis.
Source
EuroIntervention. 12 (11) (pp e1413-e1419), 2016. Date of Publication:
December 2016.
Publisher
EuroPCR
Abstract
Aims: Our aim was to assess the clinical outcomes of the Direct Flow
Medical Transcatheter Aortic Valve System (DFM-TAVS), when used in routine
clinical practice. Methods and results: This is a prospective, open-label,
multicentre, post-market registry of patients treated with DFM-TAVS
according to approved commercial indications. Echocardiographic and
angiographic data were evaluated by an independent core laboratory and
adverse events were adjudicated and classified according to VARC-2
criteria by an independent clinical events committee. The primary endpoint
was freedom from all-cause mortality at 30 days post procedure. Secondary
endpoints included procedural, early safety and efficacy endpoints at 30
days. Two hundred and fifty patients with severe aortic stenosis
undergoing transcatheter aortic valve implantation (TAVI) with the
DFM-TAVS were enrolled in 21 European centres. The primary endpoint,
freedom from all-cause mortality at 30 days, was met in 98% (245/250) of
patients. Device success was 83.8%. Moderate or severe aortic
regurgitation was reported in 3% of patients, and none/trace regurgitation
in 73% of patients. Post-procedural permanent pacemaker implantation was
performed in 30 patients (12.0%). Conclusions: The DFM-TAVS was associated
with good short-term outcomes in this real-world registry. The low
pacemaker and aortic regurgitation rates confirm the advantages of this
next-generation transcatheter heart valve (THV). Copyright &#xa9; Europa
Digital & Publishing 2016. All rights reserved.

<94>
Accession Number
613890533
Author
Gil R.J.; Bil J.; Grundeken M.J.; Kern A.; Garcia L.A.I.; Vassilev D.;
Pawlowski T.; Formuszewicz R.; Dobrzycki S.; Wykrzykowska J.J.; Serruys
P.W.
Institution
(Gil, Bil, Pawlowski) Department of Invasive Cardiology, Central Clinical
Hospital of the Ministry of Interior, 137 Woloska Street, Warsaw 02-507,
Poland
(Gil) Institute of Experimental and Clinical Medicine, Polish Academy of
Science, Warsaw, Poland
(Grundeken, Wykrzykowska) Heart Center, Academic Medical Center -
University of Amsterdam, Amsterdam, Netherlands
(Kern) Faculty of Medical Sciences, University of Varmia and Masuria,
Olsztyn, Poland
(Garcia) Costa Del Sol Hospital, Marbella, Spain
(Vassilev) Alexandrovska University Hospital, Sofia, Bulgaria
(Formuszewicz) 10th Clinical Military Hospital, Bydgoszcz, Poland
(Dobrzycki) Department of Invasive Cardiology, Medical University in
Bialystok, Bialystok, Poland
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Title
Regular drug-eluting stents versus the dedicated coronary bifurcation
sirolimus-eluting BiOSS LIM stent: The randomised, multicentre,
open-label, controlled POLBOS II trial.
Source
EuroIntervention. 12 (11) (pp e1404-e1412), 2016. Date of Publication:
December 2016.
Publisher
EuroPCR
Abstract
Aims: The aim of the POLBOS II randomised trial was to compare any regular
drug-eluting stents (rDES) with the dedicated bifurcation
sirolimus-eluting stent BiOSS LIM for the treatment of coronary
bifurcation lesions. The secondary aim was to study the effect of final
kissing balloon inflation (FKBI) on clinical outcomes. Methods and
results: Between December 2012 and December 2013, 202 patients with stable
coronary artery disease or non-ST-segment elevation acute coronary
syndrome were randomly assigned 1:1 to treatment of the coronary
bifurcation lesions either with the BiOSS LIM stent (n=102) or with an
rDES (n=100). Coronary re-angiography was performed at 12 months. The
primary endpoint was the composite of cardiac death, myocardial infarction
(MI), and target lesion revascularisation (TLR) at 12 months. The target
vessel was located in the left main in one third of the cases (35.3% in
BiOSS and 38% in rDES). Side branch treatment was required in 8.8% (rDES)
and 7% (BiOSS). At 12 months, the cumulative MACE incidence was similar in
both groups (11.8% [BiOSS] vs. 15% [rDES, p=0.08]), as was the TLR rate
(9.8% vs. 9% [p=0.8]). The binary restenosis rates were significantly
lower in the FKBI subgroup of the BiOSS group (5.9% vs. 11.8%, p<0.05).
Conclusions: MACE rates as well as TLR rates were comparable between the
BiOSS LIM and rDES. At 12 months, cumulative MACE incidence was similar in
both groups (11.8% vs. 15%), as was the TLR rate (9.8% vs. 9%).
Significantly lower rates of restenosis were observed in the FKBI subgroup
of the BiOSS group. Copyright &#xa9; Europa Digital & Publishing 2016. All
rights reserved.

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

<96>
Accession Number
613867077
Author
Byrne N.; Velasco Forte M.; Tandon A.; Valverde I.; Hussain T.
Institution
(Byrne) Department of Medical Physics, Guy's and St. Thomas' NHS
Foundation Trust, London, United Kingdom
(Byrne, Velasco Forte, Valverde) Paediatric Cardiology, Evelina London
Children's Hospital at Guy's and St. Thomas' NHS Foundation Trust, London,
United Kingdom
(Byrne, Velasco Forte, Valverde, Hussain) Division of Imaging Sciences and
Biomedical Engineering, King's College London, London, United Kingdom
(Tandon, Hussain) Departments of Paediatrics, University of Texas,
Southwestern Medical Center, Dallas, TX, United States
(Valverde) Department of Paediatric Cardiology, Hospital Virgen del Rocio,
Seville, Spain
(Valverde) Institute of Biomedicine of Seville, Seville, Spain
Title
A systematic review of image segmentation methodology, used in the
additive manufacture of patient-specific 3D printed models of the
cardiovascular system.
Source
JRSM Cardiovascular Disease. 5 (no pagination), 2016. Date of Publication:
26 Apr 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Shortcomings in existing methods of image segmentation
preclude the widespread adoption of patient-specific 3D printing as a
routine decision-making tool in the care of those with congenital heart
disease. We sought to determine the range of cardiovascular segmentation
methods and how long each of these methods takes. Methods: A systematic
review of literature was undertaken. Medical imaging modality,
segmentation methods, segmentation time, segmentation descriptive quality
(SDQ) and segmentation software were recorded. Results: Totally 136
studies met the inclusion criteria (1 clinical trial; 80 journal articles;
55 conference, technical and case reports). The most frequently used image
segmentation methods were brightness thresholding, region growing and
manual editing, as supported by the most popular piece of proprietary
software: Mimics (Materialise NV, Leuven, Belgium, 1992-2015). The use of
bespoke software developed by individual authors was not uncommon. SDQ
indicated that reporting of image segmentation methods was generally poor
with only one in three accounts providing sufficient detail for their
procedure to be reproduced. Conclusions and implication of key findings:
Predominantly anecdotal and case reporting precluded rigorous assessment
of risk of bias and strength of evidence. This review finds a reliance on
manual and semi-automated segmentation methods which demand a high level
of expertise and a significant time commitment on the part of the
operator. In light of the findings, we have made recommendations regarding
reporting of 3D printing studies. We anticipate that these findings will
encourage the development of advanced image segmentation methods.
Copyright &#xa9; 2016, &#xa9; The European Society of Cardiology 2016.

<97>
Accession Number
613845439
Author
Iannaccone M.; Piazza F.; Boccuzzi G.G.; D'Ascenzo F.; Latib A.; Pennacchi
M.; Rossi M.L.; Ugo F.; Meliga E.; Kawamoto H.; Moretti C.; Ielasi A.;
Garbo R.; Frangieh A.H.; Hildick-Smith D.; Templin C.; Colombo A.;
Sardella G.
Institution
(Iannaccone, D'Ascenzo, Moretti) Citta della Scienza e della Salute,
University of Turin, Corso Bramante 88, Turin 10126, Italy
(Piazza, Boccuzzi, Ugo, Garbo) Cardiology Department, Ospedale San
Giovanni Bosco, Turin, Italy
(Latib, Colombo) San Raffaele Scientific Institute, Milan, Italy
(Latib, Colombo) EMO-GVM Centro Cuore Columbus, Milan, Italy
(Pennacchi, Sardella) Department of Cardiovascular, Respiratory and
Morphologic Sciences, Policlinico Umberto I, Sapienza University of Rome,
Rome, Italy
(Rossi) Division of Cardiology, Istituto Humanitas, Milan, Italy
(Meliga) Interventional Cardiology Unit, A.O. Ordine Mauriziano Umberto I,
Turin, Italy
(Kawamoto) Interventional Cardiology Unit, New Tokyo Hospital, Chiba,
Japan
(Ielasi) Department of Cardiology, Azienda Ospedaliera Bolognini Seriate,
Bergamo, Italy
(Frangieh, Templin) Department of Cardiology, University Heart Center,
University Hospital Zurich, Zurich, Switzerland
(Hildick-Smith) Department of Cardiology, Sussex Cardiac Centre, Brighton,
United Kingdom
Title
RoTational AThErectomy in acute coronary syndrome: Early and midterm
outcomes from a multicentre registry.
Source
EuroIntervention. 12 (12) (pp 1457-1464), 2016. Date of Publication:
December 2016.
Publisher
EuroPCR
Abstract
Aims: The safety and efficacy of rotational atherectomy (RA) in patients
presenting with non-ST-elevation myocardial infarction (NSTE-ACS) remain
to be defined. The aim of our study was to assess the safety and efficacy
of RA in NSTE-ACS patients with reference to both short- and long-term
follow-up. Methods and results: This was an observational retrospective
registry which enrolled all consecutive patients undergoing RA, comparing
patients with stable angina (SA) and NSTE-ACS. In addition, ACS patients
were matched with those not undergoing RA. The primary endpoint was
angiographic success. Procedural complications and in-hospital MACE were
secondary endpoints along with MACE during follow-up. One thousand three
hundred and eight patients were included: 37% (484) with an NSTE-ACS
diagnosis and 63% (824) in the SA group. Angiographic success did not
differ between the groups (98.8% vs. 99.2%, p=0.57). By univariate
analysis procedural complications were more frequent in the NSTE-ACS group
(11.3% vs. 8.0%, p=0.04). In-hospital MACE rates were comparable (5.7% vs.
5.8%, p=0.93); by multivariate analysis NSTE-ACS patients showed a
non-significant trend towards a higher risk of adverse events (HR 2.39,
CI: 0.96-5.96, p=0.061). MACE after a median of 27.9 months was
significantly higher in the NSTE-ACS group compared with the SA group
(32.4% vs. 24.2%, log-rank p<0.001), results confirmed by multivariate
analysis. After propensity score matching, NSTE-ACS patients undergoing RA
had similar outcomes to ACS patients who did not undergo RA (16% vs. 13%,
log-rank p=0.14). Conclusions: Rotational atherectomy has similar safety
and angiographic outcome in patients with NSTE-ACS or SA. The higher rate
of adverse cardiac events at follow-up in NSTE-ACS patients undergoing RA
is comparable with a matched population of NSTE-ACS patients not
undergoing RA. Copyright &#xa9; Europa Digital & Publishing 2016. All
rights reserved.

<98>
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.

<99>
Accession Number
614012584
Author
Zhan S.; Xia P.; Tang M.; Liu F.; Shu M.; Wu X.
Institution
(Zhan, Xia, Tang, Liu) First Affiliated Hospital of the Third Military
Medical University, Pharmacy Department, 30 Gaotanyan Street, Shapingba
District Chongqing 400038, China
(Shu) First Affiliated Hospital of the Third Military Medical University,
Cardiovascular Department, Chongqing, China
(Wu) Third Military Medical University, Department of Health Statistics,
College of Preventive Medicine, Chongqing, China
Title
Ezetimibe for the prevention of cardiovascular disease and all-cause
mortality events.
Source
Cochrane Database of Systematic Reviews. 2017 (1) (no pagination), 2017.
Article Number: CD012502. Date of Publication: 10 Jan 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives
are as follows: To assess the efficacy and safety of ezetimibe versus
placebo or ezetimibe plus other lipid-modifying drugs versus other
lipid-modifying drugs alone for the prevention of CVD events and all-cause
mortality events. Copyright &#xa9; 2017 The Cochrane Collaboration.

<100>
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

<101>
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

<102>
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.

<103>
Accession Number
613834226
Author
Malhotra A.; Abramson J.; De Lorgeril M.; Sultan S.
Institution
(Malhotra) Lister Hospital, Stevenage, United Kingdom
(Abramson) Department of Health Care Policy, Harvard Medical School,
Boston, MA, United States
(De Lorgeril) TIMC-IMAG, School of Medicine, University of Grenoble-Alpes,
Grenoble, France
(Sultan) National University of Ireland, Ireland
(Sultan) Saolta Hospital Group, Ireland
Title
More clarity needed on the true benefits and risks of statins.
Source
Prescriber. 27 (12) (pp 15-17), 2016. Date of Publication: 01 Dec 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
The benefits and risks of statins have recently been the subject of much
controversy and debate. Dr Malhotra and colleagues argue that selective
reporting and publication bias may be overestimating the efficacy and
underestimating the side-effects of statins. Copyright &#xa9; 2016 Wiley
Interface Ltd

<104>
Accession Number
610503682
Author
Dayan V.; Vignolo G.; Soca G.; Paganini J.J.; Brusich D.; Pibarot P.
Institution
(Dayan, Vignolo, Soca, Paganini, Brusich) Centro Cardiovascular, Hospital
de Clinicas, Universidad de la Republica, Montevideo, Uruguay
(Pibarot) Insitut Universitaire de Cardiologie et de Peneumologie/Quebec
Heart and Lung Institute, Department of Cardiology, Quebec, Canada
Title
Predictors and Outcomes of Prosthesis-Patient Mismatch After Aortic Valve
Replacement.
Source
JACC: Cardiovascular Imaging. 9 (8) (pp 924-933), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate predictors of prosthesis-patient
mismatch (PPM) and its association with the risk of perioperative and
overall mortality. Background PPM is associated with increased mid- and
long-term mortality after surgical aortic valve replacement. Conflicting
results have been reported with regard to its association with
perioperative mortality. Methods Databases were searched for studies
published between 1965 and 2014. Main outcomes of interest were
perioperative mortality and overall mortality. Results The search yielded
382 studies for inclusion. Of these, 58 articles were analyzed and their
data extracted. The total number of patients included was 40,381 (39,568
surgical aortic valve replacement and 813 transcatheter aortic valve
replacement). Perioperative (odds ratio: 1.54; 95% confidence interval:
1.25 to 1.91) and overall (i.e., perioperative and post-operative)
mortality (hazard ratio: 1.26; 95% confidence interval: 1.16 to 1.36) was
increased in patients with PPM. The impact of PPM on mortality was higher
in those studies in which the mean age of the patients was <70 years of
age (and/or AVR with associated coronary artery bypass graft was
included). Severe PPM was associated with increased risk of both
perioperative and overall mortality, whereas moderate PPM was associated
with increased risk of perioperative mortality but not of overall
mortality. The impact of PPM was less pronounced in patients with larger
body mass index (>28 kg/m²) compared with those with lower
index. Predictors of PPM were older age, female sex, hypertension,
diabetes, renal failure, larger body surface area, larger body mass index,
and the utilization of a bioprosthesis. Conclusions PPM increases
perioperative and overall mortality proportionally to its severity. The
identification of predictors for PPM may be useful to identify patients
who are at higher risk for PPM. The findings of this study support the
implementation of strategies to prevent PPM especially in patients <70
years of age and/or with concomitant coronary artery bypass graft.
Copyright &#xa9; 2016 American College of Cardiology Foundation

<105>
Accession Number
610983910
Author
Serio D.; Zierer A.; Doss M.; Moritz A.
Institution
(Serio, Doss) Department of Cardiovascular Surgery, Kerckhoff Klinik GmbH,
Benekestr. 2-8, Bad Nauheim 61231, Germany
(Zierer, Moritz) Department of Cardiovascular Surgery, Goethe Universitats
Klinik, Frankfurt am Main, Germany
Title
Transcatheter Valve Unable to Cure Patient-Prosthesis Mismatch of Mosaic
Bioprosthesis.
Source
Thoracic and Cardiovascular Surgeon Reports. 5 (1) (pp 27-29), 2016. Date
of Publication: 01 Dec 2016.
Publisher
Georg Thieme Verlag (E-mail: iaorl@iaorl.org)
Abstract
Transcatheter aortic valve implantation (TAVI) has been recently
established as a less invasive alternative to conventional aortic valve
replacement (CAVR) in patients presenting with expected high procedural
risk. The rapid technologic advances and the recent improvement of
clinical outcomes with TAVI have made it possible to treat degenerated
bioprosthesis using the valve-in-valve implantation concept (Walther T,
Simon P, Dewey T, et al. Transapical minimally invasive aortic valve
implantation: multicenter experience. Circulation 2007;116(11,
Suppl):I240-I245; Webb JG, Pasupati S, Humphries K, et al. Percutaneous
transarterial aortic valve replacement in selected high-risk patients with
aortic stenosis. Circulation 2007;116(7):755-763). Recently, concerns were
raised regarding the appropriate sizing of transcatheter valve prosthesis
and its effect on residual stenosis (Klaaborg KE, Egeblad H, Jakobsen CJ,
et al. Transapical transcatheter treatment of a stenosed aortic valve
bioprosthesis using the Edwards SAPIEN Transcatheter Heart Valve. Ann
Thorac Surg 2009;87(6):1943-1946; Zedig R, Achouh P, Berrebi A, et al.
Valve- in- a- valve implantation: a word of caution. Ann Thorac Surg
2009;87:1943-1946), eventually resulting in a patient-prosthesis mismatch
(PPM). We report a case with severe PPM after inserting a 23-mm Sapien
(Edwards Lifesciences, Irvine, United States) valve into degenerated 23-mm
Medtronic Mosaic prosthesis (Medtronic, Minneapolis, Minnesota, United
States). Copyright &#xa9; 2016 Georg Thieme Verlag KG Stuttgart . New
York.

<106>
Accession Number
611570779
Author
Sibilitz K.L.; Berg S.K.; Rasmussen T.B.; Risom S.S.; Thygesen L.C.; Tang
L.; Hansen T.B.; Johansen P.P.; Gluud C.; Lindschou J.; Schmid J.P.;
Hassager C.; KOber L.; Taylor R.S.; Zwisler A.-D.
Institution
(Sibilitz, Berg, Rasmussen, Risom, Tang, Hansen, Johansen, Hassager,
KOber, Zwisler) Department of Cardiology, Rigshospitalet, Copenhagen
University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
(Sibilitz, Thygesen, Taylor, Zwisler) National Institute of Public Health,
University of Southern Denmark, Copenhagen, Denmark
(Berg, Rasmussen) Department of Cardiology, Gentofte Hospital, Gentofte,
Denmark
(Risom) Bachelor's Degree Programme in Nursing, Metropolitan University
College, Copenhagen, Denmark
(Tang) Bachelor's Degree Programme in Physiotherapy, Department of
Rehabilitation and Nutrition, Metropolitan University College, Copenhagen,
Denmark
(Tang) Section of Social Medicine, Department of Public Health, University
of Copenhagen, Copenhagen, Denmark
(Hansen) Zealand University Hospital, Department of Cardiology, KOgevej
7-13, Roskilde 4000, Denmark
(Johansen) Department of Cardiology, Bispebjerg Hospital, Copenhagen,
Denmark
(Gluud, Lindschou) Department 7812, Centre for Clinical Intervention
Research, Copenhagen University Hospital, Copenhagen, Denmark
(Schmid) Cardiology Clinic, Tiefenau Hospital, University of Bern, Bern,
Switzerland
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, United Kingdom
(Zwisler) Department of Cardiology, Holbaek Sygehus, Holbaek, Denmark
(Zwisler) National Centre of Rehabilitation and Palliation, University of
Southern Denmark, University Hospital of Odense, Odense, Denmark
Title
Cardiac rehabilitation increases physical capacity but not mental health
after heart valve surgery: A randomised clinical trial.
Source
Heart. 102 (24) (pp 1995-2003), 2016. Date of Publication: 15 Dec 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The evidence for cardiac rehabilitation after valve surgery
remains sparse. Current recommendations are therefore based on patients
with ischaemic heart disease. The aim of this randomised clinical trial
was to assess the effects of cardiac rehabilitation versus usual care
after heart valve surgery. Methods The trial was an
investigator-initiated, randomised superiority trial (The CopenHeartVR
trial, VR; valve replacement or repair). We randomised 147 patients after
heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting
of physical exercise and monthly psycho-educational consultations
(intervention) versus usual care without structured physical exercise or
psycho-educational consultations (control). Primary outcome was physical
capacity measured by VO<inf>2</inf> peak and secondary outcome was
self-reported mental health measured by Short Form-36. Results 76% were
men, mean age 62 years, with aortic (62%), mitral (36%) or
tricuspid/pulmonary valve surgery (2%). Cardiac rehabilitation compared
with control had a beneficial effect on VO<inf>2</inf> peak at 4 months
(24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short
Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40)
or the exploratory physical and mental outcomes. Cardiac rehabilitation
increased the occurrence of self-reported non-serious adverse events
(11/72 vs 3/75, p=0.02). Conclusions Cardiac rehabilitation after heart
valve surgery significantly improves VO<inf>2</inf> peak at 4 months but
has no effect on mental health and other measures of exercise capacity and
self-reported outcomes. Further research is needed to justify cardiac
rehabilitation in this patient group.

<107>
Accession Number
613792715
Author
Rosendahl J.; Koranyi S.; Jacob D.; Zech N.; Hansen E.
Institution
(Rosendahl, Jacob) Jena University Hospital, Friedrich-Schiller
University, Institute of Psychosocial Medicine and Psychotherapy, Stoystr.
3, Jena 07743, Germany
(Koranyi) University Hospital Leipzig, Department of Medical Psychology
and Medical Sociology, Philipp-Rosenthal-Str. 55, Leipzig 04103, Germany
(Zech, Hansen) University Hospital Regensburg, Department of
Anaesthesiology, Franz-Josef-Strauss-Allee 11, Regensburg 93053, Germany
Title
Efficacy of therapeutic suggestions under general anesthesia: A systematic
review and meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 16 (1) (no pagination), 2016. Article Number: 125.
Date of Publication: 22 Dec 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: General anesthesia does not block central nervous processing
of auditive information. Therefore, positive suggestions even given during
surgery might have the potential to encourage well-being and recovery of
patients. Aim of this review was to summarize the evidence on the efficacy
of therapeutic suggestions under general anesthesia in adults undergoing
surgery compared to an attention control (i.e. white noise). Methods: We
included randomized controlled trials that investigated therapeutic
suggestions presented during general anesthesia to adult patients
undergoing surgery or medical procedures. Outcomes on pain intensity,
mental distress, recovery, use of medication, measured postoperatively
within hospitalization were considered. Electronic searches were carried
out in the following databases (last search February 23, 2015): MEDLINE,
CENTRAL, Web of Science, PsycINFO, ProQuest Dissertations and Theses.
Results: Thirty-two eligible randomized controlled trials were included,
comprising a total of 2102 patients. All studies used taped suggestions.
Random effects meta-analyses revealed no effects on pain intensity
(Hedges' g = 0.04, CI 95% [0.04; 0.12], number needed to treat [NNT] =
44.3) and mental distress (g = 0.03, CI 95% [0.11; 0.16], NNT = 68.2). In
contrast, we found small but significant positive effects on use of
medication (g = 0.19, CI 95% [0.09; 0.29], NNT = 9.2) and on recovery (g =
0.14, CI 95% [0.03; 0.25], NNT = 13.0). All effects were homogeneous and
robust. Conclusions: Even though effects were small, our results provide
indications that intraoperative suggestions can have the potential to
reduce the need for medication and enhance recovery. Further high quality
trials are needed to strengthen the promising evidence on the efficacy of
therapeutic suggestions under general anesthesia for patients undergoing
surgery. Copyright &#xa9; 2017 The Author(s).

<108>
Accession Number
614148608
Author
Derakhshan P.; Maleki M.H.; Kazemi T.; Sharifabad A.R.; Mashreghimoghadam
H.R.
Institution
(Derakhshan) Anesthesiology Department, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Maleki, Kazemi, Mashreghimoghadam) Atherosclerosis and Coronary Artery
Research Center, Birjand University of Medical Sciences, Birjand, Iran,
Islamic Republic of
(Sharifabad) Birjand University of Medical Sciences, Birjand, Iran,
Islamic Republic of
Title
Comparison of the effect of two left internal mammary artery harvesting
techniques (Skeletonization and pedicled) on post coronary artery bypass
surgery pain and bleeding.
Source
Research in Cardiovascular Medicine. 6 (1) (no pagination), 2017. Article
Number: e34207. Date of Publication: January 2017.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Background: Recent evidence suggests that skeletonization of the left
internal mammary artery (LIMA) can improve the flow and length of the
flow, reduce deep sternal infections and postoperative pain. Objectives:
The present study aimed to investigate the effect of two LIMA harvesting
techniques (skeletonization and pedicled) on postoperative pain and
bleeding. Methods: This randomized double blind clinical trial study on
patients undergoing LIMA harvest in Birjand was conducted during years
2012 to 2014. The patients were divided to two (skeletonization N: 30 and
pedicled N: 30) groups according to the LIMA harvesting method. Their
demographic information and other relevant data were collected by means of
a questionnaire. Results: In total, 60 cases, who were candidates for
coronary artery bypass grafting (CABG) at the cardiac surgery department
of Valiasr hospital in Birjand, were studied. In the skeletonized group,
the conduit length was significantly longer (17.96 vs. 17.27, P < 0.001),
yet there was no significant difference between early and mid-term pain
scores (P values: 0.32 and 1.0, respectively) and early postoperative
bleeding (782.26 vs. 903.16, P = 0.657). Conclusions: The IMA skeletonized
collection resulted in the reduction of postoperative pain and increased
conduit length. Skeletonization could not decrease postoperative bleeding.
Copyright &#xa9; 2016 Rajaie Cardiovascular Medical and Research Center,
Iran University of Medical Sciences.

<109>
Accession Number
614148647
Author
Totonchi Z.; Rezvani H.; Ghorbanloo M.; Yazdanian F.; Mahdavi M.; Babaali
N.; Salajegheh S.; Chitsazan M.
Institution
(Totonchi, Yazdanian, Mahdavi, Babaali, Chitsazan) Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Rezvani) Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Ghorbanloo) Hasheminejad Kidney Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Salajegheh) Kerman University of Medical Sciences, Kerman, Iran, Islamic
Republic of
Title
Effect of dexmedetomidine infusion on hemodynamics and stress responses in
pediatric cardiac surgery: A randomized trial.
Source
Research in Cardiovascular Medicine. 6 (1) (no pagination), 2017. Article
Number: e35016. Date of Publication: January 2017.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Background: Infants and children compared with adults have intensified
stress responses that lead to increased morbidity and mortality. Stress
control reduces the incidence of complications and improves recovery. In
clinical and experimental studies, dexmedetomidine reduces the
inflammatory and neuroendocrine responses. Objectives: This prospective
randomized double-blinded clinical trial was conducted to assess the role
of dexmedetomidine in reducing stress responses. Materials and Methods:
According to convenient sampling method, 40 patients in two groups (case
under treatment with dexmedetomidine and control, each including 20
patients) were selected from whom admitted for open heart surgery.
Anesthesia was induced and maintained by fentanyl and midazolam. After
central venous and arterial catheter insertion, patients were randomly
allocated into one of two equal groups (n = 20 each). In the
dexmedetomidine group, patients received an initial loading dose (0.5
micro&#32;g/kg) during 10 minutes immediately followed by a continuous
infusion of 0.5 micro&#32;g/kg. In the control group, normal saline
solution with similar volume was infused. Results: Changes in heart rate,
systolic and diastolic blood pressures and central venous pressure before
administration of dexmedetomidine, in 10, 20 and 30 minutes after the
operation, after skin incision, after sternotomy, after separation from
the pump and at the end of procedure showed no significant difference
between the two groups (P = 0.860, 0.067, 0.888 and 0.482, respectively).
Changes in lactate, interleukin 6, tumor necrosis factor, C-reactive
protein concentrations before administration of dexmedetomidine, after
separation of pump and 24 hours after intensive care unit entrance showed
no significant difference between the two groups (P = 0.525, 0.767, 0.868
and 0.840, respectively). Conclusions: According to our findings, using
dexmedetomidine as an adjuvant anesthetic medication with initial loading
dose of 0.5 micro&#32;g/kg and maintenance dose of 0.5 micro&#32;g/kg in
pediatric heart surgeries is a safe choice. However, further studies are
needed to clarify the role of dexmedetomidine to reduce stress responses.
Copyright &#xa9; 2016 Rajaie Cardiovascular Medical and Research Center,
Iran University of Medical Sciences.

<110>
Accession Number
614135626
Author
Edwards S.J.; Crawford F.; van Velthoven M.H.; Berardi A.; Osei-Assibey
G.; Bacelar M.; Salih F.; Wakefield V.
Institution
(Edwards, Crawford, van Velthoven, Berardi, Osei-Assibey, Bacelar, Salih,
Wakefield) BMJ Technology Assessment Group, London, United Kingdom
Title
The use of fibrin sealant during non-emergency surgery: A systematic
review of evidence of benefits and harms.
Source
Health Technology Assessment. 20 (94) (pp i, 224), 2016. Date of
Publication: December 2016.
Publisher
NIHR Journals Library
Abstract
Background: Fibrin sealants are used in different types of surgery to
prevent the accumulation of post-operative fluid (seroma) or blood
(haematoma) or to arrest haemorrhage (bleeding). However, there is
uncertainty around the benefits and harms of fibrin sealant use.
Objectives: To systematically review the evidence on the benefits and
harms of fibrin sealants in non-emergency surgery in adults. Data sources:
Electronic databases [MEDLINE, EMBASE and The Cochrane Library (including
the Cochrane Database of Systematic Reviews, the Database of Abstracts of
Reviews of Effects, the Health Technology Assessment database and the
Cochrane Central Register of Controlled Trials)] were searched from
inception to May 2015. The websites of regulatory bodies (the Medicines
and Healthcare products Regulatory Agency, the European Medicines Agency
and the Food and Drug Administration) were also searched to identify
evidence of harms. Review methods: This review included randomised
controlled trials (RCTs) and observational studies using any type of
fibrin sealant compared with standard care in non-emergency surgery in
adults. The primary outcome was risk of developing seroma and haematoma.
Only RCTs were used to inform clinical effectiveness and both RCTs and
observational studies were used for the assessment of harms related to the
use of fibrin sealant. Two reviewers independently screened all titles and
abstracts to identify potentially relevant studies. Data extraction was
undertaken by one reviewer and validated by a second. The quality of
included studies was assessed independently by two reviewers using the
Cochrane Collaboration risk-of-bias tool for RCTs and the Centre for
Reviews and Dissemination guidance for adverse events for observational
studies. A fixed-effects model was used for meta-analysis. Results: We
included 186 RCTs and eight observational studies across 14 surgical
specialties and five reports from the regulatory bodies. Most RCTs were
judged to be at an unclear risk of bias. Adverse events were
inappropriately reported in observational studies. Meta-analysis across
non-emergency surgical specialties did not show a statistically
significant difference in the risk of seroma for fibrin sealants versus
standard care in 32 RCTs analysed [n = 3472, odds ratio (OR) 0.84, 95%
confidence interval (CI) 0.68 to 1.04; p = 0.13; I² = 12.7%],
but a statistically significant benefit was found on haematoma development
in 24 RCTs (n = 2403, OR 0.62, 95% CI 0.44 to 0.86; p = 0.01;
I² = 0%). Adverse events related to fibrin sealant use were
reported in 10 RCTs and eight observational studies across surgical
specialties, and 22 RCTs explicitly stated that there were no adverse
events. One RCT reported a single death but no other study reported
mortality or any serious adverse events. Five regulatory body reports
noted death from air emboli associated with fibrin sprays. Limitations: It
was not possible to provide a detailed evaluation of individual RCTs in
their specific contexts because of the limited resources that were
available for this research. In addition, the number of RCTs that were
identified made it impractical to conduct independent data extraction by
two reviewers in the time available. Conclusions: The effectiveness of
fibrin sealants does not appear to vary according to surgical procedures
with regard to reducing the risk of seroma or haematoma. Surgeons should
note the potential risk of gasembolism if spray application of fibrin
sealants is used and not to exceed the recommended pressure and spraying
distance. Future research should be carried out in surgery specialties for
which only limited datawere found, including neurological, gynaecological,
oral and maxillofacial, urology, colorectal and orthopaedics surgery (for
any outcome); breast surgery and upper gastrointestinal (development of
haematoma); and cardiothoracic heart or lung surgery (reoperation rates).
In addition, studies need to use adequate sample sizes, to blind
participants and outcome assessors, and to follow reporting guidelines.
Copyright &#xa9; Queen's Printer and Controller of HMSO 2016.

<111>
Accession Number
614093266
Author
Picano E.; Ciampi Q.; Citro R.; D'Andrea A.; Scali M.C.; Cortigiani L.;
Olivotto I.; Mori F.; Galderisi M.; Costantino M.F.; Pratali L.; Di Salvo
G.; Bossone E.; Ferrara F.; Gargani L.; Rigo F.; Gaibazzi N.; Limongelli
G.; Pacileo G.; Andreassi M.G.; Pinamonti B.; Massa L.; Torres M.A.R.;
Miglioranza M.H.; Daros C.B.; De Castro E Silva Pretto J.L.; Beleslin B.;
Djordjevic-Dikic A.; Varga A.; Palinkas A.; Agoston G.; Gregori D.;
Trambaiolo P.; Severino S.; Arystan A.; Paterni M.; Carpeggiani C.;
Colonna P.
Institution
(Picano, Pratali, Gargani, Andreassi, Paterni, Carpeggiani) Institute of
Clinical Physiology, National Research Council, Pisa, Italy
(Ciampi) Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
(Citro, Bossone, Ferrara) Heart Department, University Hospital San
Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
(D'Andrea, Pacileo) Division of Cardiology, Monaldi Hospital, Second
University of Naples, Naples, Italy
(Scali) Cardiology Department, Pisa University, Nottola (Siena) Hospital,
Pisa, Italy
(Cortigiani) Cardiology Department, San Luca Hospital, Lucca, Italy
(Olivotto, Mori) Cardiology Department, Careggi Hospital, Florence, Italy
(Galderisi) Department of Advanced Biomedical Sciences, Federico II
University Hospital, Naples, Italy
(Costantino) Cardiology Department, San Carlo Hospital, Potenza, Italy
(Di Salvo) Pediatric Cardiology Department, Brompton Hospital, London,
United Kingdom
(Rigo) Division of Cardiology, Ospedale dell'Angelo Mestre-Venice, Mestre,
Italy
(Gaibazzi) Cardiology Department, Parma University Hospital, Parma, Italy
(Limongelli) Pediatric Cardiology Department, Monaldi Hospital Clinics,
Naples, Italy
(Pinamonti, Massa) Cardiology Department, University Hospital Ospedale
Riuniti, Trieste, Italy
(Torres) Hospital de Clinicas de Porto Alegre, Universidade Federal Do Rio
Grande Do sul, Porto Alegre, Brazil
(Miglioranza) Cardiology Institute of Rio Grande Do sul, Porto Alegre,
Brazil
(Daros) Cardiology Division, Hospital San Jose, Criciuma, Brazil
(De Castro E Silva Pretto) Hospital Sao Vicente de Paulo, Hospital de
Cidade, Passo Fundo, Brazil
(Beleslin, Djordjevic-Dikic) Cardiology Clinic, Clinical Center of Serbia,
Medical School, University of Belgrade, Belgrade, Serbia
(Varga, Agoston) Institute of Family Medicine, University of Szeged,
Szeged, Hungary
(Palinkas) Department of Internal Medicine, Elisabeth Hospital,
Hodmezovasarhely, Hungary
(Gregori) Department of Biostatistics, University of Padua, Padua, Italy
(Trambaiolo) Department of Cardiology, Sandro Pertini Hospital, Rome,
Italy
(Severino) Cardiology Department, Monaldi Hospital, Naples, Italy
(Arystan) RSE, Medical Centre Hospital of the President's Affairs
Administration of the Republic of Kazakhstan, Astana, Kazakhstan
(Colonna) Cardiology Hospital, Policlinico of Bari, Bari, Italy
Title
Stress echo 2020: The international stress echo study in ischemic and
non-ischemic heart disease.
Source
Cardiovascular Ultrasound. 15 (1) (no pagination), 2017. Article Number:
3. Date of Publication: 18 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Stress echocardiography (SE) has an established role in
evidence-based guidelines, but recently its breadth and variety of
applications have extended well beyond coronary artery disease (CAD). We
lack a prospective research study of SE applications, in and beyond CAD,
also considering a variety of signs in addition to regional wall motion
abnormalities. Methods: In a prospective, multicenter, international,
observational study design, > 100 certified high-volume SE labs (initially
from Italy, Brazil, Hungary, and Serbia) will be networked with an
organized system of clinical, laboratory and imaging data collection at
the time of physical or pharmacological SE, with structured follow-up
information. The study is endorsed by the Italian Society of
Cardiovascular Echography and organized in 10 subprojects focusing on:
contractile reserve for prediction of cardiac resynchronization or medical
therapy response; stress B-lines in heart failure; hypertrophic
cardiomyopathy; heart failure with preserved ejection fraction; mitral
regurgitation after either transcatheter or surgical aortic valve
replacement; outdoor SE in extreme physiology; right ventricular
contractile reserve in repaired Tetralogy of Fallot; suspected or initial
pulmonary arterial hypertension; coronary flow velocity, left ventricular
elastance reserve and B-lines in known or suspected CAD; identification of
subclinical familial disease in genotype-positive, phenotype- negative
healthy relatives of inherited disease (such as hypertrophic
cardiomyopathy). Results: We expect to recruit about 10,000 patients over
a 5-year period (2016-2020), with sample sizes ranging from 5,000 for
coronary flow velocity/ left ventricular elastance/ B-lines in CAD to
around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of
Fallot. This data-base will allow to investigate technical questions such
as feasibility and reproducibility of various SE parameters and to assess
their prognostic value in different clinical scenarios. Conclusions: The
study will create the cultural, informatic and scientific infrastructure
connecting high-volume, accredited SE labs, sharing common criteria of
indication, execution, reporting and image storage of SE to obtain
original safety, feasibility, and outcome data in evidence-poor diagnostic
fields, also outside the established core application of SE in CAD based
on regional wall motion abnormalities. The study will standardize
procedures, validate emerging signs, and integrate the new information
with established knowledge, helping to build a next-generation SE lab
without inner walls. Copyright &#xa9; 2017 The Author(s).

<112>
Accession Number
614093226
Author
Cho Y.J.; Kim T.K.; Hong D.M.; Seo J.-H.; Bahk J.-H.; Jeon Y.
Institution
(Cho, Kim, Hong, Seo, Bahk, Jeon) Seoul National University Hospital,
Department of Anesthesiology and Pain Medicine, 101 Daehak-ro, Jongno-gu,
Seoul 03068, South Korea
Title
Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on
arterial oxygenation during one-lung ventilation for thoracoscopic
surgery: A prospective randomized trial.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 9. Date
of Publication: 18 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: One-lung ventilation during thoracic surgery frequently
disturbs normal systemic oxygenation. However, the effect of anesthetics
on arterial oxygenation during one-lung ventilation has not been well
established in human study. In this clinical trial, we investigated
whether a difference between desflurane-remifentanil and
propofol-remifentanil anesthesia can be observed with regard to
oxygenation during one-lung ventilation for thoracoscopic surgery.
Methods: Adult patients with lung cancer, scheduled for video-assisted
thoracoscopic lobectomy without preoperative oxygen support, were screened
and randomized to receive desflurane or propofol, with remifentanil
continuous infusion in both groups. Mechanical ventilation was performed
with tidal volume of 8 ml/kg and F<inf>I</inf>O<inf>2</inf> 0.5 during
two-lung ventilation, and 6 ml/kg and 1.0 during one-lung ventilation,
both with positive end-expiratory pressure of 5 cmH<inf>2</inf>O. Arterial
blood gas analysis was performed preoperatively, during two-lung
ventilation, and after 15, 30, 45, and 60 min of one-lung ventilation. The
primary endpoint was PaO<inf>2</inf> at 30 min after initiating one-lung
ventilation. Statistical analyses included the independent t-test for the
primary endpoint and a mixed model with a post-hoc analysis to evaluate
the serial changes in values. Results: Patients were recruited between
July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52
in desflurane group and n = 51 in propofol group). The primary endpoint,
PaO<inf>2</inf> at 30 min of one-lung ventilation was lower in the
desflurane group than the propofol group (170 +/- 72 vs. 202 +/- 82 mmHg;
p = 0.039). Serial changes in PaO<inf>2</inf> during one-lung ventilation
showed lower levels during desflurane anesthesia compared with propofol
anesthesia (mean difference, 45 mmHg; 95% confidence interval, 16-75 mmHg;
p = 0.003). Conclusions: In conclusion, desflurane-remifentanil anesthesia
resulted in decreased arterial oxygenation compared with that of
propofol-remifentanil anesthesia during one-lung ventilation for
thoracoscopic surgery in patients with lung cancer. Trial registration:
ClinicalTrials.gov identifier: NCT02191371, registered on July 7, 2014
Copyright &#xa9; 2017 The Author(s).

<113>
Accession Number
614112937
Author
Chakravarthy M.; Prabhakumar D.; Thimmannagowda P.; Krishnamoorthy J.;
George A.; Jawali V.
Institution
(Chakravarthy, Prabhakumar, Thimmannagowda, Krishnamoorthy, George,
Jawali) Department of Anesthesia, Critical Care and Pain Relief, Fortis
Hospitals, Bannerughatta Road, Bengaluru, Karnataka 560 076, India
Title
Comparison of two doses of heparin on outcome in off-pump coronary artery
bypass surgery patients: A prospective randomized control study.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 8-13), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: While off pump coronary artery bypass surgery is practiced
with an intention to reduce the morbidity associated with cardiopulmonary
bypass, the resultant 'hypercoagulability' needs to be addressed.
Complications such as cavitary thrombus possibly due to the hyper
coagulability after off pump coronary artery bypass surgery have been
described. Many clinicians use higher doses of heparin - up to 5 mg/kg in
order to thwart this fear. Overall, there appears to be no consensus on
the dose of heparin in off pump coronary artery bypass surgeries. Aim of
the Study: The aim of the study was understand the differences in outcome
of such as transfusion requirement, myocardial ischemia, and morbidity
when two different doses were used for systemic heparinization. Methods:
Elective patients scheduled for off pump coronary artery bypass surgery
were included. Ongoing anti platelet medication was not an exclusion
criteria, however, anti platelet medications were ceased about a week
prior to surgery when possible. Thoracic epidural anesthesia was
administered as an adjunct in patients who qualified for it. By computer
generated randomization chart, patients were chosen to receive either 2 or
3 mg/kg of intravenous unfractioned heparin to achieve systemic
heparinization with activated clotting time targeted at >240 secs.
Intraoperative blood loss, postoperative blood loss, myocardial ischemic
episodes, requirement of intraaortic balloon counter pulsation and
transfusion requirement were analyzed. Results: Sixty two patients
participated in the study. There was one conversion to cardiopulmonary
bypass. The groups had comparable ACT at baseline (138.8 vs. 146.64
seconds, P = 0.12); 3 mg/kg group had significantly higher values after
heparin, as expected. But after reversal with protamine, ACT and need for
additional protamine was similar among the groups. Intraoperative (685.56
+/- 241.42 ml vs. 675.15 +/- 251.86 ml, P = 0.82) and postoperative blood
loss (1906.29 +/- 611.87 ml vs 1793.65 +/- 663.54 ml , p value 0.49) were
similar among the groups [Table 4]. The incidence of ECG changes of
ischemia, arrhythmias, conversion to CPB, or need for intra-aortic balloon
counter pulsation were not different. Conclusions: Use of either 2 or 3
mg/kg heparin for systemic heparinization in patients undergoing OPCAB did
not affect the outcome. Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<114>
Accession Number
614112857
Author
Shah K.
Institution
(Shah) Department of Cardiac Anaesthesia, Breach Candy Hospital Trust,
60A, Bhulabhai Desai Road, Mumbai, Maharashtra 400 026, India
Title
ProSeal laryngeal mask airway as an alternative to standard endotracheal
tube in securing upper airway in the patients undergoing beating-heart
coronary artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 61-66), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: ProSeal laryngeal mask airways (PLMAs) are routinely used
after failed tracheal intubation as airway rescue, facilitating tracheal
intubation by acting as a conduit and to secure airway during emergencies.
In long duration surgeries, use of endotracheal tube (ETT) is associated
with various hemodynamic complications, which are minimally affected
during PLMA use. However, except for few studies, there are no significant
data available that promote the use of laryngeal mask during cardiac
surgery. This prospective study was conducted with the objective of
demonstrating the advantages of PLMA over ETT in the patients undergoing
beating-heart coronary artery bypass graft (CABG). Methodology: This
prospective, interventional study was carried out in 200 patients who
underwent beating-heart CABG. Patients were randomized in equal numbers to
either ETT group or PLMA group, and various hemodynamic and respiratory
parameters were observed at different time points. Results: Patients in
PLMA group had mean systolic blood pressure 126.10 +/- 5.31 mmHg compared
to the patients of ETT group 143.75 +/- 6.02 mmHg. Pulse rate in the PLMA
group was less (74.52 +/- 10.79 per min) (P < 0.05) compared to ETT group
(81.72 +/- 9.8). Thus, hemodynamic changes were significantly lower (P <
0.05) in PLMA than in ETT group. Respiratory parameters such as oxygen
saturation, pressure CO <inf>2</inf> (pCO <inf>2</inf> ), peak airway
pressure, and lung compliance were similar to ETT group at all evaluation
times. The incidence of adverse events was also lower in PLMA group.
Conclusion: In experience hand, PLMA offers advantages over the ETT in
airway management in the patients undergoing beating-heart CABG. Copyright
&#xa9; 2017 Annals of Cardiac Anaesthesia Published by Wolters Kluwer -
Medknow.

<115>
Accession Number
614112834
Author
Fernandes G.; Araujo Junior R.; Lima A.; Gonzaga I.; De Oliveira R.;
Nicolau R.
Institution
(Fernandes, Lima, Gonzaga, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IPandD, Universidade Do Vale Do
Paraiba, Vitorino Orthiges Fernandes Street, Bairro Uruguai, Teresina, PI
6321, Brazil
(Fernandes, Gonzaga, De Oliveira) Uninovafapi Universitary Center
(UNINOVAFAPI), Brazil
(Araujo Junior) Department of Cardiac Surgery, Santa Maria Hospital,
Bairro Centro, Brazil
(Lima, De Oliveira) Department of Physical Therapy, University of Piaui
State PI, Brazil
Title
Low-intensity laser (660 NM) has analgesic effects on sternotomy of
patients who underwent coronary artery bypass grafts.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 52-56), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: The aim of this study was to evaluate the efficacy of
low-level laser therapy for reducing the acute pain of sternotomy in
patients who underwent a coronary artery bypass graft (CABG). Methods:
This study was conducted with ninety volunteers who electively submitted
to CABG. The volunteers were randomly allocated into three groups of equal
size (n = 30): control, placebo, and laser (lambda of 660 nm and spatial
average energy fluency of 1.06 J/cm ² ). Pain when coughing was
assessed by a visual analog scale (VAS) and McGill Pain Questionnaire,
according to sensory, affective, evaluative, and miscellaneous domains.
The patients were followed for 1 month after the surgery. Results: The
laser group had a greater decrease in pain with analogous results, as
indicated by both the VAS and the McGill questionnaire (P < 0.05) on
sensory and affective scores, on days 6 and 8 postsurgery compared to the
placebo and control groups. Conclusion: Laser seems to be effective
promoting pain reduction after coronary-arterial bypass grafting.
Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia Published by Wolters
Kluwer - Medknow.

<116>
Accession Number
614112809
Author
Safaei N.; Babaei H.; Azarfarin R.; Jodati A.-R.; Yaghoubi A.;
Sheikhalizadeh M.-A.
Institution
(Safaei, Jodati, Sheikhalizadeh) Cardiovascular Research Center, School of
Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Babaei) Drug Applied Research Center, School of Pharmacy, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Azarfarin, Yaghoubi) Echocardiography Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Comparative effect of grape seed extract (Vitis vinifera) and ascorbic
acid in oxidative stress induced by on-pump coronary artery bypass
surgery.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 45-51), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: This study aimed to test the beneficial effect of grape seed
extract (GSE) (Vitis vinifera) and Vitamin C in oxidative stress and
reperfusion injury induced by cardiopulmonary bypass (CPB) in coronary
artery bypass surgery. Patients and Methods: In this randomized trial, 87
patients undergoing elective and isolated coronary bypass surgery
included. The patients were randomly assigned into three groups (n = 29
each): (1) Control group with no treatment, (2) GSE group who received the
extract 24 h before operation, 100 mg every 6 h, orally, (3) Vitamin C
group who received 25 mg/kg Vitamin C through CPB during surgery. Blood
samples were taken from coronary sinus at (T1) just before aortic cross
clamp; (T2) just before starting controlled aortic root reperfusion; and
(T3) 10 min after root reperfusion. Some clinical parameters and
biochemical markers were compared among the groups. Results: There were
significant differences in tracheal intubation times, sinus rhythm return,
and left ventricular function between treatment groups compared with
control (P < 0.05). Total antioxidant capacity was higher (P < 0.05) in
both grape seed and Vitamin C groups at T2 and T3 times. In reperfusion
period, malondialdehyde level was increased in control group; however, it
was significantly lower for the grape seed group (P = 0.04). The
differences in the mean levels of superoxide dismutase and glutathione
peroxidase among the three groups were not significant (P > 0.05 in all
cases). Conclusions: In our patients, GSE and Vitamin C had antioxidative
effects and reduced deleterious effects of CPB during coronary artery
bypass grafting surgery. Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<117>
Accession Number
614112417
Author
Zhao B.-C.; Huang T.-Y.; Deng Q.-W.; Liu W.-F.; Liu J.; Deng W.-T.; Liu
K.-X.; Li C.
Institution
(Zhao, Liu, Deng, Liu, Li) Department of Anesthesiology, Nanfang Hospital,
Southern Medical University, Guangzhou, China
(Zhao, Deng, Liu) Department of Anesthesiology, the First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, China
(Huang) Department of Ultrasonography, the First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
Title
Prophylaxis Against Atrial Fibrillation After General Thoracic Surgery:
Trial Sequential Analysis and Network Meta-Analysis.
Source
Chest. 151 (1) (pp 149-159), 2017. Date of Publication: 01 Jan 2017.
Publisher
Elsevier Inc
Abstract
Background Postoperative atrial fibrillation/flutter (POAF) is associated
with significant morbidity and mortality after general thoracic surgery,
but the need for and the best agent for prophylaxis remains obscure.
Methods A systematic literature search was performed to identify
randomized controlled trials that compared regimens for POAF prophylaxis
after general thoracic surgery. Random-effects meta-analyses with trial
sequential analyses were performed to compare the effects of medical
prophylaxis vs placebo/usual care. The risk of POAF among patients
receiving various prophylactic regimens was subjected to Bayesian network
meta-analysis. Results Twenty-two trials (2,891 patients and 11 regimens)
were included. Overall, medical prophylaxis reduced the incidence of POAF
(OR, 0.33; 95% CI, 0.22-0.49) but not short-term mortality (OR, 0.85; 95%
CI, 0.41-1.73). There was no significant difference in patient withdrawal
due to adverse events (OR, 1.67; 95% CI, 0.67-4.16). Trial sequential
analysis showed that as of 2012, sufficient evidence had accrued in
support of the effectiveness of medical prophylaxis in reducing POAF after
general thoracic surgery. In network meta-analysis, beta-blockers,
angiotensin-converting enzyme inhibitors, amiodarone, magnesium, and
calcium channel blockers significantly reduced the risk of POAF compared
with placebo/usual care. beta-Blockers had the highest probability of
being the most effective agents (OR, 0.12; 95% credible interval [CrI],
0.05-0.27; probability of being best, 77.7%; number needed to treat, 5.2).
Conclusions The current literature supports the effectiveness and
tolerability of medical prophylaxis and the superiority of beta-blockers
in preventing POAF after general thoracic surgery. beta-Blockers are
recommended, taking into consideration the status of the bronchopulmonary
system. Copyright &#xa9; 2016 American College of Chest Physicians

<118>
Accession Number
614112312
Author
Taksaudom N.; Siwachat S.; Tantraworasin A.
Institution
(Taksaudom, Siwachat, Tantraworasin) Department of Surgery, Faculty of
Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, 110
Suthep Rd, Chiang Mai 50200, Thailand
Title
Additional effects of topical tranexamic acid in on-pump cardiac surgery.
Source
Asian Cardiovascular and Thoracic Annals. 25 (1) (pp 24-30), 2017. Date of
Publication: 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective Postoperative bleeding after cardiac surgery is commonly
associated with hyperfibrinolysis. This study was designed to evaluate the
efficacy of topical tranexamic acid in addition to intravenous tranexamic
acid in reducing bleeding in cardiac surgery cases. Methods From July 1,
2014 to September 30, 2015, 82 patients who underwent elective on-pump
cardiac surgery were randomized into a tranexamic acid group and a placebo
group. In the tranexamic acid group, 1 g of tranexamic acid dissolved in
100 mL of normal saline solution was poured into the pericardium during
sternal closure; the placebo group had 100 mL of saline only. Two patients
were excluded from the study due to obvious surgical bleeding. The primary
endpoint was total blood loss 24 h after surgery. Repeated measures with
mixed models was used to analyze bleeding over time. Results There was no
significant difference in demographic and intraoperative data except for a
significantly lower platelet count preoperatively in the tranexamic acid
group (p = 0.030). There was no significant difference in postoperative
drainage volumes at 8, 16, and 24 h, postoperative bleeding over time
(coefficient = 0.713, p = 0.709), or blood product transfusion between the
groups. There were no serious complications. Conclusions Topical
tranexamic acid is safe but it adds no additional efficacy to the
intravenous application in reducing postoperative blood loss. Intravenous
tranexamic acid administration alone is sufficient antifibrinolytic
treatment to enhance the hemostatic effects during on-pump cardiac
surgery. Copyright &#xa9; The Author(s) 2016.

<119>
Accession Number
614127945
Author
Renaud S.; Guerrera F.; Seitlinger J.; Costardi L.; Schaeffer M.; Romain
B.; Mossetti C.; Claire-Voegeli A.; Filosso P.L.; Legrain M.; Ruffini E.;
Falcoz P.-E.; Oliaro A.; Massard G.
Institution
(Renaud, Guerrera, Seitlinger, Falcoz, Massard) Department of Thoracic
Surgery, Strasbourg University Hospital, Strasbourg, France
(Renaud) Department of Thoracic Surgery, Nancy University Hospital, Nancy,
France
(Renaud, Romain) Research Unit EA3430, Tumoral Progression and
Micro-Environment, Epidemiological and Translational Approaches,
Strasbourg University, Strasbourg, France
(Guerrera, Costardi, Mossetti, Filosso, Ruffini, Oliaro) Department of
Thoracic Surgery, Azienda Ospedaliera Universitaria Citta della Salute e
della Scienza di Torino, Torino, Italy
(Schaeffer) Department of Biostatistics, Strasbourg University Hospital,
Strasbourg, France
(Romain) Department of General and Digestive Surgery, Strasbourg
University Hospital, Strasbourg, France
(Claire-Voegeli, Legrain) Department of Molecular Biology, Strasbourg
University Hospital, Strasbourg, France
Title
KRAS exon 2 codon 13 mutation is associated with a better prognosis than
codon 12 mutation following lung metastasectomy in colorectal cancer.
Source
Oncotarget. 8 (2) (pp 2514-2524), 2017. Date of Publication: 2017.
Publisher
Impact Journals LLC (E-mail: editors@impactaging.com)
Abstract
Introduction: The utilization of molecular markers as routinely used
biomarkers is steadily increasing. We aimed to evaluate the potential
different prognostic values of KRAS exon 2 codons 12 and 13 after lung
metastasectomy in colorectal cancer (CRC). Results: KRAS codon 12
mutations were observed in 116 patients (77%), whereas codon 13 mutations
were observed in 34 patients (23%). KRAS codon 13 mutations were
associated with both longer time to pulmonary recurrence (TTPR) (median
TTPR: 78 months (95% CI: 50.61-82.56) vs 56 months (95% CI: 68.71-127.51),
P = 0.008) and improved overall survival (OS) (median OS: 82 months vs 54
months (95% CI: 48.93-59.07), P = 0.009). Multivariate analysis confirmed
that codon 13 mutations were associated with better outcomes (TTPR: HR:
0.40 (95% CI: 0.17-0.93), P = 0.033); OS: HR: 0.39 (95% CI: 0.14-1.07), P
= 0.07). Otherwise, no significant difference in OS (P = 0.78) or TTPR (P
= 0.72) based on the type of amino-acid substitutions was observed among
KRAS codon 12 mutations. Materials and Methods: We retrospectively
reviewed data from 525 patients who underwent a lung metastasectomy for
CRC in two departments of thoracic surgery from 1998 to 2015 and focused
on 150 patients that had KRAS exon 2 codon 12/13 mutations. Conclusions:
KRAS exon 2 codon 13 mutations, compared to codon 12 mutations, seem to be
associated with better outcomes following lung metastasectomy in CRC.
Prospective multicenter studies are necessary to fully understand the
prognostic value of KRAS mutations in the lung metastases of CRC.

<120>
Accession Number
614056515
Author
Dong Q.; Zhang K.; Cao S.; Cui J.
Institution
(Dong, Zhang, Cao, Cui) Harbin Medical University, Department of Thoracic
Surgery, The Fourth Affiliated Hospital, 37 Yiyuan Street, Nangang
District, Harbin, Heilongjiang 150001, China
Title
Fast-track surgery versus conventional perioperative management of lung
cancer-associated pneumonectomy: A randomized controlled clinical trial.
Source
World Journal of Surgical Oncology. 15 (1) (no pagination), 2017. Article
Number: 20. Date of Publication: 13 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of this study is to investigate the effects of
fast-track surgery (FTS) on postoperative recovery, hospital stay, total
medical costs, and the complications of pneumonectomy in patients with
non-small cell lung cancer (NSCLC). Methods: Studies were performed
between June 2012 and March 2014 in 17 patients received FTS and 18
patients given conventional management (control) after pneumonectomy in
the Department of Thoracic Surgery, the Fourth Affiliated Hospital of
Harbin Medical University. Patients were evaluated based on their days to
achieve the first postoperative flatus, C-reactive protein (CRP) at
postoperative day (POD) 1-7, the length of hospital stay, the medical
costs, and postoperative complications. Results: The results showed that
in the FTS group, latency to the first postoperative flatus (1.5 +/- 0.6
versus 3.1 +/- 0.8 s in controls, P < 0.0001), CRP (71.36 +/- 5.48 versus
80.71 +/- 8.32 mg/L in at POD 7, P < 0.0001), the length of hospital stay
(18.1 +/- 1.4 versus 27.4 +/- 6.6 days, P < 0.0001), and the medical costs
(29.9 +/- 2.7 versus 37.2 +/- 3.6 thousand Chinese Yuan, P < 0.0001) were
significantly reduced compared to the group receiving conventional
management. FTS group also had a relatively lower postoperative
complication rate (23.5% of 17 versus 33.3% of 18 in control group)
although it was statistically insignificant (P = 0.711). Conclusions:
These results indicate that application of the FTS in NSCLC pneumonectomy
efficiently accelerates postoperative recovery, shortens hospital stay,
reduces the total medical costs of the patients and thus is more
acceptable than conventional management. Copyright &#xa9; 2017 The
Author(s).

<121>
Accession Number
614031126
Author
Vedel A.G.
Institution
(Vedel) University of Copenhagen, Department of Cardiothoracic
Anaesthesiology, Heart Centre, Rigshospitalet, Copenhagen, Denmark
Title
Erratum to Perfusion Pressure Cerebral Infarct (PPCI) trial - the
importance of mean arterial pressure during cardiopulmonary bypass to
prevent cerebral complications after cardiac surgery: Study protocol for a
randomised controlled trial [Trials., 17 (2016) (247)].
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 15. Date of
Publication: 12 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Unfortunately, the original version of this article [1] contained an
error. The listings "Excusion criteria" and "Inclusion criteria" are
incorrect. The bullet point "Contractions to magnetic resonance imaging
(MRI)" should be listed under "Exclusion criteria" and not under
"Inclusion criteria". The correct listing can be found below. Copyright
&#xa9; The Author(s) 2017.

<122>
Accession Number
614148066
Author
Meersch M.; Schmidt C.; Hoffmeier A.; van Aken H.; Wempe C.; Gerss J.;
Zarbock A.
Institution
(Meersch, Schmidt, van Aken, Wempe, Zarbock) Department of Anesthesiology,
Intensive Care and Pain Medicine University, Hospital Munster,
Albert-Schweitzer-Campus 1, Building A1, Munster 48149, Germany
(Hoffmeier) Department of Cardiac Surgery, University of Munster, Munster,
Germany
(Gerss) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Title
Prevention of cardiac surgery-associated AKI by implementing the KDIGO
guidelines in high risk patients identified by biomarkers: the PrevAKI
randomized controlled trial.
Source
Intensive Care Medicine. (pp 1-11), 2017. Date of Publication: 21 Jan
2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Care bundles are recommended in patients at high risk for acute
kidney injury (AKI), although they have not been proven to improve
outcomes. We sought to establish the efficacy of an implementation of the
Kidney Disease Improving Global Outcomes (KDIGO) guidelines to prevent
cardiac surgery-associated AKI in high risk patients defined by renal
biomarkers. Methods: In this single-center trial, we examined the effect
of a "KDIGO bundle" consisting of optimization of volume status and
hemodynamics, avoidance of nephrotoxic drugs, and preventing hyperglycemia
in high risk patients defined as urinary [TIMP-2].[IGFBP7] > 0.3
undergoing cardiac surgery. The primary endpoint was the rate of AKI
defined by KDIGO criteria within the first 72 h after surgery. Secondary
endpoints included AKI severity, need for dialysis, length of stay, and
major adverse kidney events (MAKE) at days 30, 60, and 90. Results: AKI
was significantly reduced with the intervention compared to controls [55.1
vs. 71.7%; ARR 16.6% (95 CI 5.5-27.9%); p = 0.004]. The implementation of
the bundle resulted in significantly improved hemodynamic parameters at
different time points (p < 0.05), less hyperglycemia (p < 0.001) and use
of ACEi/ARBs (p < 0.001) compared to controls. Rates of moderate to severe
AKI were also significantly reduced by the intervention compared to
controls. There were no significant effects on other secondary outcomes.
Conclusion: An implementation of the KDIGO guidelines compared with
standard care reduced the frequency and severity of AKI after cardiac
surgery in high risk patients. Adequately powered multicenter trials are
warranted to examine mortality and long-term renal outcomes. Copyright
&#xa9; 2017 Springer-Verlag Berlin Heidelberg and ESICM

<123>
Accession Number
614135324
Author
Santana O.; Singla S.; Mihos C.G.; Pineda A.M.; Stone G.W.; Kurlansky
P.A.; George I.; Kirtane A.J.; Smith C.R.; Beohar N.
Institution
(Santana) From the *Columbia University Division of Cardiology at the
Mount Sinai Heart Institute, Miami Beach, FL USA; and +Columbia University
Medical Center, New York, NY USA.
Title
Outcomes of a Combined Approach of Percutaneous Coronary Revascularization
and Cardiac Valve Surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2017. Date of Publication: 13 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
ABSTRACT: A subset of patients requiring coronary revascularization and
valve surgery may benefit from a combined approach of percutaneous
coronary intervention (PCI) and valve surgery, as opposed to the standard
median sternotomy approach of combined coronary artery bypass and valve
surgery. To evaluate its potential benefits and limitations, a literature
search was performed using PubMed, EMBASE, Ovid, and the Cochrane library,
through March 2016 to identify all studies involving a combined approach
of PCI and valve surgery in patients with coronary artery and valvular
disease. There were five studies included in the study with a total of 324
patients, of which 75 (23.1%) had a history of previous cardiac surgery.
The interval between PCI and surgery ranged from simultaneous intervention
to a median of 38 days (interquartile range, 18-65 days). The surgical
approach performed consisted of a minimally invasive one or median
sternotomy. There were 275 single valve surgery (84.9%) and 49
double-valve surgery (15.1%) with a 30-day mortality ranging from 0% to
5.5%. The 1-year survival ranged from 78% to 96%, and the follow-up period
ranged from 1.3 to 5 years. Herein, we present a review of the literature
using this technique. Copyright &#xa9;2017 by the International Society
for Minimally Invasive Cardiothoracic Surgery

<124>
Accession Number
614134459
Author
Zhai A.B.; Haddad H.
Institution
(Zhai) Division of Cardiology, Department of Medicine, University of
Saskatchewan, Saskatoon, Saskatchewan, Canada
Title
The impact of obesity on heart failure.
Source
Current Opinion in Cardiology. (no pagination), 2017. Date of Publication:
13 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE OF REVIEW: Obesity, a growing global health problem, contributes
to the development of heart failure. However, increased BMI seems
protective for those with established disease, a phenomenon known as the
'obesity paradox'. In this review, we outline the mechanism through which
obesity can contribute to the development of heart failure, explore the
concept of obesity paradox, and highlight the challenges that obesity
presents for advanced heart failure therapy. RECENT FINDINGS: Although the
mechanism underlying the obesity paradox is complex, meta-analysis shows
that intentional weight loss through bariatric surgery can indeed improve
cardiac structure and function. With regard to ventricular assist device
therapy in obese patients, recent studies demonstrate that while obesity
was indeed associated with higher likelihood of complications, there were
no statistically significant differences in terms of mortality or
delisting from cardiac transplant waiting list. SUMMARY: Obesity is
strongly associated with the development of heart failure, through direct
and indirect mechanisms. Although clear consensus regarding weight
reduction in this patient population is lacking, there is mounting
clinical evidence that intentional weight loss may be beneficial, in spite
of the well-recognized obesity paradox, particularly as the presence of
obesity presents unique challenges in the advanced therapy of heart
failure patients. Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All
rights reserved.

<125>
Accession Number
614132184
Author
Altarabsheh S.E.; Deo S.V.; Dunlay S.M.; Erwin P.J.; Obeidat Y.M.; Navale
S.; Markowitz A.H.; Park S.J.
Institution
(Altarabsheh) Division of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Deo, Markowitz, Park) Division of Cardiovascular Surgery, University
Hospitals, Harrington Heart and Vascular Institute, Case Western Reserve
University, Cleveland, Ohio
(Dunlay) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota
(Erwin) Mayo Clinic Libraries, Rochester, Minnesota
(Obeidat) Department of Cardiac Surgery, AlMana General Hospital,
Alkhobar, KSA
(Navale) Division of Epidemiology and Biostatistics, Case Western Reserve
University, Cleveland, Ohio
Title
Meta-Analysis of Usefulness of Concomitant Mitral Valve Repair or
Replacement for Moderate Ischemic Mitral Regurgitation With Coronary
Artery Bypass Grafting.
Source
American Journal of Cardiology. (no pagination), 2016. Date of
Publication: July 10, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Moderate ischemic mitral regurgitation (MR) is often present in patients
undergoing coronary artery bypass grafting (CABG). However, the clinical
benefit of repairing moderate MR during CABG is unproven. We searched
multiple databases to identify original studies comparing isolated CABG
versus combined CABG and MR surgery (mitral valve surgery with coronary
artery bypass grafting [MVCABG]); survival (either early or midterm) was
the primary end point. Risk ratio (RR) or standardize mean difference was
selected as the effect estimates; survival was compared by pooling hazard
ratios. All results are presented with 95% CIs; p <0.05 is statistically
significant. Eleven studies (7 retrospective and 4 randomized controlled
trials; 547 MVCABG and 900 CABG patients) were included in our
meta-analysis. Concomitant mitral valve repair significantly prolonged
surgical duration (p <0.01). Early mortality (MVCABG 6.9% and CABG 6%) was
comparable (RR 1.3 [0.9 to 1.8]; p = 0.11). At follow-up, the MVCABG
patients had similar New York Heart Association class (standardize mean
difference -0.73 (-1.64 to 0.18; p = 0.11). However, patients who
underwent concomitant mitral valve surgery had less MR at follow-up
(recurrent significant MR, RR 0.37 [0.22 to 0.62]; p = 0.001; mean MR
grade, mean difference = 0.39 [0.26 to 0.59]; p <0.001). Midterm survival
rate (mean follow-up 5 years) was comparable in both groups (hazard ratio
for mortality in the MVCABG cohort 1.1 [0.9 to 1.3]; p = 0.38). In
conclusion, concomitant repair of moderate ischemic MR leads to improved
mitral valve competence at follow-up; however, this was not translated
into any functional or survival benefit for adding valve repair to CABG
for these patients at 5 years of follow-up. Copyright &#xa9; 2016 Elsevier
Inc.

<126>
Accession Number
614130201
Author
Wang T.K.M.; Wang M.T.M.; Gamble G.D.; Webster M.; Ruygrok P.N.
Institution
(Wang, Webster, Ruygrok) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang, Wang, Gamble, Ruygrok) Department of Medicine, University of
Auckland, Auckland, New Zealand
Title
Performance of contemporary surgical risk scores for transcatheter aortic
valve implantation: A meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: October 06, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is considered
for severe aortic valve disease at high and now intermediate risk for
surgical aortic valve replacement. Risk stratification plays a critical
role decision-making for intervention and modality. We compared the
prognostic utility of surgical risk scores for TAVI in this meta-analysis.
Methods: MEDLINE, Embase, Cochrane and Web of Science databases from 1
January 1980 to 31 December 2015 were searched. Studies were
systematically reviewed for inclusion, and data extracted for pooled
analyses. Results: Amongst 1688 articles searched, 47 full-text articles
were screened and 24 studies (12,346 TAVI cases) included for analyses.
Pooled c-statistics (95% confidence interval) for operative mortality were
EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.62 (0.59-0.66), STS Score 0.62
(0.59-0.65). Pooled calibration odds ratios (95%CI) were EuroSCORE 0.31
(0.25-0.38), EuroSCORE II 1.26 (1.06-1.51), STS 0.95 (0.72-1.27).
C-statistics (95%CI) for 1-year mortality were EuroSCORE 0.62 (0.57-0.67),
EuroSCORE II 0.66 (0.61-0.71) and STS Score 0.58 (0.53-0.64). Conclusion:
Surgical risk scores at most modestly discriminated operative and 1-year
mortality. The EuroSCORE grossly over-estimated operative mortality while
the EuroSCORE II and STS Scores fitted better to TAVI outcomes with their
own limitations. There is a need for the development and validation of
TAVI-specific risk models. Copyright &#xa9; 2017 Elsevier B.V.

<127>
Accession Number
614117344
Author
Schulz E.; Jabs A.; Tamm A.; Herz P.; Schulz A.; Gori T.; von Bardeleben
S.; Kasper-Konig W.; Hink U.; Vahl C.-F.; Munzel T.
Institution
(Schulz, Jabs, Tamm, Herz, Schulz, Gori, von Bardeleben, Hink, Munzel)
Department of Cardiology 1, Universitatsmedizin Mainz, Germany
(Kasper-Konig, Vahl) Department of Cardiovascular and Thoracic Surgery,
Universitatsmedizin Mainz, Germany
(Jabs, Hink) Department of Cardiology, Klinikum Frankfurt Hochst,
Frankfurt am Main, Germany
Title
Comparison of transcatheter aortic valve implantation with the
newest-generation Sapien 3 vs. Direct Flow Medical valve in a single
center cohort.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: May 01, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The latest generation transcatheter heart valves including
Edwards Sapien 3 (ES3) and Direct Flow Medical (DFM) were designed to
allow precise implantation at the intended position and to minimize
prosthesis dysfunction as well as procedural complications. Our aim was to
compare short-term functional and clinical outcomes of these 2
transcatheter aortic valve systems. Methods: Of 174 patients undergoing
transfemoral transcatheter aortic valve implantation (TAVI) at our
institution between August 2013 and June 2015, 113 were treated with ES3
and 61 with DFM. Device success, residual aortic regurgitation and early
safety endpoints were defined according to the updated VARC-2 criteria and
prespecified as primary endpoints. Results: Patients treated with ES3 had
a significantly higher rate of procedural success (ES3 94% vs. DFM 79%, p
= 0.005), mainly driven by lower postprocedural gradients (ES3 8.6. +/-.
0.5. mm. Hg vs. DFM 14.6. +/-. 1.4. mm. Hg by invasive recordings; p =
0.00012) and no incidence of more than mild aortic regurgitation. The
occurrence of safety endpoints at 30. days was low and comparable in the
DFM vs. ES3 group (ES3 88% vs. DFM 95% of patients without endpoints, p =
0.26). No significant differences were observed in 30. day mortality,
stroke or the incidence of new permanent pacemaker implantation.
Conclusions: These single-center experience data show a higher rate of
device success for ES3 treated patients, while 30. day safety outcome was
similar in both groups. Long-term follow-up and larger scale multicenter
experience will have to assess possible effects of these observations on
long-term clinical outcomes. Copyright &#xa9; 2017.

<128>
Accession Number
614116973
Author
Drake-Brockman T.F.E.; Ramgolam A.; Zhang G.; Hall G.L.; von
Ungern-Sternberg B.S.
Institution
(Drake-Brockman, Ramgolam, von Ungern-Sternberg) Department of Anaesthesia
and Pain Management, Princess Margaret Hospital for Children, Perth, WA,
Australia
(Drake-Brockman, von Ungern-Sternberg) School of Medicine and
Pharmacology, University of Western Australia, Perth, WA, Australia
(Zhang) Centre for Genetic Origins of Health and Disease, University of
Western Australia, Perth, WA, Australia
(Hall) Centre of Child Health Research, University of Western Australia,
Perth, WA, Australia
(Ramgolam, Hall, von Ungern-Sternberg) Children's Lung Health, Telethon
Kids Institute, Perth, WA, Australia
(Zhang) School of Public Health, Curtin University, Perth, WA, Australia
(Hall) School of Physiotherapy and Exercise Science, Curtin University,
Perth, WA, Australia
(Zhang) Centre for Genetic Origins of Health and Disease, Curtin
University, Perth, WA, Australia
Title
The effect of endotracheal tubes versus laryngeal mask airways on
perioperative respiratory adverse events in infants: A randomised
controlled trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Perioperative respiratory adverse events (PRAE) are the most
common critical incidents in paediatric anaesthesia and occur more often
in infants. Use of laryngeal mask airways (LMAs) is associated with
reduced PRAE compared with endotracheal tubes in older children (>1 year).
We aimed to evaluate the effect of these devices on the incidence of PRAE
in infants. Methods: We did a randomised controlled trial at the Princess
Margaret Hospital for Children in Perth (WA, Australia) by recruiting
infants (aged 0-12 months) undergoing general (with or without regional or
local) anaesthesia with anticipated fentanyl dose 1 mug/kg or lower for
minor elective surgery. We excluded patients contraindicated for LMA or
endotracheal tube; who had known cardiac disease or airway or thoracic
malformations; who were receiving midazolam premedication; who were
undergoing airway, thoracic, or abdomen surgery at the time of
participation; and if the parents did not speak English. Written parental
or guardian consent was obtained before enrolment. Participants were
randomly assigned (1:1), by computer-generated variable block
randomisation, to receive an LMA (PRO-Breathe, Well Lead Medical Co Ltd,
Panyu, China) or an endotracheal tube (Microcuff, Halyard Health Inc,
Atlanta, GA, USA). Sealed randomisation envelopes were used to conceal
device assignment. An interim analysis was planned once half the number of
infants needed (145) had been recruited. The primary outcome was incidence
of PRAE, assessed in the intention-to-treat population. The institutional
ethics committee at the Princess Margaret Hospital for Children granted
ethical approval (1786/EP). The trial is registered with the Australian
New Zealand Clinical Trials Registry (ACTRN12610000250033). Findings: The
trial began on July 8, 2010, and was ended early on May 7, 2015, after the
interim analysis results met the study stopping rules. During this time,
239 infants were assessed and 181 eligible infants were randomly assigned
to receive an LMA (n=85) or an endotracheal tube (n=95). Four infants were
not included in the analysis (two due to cancelled procedures, one did not
meet inclusion criteria, and one with missing dataset). In the
intention-to-treat analysis, PRAE occurred in 50 (53%) infants in the
endotracheal tube group and in 15 (18%) infants in the LMA group (risk
ratio [RR] 2.94, 95% CI 1.79-4.83, p<0.0001). Laryngospasm and
bronchospasm (major PRAE) were recorded in 18 (19%) infants in the
endotracheal tube group and in three (4%) infants in the LMA group (RR
5.30, 95% CI 1.62-17.35, p=0.002). No deaths were reported.
Interpretation: In infants undergoing minor elective procedures, LMAs were
associated with clinically significantly fewer PRAE and lower occurrence
of major PRAE (laryngospasm and bronchospasm) than endotracheal tubes.
This difference should be a consideration in airway device selection.
Funding: Princess Margaret Hospital Foundation, National Health and
Australian Medical Research Council, Stan Perron Charitable Trust, and
Callahan Estate. Copyright &#xa9; 2017 Elsevier Ltd.

<129>
Accession Number
614111787
Author
Paraskevas K.I.; Nduwayo S.; Saratzis A.N.; Naylor A.R.
Institution
(Paraskevas, Nduwayo, Saratzis, Naylor) The Department of Vascular Surgery
at Leicester Royal Infirmary, Leicester, UK
Title
Carotid Stenting Prior to Coronary Bypass Surgery: An Updated Systematic
Review and Meta-Analysis.
Source
European Journal of Vascular and Endovascular Surgery. (no pagination),
2016. Date of Publication: July 01, 2016.
Publisher
W.B. Saunders Ltd
Abstract
Objectives: The aim was to determine 30-day outcomes in patients with
concurrent carotid and cardiac disease who underwent carotid artery
stenting (CAS) followed by coronary artery bypass grafting (CABG).
Methods: This was a systematic review with searches of PubMed/Medline,
Embase, and Cochrane databases. "Same-day" procedures involved CAS + CABG
being performed on the same day, and "staged" interventions involved at
least 1 day's delay between undergoing CAS and then CABG. Results: There
were 31 eligible studies (2727 patients), with 80% being neurologically
asymptomatic with unilateral stenoses. Overall, the 30-day death/stroke
rate was 7.9% (95% confidence interval [CI] 6.9-9.2), while
death/stroke/MI was 8.8% (95% CI 7.3-10.5). Staged CAS + CABG was
associated with 30-day death/stroke rate of 8.5% (95% CI 7.3-9.7) compared
with 5.9% (95% CI 4.0-8.5) after "same-day" procedures. Outcomes following
CAS + CABG in neurologically symptomatic patients were poorer, with
procedural stroke rates of 15%. There were five antiplatelet (APRx)
strategies: (a) no APRx (death/stroke/MI, 4.2%; no data on bleeding
complications); (b) single APRx before CAS and CABG, then dual APRx after
CABG (death/stroke/MI, 6.7%; 7.3% bleeding complications); (c) dual APRx
pre-CAS down to one APRx pre-CABG (death/stroke/MI, 10.1%; 2.8% bleeding
complications); (d) dual APRx pre-CAS, both stopped pre-CABG
(death/stroke/MI, 14.4%); (e) dual APRx pre-CAS and continued through CABG
(death/stroke/MI, 16%). There were insufficient data on bleeding
complication in the last two strategies. Conclusions: In a cohort of
predominantly asymptomatic patients with unilateral carotid stenoses, the
30-day rate of death/stroke was about 8%. Notwithstanding the effect of
potential biases, this meta-analysis did not find evidence that outcomes
after same-day CAS + CABG were higher than after staged interventions.
However, outcomes were poorer in neurologically symptomatic patients. More
data are required to establish the optimal antiplatelet strategy in
patients undergoing same-day or staged CAS + CABG. Copyright &#xa9; 2016
European Society for Vascular Surgery.

<130>
Accession Number
614111733
Author
Silvestri L.; Weir W.I.; Gregori D.; Taylor N.; Zandstra D.F.; van Saene
J.J.M.; van Saene H.K.F.
Institution
(Silvestri) Department of Anaesthesia and Intensive Care, S. Giovanni di
Dio Hospital, Gorizia, Italy
(Silvestri, Taylor, van Saene, van Saene) Institute of Ageing and Chronic
Disease, University of Liverpool, Liverpool, UK
(Weir) Department of Cardiothoracic Surgery, London Chest Hospital,
London, UK
(Gregori) Department of Cardiological, Thoracic and Vascular Sciences,
Unit of Biostatistics Epidemiology and Public Health, University of
Padova, Padova, Italy
(Zandstra) University of Amsterdam, Amsterdam, The Netherlands
Title
Impact of Oral Chlorhexidine on Bloodstream Infection in Critically Ill
Patients: Systematic Review and Meta-Analysis of Randomized Controlled
Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objectives: Oropharyngeal overgrowth of microorganisms in the critically
ill is a risk factor for lower respiratory tract infection and subsequent
invasion of the bloodstream. Oral chlorhexidine has been used to prevent
pneumonia, but its effect on bloodstream infection never has been assessed
in meta-analyses. The authors explored the effect of oral chlorhexidine on
the incidence of bloodstream infection, the causative microorganism, and
on all-cause mortality in critically ill patients. Design: Systematic
review and meta-analysis of published studies. Setting: Intensive care
unit. Participants: The study comprised critically ill patients receiving
oral chlorhexidine (test group) and placebo or standard oral care (control
group). Interventions: PubMed and the Cochrane Register of Controlled
Trials were searched. Odds ratios (ORs) were pooled using the
random-effects model. Measurements and Main Results: Five studies
including 1,655 patients (832 chlorhexidine and 823 control patients) were
identified. The majority of information was from studies at low or unclear
risk bias; 1 study was at high risk of bias. Bloodstream infection and
mortality were not reduced significantly by chlorhexidine (OR 0.74; 95%
confidence interval [CI] 0.37-1.50 and OR 0.69; 95% CI 0.31-1.53,
respectively). In the subgroup of surgical, mainly cardiac, patients,
chlorhexidine reduced bloodstream infection (OR 0.47; 95% CI 0.22-0.97).
Chlorhexidine did not affect any microorganism significantly. Conclusion:
In critically ill patients, oropharyngeal chlorhexidine did not reduce
bloodstream infection and mortality significantly and did not affect any
microorganism involved. The presence of a high risk of bias in 1 study and
unclear risk of bias in others may have affected the robustness of these
findings. Copyright &#xa9; 2016 Elsevier Inc.

<131>
Accession Number
614111723
Author
Fuentes-Reyes R.A.; Pacheco-Patino M.F.; Ponce-Escobedo A.N.;
Munoz-Maldonado G.E.; Hernandez-Guedea M.A.
Institution
(Fuentes-Reyes, Pacheco-Patino, Ponce-Escobedo, Munoz-Maldonado,
Hernandez-Guedea) Servicio de Cirugia General, Hospital Universitario Dr.
Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey,
Nuevo Leon, Mexico
Title
Impact of Telmisartan on glomerular filtration in laparoscopic surgery. A
double blinded randomised controlled study.
Source
Cirugia y Cirujanos (English Edition). (no pagination), 2016. Date of
Publication: March 09, 2016.
Publisher
Mexican Academy of Surgery
Abstract
Background: Laparoscopic surgery has begun to replace a great number of
procedures that were previously practiced using open or conventional
techniques. This is due to the minimal invasion, small incisions, and
short time recovery. However, it has come to knowledge, that the increase
in intra-abdominal pressure due to carbon dioxide pneumoperitoneum during
laparoscopic surgery causes cardiovascular, respiratory, endocrine, and
renal alterations. Objective: To evaluate the nephroprotective effect of
Telmisartan, an angiotensin II AT1 receptor antagonist, on glomerular
filtration in laparoscopic surgery. Material and methods: Analytical
prospective, randomised, double-blind study was conducted on patients
undergoing elective laparoscopic cholecystectomy. They were randomised
into 2 groups, with the treatment group receiving a single dose of 40. mg
Telmisartan orally 2. h prior to surgery, and the placebo group. Results:
There were 20 patients in each group (n = 40), with a mean age of 32.65
years in the treatment group. Plasma creatinine did not show any
significant change in the different time lapse in which blood samples were
taken, but creatinine clearance at the end of surgery (196.415+/-56.507
vs. 150.1995+/-75.081; p = 0.034), and at 2. h postoperative period
(162.105+/-44.756 vs. 113.235+/-31.228; p <. 0.001) was statistically
significant, which supports an increase in renal function in the
Telmisartan group. Conclusion: The use of Telmisartan, an angiotensin II
AT1 receptor antagonist, offers renal protection during laparoscopic
surgery. Copyright &#xa9; 2016 Academia Mexicana de Cirugia A.C.

<132>
Accession Number
614117388
Author
Lau J.K.; Pennings G.J.; Yong A.; Kritharides L.
Institution
(Lau, Yong, Kritharides) Department of Cardiology, Concord Hospital,
University of Sydney, Sydney, NSW, Australia
(Lau, Pennings, Yong, Kritharides) ANZAC Research Institute, University of
Sydney, Sydney, NSW, Australia
(Yong) Faculty of Medicine and Health Sciences, Macquarie University,
Sydney, NSW, Australia
Title
Cardiac Remote Ischaemic Preconditioning: Mechanistic and Clinical
Considerations.
Source
Heart Lung and Circulation. (no pagination), 2016. Date of Publication:
October 26, 2016.
Publisher
Elsevier Ltd
Abstract
Brief, non-harmful ischaemic insults to an organ remote from the heart,
remote ischaemic preconditioning (RIPC), has been proposed to confer
protection to the heart against ischaemia-reperfusion injury. While most
clinical trials of RIPC during coronary interventions (PCI) suggest
benefit, recent large, multicentre trials in coronary artery bypass
surgery suggest a lack of efficacy. Mechanistically, RIPC most likely
promotes the release of circulating factors which modulate multiple
cellular pathways in the heart, promoting cell survival. This review
explores potential mechanisms underlying RIPC and includes a contemporary
evaluation of clinical studies in PCI and cardiac surgery, highlighting
methodological differences which may explain discrepant findings between
these two clinical groups. Copyright &#xa9; 2016.

<133>
Accession Number
614130504
Author
Racca V.; Bordoni B.; Castiglioni P.; Modica M.; Ferratini M.
Institution
(Racca, Bordoni, Modica, Ferratini) Cardiology Rehabilitation Center,
Santa Maria Nascente Institute-IRCCS, Don C. Gnocchi Foundation, Milan,
Italy
(Castiglioni) Biomedical Technology Department, Santa Maria Nascente
Institute-IRCCS, Don C. Gnocchi Foundation, Milan, Italy
Title
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A
Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2016. Date of Publication:
2016.
Publisher
Elsevier USA
Abstract
Background: Controlling sternal pain after heart surgery is important to
reduce the risk of postoperative complications, but pain is often
undertreated because of contraindications and side effects of analgesic
drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated
to reduce pain in different clinical contexts, suggesting its potential
utility after cardiac surgery. The aim of this open-label, controlled
study is to assess whether OMT contributes to sternal pain relief and
improves postoperative outcomes. Methods: Eighty post-sternotomy adult
inpatients were randomly allocated one to one to receive a standardized
cardiorespiratory rehabilitation program alone (control group) or combined
with OMT. Pain intensity and respiratory functional capacity were
quantified by the Visual Analogue Scale score and by a standardized
breathing test, at the start and end of rehabilitation. Results: At the
start of rehabilitation, the control group and the OMT group had similar
Visual Analogue Scale median scores (controls 4, interquartile range
[IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean
inspiratory volumes (controls 825 +/- 381 mL; OMT 744 +/- 291 mL; p = not
significant). At the end of rehabilitation, the OMT group had a lower
Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1
to 2; p < 0.01) and higher mean inspiratory volume (controls 1,400 +/- 588
mL; OMT 1,781 +/- 633 mL; p < 0.01). The analgesic drug intake was similar
in the two groups. The hospitalization was shorter in the OMT group than
in the control group (19.1 +/- 4.8 versus 21.7 +/- 6.3 days; p < 0.05).
Conclusions: The combination of standard care with OMT is effective in
inducing pain relief and functional recovery, and significantly improves
the management of patients after heart surgery with sternotomy. Copyright
&#xa9; 2016 The Society of Thoracic Surgeons.

<134>
Accession Number
614130404
Author
Posenau J.T.; Wojdyla D.M.; Shaw L.K.; Alexander K.P.; Ohman E.M.; Patel
M.R.; Smith P.K.; Rao S.V.
Institution
(Posenau) Cardiovascular Division, Washington University School of
Medicine, St. Louis, Missouri
(Wojdyla, Shaw, Alexander, Ohman, Patel, Rao) Duke Clinical Research
Institute, Durham, North Carolina
(Smith) Division of Cardiovascular and Thoracic Surgery, Duke University
Medical Center, Durham, North Carolina
Title
Revascularization Strategies and Outcomes in Elderly Patients With
Multivessel Coronary Disease.
Source
Annals of Thoracic Surgery. (no pagination), 2016. Date of Publication:
2016.
Publisher
Elsevier USA
Abstract
Background: Balancing risks and benefits of revascularization in elderly
patients with multivessel coronary artery disease (CAD) is challenging.
The appropriate revascularization strategy for elderly patients with
multivessel CAD is unclear. Methods: We used the Duke Databank for
Cardiovascular Disease to identify patients aged 75 years or more who had
multivessel disease and treatment with percutaneous coronary intervention
or coronary artery bypass graft surgery (CABG) within 30 days of the index
catheterization between October 1, 2003, and June 30, 2013. The primary
outcome was a composite of all-cause death, myocardial infarction, and
coronary revascularization through latest follow-up. Associations between
bare-metal stents (BMS), drug-eluting stents (DES), CABG, and outcomes
were determined using multivariable Cox proportional hazards modeling,
adjusting for potential confounders with CABG as the reference.
Comparisons between BMS and DES were done using BMS as the reference.
Results: We identified 763 patients who met the criteria (BMS, n = 202;
DES, n = 411; CABG, n = 150). The median age was 79 years (interquartile
range, 76 to 82), and the median follow-up was 6.28 years. After
adjustment, both BMS and DES were associated with a higher risk of the
primary outcome. The BMS versus CABG hazard ratio was 1.58 (95% confidence
interval: 1.15 to 2.19, p = 0.01). The DES versus CABG hazard ratio was
1.45 (95% confidence interval: 1.08 to 1.95, p = 0.01). The adjusted
hazard ratio for DES versus BMS (0.92, 95% confidence interval: 0.71 to
1.19, p = 0.51) was not statistically significant. Conclusions: In this
single-center analysis of 763 elderly patients with multivessel disease,
CABG was associated with the best overall clinical outcomes, but was
selected for a minority of patients. An adequately powered, randomized
trial should be considered to define the best treatment strategy for this
population. Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<135>
Accession Number
614114891
Author
Bajaj A.; Pancholy S.; Sethi A.; Rathor P.
Institution
(Bajaj, Pancholy) The Wright Center for Graduate Medical Education,
Scranton, PA, USA
(Bajaj, Pancholy) The Common Wealth Medical College, Scranton, PA, USA
(Sethi) St. Luke's Cardiology Associates, Bethlehem, PA, USA
(Rathor) Zhengzhou University, China
Title
Safety and feasibility of PCI in patients undergoing TAVR: A systematic
review and meta-analysis.
Source
Heart and Lung: Journal of Acute and Critical Care. (no pagination), 2016.
Date of Publication: July 31, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
We aimed to evaluate the safety and feasibility of PCI (percutaneous
coronary intervention) for coronary artery disease (CAD) in patients
undergoing transcatheter aortic valve replacement (TAVR) by performing a
meta-analysis. A systemic search of the database was performed. Studies
were included comparing TAVR versus TAVR with PCI for significant CAD in
patients undergoing TAVR for severe aortic stenosis. The primary outcome
was 30 day mortality and secondary outcomes were myocardial infarction,
stroke, life threatening bleeding, major access site vascular
complications and renal failure. There were no significant differences in
30 day and six months-one year mortality between TAVR and TAVR with PCI
group. There were also no significant differences in myocardial
infarction, stroke, and life threatening bleeding and major access site
vascular complications between the two groups. PCI in addition to TAVR in
patients with concomitant severe aortic stenosis and CAD is safe and
feasible and does not increase procedural risk. Copyright &#xa9; 2016
Elsevier Inc.

<136>
Accession Number
614099211
Author
Godino C.; Chiarito M.; Donahue M.; Testa L.; Colantonio R.; Cappelletti
A.; Monello A.; Magni V.; Milazzo D.; Parisi R.; Nicolino A.; Moshiri S.;
Fattori R.; Aprigliano G.; Palloshi A.; Caramanno G.; Montorfano M.;
Bedogni F.; Briguori C.; Margonato A.; Colombo A.
Institution
(Godino, Chiarito, Cappelletti, Monello, Magni, Montorfano, Margonato,
Colombo) San Raffaele Scientific Institute, Milan, Italy
(Donahue, Briguori) Clinica Mediterranea, Naples, Italy
(Testa, Bedogni) IRCCS Policlinico San Donato, San Donato M.ne, Milan,
Italy
(Colantonio) Ospedale San Pietro FBF, Rome, Italy
(Milazzo, Caramanno) Ospedale San Giovanni di Dio, Agrigento, Italy
(Parisi, Fattori) Ospedali Riuniti Marche Nord, Pesaro, Italy
(Nicolino, Moshiri) Ospedale Santa Corona, Pietra Ligure, Italy
(Aprigliano, Palloshi) Istituto Clinico Citta Studi, Milan, Italy
(Colombo) EMO-GVM Centro Cuore Columbus, Milan, Italy
Title
Midterm and one-year outcome of amphilimus polymer free drug eluting stent
in patients needing short dual antiplatelet therapy. Insight from the
ASTUTE registry (AmphilimuS iTalian mUlticenTer rEgistry).
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: September 18, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: To assess clinical outcomes of patients needing short dual
antiplatelet therapy (S-DAPT) after PCI with Cre8 polymer-free amphilimus
eluting-stent (AES). The Cre8-AES with pure i-Carbofilm coating was
supposed to induce faster stent endothelialization and reduce device
thrombogenicity. Methods: We performed a sub-analysis of unrestricted
consecutive patients treated with Cre8-AES between August 2011 and January
2015. Two groups were formed: 1) patients discharged with S-DAPT (<.
3-month), because of high bleeding risk or attending urgent non-cardiac
surgery; and 2) patients discharged with Recommended DAPT duration
(R-DAPT; >. 6-month). The primary ischemic- and bleeding-safety endpoints
were Target Vessel Failure (TVF, composite endpoint of cardiac-death,
target vessel-myocardial infarction and target vessel-revascularization),
and major-bleeding (BARC >. type-3a) at 6-month and 1-year. Results: 106
patients (8.7%) were discharged with <. 3-month DAPT (83. +/-. 19. days;
S-DAPT group) and 1102 patients (90.6%) with >. 6-month DAPT (342. +/-.
62. days; R-DAPT group). Between S-DAPT and R-DAPT groups no significant
differences were observed in TVF at 1-year (5.7% vs 5.1%); 1-year BARC
major bleeding rate was higher in S-DAPT group (3.4% vs 0.2%, p = 0.007)
with all bleeding events occurred within 3. months. The landmark analysis
(started at 90. days, ended at 1. year) showed no differences in BARC
major bleedings between groups (0% vs. 0.3%). Conclusions: The results of
this multicenter registry show that the use of Cre8 AES in patients
needing short DAPT (<. 3-month) was safe regarding ischemic events and
could favor a reduction of bleeding events related to the recommended
DAPT. A large randomized trial is necessary to support these preliminary
findings. Copyright &#xa9; 2017 Elsevier Ireland Ltd.

<137>
Accession Number
614107348
Author
Hart E.A.; Jansen R.; Meijs T.A.; Bouma B.J.; Riezebos R.K.; Tanis W.; van
Boven W.J.P.; Hindori V.; Wiersma N.; Dessing T.; Westerink J.; Chamuleau
S.A.J.
Institution
(Hart, Jansen, Meijs, Dessing, Westerink, Chamuleau) University Medical
Center Utrecht, Utrecht, The Netherlands
(Bouma, van Boven) Academic Medical Center, Amsterdam, The Netherlands
(Riezebos, Hindori) Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
(Tanis) Haga Ziekenhuis, The Hague, The Netherlands
(Wiersma) Thrombosis Center Saltro, Utrecht, The Netherlands
Title
Anticoagulant bridging in left-sided mechanical heart valve patients.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: August 10, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: In preparation for an invasive procedure with a high bleeding
risk, patients with a mechanical heart valve temporarily have to
discontinue their anticoagulant therapy and are usually bridged with
either intravenous unfractionated heparin (UFH) or subcutaneous
low-molecular-weight heparin (LMWH). In this study we retrospectively
analyzed the safety of UFH versus LMWH as bridging strategy in left-sided
mechanical heart valve patients. Methods: We performed a retrospective
multicenter study in four surgical centers in The Netherlands. Patients
with a mechanical heart valve implantation bridged from January 2010 until
January 2015 were included. The cumulative incidence of adverse events in
the 30. days following the procedure was recorded. Main outcomes were
major bleeding according to International Society on Thrombosis and
Haemostasis (ISTH) criteria, symptomatic thromboembolism, and mortality.
Results: In total, 238 (174 aortic, 42 mitral, 22 aortic + mitral)
bridging episodes were included. The incidence of major bleeding was 16
(19%) events in the UFH group versus 29 (19%) events in the LMWH group (p
= 0.97). Incidences of thromboembolism were 2 (2.4%) versus 1 (0.6%). The
incidence of death was 1 (1.2%) patient in the UFH group versus 3 (1.9%)
patients in the LMWH group. More than 50% of all bleeding complications
were categorized as a major bleeding. Conclusions: Bridging
anticoagulation in patients with aortic and mitral mechanical valves is
associated with considerable risk, but no difference was apparent between
UFH and LMWH strategy. The rate of thromboembolism and death was low with
either strategy and the vast majority of adverse events were bleedings.
Copyright &#xa9; 2017 Elsevier B.V.

<138>
Accession Number
614107960
Author
Peng F.; Liu S.; Hu Y.; Yu M.; Chen J.; Liu C.
Institution
(Peng, Liu, Hu, Yu, Chen, Liu) Department of Anesthesiology, First
Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
(Peng) Department of Anesthesiology, Northern Jiangsu People's Hospital,
Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
Title
Influence of perioperative nonsteroidal anti-inflammatory drugs on
complications after gastrointestinal surgery: A meta-analysis.
Source
Acta Anaesthesiologica Taiwanica. (no pagination), 2017. Date of
Publication: July 29, 2016.
Publisher
Elsevier Taiwan LLC (96 Chung Shan North Road, Section 2, Taipei, Taiwan
(Republic of China))
Abstract
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are a key part
of multimodal perioperative analgesia. This study aimed to evaluate the
influence of perioperative NSAIDs application on complications after
gastrointestinal surgery by using meta-analysis. Methods: A systematic
review of published literature was conducted by searching computerized
databases including PubMed, CBM, Springer, Chinese Academic Journals, and
China Info since the databases were published until June 2015. The
articles and retrospective references regarding complications after
gastrointestinal surgery were collected to compare postoperative
complications associated with NSAIDs or other analgesics. After they were
assessed by randomized controlled trials and extracted by the standard of
the Jadad systematic review, the homogeneous studies were pooled using
RevMan 5.3 software. The meta-analysis was performed on five postoperative
complications: postoperative anastomotic leak, cardiovascular events,
surgical site infection, nausea and vomiting, and intestinal obstruction.
Results: Twelve randomized controlled trials involving 3829 patients met
the inclusion criteria. The results of meta-analyses showed the following:
(1) postoperative anastomotic leak: NSAIDs (including selective and
nonselective NSAIDs) increased the incidence of anastomotic leak [odds
ratio (OR) = 3.02, 95% confidence interval (CI): 2.16-4.23, p = 0.00001].
Further results showed that nonselective NSAIDs significantly increased
the incidence of anastomotic leak (OR = 2.96, 95% CI: 1.99-4.42, p <.
0.00001), and selective NSAIDs had no significant difference as compared
with the control group using other analgesics (OR = 2.27, 95% CI:
0.68-7.56, p = 0.18); (2) postoperative cardiovascular events: NSAIDs
(selective and nonselective NSAIDs) had no difference when compared with
other analgesics (OR = 0.50, 95% CI: 0.23-1.12, p = 0.09); (3)
postoperative surgical site infection: NSAIDs (selective and nonselective
NSAIDs) and other analgesics had no difference in surgical site infection
(OR = 0.77, 95% CI: 0.52-1.15, p = 0.20); (4) postoperative nausea and
vomiting: NSAIDs (selective and nonselective NSAIDs) decreased the
incidence of nausea and vomiting (OR = 0.53, 95% CI: 0.34-0.81, p =
0.003); (5) postoperative intestinal obstruction: NSAIDs (selective and
nonselective NSAIDs) decreased the incidence of intestinal obstruction (OR
= 0.35, 95% CI: 0.13-0.89, p = 0.03). Conclusions: The meta-analysis
suggests that postoperative NSAIDs, especially nonselective NSAIDs, could
increase the incidence of anastomotic leak. NSAIDs could decrease
postoperative nausea and vomiting and intestinal obstruction, but showed
no difference in cardiovascular events and surgical site infection as
compared with other analgesics. Copyright &#xa9; 2017.

<139>
Accession Number
614103034
Author
Molstrom S.; Nielsen T.H.; Andersen C.; Nordstrom C.H.; Toft P.
Institution
(Molstrom, Toft) Department of*Anesthesiology and Intensive Care
(Nielsen, Nordstrom) Neurosurgery
(Andersen) Anesthesiology and Intensive Care, Thorax Anesthesiology Unit
VITA, Odense University Hospital, 5000 Odense C, Denmark
Title
Bedside Monitoring of Cerebral Energy State During Cardiac Surgery-A Novel
Approach Utilizing Intravenous Microdialysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objectives: This study investigated whether the lactate-to-pyruvate (LP)
ratio obtained by microdialysis (MD) of the cerebral venous outflow
reflected a derangement of global cerebral energy state during
cardiopulmonary bypass (CPB). Design: Interventional, prospective,
randomized study. Setting: Single-center, university teaching hospital.
Participants: The study included 10 patients undergoing primary, elective
coronary artery bypass grafting. Interventions: Patients were randomized
blindly to low mean arterial pressure (MAP) (40-60 mmHg; n = 5) or high
MAP (60-80 mmHg; n = 5) during CPB. The MD catheters were positioned in a
retrograde direction into the jugular bulb, and a reference catheter was
inserted into the brachial artery. The correlations among LP ratio, MAP,
data obtained from bifrontal near-infrared spectroscopy (NIRS), and
postoperative neurologic outcome measures were assessed. Measurements and
Main Results: The correlated difference between pooled LP ratio (low and
high MAP) of the jugular venous and the arterial blood was significant
(LP<inf>arterial</inf> 17 [15-20] v LP<inf>venous</inf> 26 [23-27]; p =
0.0001). No cerebral desaturations (decrease in rSO<inf>2</inf>>20% from
baseline) were observed in either group during CPB. In each group, 50% of
the patients showed significant cognitive decline (mini-mental state
examination, 3 points) 2 days after surgery. Conclusion: The LP ratio of
cerebral venous blood increased significantly during CPB, indicating
compromised cerebral oxidative metabolism. Conventional monitoring of
rSO<inf>2</inf> by NIRS did not show a corresponding decrease in cerebral
oxygenation. As the patients exhibited decreased cognitive functions after
CPB, increases in jugular venous LP ratio may be a sensitive indicator of
impending cerebral damage. Copyright &#xa9; 2016 Elsevier Inc.

<140>
Accession Number
614105213
Author
O'Brien E.O.; Newhouse B.J.; Cronin B.; Robbins K.; Nguyen A.P.; Khoche
S.; Schmidt U.
Institution
(O'Brien, Newhouse, Cronin, Robbins, Nguyen, Khoche, Schmidt) Department
of Anesthesiology, University of California, San Diego, CA
Title
Hemodynamic Consequence of Hand Ventilation Versus Machine Ventilation
During Transport After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objectives: The hemodynamic consequences of ventilation of intubated
patients during transport either by hand or using a transport ventilator
have not been reported in patients after cardiac surgery. The authors
hypothesized that bag-mask ventilation would alter end-tidal
CO<inf>2</inf> during transport and hemodynamic parameters in patients
post-cardiac surgery. Design: A prospective, randomized trial. Setting: A
university-affiliated tertiary care hospital. Participants: Cardiac
surgery patients. Interventions: Thirty-six patients were randomized to
hand ventilation or machine ventilation. Hemodynamic variables including
blood pressure, heart rate, peripheral saturation of oxygen, and end-tidal
carbon dioxide (ETCO<inf>2</inf>) were measured in these patients prior to
transport, every 2 minutes during transport and upon arrival in the
intensive care unit (ICU). Pulmonary artery pressure (PA) pressures were
measured at origin and at destination. Measurements and Main Results:
Outcomes were changes from baseline in end-tidal CO<inf>2</inf>,
hemodynamic changes from baseline and pulmonary artery pressure changes
from origin to destination. The average transport time between the 2
groups was not different: 5 minutes for patients ventilated by hand and
5.47 minutes for patients ventilated with a transport ventilator (p =
0.369 by 2-sided t-test). The difference in all measured changes in
ETCO<inf>2</inf> between hand-ventilated and machine-ventilated patients
during transport was 2.74 mmHg (p = 0.013). The difference between
operating room and ICU ETCO<inf>2</inf> from each cohort was 1.31 mmHg (p
= 0.067). The difference in PA<inf>mean</inf> measured at origin and
destination was 0.783 mmHg (p = 0.622). All other hemodynamic variables
were not different during transport. Conclusions: Hand ventilation during
transport was associated with greater change from baseline of
ETCO<inf>2</inf> compared to machine ventilation during transport after
cardiac surgery, but this did not translate into any difference in
hemodynamic changes upon arrival in ICU. A hemodynamic benefit of machine
transport ventilation to cardiac patients was not demonstrated. Copyright
&#xa9; 2016 Elsevier Inc.

<141>
Accession Number
614085331
Author
Praz F.; Siontis G.C.M.; Verma S.; Windecker S.; Juni P.
Institution
(Praz) aDepartment of Cardiology, Bern University Hospital, Bern,
Switzerland bDivision of Cardiac Surgery cApplied Health Research Centre
(AHRC), Li Ka Shing Knowledge Institute, St Michael's Hospital, University
of Toronto, Toronto, Ontario, Canada *Fabien Praz and George C.M. Siontis
contributed equally to this manuscript.
Title
Latest evidence on transcatheter aortic valve implantation vs. surgical
aortic valve replacement for the treatment of aortic stenosis in high and
intermediate-risk patients.
Source
Current Opinion in Cardiology. (no pagination), 2017. Date of Publication:
11 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE OF REVIEW: The goal of this review is to summarize the current
evidence supporting the use of transcatheter aortic valve implantation
(TAVI) in high and intermediate-risk patients. The focus is on the five
randomized controlled trials comparing TAVI with surgical aortic valve
replacement (SAVR) published to date, as well as two recent meta-analyses.
RECENT FINDINGS: TAVI has profoundly transformed the treatment of elderly
patients presenting with symptomatic severe aortic stenosis. In
experienced hands, the procedure has become well tolerated and the results
more predictable. So far, two trials using two different devices
[Placement of Aortic Transcatheter Valve (PARTNER) 1A and US CoreValve
High Risk] have shown that TAVI is able to compete in terms of mortality
with SAVR in high-risk patients. These findings have been extended to the
intermediate-risk population in two recently published randomized
controlled trials [PARTNER 2 and Nordic Aortic Valve Intervention
(NOTION)]. The two meta-analyses suggested improved survival in both high
and intermediate-risk patients during the first 2 years following the
intervention. The survival benefit was only found in patients treated via
the transfemoral access, and appeared more pronounced in women. SUMMARY:
Individual randomized trials enrolling high and intermediate-risk patients
have established the noninferiority of TAVI in comparison with SAVR,
whereas subsequent meta-analyses suggest superiority of transfemoral TAVI
in terms of a sustained survival benefit 2 years after valve implantation
irrespective of the surgical risk category. The benefit of TAVI appears
more pronounced in women than in men. Copyright &#xa9; 2017 Wolters Kluwer
Health, Inc. All rights reserved.

<142>
Accession Number
614095871
Author
Cho Y.J.; Lee E.-H.; Lee K.; Kim T.K.; Hong D.M.; Chin J.-H.; Choi D.-K.;
Bahk J.-H.; Sim J.-Y.; Choi I.-C.; Jeon Y.
Institution
(Cho, Lee, Kim, Hong, Bahk, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, Republic of Korea
(Lee, Chin, Choi, Sim, Choi) Department of Anesthesiology and Pain
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, Republic of Korea
Title
Long-term clinical outcomes of Remote Ischemic Preconditioning and
Postconditioning Outcome (RISPO) trial in patients undergoing cardiac
surgery.
Source
International Journal of Cardiology. (no pagination), 2016. Date of
Publication: December 09, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Remote ischemic conditioning has been shown to confer
myocardial protection. However, there is still no sufficient data on its
long-term clinical outcomes. We analyzed the long-term results of the
Remote Ischemic Preconditioning and Postconditioning Outcome (RISPO) trial
in cardiac surgery patients. Methods: In the RISPO trial, 1280 patients
were randomized to receive remote ischemic preconditioning (RIPC) with
postconditioning (RIPostC, upper arm ischemia by four cycles of 5-min
inflation followed by 5-min deflation of a pneumatic cuff, N = 644) or
sham (N = 636) during cardiac surgery. Patient follow-up data were
collected by review of medical records, telephone interviews, and from the
National Statistical Office. The primary endpoint was major adverse
cardiac and cerebrovascular events (MACCE; a composite of all-cause
mortality, myocardial infarction (MI), stroke, and revascularization), and
the secondary endpoints were the individual components of the primary
endpoint. Results: At completion of follow-up (mean 44. months), there was
no difference in MACCE between the groups (90 [14.0%] versus 101 [15.9%]
in the RIPC with RIPostC versus control groups; hazard ratio [HR], 0.893;
95% confidence interval [CI], 0.672-1.187; P = 0.435). However, MI was
reduced to half in the RIPC with RIPostC group (10 [1.6%] versus 23
[3.6%]; HR, 0.468; 95% CI, 0.222-0.984; P = 0.045). Conclusions: Remote
ischemic preconditioning with RIPostC did not improve long-term MACCE
after cardiac surgery. However, MI was reduced in the RIPC with RIPostC
group compared with the control group during the follow-up period.
Clinical trial registration: ClinicalTrials.gov identifier, NCT00997217
Copyright &#xa9; 2016 Elsevier Ireland Ltd.

<143>
Accession Number
614093520
Author
Fink N.; Segev A.; Kornowski R.; Finkelstein A.; Assali A.; Rozenbaum Z.;
Vaknin-Assa H.; Halkin A.; Fefer P.; Ben-Shoshan J.; Regev E.; Konigstein
M.; Orvin K.; Guetta V.; Barbash I.M.
Institution
(Fink, Segev, Fefer, Regev, Guetta, Barbash) Leviev Heart Center,
Interventional Cardiology, Sheba Medical Center, Ramat Gan, Israel
(Finkelstein, Rozenbaum, Halkin, Ben-Shoshan, Konigstein) Department of
Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
(Kornowski, Assali, Vaknin-Assa, Orvin) Department of Cardiology, Rabin
Medical Center, Petach Tikva, Israel
Title
Balloon dilatation and outcome among patients undergoing trans-femoral
aortic valve replacement.
Source
International Journal of Cardiology. (no pagination), 2016. Date of
Publication: June 25, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Balloon pre-dilatation before transcatheter aortic valve
replacement (TAVR) is performed at the discretion of the treating
physician. Clinical data assessing the implications of this step on
procedural outcomes are limited. Methods: We conducted a retrospective
analysis of 1164 consecutive TAVR patients in the Israeli multicenter TAVR
registry (Sheba, Rabin, and Tel Aviv Medical Centers) between the years
2008 and 2014. Patients were divided to those who underwent balloon
pre-dilation (n=1026) versus those who did not (n=138). Results: Rates of
balloon pre-dilation decreased from 95% in 2008-2011 to 59% in 2014 (p for
trend. =0.002). Baseline characteristics between groups were similar
except for more smoking (22% vs. 8%, p=0.008), less past CABG (18% vs.
26%, p=0.016), less diabetes mellitus (35% vs. 45%, p=0.01), and lower STS
mortality scores (5.2. +/-. 3.7 vs. 6.1. +/-. 3.5, p=0.006) in the
pre-dilatation group. The pre-dilation group included less patients with
moderate to severely depressed LVEF (7% vs. 16%, p <. 0.001) and higher
aortic peak gradients (76.9. +/-. 22.7. mmHg vs. 71.4. +/-. 24.3. mmHg,
p=0.01). Stroke rates were comparable in both groups (2.5% vs. 3%, p=0.8),
but pre-dilation was associated with lower rates of balloon
post-dilatation (9% vs. 26%, p <. 0.001). On multivariate analysis,
balloon pre-dilatation was not a predictor of device success or any
post-procedural complications (p=0.07). Conclusions: Balloon
pre-dilatation was not associated with procedural adverse events and may
decrease the need for balloon post-dilatation. The results of the present
study support the current practice to perform liberally balloon
pre-dilatation prior to valve implantation. Copyright &#xa9; 2016 Elsevier
Ireland Ltd.

<144>
Accession Number
614088346
Author
Brascia D.; Reichart D.; Onorati F.; Perrotti A.; Ruggieri V.G.; Bounader
K.; Verhoye J.P.; Santarpino G.; Fischlein T.; Maselli D.; Dominici C.;
Mariscalco G.; Gherli R.; Rubino A.S.; De Feo M.; Bancone C.; Gatti G.;
Santini F.; Dalen M.; Saccocci M.; Faggian G.; Tauriainen T.; Kinnunen
E.-M.; Nicolini F.; Gherli T.; Rosato S.; Biancari F.
Institution
(Brascia, Tauriainen, Kinnunen, Biancari) Department of Surgery, Oulu
University Hospital, Oulu, Finland
(Reichart) Hamburg University Heart Center, Hamburg, Germany
(Onorati, Faggian) Division of Cardiovascular Surgery, Verona University
Hospital, Verona, Italy
(Perrotti) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Ruggieri, Bounader, Verhoye) Division of Cardiothoracic and Vascular
Surgery, Pontchaillou University Hospital, Rennes, France
(Santarpino, Fischlein) Cardiovascular Center, Paracelsus Medical
University, Nuremberg, Germany
(Maselli, Dominici) Department of Cardiac Surgery, St. Anna Hospital,
Catanzaro, Italy
(Mariscalco) Department of Cardiovascular Sciences, Clinical Science Wing,
University of Leicester, Glenfield Hospital, Leicester, United Kingdom
(Gherli) Unit of Cardiac Surgery, Department of Cardiosciences, Hospital
S. Camillo-Forlanini, Rome, Italy
(Rubino) Centro Cuore Morgagni, Pedara, Italy
(De Feo, Bancone) Division of Cardiac Surgery, Department of
Cardiothoracic Sciences, Second University of Naples, Naples, Italy
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Santini) Division of Cardiac Surgery, University of Genoa, Genoa, Italy
(Dalen) Department of Molecular Medicine and Surgery, Department of
Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet,
Karolinska University Hospital, Stockholm, Sweden
(Saccocci) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino IRCCS, University of Milan, Milan, Italy
(Nicolini, Gherli) Division of Cardiac Surgery, University of Parma,
Parma, Italy
(Rosato) National Center for Epidemiology, Surveillance and Health
Promotion, Istituto Superiore di Sanita, Rome, Italy
Title
Validation of Bleeding Classifications in Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. (no pagination), 2016. Date of
Publication: October 10, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Perioperative bleeding is a determinant of poor outcome in patients
undergoing coronary artery bypass grafting (CABG), but there is a lack of
adequate stratification of its severity. The ability of the European
registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition
of Perioperative Bleeding (UDPB), Study of Platelet Inhibition and Patient
Outcomes (PLATO), Clopidogrel and Aspirin Optimal Dose Usage to Reduce
Recurrent Events-Seventh Organization to Assess Strategies in Ischemic
Syndromes (CURRENT-OASIS 7), Efficacy and Safety of Subcutaneous
Enoxaparin in Non-Q Wave Coronary Events (ESSENCE), and SafeTy and
Efficacy of Enoxaparin in Percutaneous coronary intervention patients, an
internationaL randomized Evaluation (STEEPLE) bleeding classifications to
predict early mortality, stroke, acute kidney injury (AKI) stage 3, and
deep sternal wound infection/mediastinitis was investigated in 3,730
patients from the prospective, multicentre E-CABG registry. Increasing
grades of the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 classifications
were associated with increasing risks of early mortality, had similar
receiver-operating characteristic area under the curves (>0.7), and were
predictive also when adjusted for EuroSCORE II. The E-CABG and UDPB
classifications had satisfactory area under the curves (>0.6) in
predicting stroke, AKI stage 3, and deep sternal wound
infection/mediastinitis even when adjusted for EuroSCORE II. The PLATO and
CURRENT-OASIS 7 classifications had similar predictive ability for stroke
and AKI stage 3 as confirmed by multivariate analysis adjusted for
EuroSCORE II but showed inferior ability in predicting severe wound
infection compared to the E-CABG and UDPB classifications. The STEEPLE and
ESSENCE classifications had a poor ability of predicting all these adverse
events. Decision curve analysis showed a benefit of the E-CABG bleeding
classification over the other classifications in predicting all adverse
events. In conclusion, the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7
bleeding classifications have a satisfactory ability in predicting adverse
events after CABG. Decision curve analysis showed that the E-CABG bleeding
classification had the best predictive performance. Copyright &#xa9; 2016
Elsevier Inc.

<145>
Accession Number
614085479
Author
Widimsky P.; Tousek P.; Tousek F.; Sluka M.; Vodzinska A.; Kupkova P.;
Hutyra M.; Jarkovsky J.
Institution
(Widimsky, Tousek) Cardiocenter, Charles University Prague and University
Hospital Kralovske Vinohrady, Czech Republic
(Tousek) Cardiocenter, Regional Hospital Ceske Budejovice, Czech Republic
(Sluka, Hutyra) University Hospital Olomouc, Czech Republic
(Vodzinska) Cardiocenter Trinec Podlesi, Czech Republic
(Kupkova) Municipal Hospital Ostrava, Czech Republic
(Jarkovsky) Institute of Biostatistics and Analyses, Faculty of Medicine,
Masaryk University Brno, Czech Republic
Title
Barriers in the implementation of guidelines for acute coronary syndromes.
Focus on antiplatelet therapy.
Source
Cor et Vasa. (no pagination), 2016. Date of Publication: October 27, 2016.
Publisher
Elsevier Science B.V.
Abstract
Aim: Modern treatment of acute coronary syndromes significantly improved
outcomes of patients with this life-threatening disease. Especially the
combination of timely interventional treatment with potent novel
antiplatelet agents was proven to be effective in several randomized
trials and is now recommended by guidelines worldwide. The aim of this
study was to analyze how the guidelines are implemented in real life
practice. Methods and patients: Between 2013 and 2015 two complementary
acute coronary syndrome registries were organized in the Czech Republic
and included a total of 1967 patients. The ATHRO-II registry was done in
29 outpatient cardiology practices, focused on the prescription of
antithrombotic drugs and enrolled 687 patients discharged home after
percutaneous coronary intervention (PCI) for acute coronary syndrome (with
or without ST elevation). These patients were followed for 12 months. The
CZECH-3 registry was done in 43 hospitals of all types (13 PCI capable and
30 non-PCI) and enrolled 1280 consecutive patients admitted for proven
acute coronary syndrome during a period of 2 months, irrespective of
treatment strategy and in-hospital outcome. These patients were followed
for 30 days. Weighted average values were calculated for both cohorts
combined. The mean age of all enrolled patients was 66 years, females
presented 32% of study population, 21% had prior MI, 19% prior PCI and 7%
prior CABG. Results: Prehospital aspirin was used in 51% of patients (i.e.
majority of those arriving via emergency medical services), prehospital
ticagrelor in 13% and clopidogrel in 16% of patients. Coronary angiography
was performed in 94% of patients, PCI in 80% and coronary artery bypass
graft (CABG) in 13%. Among stented patients the use of drug-eluting stents
was only 69%, and 31% of stent were bare metal stents. There were major
differences between PCI centres in DES proportion (36-78%). Discharge
medication included aspirin in 93%, clopidogrel in 73%, ticagrelor in 14%,
prasugrel in 4% and warfarin in 6%. Surprisingly, clopidogrel preference
(over ticagrelor or prasugrel) was caused by economic reasons (patients
refused to pay the price difference) only in 4% of those, who were put on
aspirin + clopidogrel treatment. Contraindication of prasugrel or
ticagrelor was present in 17% (including 5% of patients with an indication
for oral anticoagulation). Among remaining 79% of patients who were
treated by clopidogrel + aspirin (instead of more potent novel
antiplatelet agents) the attending physicians were unable to explain the
reason for not using the guidelines-recommended treatment. Conclusions:
The use of modern guidelines-recommended treatment (DES or novel
antiplatelet agents) is surprisingly poor and is not limited by economic
restrictions but rather by lack of guidelines knowledge or lack of
physicians' activity to quickly implement the new guidelines. Copyright
&#xa9; 2016 The Czech Society of Cardiology.

<146>
Accession Number
614075979
Author
Gozdek M.; Pawliszak W.; Hagner W.; Zalewski P.; Kowalewski J.; Paparella
D.; Carrel T.; Anisimowicz L.; Kowalewski M.
Institution
(Gozdek, Pawliszak, Anisimowicz, Kowalewski) Department of Cardiac
Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz,
Bydgoszcz, Poland
(Gozdek, Zalewski, Kowalewski) Department of Hygiene, Epidemiology and
Ergonomics, Division of Ergonomics and Physical Effort, Collegium Medicum
UMK in Bydgoszcz, Bydgoszcz, Poland
(Hagner) Chair and Clinic of Rehabilitation, Faculty of Health Sciences,
Nicolaus Copernicus University in Torun, Torun, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
(Paparella) Division of Cardiac Surgery, Department of Emergency and Organ
Transplant, University of Bari Aldo Moro, Bari, Italy
(Carrel) Clinic for Cardiovascular Surgery, University Hospital and
University of Bern, Bern, Switzerland
Title
Systematic review and meta-analysis of randomized controlled trials
assessing safety and efficacy of posterior pericardial drainage in
patients undergoing heart surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2016.
Date of Publication: September 06, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To investigate the potential beneficial effects of posterior
pericardial drainage in patients undergoing heart surgery. Methods:
Multiple online databases and relevant congress proceedings were screened
for randomized controlled trials assessing the efficacy and safety of
posterior pericardial drainage, defined as posterior pericardiotomy
incision, chest tube to posterior pericardium, or both. Primary endpoint
was in-hospital/30 days' cardiac tamponade. Secondary endpoints comprised
death or cardiac arrest, early and late pericardial effusion,
postoperative atrial fibrillation (POAF), acute kidney injury, pulmonary
complications, and length of hospital stay. Results: Nineteen randomized
controlled trials that enrolled 3425 patients were included. Posterior
pericardial drainage was associated with a significant 90% reduction of
the odds of cardiac tamponade compared with the control group: odds ratio
(95% confidence interval) 0.13 (0.07-0.25); P < .001. The corresponding
event rates were 0.42% versus 4.95%. The odds of early and late
pericardial effusion were reduced significantly in the intervention arm:
0.20 (0.11-0.36); P < .001 and 0.05 (0.02-0.10); P < .001, respectively.
Posterior pericardial drainage significantly reduced the odds of POAF by
58% (P < .001) and was associated with significantly shortened (by nearly
1 day) overall length of hospital stay (P < .001). Reductions in
postoperative complications translated into significantly reduced odds of
death or cardiac arrest (P = .03) and numerically lower odds of acute
kidney injury (P = .08). Conclusions: Posterior pericardial drainage is
safe and simple technique that significantly reduces not only the
prevalence of early pericardial effusion and POAF but also late
pericardial effusion and cardiac tamponade. These benefits, in turn,
translate into improved survival after heart surgery. Copyright &#xa9;
2016 The American Association for Thoracic Surgery.