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<1>
Accession Number
613513126
Author
Kotsoeva O.T.
Institution
(Kotsoeva) Department of Medical Rehabilitation, North-Caucasian
Multidisciplinary Medical Center, 139a, Frieva str., Beslan 363025,
Russian Federation
Title
Comparison of impact of medical therapy and surgical treatment on overall
mortality in patients with severe chronic heart failure: A meta-analysis.
Source
Russian Open Medical Journal. 5 (3) (no pagination), 2016. Article Number:
e0304. Date of Publication: 2016.
Publisher
Russian Open Medical Journal (E-mail: rusomj@mail.ru)
Abstract
Aim - Meta-analysis of clinical trials comparing the efficacy of medical
therapy (MT) and surgical treatment, including cardiac resynchronization
therapy with and without cardioversion-defibrillation (CRT and CRT-D),
circulatory support system (CSS) and heart transplantation (HT), in terms
of decreasing overall mortality in patients with severe chronic heart
failure (CHF). Material and Methods - Meta-analysis included 39 clinical
trials with a total number of 30,257 patients. Search was performed in
MEDLINE, Medscape, Pubmed databases and on web resources, dedicated to
clinical trials (National Institutes of Health, Clinical Center,
ClinicalStudyResults.org, ClinicalTrials.gov). Results - There was no
significant overall mortality reduction in patients receiving MT when
compared to control group: OR=0.97 (95% CI: 0.85-1.10), p=0.211. Treatment
with CRT and CRT-D, as well as CSS implantation and HT reduced overall
mortality: OR=0.67 (95% CI: 0.57-0.79), p < 0.001 for CRT/CRT-D and
OR=0.46 (95% CI: 0.24-0.86), p = 0.018 for CSS/HT. Conclusion -
Superiority of surgical treatment over traditional MT in terms of overall
mortality was observed in patients with severe CHF. Copyright &#xa9; 2016,
Kotsoeva O.T.

<2>
Accession Number
612422315
Author
Kim T.K.; Nam K.; Cho Y.J.; Min J.J.; Hong Y.J.; Park K.U.; Hong D.M.;
Jeon Y.
Institution
(Kim, Cho, Min, Hong, Jeon) Department of Anaesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
(Nam) Cheoncheon Public Health Subcentre, Jangsu Health Centre and County
Hospital, Jangsu, Jeollabuk-do, South Korea
(Hong, Park) Department of Laboratory Medicine, Seoul National University
Bundang Hospital, Seongnam, Gyeongi-do, South Korea
Title
Microvascular reactivity and endothelial glycocalyx degradation when
administering hydroxyethyl starch or crystalloid during off-pump coronary
artery bypass graft surgery: a randomised trial.
Source
Anaesthesia. 72 (2) (pp 204-213), 2017. Date of Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
The infusion of fluids to patients may affect tissue microcirculation and
the endothelial glycocalyx. However, the effects of hydroxyethyl starch
and crystalloid on endothelial glycocalyx degradation and microvascular
reactivity have not been evaluated in detail. We hypothesised that
hydroxyethyl starch may cause less endothelial glycocalyx degradation and
better microvascular reactivity than that caused by crystalloid. We
randomly allocated 120 patients undergoing off-pump coronary artery bypass
graft surgery to receive up to 20 ml.kg^-1 of either
hydroxyethyl starch 670/0.75 or crystalloid for intra-operative fluid
resuscitation. Crystalloid was then infused to meet ongoing fluid
requirements. During the peri-operative period, vascular occlusion tests
were performed to assess microvascular reactivity, and serum syndecan-1
was measured as an index of endothelial glycocalyx degradation. The median
(IQR [range]) fluid infused during surgery was significantly less in the
hydroxyethyl starch group than the crystalloid group; 2800 (2150-3550
[1400-7300]) vs. 3925 (3100-4725 [1900-6700]) ml, respectively, p < 0.001.
Vascular occlusion test parameters, including tissue oxygen saturation,
occlusion and recovery slope did not differ significantly between the
groups. Peri-operative changes in syndecan-1 were not significantly
different between the groups. We conclude that, in patients undergoing
off-pump coronary artery bypass graft surgery, compared with crystalloid,
the use of hydroxyethyl starch 670/0.75 did not result in significant
differences in microvascular reactivity or endothelial glycocalyx
degradation. Copyright &#xa9; 2016 The Association of Anaesthetists of
Great Britain and Ireland

<3>
[Use Link to view the full text]
Accession Number
613145958
Author
Asgar A.; Chandrasekhar J.; Mikhail G.; Webb J.; Lefevre T.; Tamburino C.;
Hildick-Smith D.; Hambrecht R.; Van Belle E.; Widder J.; Dumonteil N.;
Hink U.; Jeger R.; Linke A.; Deliargyris E.; Gao P.; Mehran R.;
Hengstenberg C.; Anthopoulos P.; Dangas G.
Institution
(Asgar) Division of Cardiology, Montreal Heart Institute, Montreal, Canada
(Chandrasekhar, Mehran, Dangas) Icahn School of Medicine at Mount Sinai,
The Zena and Michael a. Wiener Cardiovascular Institute, New York, NY,
United States
(Mikhail) Imperial College Healthcare NHS Trust, Hammersmith Hospital,
London, United Kingdom
(Webb) Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada
(Lefevre) Ramsay Generale De Sante, Institut Hospitalier Jacques Cartier,
Massy, France
(Tamburino) Department of Cardiology, University of Catania, Catania,
Italy
(Hildick-Smith) Sussex Cardiac Centre-Brighton & Sussex University
Hospitals NHS Trust, Brighton, East Sussex, United Kingdom
(Hambrecht) Department of Cardiology and Angiology, Klinikum Links Der
Weser, Bremen, Germany
(Van Belle) Centre Hospitalier Universitaire De Lille, Lille, France
(Widder) Department of Cardiology and Angiology, Hannover Medical School,
Hannover, Germany
(Dumonteil) Department of Cardiology, Rangueil University Hospital,
Toulouse, France
(Hink) Cardiology Department, Johannes Gutenberg University Hospital,
Mainz, Germany
(Jeger) Department of Cardiology, University Hospital Basel, Basel,
Switzerland
(Linke) Department of Internal Medicine/Cardiology, University of Leipzig,
Heart Centre, Germany
(Deliargyris, Gao) The Medicines Company, Parsippany, NJ, United States
(Hengstenberg) DZHK (German Centre for Cardiovascular Research), Partner
Site Munich Heart Alliance, Munich, Germany, and Deutsches Herzzentrum
Munchen, Technische Universitat Munchen, Munich, Germany
(Anthopoulos) The Medicines Company, Zurich, Switzerland
Title
Sex-based differences in outcomes with bivalirudin or unfractionated
heparin for transcatheter aortic valve replacement: Results from the
BRAVO-3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp 144-153),
2017. Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Women comprise almost 50% of patients undergoing transcatheter
aortic valve replacement (TAVR) and previous studies have indicated higher
rates of procedural complications and bleeding in women compared to men.
It is unknown whether men and women demonstrate a differential response to
bivalirudin versus unfractionated heparin (UFH) in TAVR. We sought to
evaluate outcomes by sex and type of anticoagulant from the Bivalirudin
Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement
(BRAVO-3) trial of transfemoral TAVR. Methods: BRAVO-3 was a randomized
multicenter trial comparing transfemoral TAVR with bivalirudin versus UFH
(31 centers, n = 802). The primary endpoint was 48 h major bleeding
defined as Bleeding Academic Research Consortium (BARC) type >3b. Major
adverse cardiovascular events (MACE) were a composite of 30-day death,
myocardial infarction, or stroke. Net adverse cardiovascular events (NACE)
were a composite of BARC >3b bleeding or 30-day MACE. We examined the
outcomes in men and women. Results: The total cohort included 49% women (n
= 391, 195 received bivalirudin and 196 UFH) and 51% men (n = 411, 209
received bivalirudin and 202 UFH). Women were older than men with fewer
comorbidities including coronary artery disease, atrial fibrillation,
diabetes but similar EuroSCORE I. Women received smaller sheath and device
sizes compared with men without differences in the use of vascular closure
devices. At 48-hr post-TAVR there was no difference in bleeding or
vascular complications in women compared to men. The use of bivalirudin
did not result in significantly lower bleeding at 48 hr or 30-days
compared to UFH. Conclusions: There was no difference in early outcomes
with bivalirudin versus UFH in men or women undergoing contemporary TAVR.
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<4>
Accession Number
613084377
Author
Rossini R.; Angiolillo D.J.; Musumeci G.; Capodanno D.; Lettino M.;
Trabattoni D.; Pilleri A.; Calabria P.; Colombo P.; Bernabo P.; Ferlini
M.; Ferri M.; Tarantini G.; De Servi S.; Savonitto S.
Institution
(Rossini, Musumeci) Dipartimento Cardiovascolare, ASST Papa Giovanni
XXIII, Bergamo, Italy
(Angiolillo) College of Medicine-Jacksonville, University of Florida,
Jacksonville, FL, United States
(Capodanno) Dipartimento Di Cardiologia, Ospedale Ferrarotto, Universita
Di Catania, Italy
(Lettino) U.O.C. Cardiologia Clinica I, Istituto Clinico Humanitas,
Rozzano, (MI), Italy
(Trabattoni) Dipartimento Di Scienze Cardiovascolari, Centro Cardiologico
Monzino, IRCCS, Universita Degli Studi Di Milano, Milano, Italy
(Pilleri) SSD Centro di valutazione e consulenza cardiologica, Azienda
Ospedaliera Brotzu, Presidio San Michele, Cagliari, Italy
(Calabria) UO Emodinamica, Ospedale Misericordia, Grosseto, USL Toscana
Sudest, Italy
(Colombo) Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale
Metropolitano, Milano, Italy
(Bernabo) Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera,
Genova, Italy
(Ferlini, De Servi) SC Cardiologia, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
(Ferri) S.C. Di Cardiologia, Arcispedale S. Maria Nuova, IRCCS, Reggio
Emilia, Italy
(Tarantini) Dipartimento Di Scienze Cardiache, Toraciche E Vascolari,
Universita Di Padova, Italy
(Savonitto) Dipartimento Cardiovascolare, Ospedale A. Manzoni, Lecco,
Italy
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine-Jacksonville, Jacksonville, FL, United States
(Lettino) Dipartimento Cardiovascolare, Humanitas Research Hospital,
Rozzano, Milano, Italy
Title
Antiplatelet therapy and outcome in patients undergoing surgery following
coronary stenting: Results of the surgery after stenting registry.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp E13-E25),
2017. Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of the present study was to define the feasibility and
clinical impact of complying with national consensus recommendations on
perioperative management of antiplatelet therapy in patients with coronary
stents undergoing cardiac and noncardiac surgery. Background: There are
limited evidence-based recommendations on the perioperative management of
antiplatelet therapy in stented patients undergoing surgery. Methods: The
recommendations provided by the national consensus document were applied
in a multicenter, prospective registry of consecutive patients with prior
coronary stenting undergoing any type of surgery at 19 hospitals in Italy.
The primary end-point was in-hospital net adverse clinical events (NACE)
represented by the composite of all-cause death, myocardial infarction,
probable/definite stent thrombosis and Bleeding Academic Research
Consortium (BARC) grade >3 bleeding. Patients were followed for 30 days.
Results: A total of 1,082 patients were enrolled. Adherence to consensus
recommendations occurred in 85% of the cases. Perioperative aspirin and
dual antiplatelet therapy were maintained in 69.7 and 10.5% of the cases,
respectively. In-hospital NACE rate was 12.7%, being significantly higher
in patients undergoing cardiac surgery (36.3% vs. 7.3%, P < 0.01), mainly
due to BARC 3 bleeding events (32.3%). At 30 days, MACE rates were similar
(3.5% vs. 3.5%, P = NS) in patients undergoing cardiac and noncardiac
surgery, whereas BARC >3 bleeding events were significantly higher with
cardiac surgery (36.3% vs. 5.6%, P < 0.01). Conclusions: The results of
this registry demonstrate the safety and feasibility of applying a
national consensus document on the perioperative management of
antiplatelet therapy in stented patients undergoing surgery. &#xa9; 2016
Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<5>
Accession Number
610354392
Author
Conrotto F.; D'Ascenzo F.; Stella P.; Pavani M.; Rossi M.L.; Brambilla N.;
Napodano M.; Covolo E.; Saia F.; Tarantini G.; Agostoni P.; Marzocchi A.;
Presbitero P.; Bedogni F.; Salizzoni S.; D'Amico M.; Moretti C.; Rinaldi
M.; Gaita F.
Institution
(Conrotto, D'Ascenzo, Pavani, D'Amico, Moretti, Gaita) Division of
Cardiology, Citta della Salute e della Scienza Hospital, Corso Bramante
88, Turin 10100, Italy
(Stella, Agostoni) Department of Cardiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Rossi) Division of Cardiology, Istituto Clinico Humanitas, Netherlands
(Brambilla, Presbitero, Bedogni) Department of Cardiology, Clinical
Institute S. Ambrogio, Milan, Italy
(Napodano, Covolo, Tarantini) Department of Cardiac, Thoracic and Vascular
Sciences, Division of Cardiology, University of Padova, Padova, Italy
(Saia, Marzocchi) Division of Cardiology, Policlinico
Sant'Orsola-Malpighi, Bologna, Italy
(Salizzoni, Rinaldi) Division of Cardiac Surgery, Citta della Salute e
della Scienza Hospital, University of Turin, Turin, Italy
Title
Transcatheter aortic valve implantation in low ejection fraction/low
transvalvular gradient patients: The rule of 40.
Source
Journal of Cardiovascular Medicine. 18 (2) (pp 103-108), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Several factors have been identified as predictors of events
after transcatheter aortic valve implantation (TAVI) but the impact of
left ventricular ejection fraction (LVEF) and mean transaortic gradient
(MTG) is controversial. This multicenter study aimed to clarify the
prognostic role of low LVEF and low MTG after TAVI. Methods From 2007 to
2012, 764 consecutive patients with severe symptomatic aortic valve
stenosis underwent TAVI at participating hospitals. Patients were divided
according to LVEF and MTG into four groups. Results Sixty-four patients
had LVEF 40% or less and MTG less than 40 mmHg, 76 had LVEF 40% or less
and MTG at least 40 mmHg, 163 had LVEF more than 40% and MTG less than 40
mmHg, 461 had LVEF more than 40% and MTG at least 40 mmHg. Two-year
mortality was significantly higher in patients with low LVEF and low MTG,
whereas it was similar in patients with low LVEF and high MTG, high LVEF
and low MTG, and high LVEF and high MTG (51.3 vs. 22.4 vs. 23.3. vs.
25.5%, respectively; P = 0.001). These results were confirmed by
multivariate analysis, as the combination of low LVEF and low MTG (both
less than 40) was identified as the stronger mid-term mortality predictor
(hazard ratio 2.4, confidence interval 95% 1.4-3.9; P = 0.001). Conclusion
At least one parameter between LVEF or MTG over 40 predicts a good
prognosis for TAVI patients at midterm follow-up, whereas those with both
left ventricular dysfunction and low mean aortic pressure gradient are at
high risk of all-cause death after TAVI. Copyright &#xa9; 2017 Italian
Federation of Cardiology. All rights reserved.

<6>
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. 230 (pp 537-541), 2017. Date of
Publication: 01 Mar 2017.
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

<7>
Accession Number
613549637
Author
Sunaga H.; Blasberg J.D.; Heerdt P.M.
Institution
(Sunaga) Department of Anesthesiology, Jikei University School of
Medicine, 3-25-8 Nishishimbashi, Minatoku, Tokyo 105-8461, Japan
(Blasberg) Department of Surgery, Yale School of Medicine, New Haven, CT,
United States
(Heerdt) Department of Anesthesiology, Yale School of Medicine, New Haven,
CT, United States
Title
Anesthesia for nonintubated video-assisted thoracic surgery.
Source
Current Opinion in Anaesthesiology. 30 (1) (pp 1-6), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Purpose of review This review focuses primarily on nonintubated
video-assisted thoracic surgery (NIVATS), and discusses advantages,
indications, anesthetic techniques, and approaches to intraoperative
crisis management. Recent findings Advancements in endoscopic,
endovascular, and robotic techniques have expanded the range of surgical
procedures that can be performed in a minimally invasive fashion. For
thoracic operations in particular, video-assisted thoracic surgery (VATS)
has largely replaced traditional thoracotomy, and continued technical
development has made surgical access into the pleural space even less
disruptive. As a consequence, the need for general anesthesia and
endotracheal intubation has been re-examined, such that regional or
epidural analgesia may be sufficient for cases where lung collapse can be
accomplished with spontaneous ventilation and an open hemithorax. This
concept of NIVATS has gained popularity, and in some centers has now
expanded to include procedures involving placement of multiple ports.
Although still relatively uncommon at present, a small number of
randomized trials and meta-analyses have indicated some advantages,
suggesting that NIVATS may be a desirable alternative to general
anesthesia with endotracheal intubation for specific indications. Summary
Although anesthesia for NIVATS is associated with some of the same risks
as general anesthesia with endotracheal intubation, NIVATS can be
successfully performed in carefully selected patients. Copyright &#xa9;
2017 Wolters Kluwer Health, Inc. All rights reserved.

<8>
Accession Number
612361767
Author
Sun E.Y.; Jadotte Y.T.; Halperin W.
Institution
(Sun) Internal Medicine Resident Physician, University of North Carolina,
126 Macnider Hall, CB #7005, Chapel Hill, NC 27599, United States
(Halperin) New Jersey Medical School, Newark, NJ, United States
(Halperin) School of Public Health, Newark Campus, Newark, NJ, United
States
(Jadotte) School of Nursing, Newark Campus, Newark, NJ, United States
(Jadotte) Northeast Institute for Evidence Synthesis and Translation,
Rutgers University, School of Nursing, Newark, NJ, United States
(Jadotte) Department of Family, Population and Preventive Medicine, Stony
Brook University, Stony Brook, NY, United States
Title
Disparities in cardiac rehabilitation participation in the United States:
A systematic review and meta-analysis.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 37 (1) (pp
2-10), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE: Phase 2 cardiac rehabilitation (CR) is a class I recommendation
for all patients following an acute cardiac event or cardiac surgery
according to the The American Heart Association and the American College
of Cardiology Foundation. Studies have shown that there are differences in
cardiac rehabilitation participation rates between sociodemographic
groups. The purpose of this systematic review and meta-analyses was to
synthesize quantitative data on the relationship between outpatient
cardiac rehabilitation (OCR) attendance and various sociodemographic
factors. METHODS: We conducted a search of PubMed, PsycINFO, CINAHL,
Google Scholar, Dissertations & Theses A&I, and conference abstracts for
observational studies conducted in the United States that fit our
inclusion criteria. A total of 21 studies were included in our final
review and meta-analyses. RESULTS: Our meta-analyses showed that overall,
attenders were younger than nonattenders (mean difference = - 3.74 years,
95% CI = - 5.87 to - 1.61) and the odds of participation were lower among
females (OR = 0.59; 95% CI = 0.51-0.69), individuals with a high school
degree or less (OR = 0.67; 95% CI = 0.50-0.91), and the uninsured or
self-payers (OR = 0.32; 95% CI = 0.14-0.71). Full- or part-time employees
were more likely to participate than those not employed (OR = 1.45; 95% CI
= 1.08-1.95). CONCLUSIONS: Our systematic review and meta-analyses showed
that there are significant sociodemographic disparities in CR
participation. On the basis of this knowledge, clinicians and policy
makers should focus on identifying and eliminating barriers to
participation. Copyright &#xa9; 2017 Wolters Kluwer Health, Inc.

<9>
Accession Number
614225050
Author
Revel-Vilk S.; Karavany B.; Saban R.; Zelig O.; Naamad M.; Turniansky M.;
Savitsky B.; Hochner H.
Title
Are we choosing wisely with blood use? an assessment of transfusion
practices.
Source
Blood. Conference: 58th Annual Meeting of the American Society of
Hematology, ASH 2016. United States. Conference Start: 20161203.
Conference End: 20161206. 128 (22) (no pagination), 2016. Date of
Publication: 02 Dec 2016.
Publisher
American Society of Hematology
Abstract
Background: Blood transfusions save lives and improve health; however,
unnecessary transfusion practice exposes patients to immediate and
long-term negative consequences. One of the 2013 Choosing Wisely
recommendations focused on avoiding liberal red blood cell (RBC)
transfusion. The specific recommendation was that in situations where
transfusion of RBCs is necessary, transfuse the minimum number of units
required to relieve symptoms of anemia or to return the patient to a safe
hemoglobin (Hb) range (7-8 gr/dl in stable, non-cardiac inpatients). As
part of an initiative to improve the quality of RBC transfusion practice
we performed this study to examine RBC transfusion practices by patient-
and admission-related characteristics. Methods: A cross-sectional survey
of RBC transfusions was conducted at three Jerusalem hospitals in the
following departments: intensive care (general, adult), internal medicine,
orthopedics, hematology and cardiothoracic surgery. These departments were
chosen based on their high volume of RBC use. RBC transfusions were
identified from the list of RBC units discharged from the hospital's blood
bank within a specified 30-day period and data were collected daily by
trained nurses. Exclusion criteria included patients who underwent liver
transplants, patients with solid tumors, patients requiring massive
transfusions (>6) and transfusions given during surgery. Orthopedic and
cardiothoracic departments were grouped together as surgical departments
and compared to all others (i.e. non-surgical). Off-protocol RBC
transfusion was defined in this study as patients receiving>1 RBC unit
consecutively or transfusion given to non-bleeding, non-active cardiac
patients with Hb levels >8 gr/dl. Generalized estimating equations (GEE)
method was applied to assess the separate associations of each selected
characteristic with off-protocol RBC transfusion, taking into account
clustering of observations due to repeated transfusions per patient.
Results: During the study period 584 RBC transfusions met inclusion
criteria. These transfusions were given to 302 patients, mean age of 67
(+/-19.5, range 14 to 100) years, of which 162 (53.6%) were female. Mean
number of transfusions per patient was 1.9 (+/-1.3) [range from 1 (in
52.6%) to 8 (in 2) patients]. Nearly all patients (291, 96.4%) had at
least one underlying medical condition; hypertension (48.3%), malignancy
(33.1%), heart (44.7%), nephrology (32.1%) and pulmonary diseases (32.1%).
Antithrombotic therapy was taken by 142 (47%) patients. Of the 584 RBC
transfusions, 498 (85.3%) were given in the non-surgical departments and
247 (42.3%) were given to patients who underwent invasive
procedures/surgery during the current admission, of which 137 (55.5%) were
considered major operations (e.g. open laparotomy, open heart, etc.).
Pre-transfusion Hb level was >8 gr/dl in 229 (39.2%) transfusions and>1
RBC unit was given consecutively in 96 (16.4%) transfusions. The
prevalence of off-protocol RBC transfusion, as defined in this study, was
48.1%. Mean age of patients receiving off-protocol RBC transfusion was
higher than those receiving by protocol (67.8+/-18.2 vs. 60.7+/-21.8,
OR=1.02, 95% CI 1.01- 1.03). Off-protocol RBC transfusion was more common
in the surgical departments vs. nonsurgical (OR=7.4, 95% CI 3.7-14.7). In
patients undergoing invasive procedure/surgery, major operations were
associated with higher odds of off-protocol RBC transfusion compared to
minor procedures (OR=1.7, 95% CI 1.1-2.8). Off-protocol RBC transfusion
was not related to presence of underling malignancy, heart, nephrology and
pulmonary diseases, but was more common among patients taking
antithrombotic therapy (OR=1.7, 95% CI 1.2-2.4). Pretransfusion recording
of patients' blood pressure, pulse rate and saturation were not associated
with off-protocol RBC transfusion. Conclusions: This study demonstrates
that almost half of RBC transfusions are not given based on suggested
guidelines. Although clinical considerations, such as underlying diseases
or patient's pre-transfusion signs, may explain non-adherence to
guidelines, no clear pattern was observed in the current study to support
this explanation. The study findings highlight the need to further our
understanding of clinical decision making leading to RBC transfusion and
call for establishing clear guidelines to facilitate wise
transfusion-related choices.

<10>
Accession Number
614224496
Author
Samour M.; Saygin C.; Abdallah R.; Kundu S.; McCrae K.R.
Title
Pomalidomide in hereditary hemorrhagic telangiectasia: Interim results of
a phase i study.
Source
Blood. Conference: 58th Annual Meeting of the American Society of
Hematology, ASH 2016. United States. Conference Start: 20161203.
Conference End: 20161206. 128 (22) (no pagination), 2016. Date of
Publication: 02 Dec 2016.
Publisher
American Society of Hematology
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) is an autosomal
dominant disorder characterized by telangiectasias on mucocutaneous
surfaces and arteriovenous malformations in visceral organs. Most patients
present with epistaxis and gastrointestinal (GI) bleeding requiring iron
supplementation and blood transfusion. There is no accepted medical
treatment for HHT, although several studies suggest the potential efficacy
of thalidomide. However, thalidomide is not available for treatment of
patients with HHT. To address this, we initiated a Phase I trial of
pomalidomide, a third generation thalidomide analogue with a lower
incidence of cytopenias and neuropathy than thalidomide, in patients with
HHT and dependence on iron infusion or blood transfusion. The aim of this
phase 1 trial is to investigate the safety and efficacy of pomalidomide in
HHT related epistaxis and GI bleeding. Methods Adult HHT patients with GI
bleeding requiring at least 4 units transfusion or four doses of
intravenous iron in the preceding four months, and patients with epistaxis
requiring 2 units transfusion or 500 mg of intravenous iron in the
preceding four months, and with an epistaxis severity score (ESS) > 4 were
enrolled. Pomalidomide was initiated at a 1 mg daily dose, which was
increased by 1 mg/month to a maximal dose of 5 mg/day if bleeding did not
entirely stop as judged by clinical evaluation. If bleeding stopped,
patients were maintained on the dose of pomalidomide they were taking at
the time of bleeding cessation for an additional 4 months. If bleeding did
not stop, but improved, and patients escalated to the 5 mg/daily dose,
they were maintained on this dose for an additional 4 months. After
treatment with a stable dose of pomalidomide for 4 months, it was tapered
by 1 mg/month until discontinued. The primary endpoint was a 50% reduction
in the need for transfusion or parenteral iron therapy. A secondary
endpoint was a reduction in the ESS of at least 1 point. Results The trial
was designed for 9 patients and is continuing to accrue. Six patients, 5
males and 1 female, aged 48-70 with clinically diagnosed HHT provided
informed consent. One patient withdrew consent before initiating therapy
due to valvular heart disease requiring surgery. One patient had a
drug-related adverse event (rash) soon after starting pomalidomide, which
required removal from the study. Two patients (brothers) had non-drug
related adverse events (diagnosis of a neuroendocrine tumor and recurrence
of a perianal abscess requiring surgery) and were removed from the study
within 5-7 months after initiation. One of these also had significant
cramping after 7 months of treatment. Both of these siblings had presented
with epistaxis and GI bleeding and reported a decrease in frequency of
melanotic stools. Both required one course of IV iron soon after entering
the study (prior to pomalidomide, they received iron every 2-3 months),
however both maintained hemoglobin levels at least 1 gm higher than their
previous baseline during study, and iron studies remained in the normal
range after initiation of therapy. Two patients had primarily epistaxis.
Both responded to pomalidomide within 1-2 months with decreases of > 50%
(2-3 points) in the ESS; this was associated with an increase in quality
of life. One of these patients required weekly iron infusions as well as
red blood cell transfusions every 3-6 weeks before study; however, she has
currently been on study for more than 6 months with a hemoglobin of 10-11
gm/dl, has not required blood transfusion, and has not received
intravenous iron for more than 3 months with iron studies remaining
normal. An additional patient has recently entered the study at the time
of this abstract preparation. Pre- and post-treatment blood sampling has
been performed and will be analyzed for biomarker changes prior to the ASH
meeting. Toxicity has consisted primarily of grade 1-2 fatigue (n = 2),
and cramps (n = 2), but these were not felt to be of sufficient severity
to stop pomalidomide. Conclusions Preliminary interim findings from this
phase I study provide an efficacy signal for patients with HHT and
refractory bleeding. As with thalidomide, we speculate that pomalidomide
causes remodeling of abnormal vasculature leading to decreases in AVMs and
improvements in vessel stability. These findings support the development
of a larger, multi-institutional HHT study.

<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
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

<13>
Accession Number
613921929
Author
Fischer D.; Remberg F.; Bose D.; Lichtenberg M.; Kumpers P.; Lebiedz P.;
Pavenstadt H.-J.; Waltenberger J.; Breuckmann F.
Institution
(Fischer, Lebiedz, Waltenberger) Department of Cardiology and Angiology,
University Hospital Munster, Albert-Schweitzer-Campus 1, A1, Munster
48149, Germany
(Remberg, Bose, Breuckmann) Department of Cardiology, Arnsberg Medical
Center, Arnsberg, Germany
(Lichtenberg) Department of Angiology, Arnsberg Medical Center, Arnsberg,
Germany
(Kumpers, Pavenstadt) Department of General Internal Medicine, Nephrology
and Rheumatology, University Hospital Munster, Munster, Germany
Title
How rapid is rapid? Exemplary results of real-life rapid rule-out troponin
timing in troponin-positive acute coronary syndromes without persistent
ST-segment elevation in two contrasting German chest pain unit facilities.
Source
European Journal of Medical Research. 21 (1) (no pagination), 2016.
Article Number: 11. Date of Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Aim: To analyse the timing of cardiac troponin (cTn) measurements in
high-risk and cTn-positive acute coronary syndromes without persistent
ST-segment elevation (NSTE-ACS) in two structurally different German chest
pain units (CPUs), contrasting an urban university maximum care and a
rural regional primary care facility. Methods: All patients encoded as
NSTEMI during the year 2013 were retrospectively enrolled in two centres:
site (I)-centre of maximum care in an urban university setting and site
(II)-centre of primary care in a rural regional care setting. Data
acquisition included time intervals from admission to baseline cTn and
first and second cTn control as well as type and timing of invasive
management. Results: The median times (site I vs. site II) from admission
to cTn result announcement were 26.5 vs. 33.0 min (p = 0.02) for baseline,
4 vs. 4 h (p = 0.43) for the first and 11.0 vs. 16.5 h (p = 0.03) for the
second control. Timely announcement, as recommended by guidelines, was
available in 86.9 % at baseline, 59.4 % for the first or 41.1 % for the
second cTn control. Rates and timing of invasive management were
independent from the time point of positive cTn announcement (p = 0.51 and
p = 0.68, respectively). Conclusions: German CPUs provide timely
identification of cTn-positive patients in a narrow and guideline-adherent
time frame using a rapid rule-out protocol. Especially, baseline and early
cTn timing was comparable between the urban university maximum care and
the rural regional primary care facility without relevant impact on
guideline-conforming invasive management, underlining the high standard of
care in those highly professional institutions. Copyright &#xa9; 2016
Ijaopo et al.

<14>
Accession Number
613877784
Author
Taggart D.P.; Altman D.G.; Gray A.M.; Lees B.; Gerry S.; Benedetto U.;
Flather M.
Institution
(Taggart, Lees) Nuffield Department of Surgical Sciences, United Kingdom
(Altman, Gerry) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology, Musculoskeletal Sciences, Botnar Research
Centre, United Kingdom
(Gray) Health Economics Research Centre, Nuffield Department of Population
Health, United Kingdom
(Benedetto) University of Oxford, Oxford, United Kingdom
(Benedetto) School of Clinical Sciences, University of Bristol and Bristol
Royal Infirmary, Bristol, United Kingdom
(Flather) Norwich Medical School, University of East Anglia and Norfolk
and Norwich University Hospital, Norwich NR4 7TJ, United Kingdom
Title
Randomized trial of bilateral versus single internal-thoracic-artery
grafts.
Source
New England Journal of Medicine. 375 (26) (pp 2540-2549), 2016. Date of
Publication: 29 Dec 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The use of bilateral internal thoracic (mammary) arteries for
coronary-artery bypass grafting (CABG) may improve long-term outcomes as
compared with the use of a single internal-thoracic-artery plus vein
grafts. METHODS We randomly assigned patients scheduled for CABG to
undergo single or bilateral internal-thoracic-artery grafting in 28
cardiac surgical centers in seven countries. The primary outcome was death
from any cause at 10 years. The composite of death from any cause,
myocardial infarction, or stroke was a secondary outcome. Interim analyses
were prespecified at 5 years of follow-up. RESULTS A total of 3102
patients were enrolled; 1554 were randomly assigned to undergo single
internal-thoracic-artery grafting (the single-graft group) and 1548 to
undergo bilateral internal-thoracic-artery grafting (the bilateral-graft
group). At 5 years of follow-up, the rate of death was 8.7% in the
bilateral-graft group and 8.4% in the single-graft group (hazard ratio,
1.04; 95% confidence interval [CI], 0.81 to 1.32; P = 0.77), and the rate
of the composite of death from any cause, myocardial infarction, or stroke
was 12.2% and 12.7%, respectively (hazard ratio, 0.96; 95% CI, 0.79 to
1.17; P = 0.69). The rate of sternal wound complication was 3.5% in the
bilateralgraft group versus 1.9% in the single-graft group (P = 0.005),
and the rate of sternal reconstruction was 1.9% versus 0.6% (P = 0.002).
CONCLUSIONS Among patients undergoing CABG, there was no significant
difference between those receiving single internal-thoracic-artery grafts
and those receiving bilateral internal-thoracic-artery grafts with regard
to mortality or the rates of cardiovascular events at 5 years of
follow-up. There were more sternal wound complications with bilateral
internal-thoracic-artery grafting than with single internal-thoracicartery
grafting. Ten-year follow-up is ongoing. Copyright &#xa9; 2016
Massachusetts Medical Society. All rights reserved.

<15>
Accession Number
613811082
Author
Gibson C.M.; Mehran R.; Bode C.; Halperin J.; Verheugt F.W.; Wildgoose P.;
Birmingham M.; Ianus P.J.; Burton P.; Van Eickels M.; Korjian S.; Daaboul
Y.; Lip G.Y.H.; Cohen M.; Husted S.; Peterson E.D.; Fox A.K.
Institution
(Gibson, Korjian, Daaboul) Cardiovascular Division, Department of
Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, United States
(Mehran, Halperin) Cardiovascular Institute, Mount Sinai Medical Center,
Icahn School of Medicine, Mount Sinai, NY, United States
(Bode) Heart Center, Department for Cardiology and Angiology I, University
of Freiburg, Freiburg, Germany
(Verheugt) Bayer Pharmaceuticals, Leverkusen (M.E.), Germany
(Wildgoose, Birmingham, Ianus, Burton) Onze Lieve Vrouwe Gasthuis
Amsterdam, Janssen Pharmaceuticals, Titusville, United States
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Newark,
NJ, United States
(Lip) University of Birmingham Institute of Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom
(Husted) Aarhus University Hospital, Medical Department, Hospital Unit
West, Herning, Denmark
(Peterson) Duke Clinical Research Institute, Durham, NC, United States
(Van Eickels, Fox) Centre for Cardiovascular Science, University of
Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
(Gibson) Harvard Medical School, Beth Israel Deaconess Medical Center, 330
Brookline Ave., Overland 540, MA 02215, United States
Title
Prevention of bleeding in patients with atrial fibrillation undergoing
PCI.
Source
New England Journal of Medicine. 375 (25) (pp 2423-2434), 2016. Date of
Publication: 22 Dec 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In patients with atrial fibrillation undergoing percutaneous
coronary intervention (PCI) with placement of stents, standard
anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy
(DAPT) with a P2Y12 inhibitor and aspirin reduces the risk of thrombosis
and stroke but increases the risk of bleeding. The effectiveness and
safety of anticoagulation with rivaroxaban plus either one or two
antiplatelet agents are uncertain. METHODS We randomly assigned 2124
participants with nonvalvular atrial fibrillation who had undergone PCI
with stenting to receive, in a 1:1:1 ratio, low-dose rivaroxaban (15 mg
once daily) plus a P2Y12 inhibitor for 12 months (group 1), very-low-dose
rivaroxaban (2.5 mg twice daily) plus DAPT for 1, 6, or 12 months (group
2), or standard therapy with a doseadjusted vitamin K antagonist (once
daily) plus DAPT for 1, 6, or 12 months (group 3).The primary safety
outcome was clinically significant bleeding (a composite of major bleeding
or minor bleeding according to Thrombolysis in Myocardial Infarction
[TIMI] criteria or bleeding requiring medical attention). RESULTS The
rates of clinically significant bleeding were lower in the two groups
receiving rivaroxaban than in the group receiving standard therapy (16.8%
in group 1, 18.0% in group 2, and 26.7% in group 3; hazard ratio for group
1 vs. group 3, 0.59; 95% confidence interval [CI], 0.47 to 0.76; P<0.001;
hazard ratio for group 2 vs. group 3, 0.63; 95% CI, 0.50 to 0.80;
P<0.001). The rates of death from cardiovascular causes, myocardial
infarction, or stroke were similar in the three groups (Kaplan-Meier
estimates, 6.5% in group 1, 5.6% in group 2, and 6.0% in group 3; P values
for all comparisons were nonsignificant). CONCLUSIONS In participants with
atrial fibrillation undergoing PCI with placement of stents, the
administration of either low-dose rivaroxaban plus a P2Y12 inhibitor for
12 months or very-lowdose rivaroxaban plus DAPT for 1, 6, or 12 months was
associated with a lower rate of clinically significant bleeding than was
standard therapy with a vitamin K antagonist plus DAPT for 1, 6, or 12
months. The three groups had similar efficacy rates, although the observed
broad confidence intervals diminish the surety of any conclusions
regarding efficacy. (Funded by Janssen Scientific Affairs and Bayer
Pharmaceuticals; PIONEER AF-PCI ClinicalTrials.gov number, NCT01830543.)
Copyright &#xa9; 2016 Massachusetts Medical Society. All rights reserved.

<16>
[Use Link to view the full text]
Accession Number
613316303
Author
McGregor G.; Nichols S.; Hamborg T.; Bryning L.; Tudor-Edwards R.;
Markland D.; Mercer J.; Birkett S.; Ennis S.; Powell R.; Begg B.;
Haykowsky M.J.; Banerjee P.; Ingle L.; Shave R.; Backx K.
Institution
(McGregor, Ennis, Powell, Banerjee) Department of Cardiac Rehabilitation,
Centre for Exercise and Health, University Hospital, Coventry, United
Kingdom
(McGregor, Mercer, Ennis, Begg, Shave, Backx) Cardiff Centre for Exercise
and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
(Nichols, Birkett, Ingle) Department of Sport, Health and Exercise
Science, University of Hull, Hull, United Kingdom
(Hamborg) Statistics and Epidemiology, Division of Health Sciences,
Warwick Medical School, Warwick, United Kingdom
(Bryning, Tudor-Edwards) Centre for Health Economics and Medicines
Evaluation, Bangor University, Bangor, Gwynedd, United Kingdom
(Markland) School of Sport, Health and Exercise Sciences, Bangor
University, Bangor, Gwynedd, United Kingdom
(Begg) Aneurin Bevan University Health Board, Gwent, United Kingdom
(Haykowsky) College of Nursing and Health Innovation, University of Texas
at Arlington, Arlington, TX, United States
(Banerjee) School of Health and Life Sciences, Coventry University,
Coventry, United Kingdom
Title
High-intensity interval training versus moderate-intensity steady-state
training in UK cardiac rehabilitation programmes (HIIT or MISS UK): Study
protocol for a multicentre randomised controlled trial and economic
evaluation.
Source
BMJ Open. 6 (11) (no pagination), 2016. Article Number: e012843. Date of
Publication: 01 Nov 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Current international guidelines for cardiac rehabilitation
(CR) advocate moderate-intensity exercise training (MISS,
moderate-intensity steady state). This recommendation predates significant
advances in medical therapy for coronary heart disease (CHD) and may not
be the most appropriate strategy for the modern' patient with CHD.
High-intensity interval training (HIIT) appears to be a safe and effective
alternative, resulting in greater improvements in peak oxygen uptake (VO 2
peak). To date, HIIT trials have predominantly been proof-of-concept
studies in the laboratory setting and conducted outside the UK. The
purpose of this multicentre randomised controlled trial is to compare the
effects of HIIT and MISS training in patients with CHD attending UK CR
programmes. Methods and analysis This pragmatic study will randomly
allocate 510 patients with CHD to 8weeks of twice weekly HIIT or MISS
training at 3 centres in the UK. HIIT will consist of 10 high-intensity
(85-90% peak power output (PPO)) and 10 low-intensity (20-25% PPO)
intervals, each lasting 1min. MISS training will follow usual care
recommendations, adhering to currently accepted UK guidelines (ie, >20min
continuous exercise at 40-70% heart rate reserve). Outcome measures will
be assessed at baseline, 8weeks and 12months. The primary outcome for the
trial will be change in VO 2 peak as determined by maximal cardiopulmonary
exercise testing. Secondary measures will assess physiological,
psychosocial and economic outcomes. Ethics and dissemination The study
protocol V.1.0, dated 1 February 2016, was approved by the NHS Health
Research Authority, East Midlands-Leicester South Research Ethics
Committee (16/EM/0079). Recruitment will start in August 2016 and will be
completed in June 2018. Results will be published in peer-reviewed
journals, presented at national and international scientific meetings and
are expected to inform future national guidelines for exercise training in
UK CR. Trial registration number NCT02784873; pre-results. Copyright
&#xa9; 2016 Published by the BMJ Publishing Group Limited.

<17>
Accession Number
612946616
Author
Codner P.; Levi A.; Gargiulo G.; Praz F.; Hayashida K.; Watanabe Y.;
Mylotte D.; Debry N.; Barbanti M.; Lefevre T.; Modine T.; Bosmans J.;
Windecker S.; Barbash I.; Sinning J.-M.; Nickenig G.; Barsheshet A.;
Kornowski R.
Institution
(Codner, Levi, Barsheshet, Kornowski) Cardiology Department, Rabin Medical
Center, Petah Tikva, Israel
(Codner, Levi, Barsheshet, Kornowski) "Sackler" School of Medicine, Tel
Aviv University, Tel Aviv, Israel
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(Gargiulo, Praz, Windecker) Cardiology Department, Inselspital University
Hospital, Bern, Switzerland
(Hayashida) Keio University School of Medicine, Tokyo, Japan
(Watanabe, Lefevre) Hospital Prive Jacques Cartier, Institut
Cardiovasculaire Paris Sud, Massy, France
(Mylotte) Cardiology Department, Galway University Hospital, Galway,
Ireland
(Debry, Modine) Institut cardio-pneumologique, CHRU, Lille, France
(Barbanti) Cardiology Department, Ferrarotto Hospital, Catania, Italy
(Bosmans) Interventional Cardiology, University Hospital, Antwerp, Belgium
(Barbash) Interventional Cardiology, Sheba Medical Center, Ramat Gan,
Israel
(Sinning, Nickenig) Cardiology Department, Bonn University Hospital, Bonn,
Germany
Title
Impact of Renal Dysfunction on Results of Transcatheter Aortic Valve
Replacement Outcomes in a Large Multicenter Cohort.
Source
American Journal of Cardiology. 118 (12) (pp 1888-1896), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with advanced chronic renal dysfunction were excluded from
randomized trials of transcatheter aortic valve replacement (TAVR). The
potential impact of chronic renal disease on TAVR prognosis is not fully
understood. We aim to evaluate outcomes within a large cohort of patients
who underwent TAVR distinguished by renal function. Baseline
characteristics, procedural data, and clinical follow-up findings were
collected from 10 high-volume TAVR centers in Europe, Israel, and Japan.
Data were analyzed according to renal function. Patients (n = 1,204) were
divided into 4 groups according to pre-TAVR-estimated glomerular
filtration rate (eGFR): group I (eGFR >60), n = 288 (female 45%), group II
(eGFR 31 to 60), n = 452 (female 61%), group III (eGFR <30), n = 398
(female 61%), and group IV (dialysis), n = 66 (female 31%). Mean Society
of Thoracic Surgeons score was higher in patients with lower preprocedural
eGFR. All-cause mortality at 1 year was higher in patients with lower eGFR
(9.0%, 12.1%, 24.3%, and 24.2% for group I, II, III, and IV, respectively,
p <0.001). Multivariate analysis demonstrated that eGFR <30, but not eGFR
31 to 60, was associated with increased risk of death (odds ratio 3),
bleeding (odds ratio 5.2), and device implantation failure (hazard ratio
2.28). For each 10 ml/min decrease in eGFR, there was an associated
relative increase in the risk of death (35%; p <0.001), cardiovascular
death (14%; p = 0.018), major bleeding 35% (p <0.001), and transcatheter
valve failure (16%; p = 0.007). Renal dysfunction was not associated with
stroke or need for pacemaker implantation. In conclusion, among patients
who underwent TAVR, baseline renal dysfunction is an important independent
predictor of morbidity and mortality. Copyright &#xa9; 2016 Elsevier Inc.

<18>
Accession Number
614176459
Author
Bosch P.; Kenkre T.S.; Londino J.A.; Cassara A.; Yang C.; Waters J.H.
Institution
(Bosch, Londino) Department of Orthopaedic Surgery, Children's Hospital of
Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Cassara) Department of Anesthesia, Children's Hospital of Pittsburgh,
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
(Kenkre, Yang) Epidemiology Data Center, University of Pittsburgh,
Graduate School of Public Health, Pittsburgh, PA, United States
(Waters) Department of Anesthesia, Magee-Womens Hospital, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
Title
Coagulation profile of patients with adolescent idiopathic scoliosis
undergoing posterior spinal fusion.
Source
Journal of Bone and Joint Surgery - American Volume. 98 (20) (pp e88),
2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Blood loss and transfusion requirements during posterior
spinal fusion for adolescent idiopathic scoliosis remain a concern. The
mechanism of bleeding in these patients is poorly characterized.
Thromboelastography is a comprehensive test of a patient's coagulation
system commonly used in cardiac surgical procedures. It has not been well
studied for use in patients with adolescent idiopathic scoliosis. Methods:
A prospective, observational study of the coagulation profile of patients
with adolescent idiopathic scoliosis undergoing posterior spinal fusion is
presented. Healthy patients with adolescent idiopathic scoliosis without a
bleeding abnormality were analyzed during posterior spinal fusion.
Standard coagulation laboratory and thromboelastogram measures were
obtained at the time of the incision and at 1-hour intervals during the
surgical procedure. Laboratory values were analyzed in relation to
outcomes such as bleeding, transfusion, and a fibrinolysis score. Results:
Fifty-eight patients were observed. Eighty-one percent of patients were
female, the mean age was 13.5 years, a mean of 11.1 levels were fused, the
median estimated blood loss was 645 mL, and 47% of patients received blood
products. Overall, laboratory values remained stable throughout the
surgical procedure. Mild increases in prothrombin time and partial
thromboplastin time were observed, and platelets remained stable. From
thromboelastogram analysis, an acceleration of clot formation (decreased
reaction time) and a slight increase in clot lysis (increased lysis
percentage at 30 minutes) were observed. Afibrinolysis score compiled from
the presence of fibrin degradation products, the presence of D-dimers, and
increased prothrombin time rose steadily over surgical time. The
fibrinolysis score was predictive of both transfusion and greater
estimated blood loss per level. Conclusions: The stress of posterior
spinal fusion induces a hypercoagulable state in patients with adolescent
idiopathic scoliosis. Over the first 2 hours of a surgical procedure,
varying degrees of fibrinolysis develop. Platelets and coagulation factors
are not depleted. Our data support the use of antifibrinolytic therapy for
patients with adolescent idiopathic scoliosis. &#xa9; Copyright 2016 BY
THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.

<19>
Accession Number
614182271
Author
Villablanca P.A.; Massera D.; Mathew V.; Bangalore S.; Christia P.; Perez
I.; Wan N.; Schulz-Schupke S.; Briceno D.F.; Bortnick A.E.; Garcia M.J.;
Lucariello R.; Menegus M.; Pyo R.; Wiley J.; Ramakrishna H.
Institution
(Villablanca, Massera, Briceno, Bortnick, Garcia, Lucariello, Menegus,
Pyo, Wiley) Division of Cardiovascular Diseases, Montefiore Medical
Center, Albert Einstein College of Medicine, New York, NY, United States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(Bangalore) New York University School of Medicine, United States
(Christia, Perez, Wan) Department of Internal Medicine, Jacobi Medical
Center, Albert Einstein College of Medicine, New York, NY, United States
(Schulz-Schupke) Deutsches Herzzentrum Munchen, Technische Universitat,
Klinik Fur Herz-und Kreislauferkrankungen, Munich, Germany
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic College of Medicine, 5777 East Mayo Blvd, Scottsdale, Phoenix, AZ
85054, United States
Title
Outcomes of <6-month versus 12-month dual antiplatelet therapy after
drug-eluting stent implantation: A meta-analysis and meta-regression.
Source
Medicine (United States). 95 (52) (no pagination), 2016. Article Number:
e5819. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The benefit of <6-month compared with 12-month dual
antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI)
with drug-eluting stent (DES) placement remains controversial. We
performed a meta-analysis and meta-regression of <6-month versus 12-month
DAPT in patients undergoing PCI with DES placement. Methods: We conducted
electronic database searches of randomized controlled trials (RCTs)
comparing DAPT durations after DES placement. For studies with longer
follow-up, outcomes at 12 months were identified. Odds ratios and 95%
confidence intervals were computed with the Mantel-Haenszel method.
Fixed-effect models were used; if heterogeneity (I2)>40 was identified,
effects were obtained with random models. Results: Nine RCTs were included
with total n=19,224 patients. No significant differences were observed
between <6-month compared with 12-month DAPT in all-cause mortality (OR
0.87; 95% confidence interval (CI): 0.69-1.11), cardiovascular (CV)
mortality (OR 0.89; 95% CI: 0.66-1.21), non-CV mortality (OR 0.85; 95%
0.58-1.24), myocardial infarction (OR 1.10; 95% CI: 0.89-1.37), stroke (OR
0.97; 95% CI: 0.67-1.42), stent thrombosis (ST) (OR 1.37; 95% CI:
0.89-2.10), and target vessel revascularization (OR 0.95; 95% CI:
0.77-1.18). No significant difference in major bleeding (OR 0.72; 95% CI:
0.49-1.05) was observed, though the all-bleeding event rate was
significantly lower in the <6-month DAPT group (OR 0.76; 95% CI:
0.59-0.96). In the meta-regression analysis, a significant association
between bleeding events and non-CV mortality with 12-month DAPT was found,
as well as between ST and mortality in addition to MI with <6-month DAPT.
Conclusion: DAPT for <6 months is associated with similar mortality and
ischemic outcomes but less bleeding events compared with 12-month DAPT
after PCI with DES. Copyright &#xa9; 2016 the Author(s).

<20>
Accession Number
613955096
Author
Pedersen P.U.; Larsen P.; Hakonsen S.J.
Institution
(Pedersen, Larsen, Hakonsen) Danish Center of Systematic Reviews in
Nursing: a Collaborating Center of the Joanna Briggs Institute, Australia
Title
The effectiveness of systematic perioperative oral hygiene in reduction of
postoperative respiratory tract infections after elective thoracic surgery
in adults: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 14 (1) (pp
140-173), 2016. Date of Publication: 2016.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Nosocomial infections are a significant contributor to patient morbidity
and mortality. Nosocomial infections significantly increase hospital
length of stay and total hospital costs. Thoracic surgery, mechanical
ventilation and/or admission to an intensive care unit are known to
increase patients' risk for nosocomial respiratory tract infection.
Objectives To identify, appraise and synthesize the best available
evidence on the effectiveness of systematic perioperative oral hygiene in
the reduction of postoperative respiratory airway infections in adult
patients undergoing elective thoracic surgery. Inclusion criteria Types of
participants Patients over the age of 18 years who had been admitted for
elective thoracic surgery, regardless of gender, ethnicity, diagnosis
severity, co-morbidity or previous treatment. Types of intervention(s)
Perioperative systematic oral hygiene (such as mechanical removal of
dental biofilm or plaques and/or systematic use of mouth rinse) performed
by patients themselves or by healthcare staff (such as nurses). Types of
studies Randomized controlled trials and quasi-experimental studies. Types
of outcomes Nosocomial infections, specifically respiratory tracts
infections, and surgical site infections Search strategy Multiple
databases (PubMed, CINAHL, Embase, Scopus, Swemed+, Health Technology
Assessment Database and Turning Research Into Practice [TRIP] database)
were searched from 1980 to December 2014. Studies published in English,
German, Danish, Swedish and Norwegian were considered for inclusion in
this review. Methodological quality Two independent reviewers used the
standard critical appraisal tool from the Joanna Briggs Institute to
assess the methodological quality of studies. Data extraction The process
of data extraction was undertaken independently by two reviewers using
tools from the Joanna Briggs Institute. Data synthesis Quantitative
results were synthesized in meta-analysis. Results This review includes
six studies: three randomized controlled trials and three
quasi-experimental studies. The absolute magnitude of the summary effect
sizes were: for nosocomial infections relative risk (RR) 0.65 (95%
confidence interval [CI] 0.55-0.78) for respiratory tract infections RR
0.48 (95%CI: 0.36-0.65) and for deep surgical site infections RR 0.48
(95%CI 0.27-0.84). Conclusions Systematic perioperative oral hygiene
reduces postoperative nosocomial, lower respiratory tract infections and
surgical site infections but not urinary tract infections. The effect is
statistically, clinically and practically significant. Implications for
practice Perioperative decontamination of the nasopharynx and/or
oropharynx is a strategy worth pursuing. The intervention is cheap and can
easily be carried out by the patients themselves. (Grade A) Implications
for research Studies testing decontamination of the nasopharynx and/or
oropharynx have until now only included patients undergoing thoracic
surgical procedures. As the interventions are cheap, easy to carry out and
have a great impact on the patients' outcome, it is recommendable to carry
out more studies involving other type of patients undergoing major surgery
with a high prevalence of nosocomial infections, respiratory tract
infections and surgical site infections. Copyright &#xa9; the authors
2016.

<21>
Accession Number
613764737
Author
Pandit A.; Aryal M.R.; Aryal Pandit A.; Hakim F.A.; Giri S.; Mainali N.R.;
Sharma P.; Lee H..; Fortuin F.D.; Mookadam F.
Institution
(Pandit, Aryal Pandit, Hakim, Lee, Fortuin, Mookadam) Division of
Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, United States
(Aryal, Mainali) Department of Internal Medicine, Eading Hospital, West
eading, Pennsylvania, United States
(Giri) Department of Internal Medicine, University of Tennessee, Memphis,
Tennessee, United States
(Sharma) Department of Internal Medicine, Mayo Clinic, ochester,
Minnesota, United States
Title
Preventive PCI versus culprit lesion stenting during primary PCI in acute
STMI: A systematic review and meta-analysis.
Source
Open Heart. 1 (1) (no pagination), 2014. Article Number: e000012. Date of
Publication: 01 Feb 2014.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Aim: The benefit of preventive percutaneous coronary intervention (PCI) in
ST elevation myocardial infarction (STMI) has been shown in randomised
trials. However, all the randomised trials are underpowered to detect
benefit in cardiac death. We aim to systematically review evidence on the
cardiac mortality benefit of preventive PCI in patients presenting with
acute STMI in randomised patient populations. Methods: PubMed, Scopus,
Cochrane and clinicaltrials.gov databases were searched for studies
published until 30 September 2013. The studies were limited to randomised
clinical trials. Independent observers abstracted the data on outcomes,
characteristics and qualities of studies included. Fixed effect model was
employed for meta-analysis. Heterogeneity of studies included was analysed
using I2 statistics. esults: In three randomised clinical trials
published, involving 748 patients with acute STMI and multivessel disease,
416 patients were randomised to preventive PCI and 332 to culprit-only
PCI. Patients undergoing preventive PCI had significant lower risk of
cardiovascular deaths (pooled O 0.39, 95% CI 0.18 to 0.83, p=0.01, I2=0%),
repeat revascularisation (pooled O 0.28, 95% CI 0.18 to 0.44, p=0.00001,
I2=0%) and non-fatal myocardial infarction (pooled O 0.38, 95% CI 0.20 to
0.75, p=0.005, I2=0%) compared with culprit-only revascularisation.
Conclusions: In patients presenting with acute STMI and significant
multivessel coronary artery disease, based on our data, preventive PCI is
associated with lower risk of cardiovascular mortality compared with
primary PCI of only the culprit artery. This finding needs to be confirmed
in larger adequately powered randomised clinical trials.

<22>
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).

<23>
Accession Number
613941946
Author
Brown E.G.; Anderson J.E.; Burgess D.; Bold R.J.; Farmer D.L.
Institution
(Brown, Anderson, Burgess, Bold, Farmer) University of California, Davis
Health System, Sacramento, CA, United States
Title
Pediatric surgical readmissions: Are they truly preventable?.
Source
Journal of Pediatric Surgery. 52 (1) (pp 161-165), 2017. Date of
Publication: 01 Jan 2017.
Publisher
W.B. Saunders
Abstract
Background/purpose Reimbursement penalties for excess hospital
readmissions have begun for the pediatric population. Therefore, research
determining incidence and predictors is critical. Methods A retrospective
review of University HealthSystem Consortium database (N = 258 hospitals;
2,723,621 patients) for pediatric patients (age 0-17 years) hospitalized
from 9/2011 to 3/2015 was performed. Outcome measures were 7-, 14-, and
30-day readmission rates. Hospital and patient characteristics were
evaluated to identify predictors of readmission. Results Readmission rates
at 7, 14, and 30 days were 2.1%, 3.1%, and 4.4%. For pediatric surgery
patients (N = 260,042), neither index hospitalization length of stay (LOS)
nor presence of a complication predicted higher readmissions. Appendectomy
was the most common procedure leading to readmission. Evaluating
institutional data (N = 5785), patients admitted for spine surgery,
neurosurgery, transplant, or surgical oncology had higher readmission
rates. Readmission diagnoses were most commonly infectious (37.2%) or for
nausea/vomiting/dehydration (51.1%). Patients with chronic medical
conditions comprised 55.8% of patients readmitted within 7 days. 92.0% of
patients requiring multiple rehospitalizations had comorbidities.
Conclusions Readmission rates for pediatric patients are significantly
lower than adults. Risk factors for adult readmissions do not predict
pediatric readmissions. Readmission may be a misnomer for the pediatric
surgical population, as most are related to chronic medical conditions and
other nonmodifiable risk factors. Level of Evidence Level IV. Copyright
&#xa9; 2017

<24>
Accession Number
614172646
Author
Wolff G.; Dimitroulis D.; Andreotti F.; Kolodziejczak M.; Jung C.;
Scicchitano P.; Devito F.; Zito A.; Occhipinti M.; Castiglioni B.; Calveri
G.; Maisano F.; Ciccone M.M.; De Servi S.; Navarese E.P.
Institution
(Wolff, Dimitroulis, Andreotti, Kolodziejczak, Jung, Scicchitano, Devito,
Zito, Occhipinti, Ciccone, De Servi, Navarese) Systematic Investigation
and Research on Interventions and Outcomes (SIRIO), MEDICINE Research
Network, Milan, Italy
(Wolff, Dimitroulis, Jung) Department of Internal Medicine, Division of
Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University,
Dusseldorf, Germany
(Andreotti) Institute of Cardiology, Catholic University, Rome, Italy
(Kolodziejczak) Collegium Medicum in Bydgoszcz, University of Nicolaus
Copernicus, Torun, Poland
(Scicchitano, Devito, Zito, Ciccone) Department of Emergency and Organ
Transplantation, Section of Cardiovascular Diseases, School of Medicine,
University of Bari, Italy
(Occhipinti, Castiglioni, Calveri) Department of Heart Science, Ospedale
di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
(Maisano) Department of Cardiosurgery, University of Zurich, Switzerland
(De Servi, Navarese) Department of Cardiology, Multimedica IRCCS Via
Milanese 300, Milan 20099, Italy
Title
Survival Benefits of Invasive Versus Conservative Strategies in Heart
Failure in Patients with Reduced Ejection Fraction and Coronary Artery
Disease: A Meta-Analysis.
Source
Circulation: Heart Failure. 10 (1) (no pagination), 2017. Article Number:
e003255. Date of Publication: 01 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Heart failure with reduced ejection fraction caused by
ischemic heart disease is associated with increased morbidity and
mortality. It remains unclear whether revascularization by either coronary
artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)
carries benefits or risks in this group of stable patients compared with
medical treatment. Methods and Results - We performed a meta-analysis of
available studies comparing different methods of revascularization (PCI or
CABG) against each other or medical treatment in patients with coronary
artery disease and left ventricular ejection fraction <40%. The primary
outcome was all-cause mortality; myocardial infarction, revascularization,
and stroke were also analyzed. Twenty-one studies involving a total of 16
191 patients were included. Compared with medical treatment, there was a
significant mortality reduction with CABG (hazard ratio, 0.66; 95%
confidence interval, 0.61-0.72; P<0.001) and PCI (hazard ratio, 0.73; 95%
confidence interval, 0.62-0.85; P<0.001). When compared with PCI, CABG
still showed a survival benefit (hazard ratio, 0.82; 95% confidence
interval, 0.75-0.90; P<0.001). Conclusions - The present meta-analysis
indicates that revascularization strategies are superior to medical
treatment in improving survival in patients with ischemic heart disease
and reduced ejection fraction. Between the 2 revascularization strategies,
CABG seems more favorable compared with PCI in this particular clinical
setting. Copyright &#xa9; 2017 American Heart Association, Inc.

<25>
Accession Number
614175304
Author
Gholipour Baradari A.; Habibi M.R.; Habibi V.; Nouraei S.M.
Institution
(Gholipour Baradari, Habibi) Department of Anesthesiology, Faculty of
Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Habibi, Nouraei) Department of Cardiac Surgery, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
Title
Administration of lidocaine to prevent cognitive deficit in patients
undergoing coronary artery bypass grafting and valve plasty: a systematic
review and meta-analysis.
Source
Expert Review of Clinical Pharmacology. 10 (2) (pp 179-185), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: The administration of lidocaine to maintain cognitive
function following coronary artery bypass grafting (CABG) and valve plasty
is a controversial concept in terms of its effectiveness. We performed a
systematic review to determine the effectiveness of treatment with
lidocaine in preventing the occurrence of cognitive deficit after cardiac
surgery. Area covered: To review the current literature on the subject, we
searched the PubMed database and the Cochrane Library database (up to May
2015) and compiled a list of retrieved articles. Our final review includes
only randomized controlled trials (RCTs) that compared lidocaine to a
control (placebo) following CABG and valve plasty. Statistical analysis of
the odds ratio (OR) and corresponding 95% confidence interval (CI) were
used to determine the overall effectiveness of lidocaine for the
prevention of cognitive deficit with both procedures. The Mantel-Haenszel
method was used to pool data of the outcomes of cognitive deficit
occurrence into fixed-effect model meta-analyses. Five RCTs were included
in this study, with a total of 688 patients. Perioperative administration
of lidocaine in patients undergoing cardiac surgery reduced occurrence of
cognitive deficit (OR 0.583 [95% CI 0.438-0.777]; Z = -3.680; P = 0.00;
I² = 52%). No significant difference in the early occurrence of
cognitive deficit was revealed in patients after cardiac surgery (OR 0.909
[95% CI 0.600-1.376]; Z = -0.451; P = 0.652; I² = 11%). Expert
commentary: Cognitive deficit associated with cardiac surgery is a common
postoperative event. Lidocaine is contributed to a significantly reduced
occurrence of cognitive deficit. Cognitive deficit management is
recommended. Copyright &#xa9; 2016 Informa UK Limited, trading as Taylor &
Francis Group.

<26>
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.

<27>
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.

<28>
Accession Number
613898873
Author
Tan X.-F.; Shi J.-X.; Chen M.-H.
Institution
(Tan, Shi, Chen) Institute of Cardiovascular Diseases, The First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
530027, China
Title
Prolonged and intensive medication use are associated with the obesity
paradox after percutaneous coronary intervention: A systematic review and
meta-analysis of 12 studies.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 125. Date of Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Obesity paradox is defined as the unexpected decrease in the
total number of death which has been observed among patients who are
overweight and obese compared to patients with normal weight after
undergoing revascularization by percutaneous coronary intervention (PCI).
Despite of so many recent studies which showed the existence of this
phenomenon, prolonged and intensive medication use were only suggested to
be among the reasons responsible for this 'obesity paradox' but it was
never confirmed whether this hypothesis should really be considered true
or not. Therefore, this study aimed to investigate whether prolonged and
intensive medication use were associated with this obesity paradox after
PCI. Methods: Medline, PubMed, EMBASE and the Cochrane Library were
searched for studies showing the existence of this 'obesity paradox' in
patients who underwent coronary revascularization by PCI and only articles
comprising of medication use among the patients analyzed were considered
relevant for this research. Medication use among the different subgroups
of patients was calculated. Mortality was considered as the clinical
endpoint in this study. Risk Ratio (RR) with 95 % Confidence Interval (CI)
was used to express the pooled effect on discontinuous variables and the
pooled analyses were performed with RevMan 5.3. Results: Twelve studies
consisting of a total number of 91,582 patients was included in this
meta-analysis. An intensive medication use after the hospital discharge
and during the follow up period after PCI was observed in the subgroup of
obese patients, followed by the overweight patients and the normal weight
patients respectively. Our results showed that the short-term (30 days)
mortality in overweight and obese patients was significantly lower
compared to the normal weight patients with RR: 0.72; 95 % CI: 0.56-0.92,
p = 0.008 and RR: 0.47, 95 % CI: 0.34-0.65; p < 0.00001 respectively. The
long-term (> one year) mortality was also significantly lower in the
overweight and the obese groups with RR: 0.74, 95 % CI: 0.67-0.82; p <
0.00001 and RR: 0.63, 95 % CI: 0.55-0.72; p < 0.00001 respectively.
Conclusion: Our study has confirmed to some extent, that prolonged and
intensive use of medications which were more prominent in patients who
were overweight and obese during the follow up period, might apparently be
among the reasons responsible for this obesity paradox after PCI.
Copyright &#xa9; 2016 The Author(s).

<29>
Accession Number
613993666
Author
Karagiannis C.; Savva C.; Mamais I.; Efstathiou M.; Monticone M.; Xanthos
T.
Institution
(Karagiannis, Savva, Mamais) European University of Cyprus, School of
Sciences, Department of Health Sciences, Nicosia, Cyprus
(Efstathiou) University of Nicosia, Department of Life and Health
Sciences, Nicosia, Cyprus
(Monticone) University of Cagliari, Department of Public Health, Clinical
and Molecular Medicine, Cagliari, Italy
(Xanthos) European University of Cyprus, School of Medicine, Nicosia,
Cyprus
Title
Eccentric exercise in ischemic cardiac patients and functional capacity: A
systematic review and meta-analysis of randomized controlled trials.
Source
Annals of Physical and Rehabilitation Medicine. 60 (1) (pp 58-64), 2017.
Date of Publication: 01 Jan 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background Eccentric (ECC) exercise is an "economical" type of exercise
with low energy requirements and does not cause early fatigue. Therefore,
it is used for cardiac patients, who have low physical activity and
exercise intolerance, as an easier kind of training. Objective This
systematic review aimed to investigate the efficacy of ECC exercise for
functional capacity (FC) in patients with ischemic heart disease. Design
Systematic review. Methods MEDLINE via PubMed and EBSCO databases were
searched for articles of randomized controlled trials of adults with
ischemic heart disease who underwent ECC training as compared with other
forms of exercise (concentric exercise) or no exercise and assessed FC.
The methodologic quality of studies was assessed by the PEDro scale. A
meta-analysis was performed with sufficient homogeneity between at least 2
studies in the pre-defined comparisons. Results Four studies,
investigating a total of 99 subjects, met the inclusion criteria. The
results of the studies did not clearly indicate whether ECC exercise could
improve FC better than traditional forms of exercise. However, the small
number of studies and their methodologic weaknesses do not allow for
drawing firm conclusions. Conclusions We found contradictory results about
the effectiveness of ECC as compared with concentric exercise in terms of
FC in ischemic cardiac patients. Further investigation with well-designed
randomized trials is needed to determine the effectiveness of this kind of
exercise for FC in such patients. Copyright &#xa9; 2016 Elsevier Masson
SAS

<30>
[Use Link to view the full text]
Accession Number
613916235
Author
Garg A.; Sharma A.; Krishnamoorthy P.; Garg J.; Virmani D.; Sharma T.;
Stefanini G.; Kostis J.B.; Mukherjee D.; Sikorskaya E.
Institution
(Garg) Department of Medicine, St. Peter's University Hospital,
Rutgers/Robert Wood Johnson Medical School, New Brunswick, NJ, United
States
(Sharma) Division of Cardiovascular Medicine, State University of New York
Downstate Medical Center, Brooklyn, NY, United States
(Krishnamoorthy) Department of Cardiovascular Medicine, Albert Einstein
Medical Center, Philadelphia, Penn, United States
(Garg) Department of Cardiology, Lehigh Valley Health Network, Allentown,
Penn, United States
(Virmani) Department of Medicine, Albert Einstein College of Medicine,
Bronx, NY, United States
(Sharma) Department of Medicine, Cleveland Clinic, Weston, Fla, United
States
(Stefanini) Division of Cardiology, Humanitas Research Hospital, Rozzano,
Italy
(Kostis) Division of Cardiology, Cardiovascular Institute, Rutgers/Robert
Wood Johnson Medical School, New Brunswick, NJ, United States
(Mukherjee) Division of Cardiology, Texas Tech University, El Paso, Tex,
United States
(Sikorskaya) Department of Internal Medicine, The Brooklyn Hospital
Center, Brooklyn, NY, United States
Title
Role of Niacin in Current Clinical Practice: A Systematic Review.
Source
American Journal of Medicine. 130 (2) (pp 173-187), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Niacin, a potent high-density lipoprotein cholesterol-raising
drug, seems an attractive approach to reduce cardiac events in patients
with or at risk of atherosclerotic cardiovascular disease. However,
previous evidence for niacin has been challenged recently by negative
outcomes in 2 large, randomized, controlled trials comparing niacin to
placebo with background statin therapy. We studied the currently available
evidence for the role of niacin treatment for reducing the risk of
cardiovascular events in current practice. Methods A systematic review of
randomized controlled trials in the MEDLINE, EMBASE, CINAHL, and Cochrane
databases comparing niacin alone or combined with statin therapy was
performed. We extracted trial level data, including basic characteristics
and number of patients enrolled, duration of follow up, occurrence of
adverse events, and cardiovascular-related outcomes. Random effects
meta-analysis was conducted to estimate the risk ratio (RR) for individual
trial endpoints. Results Thirteen trials (N = 35,206) were selected for
final analysis. The mean follow-up duration was 32.8 months. Overall,
niacin led to significant increases in serum high-density lipoprotein
cholesterol levels from baseline trial enrolment by 21.4%, 9.31 (95%
confidence interval [CI] 5.11-13.51) mg/dL. However, we did not observe
any differences in all-cause mortality rates (RR 0.99; 95% CI 0.88-1.12)
between niacin and control arms. Further, niacin treatment was associated
with a trend toward lower risk of cardiovascular mortality (RR 0.91; 95%
CI 0.81-1.02), coronary death (RR 0.93; 95% CI 0.78-1.10), nonfatal
myocardial infarction (RR 0.85; 95% CI 0.73-1.0), revascularization
(coronary and noncoronary) (RR 0.83; 95% CI 0.65-1.06), and stroke (RR
0.89; 95% CI 0.72-1.10), compared with control. Conclusion Niacin therapy
does not lead to significant reductions in total or cause-specific
mortality or recurrent cardiovascular events among persons with or at risk
of atherosclerotic cardiovascular disease. Copyright &#xa9; 2016 Elsevier
Inc.

<31>
Accession Number
611532826
Author
Karabayirli S.; Ugur K.S.; Demircioglu R.I.; Muslu B.; Usta B.; Sert H.;
Ark N.
Institution
(Karabayirli, Demircioglu, Muslu, Usta, Sert) Department of Anesthesiology
and Reanimation, Faculty of Medicine, Turgut Ozal University, Alparslan
Turkes Caddesi, No: 57, Emek, Ankara 06510, Turkey
(Ugur, Ark) Department of Otolaryngology and Head and Neck Surgery,
Faculty of Medicine, Turgut Ozal University, Ankara, Turkey
Title
Surgical conditions during FESS; comparison of dexmedetomidine and
remifentanil.
Source
European Archives of Oto-Rhino-Laryngology. 274 (1) (pp 239-245), 2017.
Date of Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
To compare dexmedetomidine with remifentanil in functional endoscopic
sinus surgery (FESS) in regards to intra-operative bleeding, anesthetic
consumption and post-operative recovery. Randomized, double blind study.
Tertiary care medical center. Fifty patients with nasal polyposis who had
been scheduled for FESS were randomly divided into two groups. In group D
(n = 25), dexmedetomidine 1 micro&#32;g/kg infused intravenous (IV) over
10 min before anesthesia induction, followed by a continuous of 0.7
micro&#32;g/kg/h infusion during operation. In group R (n = 25), 1
micro&#32;g/kg remifentanil IV bolus, was administered with induction of
anesthesia and continued 0.25-0.50 micro&#32;g/kg/min during operation.
Heart rates, mean arterial pressure, end tidal CO<inf>2</inf>, end tidal
sevoflurane were recorded. The amount of bleeding, surgical field
condition for bleeding and the time to reach Aldrete recovery score 9-10
were recorded. Postoperative nausea, vomiting, pain, shivering, sedation
were followed up over 24 h. There was no significant difference between
groups according to the amount of bleeding during surgery, assessment of
surgical field condition, consumption of sevoflurane, scores of
postoperative VAS, rates of nausea and vomiting, shivering, demands of
additional analgesic medication (P > 0.05). The time to reach Aldrete
recovery score 9-10, sedation scores at the postoperative first hour were
significantly higher in group D (P = 0.001). We concluded that in
comparison to remifentanil, dexmedetomidine during FESS for controlled
hypotension is of limited value as it has no additional benefits in terms
of control of hypotension and amount of bleeding in the surgical field and
it is associated with higher recovery time and first-hour postoperative
sedation scores. Copyright &#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<32>
Accession Number
613974291
Author
Reinartz S.D.; Winkler M.; Diefenbach S.B.; Allmendinger T.; Penzkofer T.;
Kuhl C.K.; Mahnken A.H.
Institution
(Reinartz, Winkler, Diefenbach, Kuhl) Department of Diagnostic and
Interventional Radiology, University hospital RWTH Aachen, Pauwelsstrasse
30, Aachen 52074, Germany
(Allmendinger) Computed Tomography, Siemens Medical Healthcare, Forchheim,
Germany
(Penzkofer) Department of Diagnostic and Interventional Radiology, Charite
University Hospital, Berlin University, Berlin, Germany
(Mahnken) Department of Diagnostic and Interventional Radiology,
University Hospital, Philipps University Marburg, Marburg, Germany
Title
Reconstructions Using RIF in Motion Mapping Technique Have Substantially
Less Arrhythmogenic Artifacts in Dual-source Coronary CTA.
Source
Academic Radiology. 24 (2) (pp 167-174), 2017. Date of Publication: 01 Feb
2017.
Publisher
Elsevier USA
Abstract
Rationale and Objectives Particularly for patients with heart arrhythmias,
conventional BestSystole (BS) and BestDiastole (BD) reconstruction
techniques in computed tomography (CT) frequently show artifacts that
hinder the readability of the coronary tree. To address this problem, this
paper presents an alternative reconstruction method that combines the
technique "reconstructions with identical filling" (RIF) with motion
mapping: This new technique is called "RIF in motion mapping" (RIMM). This
study compares the diagnostic quality of images generated with RIMM to
that of the other reconstruction techniques. Materials and Methods Having
shown major artifacts in standard reconstructions, the CT datasets of 23
patients with suspected coronary artery disease or prior to transcatheter
aortic valve replacement were selected manually. Each dataset was
evaluated with four reconstruction techniques: BS, BD, RIF, and RIMM. Two
radiologists, blinded to the applied reconstruction type, then evaluated
the entire coronary tree of each sample using the 15-segment American
Heart Association model and the six-grade Likert scale. Results Of the 345
analyzed coronary segments, the RIMM technique showed a significant number
of images with reliable diagnostic quality (n=228, 66%) as compared to RIF
(P=0.002) and BS/BD reconstructions (P<0.001). Per coronary segment,
vessel, and patient, the RIMM technique scored significantly better than
the conventional BS/BD reconstructions (P=0.003) and better than the RIF
reconstructions with regard to the right coronary artery (P=0.041).
Conclusions This new technique works: Using RIMM on the worst CT images
substantially erased many of these artifacts, thereby enabling the
radiologists to clearly visualize these segments. As RIMM considerably
eliminates artifacts, this new CT reconstruction technique can help make a
fast reliable evaluation of a patient's coronary tree. Thus, this enhanced
visualization of cardiac images by RIMM avoids the need for further
invasive diagnostic procedures. Copyright &#xa9; 2017

<33>
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.

<34>
Accession Number
613853744
Author
El-Mashad A.E.-R.; El-Mahdy H.; El Amrousy D.; Elgendy M.
Institution
(El-Mashad, El-Mahdy, El Amrousy, Elgendy) Pediatric Department, Tanta
University Hospital, Elgeish street, Tanta, Egypt
Title
Comparative study of the efficacy and safety of paracetamol, ibuprofen,
and indomethacin in closure of patent ductus arteriosus in preterm
neonates.
Source
European Journal of Pediatrics. 176 (2) (pp 233-240), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
In this prospective study, we compared the efficacy and side effects of
indomethacin, ibuprofen, and paracetamol in patent ductus arteriosus (PDA)
closure in preterm neonates. Three hundred preterm neonates with
hemodynamically significant PDA (hs-PDA) admitted at our neonatal
intensive care unit were enrolled in the study. They were randomized into
three groups. Group I (paracetamol group) received 15 mg/kg/6 h IV
paracetamol infusion for 3 days. Group II (ibuprofen group) received 10
mg/kg IV ibuprofen infusion followed by 5 mg/kg/day for 2 days. Group III
(indomethacin group) received 0.2 mg/kg/12 h indomethacin IV infusion for
three doses. Laboratory investigations such as renal function test, liver
function test, complete blood count, and blood gases were conducted in
addition to echocardiographic examinations. All investigations were done
before and 3 days after treatment. There was no significant difference
between all groups regarding efficacy of PDA closure (P = 0.868). There
was a significant increase in serum creatinine levels and serum blood urea
nitrogen (BUN) in the ibuprofen and indomethacin groups (P < 0.001). There
was a significant reduction in platelet count and urine output (UOP) in
both ibuprofen and indomethacin groups (P < 0.001). There was a
significant increase in bilirubin levels in only the ibuprofen group (P =
0.003). No significant difference of hemoglobin (HB) level or liver
enzymes in all groups (P > 0.05). Ventilatory settings improved
significantly in patients with successful closure of PDA than those with
failed PDA closure (P < 0.001). Conclusion: Paracetamol is as effective as
indomethacin and ibuprofen in closure of PDA in preterm neonates and has
less side effects mainly on renal function, platelet count, and GIT
bleeding.What is Known:* Hemodynamically significant patent ductus
arteriosus has many complications for preterm and low birth weight
neonates and better to be closed. Many drugs were used for medical closure
of PDA e.g. indomethacin, ibuprofen and recently paracetamol. Many studies
compare safety and efficacy of paracetamol with either indomethacin or
ibuprofen.What is New:* It is the first large study that compares the
efficacy and side effects of the three drugs in one study. Copyright
&#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<35>
Accession Number
613915057
Author
Fan Y.; Chen Y.; Wan Z.; Zhou D.; Ma A.
Institution
(Fan, Chen, Wan, Zhou, Ma) Department of Cardiovascular Medicine, First
Affiliated Hospital of Medical College, Xi'an Jiaotong University,
Institute of Cardiovascular Channelopathy, Key Laboratory of Environment
and Genes Related to Diseases of Ministry of Education, Key Laboratory of
Molecular Cardiology of Shaanxi Province, 277 Yanta West Road, Xi'an,
Shaanxi 710061, China
Title
The prognostic value of autoantibodies against beta1-adrenoceptor and
cardiac troponin-I for clinical outcomes in STEMI.
Source
Journal of Cardiovascular Medicine. 18 (1) (pp 34-41), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims: The prevalence and potential role of autoantibodies against the
beta1-adrenoceptor autoantibody (beta1-aab) and cardiac troponin-I
(anti-cTnI) in patients with ST-elevation myocardial infarction (STEMI)
are unknown. The aim of this study is to test whether beta1-aab and
anti-cTnI are prevalent in STEMI patients and to investigate their
prognostic value for left ventricular remodeling and clinical outcomes in
STEMI patients. Methods: This study included 491 patients with first STEMI
at two centers. Serum samples were obtained. beta1-aab and anti-cTnI were
detected by enzyme-linked immunoabsorbent assay. Echocardiographic
assessments were performed at admission and following 1 year. The major
adverse cardiovascular events (MACEs) were evaluated during a median
follow-up period of 37 months. Results: The positive rates of beta1-aab
and anti-cTnI in STEMI patients were 39.1 and 19.1%, respectively. The
extent of left ventricular remodeling correlated with the presence of
beta1-aab and/or anti-cTnI (double positive > single positive > double
negative). Logistic regression revealed that both beta1-aab [odds ratio
(OR) 2.298, 95% confidence interval (CI) 1.561-3.384, P<0.001] and
anti-cTnI (OR 2.389, 95% CI 1.460-3.909, PU0.001) were predictive of left
ventricular remodeling. Cox proportional-hazard regression revealed that
beta1-aab, but not anti-cTnI, was strongly predictive of MACEs (hazard
ratio 1.802, 95% CI 1.301-2.496, P<0.001). Conclusion: beta1-aab and
anti-cTnI were prevalent in STEMI patients. Both beta1-aab and anti-cTnI
were independent predictors of left ventricular remodeling, whereas only
beta1-aab was an independent predictor of MACEs. Our findings suggest that
beta1-aab and anti-cTnI may actively participate in the process of left
ventricular remodeling after STEMI. Copyright &#xa9; 2017 Italian
Federation of Cardiology. All rights reserved.

<36>
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.

<37>
Accession Number
614039898
Author
Myles P.S.; Smith J.A.; Forbes A.; Silbert B.; Jayarajah M.; Painter T.;
Cooper D.J.; Marasco S.; McNeil J.; Bussieres J.S.; McGuinness S.; Byrne
K.; Chan M.T.V.; Landoni G.; Wallace S.
Institution
(Myles, Cooper, Marasco, Wallace) Department of Anaesthesia and
Perioperative Medicine, Alfred Hospital, Commercial Rd., Melbourne, VIC
3004, Australia
(Myles, Smith, Forbes, Jayarajah, Cooper, Marasco, Wallace) Monash
University, Melbourne, VIC, Australia
(Silbert) St. Vincent's Hospital, Fitzroy, VIC, Australia
(Painter) Royal Adelaide Hospital, Adelaide, SA, Australia
(McNeil) South West Cardiac Centre, Derriford Hospital, Plymouth, United
Kingdom
(Bussieres) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
(McGuinness) Auckland Hospital, Auckland, New Zealand
(Byrne) Waikato Hospital, Hamilton, New Zealand
(Chan) Chinese University of Hong Kong, Hong Kong, Hong Kong
(Landoni) Istituto di Ricovero e Cura A Carattere Scientifico San Raffaele
and Vita-Salute, San Raffaele University, Milan, Italy
Title
Tranexamic acid in patients undergoing coronary-artery surgery.
Source
New England Journal of Medicine. 376 (2) (pp 136-148), 2017. Date of
Publication: 12 Jan 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Tranexamic acid reduces the risk of bleeding among patients
undergoing cardiac surgery, but it is unclear whether this leads to
improved outcomes. Furthermore, there are concerns that tranexamic acid
may have prothrombotic and proconvulsant effects. METHODS In a trial with
a 2-by-2 factorial design, we randomly assigned patients who were
scheduled to undergo coronary-artery surgery and were at risk for
perioperative complications to receive aspirin or placebo and tranexamic
acid or placebo. The results of the tranexamic acid comparison are
reported here. The primary outcome was a composite of death and thrombotic
complications (nonfatal myocardial infarction, stroke, pulmonary embolism,
renal failure, or bowel infarction) within 30 days after surgery. RESULTS
Of the 4662 patients who were enrolled and provided consent, 4631
underwent surgery and had available outcomes data; 2311 were assigned to
the tranexamic acid group and 2320 to the placebo group. A primary outcome
event occurred in 386 patients (16.7%) in the tranexamic acid group and in
420 patients (18.1%) in the placebo group (relative risk, 0.92; 95%
confidence interval, 0.81 to 1.05; P = 0.22). The total number of units of
blood products that were transfused during hospitalization was 4331 in the
tranexamic acid group and 7994 in the placebo group (P<0.001). Major
hemorrhage or cardiac tamponade leading to reoperation occurred in 1.4% of
the patients in the tranexamic acid group and in 2.8% of the patients in
the placebo group (P = 0.001), and seizures occurred in 0.7% and 0.1%,
respectively (P = 0.002 by Fisher's exact test). CONCLUSIONS Among
patients undergoing coronary-artery surgery, tranexamic acid was
associated with a lower risk of bleeding than was placebo, without a
higher risk of death or thrombotic complications within 30 days after
surgery. Tranexamic acid was associated with a higher risk of
postoperative seizures. (Funded by the Australian National Health and
Medical Research Council and others; ATACAS Australia New Zealand Clinical
Trials Registry number, ACTRN12605000557639.). Copyright &#xa9; 2017
Massachusetts Medical Society.

<38>
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.

<39>
Accession Number
613497694
Author
Liu X.; Zhang K.; Wang W.; Xie G.; Cheng B.; Wang Y.; Hu Y.; Fang X.
Institution
(Liu, Zhang, Wang, Xie, Cheng, Wang, Fang) Departments of Anesthesiology
and Intensive Care Unit, First Affiliated Hospital, School of Medicine,
Zhejiang University, Hangzhou, Zhejiang, China
(Hu) Anesthesiology, Children's Hospital, School of MedicineZhejiang
University, Hangzhou, Zhejiang, China
Title
Dexmedetomidine Versus Propofol Sedation Improves Sublingual
Microcirculation After Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1509-1515),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives To compare the effects of dexmedetomidine and propofol on
sublingual microcirculation in patients after cardiac surgery. Design A
prospective, randomized, single-blind study. Setting University hospital.
Participants Adult patients undergoing elective valve surgery with
cardiopulmonary bypass. Interventions On arrival in the intensive care
unit (ICU), patients were assigned randomly to receive either
dexmedetomidine (0.2-1.5 mug/kg/h) or propofol (5-50 mug/kg/min) with
open-label titration to a target Richmond Agitation-Sedation Scale of 0 to
-3. Measurements and Main Results Sublingual microcirculation was recorded
using sidestream dark-field imaging at ICU admission (baseline [T1]) and 4
hours (T2) and 24 hours after ICU admission (T3). At T2, median changes in
perfused small-vessel density and the De Backer score from baseline were
significantly greater in the dexmedetomidine group (n = 29) than in the
propofol group (n = 32) (1.3 v 0 mm/mm², p = 0.025; 0.9 v
-0.1/mm, p = 0.005, respectively); median changes in small-vessel density
and the proportion of perfused small vessels from baseline also tended to
be higher in the dexmedetomidine group compared with the propofol group
(1.0 v -0.1 mm/mm², p = 0.050; 2.1% v 0.5%, p = 0.062,
respectively). At T3, there still was a trend toward greater improvements
in the small-vessel density, proportion of perfused small-vessels,
perfused small-vessel density, and De Backer score from baseline in the
dexmedetomidine group than in the propofol group. Conclusions This trial
demonstrated that dexmedetomidine sedation may be better able to improve
microcirculation in cardiac surgery patients during the early
postoperative period compared with propofol. Copyright &#xa9; 2016

<40>
Accession Number
613497553
Author
Ushio M.; Egi M.; Wakabayashi J.; Nishimura T.; Miyatake Y.; Obata N.;
Mizobuchi S.
Institution
(Ushio) Department of Anesthesia, Kakogawa West City Hospital, Kakogawa
City, Hyogo, Japan
(Egi, Wakabayashi, Nishimura, Obata, Mizobuchi) Department of
Anesthesiology, Kobe University Hospital, Kobe City, Hyogo, Japan
(Miyatake) Department of Surgery Related, Kobe University Graduate School
of Medicine, Kobe City, Hyogo 650-0017, Japan
Title
Impact of Milrinone Administration in Adult Cardiac Surgery Patients:
Updated Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1454-1460),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objective To determine the effects of milrinone on short-term mortality in
cardiac surgery patients with focus on the presence or absence of
heterogeneity of the effect. Design A systematic review and meta-analysis.
Setting and Participants Five hundred thirty-seven adult cardiac surgery
patients from 12 RCTs. Interventions Milrinone administration.
Measurements and Main Results The authors conducted a systematic Medline
and Pubmed search to assess the effect of milrinone on short-term
mortality in adult cardiac surgery patients. Subanalysis was performed
according to the timing for commencement of milrinone administration and
the type of comparators. The primary outcome was any short-term mortality.
Overall analysis showed no difference in mortality rates in patients who
received milrinone and patients who received comparators (odds ratio =
1.25, 95% CI 0.45-3.51, p = 0.67). In subanalysis for the timing to
commence milrinone administration and the type of comparators, odds ratio
for mortality varied from 0.19 (placebo as control drug, start of
administration after cardiopulmonary bypass) to 2.58 (levosimendan as
control drug, start of administration after cardiopulmonary bypass).
Conclusions Among RCTs to assess the effect of milrinone administration in
adult cardiac surgery patients, there are wide variations of the odds
ratios of administration of milrinone for short-term mortality according
to the comparators and the timing of administration. This fact may suggest
that a simple pooling meta-analysis is not applicable for assessing the
risk and benefit of milrinone administration in an adult cardiac surgery
cohort. Copyright &#xa9; 2016 Elsevier Inc.

<41>
Accession Number
613497551
Author
Freiermuth D.; Mets B.; Bolliger D.; Reuthebuch O.; Doebele T.; Scholz M.;
Gregor M.; Haschke M.; Seeberger M.D.; Fassl J.
Institution
(Freiermuth, Bolliger, Gregor, Seeberger, Fassl) Department of
Anesthesiology and Intensive Care Medicine, University Hospital Basel,
Basel, Switzerland
(Mets) Department of Anesthesiology and Perioperative Medicine, Penn State
Hershey Medical Center, Hershey, PA, United States
(Reuthebuch, Doebele) Division of Cardiac Surgery, Department of Surgery,
University Hospital Basel, Basel, Switzerland
(Scholz) Institute of Medical Informatics, Statistics and Epidemiology,
University Leipzig, Leipzig, Germany
(Haschke) Division of Clinical Pharmacology and Toxicology, University
Hospital Basel, Basel, Switzerland
(Seeberger) Institute of Anesthesia and Intensive Care Medicine, Klinik
Hirslanden Zurich, Zurich, Switzerland
Title
Sevoflurane and Isoflurane-Pharmacokinetics, Hemodynamic Stability, and
Cardioprotective Effects During Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1494-1501),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives This study aimed to evaluate the pharmacokinetic profiles of
sevoflurane and isoflurane during use of minimized extracorporeal
circulation to perform coronary artery bypass graft surgery. Furthermore,
cardiovascular stability during bypass and the postoperative release of
troponins were evaluated. Design Prospective, randomized study. Setting
University hospital. Participants The study comprised 31 adult patients
undergoing coronary artery bypass grafting. Interventions The
pharmacokinetic measurements of the concentration of the volatile
anesthetics in the arterial and venous blood, air inlet, air outlet, and
gas exhaust of the extracorporeal circulation were recorded. Secondary
end-points were cardiovascular stability during bypass, amount of
postoperative release of troponin, time to extubation, time to discharge
from the intensive care unit and the hospital, and 30-day mortality.
Measurements and Main Results Thirty patients completed the protocol. The
pharmacokinetics of isoflurane and sevoflurane were almost identical, with
a rapid wash-in (time to reach 50% of arterial steady state) concentration
of 0.87+/-0.97 minutes and 1.14+/-0.35 minutes for isoflurane and
sevoflurane, respectively, and a biphasic venous elimination with a
terminal half-life of approximately 10 minutes for both compounds. There
was a correlation between the gas inlet and the gas exhaust of the
extracorporeal circulation. No difference in cardiovascular stability was
found. High-sensitivity troponin concentrations on the first postoperative
morning were 0.355+/-0.312 micro&#32;g/mL and 0.225+/-0.111 micro&#32;g/mL
in the isoflurane and sevoflurane groups, respectively (p = 0.147).
Conclusions The study found similar pharmacokinetics regarding wash-in and
wash-out for sevoflurane and isoflurane. In addition, no difference in
cardiovascular stability was found. The markers of cardiac damage were not
different between the two anesthetics. Based on these data, sevoflurane
and isoflurane might be used equivalently in patients undergoing coronary
artery bypass graft surgery with extracorporeal circulation. Copyright
&#xa9; 2016 Elsevier Inc.

<42>
Accession Number
613485579
Author
Piccolo R.; Galasso G.; Eitel I.; Dominguez-Rodriguez A.; Iversen A.Z.; Gu
Y.L.; Abreu-Gonzalez P.; de Smet B.J.G.L.; Esposito G.; Windecker S.;
Thiele H.; Piscione F.
Institution
(Piccolo, Windecker) Department of Cardiology, Bern University Hospital,
Bern, Switzerland
(Galasso, Piscione) Department of Medicine and Surgery, University of
Salerno, Salerno, Italy
(Eitel, Thiele) University Heart Center Lubeck, Medical Clinic II,
University of Lubeck, Lubeck, Germany
(Dominguez-Rodriguez) Hospital Universitario de Canarias, Facultad de
Ciencias de la Salud, Department of Cardiology, Universidad Europea de
Canarias Tenerife, Spain
(Iversen) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Gu) Department of Cardiology, Thorax Center, University Medical Center
Groningen, Groningen, Netherlands
(Abreu-Gonzalez) Department of Physiology, Universidad de La Laguna,
Tenerife, Spain
(de Smet) Department of Cardiology, Meander Medisch Centrum, Amersfoort,
Netherlands
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
Title
Pooled Analysis Comparing the Efficacy of Intracoronary Versus Intravenous
Abciximab in Smokers Versus Nonsmokers Undergoing Primary Percutaneous
Coronary Revascularization for Acute ST-Elevation Myocardial Infarction.
Source
American Journal of Cardiology. 118 (12) (pp 1798-1804), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cigarette smokers with ST-segment elevation myocardial infarction (STEMI)
may present different response to potent antithrombotic therapy compared
to nonsmokers. We assessed the impact of smoking status and intracoronary
abciximab in patients with STEMI undergoing primary percutaneous coronary
intervention (PCI). We pooled data from 5 randomized trials comparing
intracoronary versus intravenous abciximab bolus in patients undergoing
primary PCI. The primary end point was the composite of death or
reinfarction at a mean follow-up of 292 +/- 138 days. Of 3,158
participants, 1,369 (43.3%) were smokers, and they had a lower risk of the
primary end point in crude, but not in adjusted analyses (hazard ratio
[HR] 0.87, 95% confidence interval [CI] 0.63 to 1.21, p = 0.405).
Intracoronary versus intravenous abciximab was associated with a
significant reduction in the risk of primary end point among smokers (3.6%
vs 8.0%; HR 0.43, 95% CI 0.26 to 0.72, p = 0.001), but not in nonsmokers
(10.2% vs 9.9%; HR 0.99, 95% CI 0.72 to 1.36, p = 0.96), with a
significant interaction (p = 0.009). Furthermore, intracoronary abciximab
decreased the risk of reinfarction in smokers (HR 0.30, 95% CI 0.15 to
0.62, p = 0.001), with no difference in nonsmokers (HR 1.20, 95% CI 0.71
to 2.01, p = 0.50). Stent thrombosis was lowered by intracoronary
abciximab in smokers (HR 0.28, 95% CI 0.06 to 0.66, p = 0.009), but was
ineffective in nonsmokers (HR 1.04, 95% CI 0.54 to 2.00, p = 0.903).
Interaction testing showed heterogeneity in treatment effect for
reinfarction (p = 0.002) and stent thrombosis (p = 0.018) according to
smoking status. In conclusion, among patients with STEMI undergoing
primary PCI, smoking status did not affect the adjusted risk of clinical
events. Intracoronary abciximab bolus improved clinical outcomes by
reducing the risk of death or reinfarction. Copyright &#xa9; 2016 Elsevier
Inc.

<43>
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.

<44>
Accession Number
614105930
Author
Divers C.; Platt D.; Wang E.; Lin J.; Lingohr-Smith M.; Mathai S.C.
Institution
(Divers, Platt, Wang) Bayer HealthCare Pharmaceuticals, Whippany, NJ,
United States
(Lin, Lingohr-Smith) Novosys Health, Green Brook, NJ, United States
(Mathai) Johns Hopkins University School of Medicine, Baltimore, MD,
United States
Title
A review of clinical trial endpoints of patients with pulmonary arterial
hypertension and chronic thromboembolic pulmonary hypertension and how
they relate to patient outcomes in the United States.
Source
Journal of Managed Care and Specialty Pharmacy. 23 (1) (pp 92-104), 2017.
Date of Publication: 2017.
Publisher
Academy of Managed Care Pharmacy (AMCP) (E-mail: tfaggen@amcp.org)
Abstract
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary
hypertension (CTEPH) are subgroups of pulmonary hypertension and are
considered rare diseases. Understanding how endpoints of clinical trials
(and patient registry studies) of patients with PAH and CTEPH are
associated with patient outcomes is important in order to address the
concerns of patients, health care providers, decision makers, and payers.
The purpose of this review was to examine how endpoints used in clinical
trials and patient registry studies are associated with outcomes of
patients with PAH and CTEPH. A PubMed literature search was conducted to
retrieve published studies, including randomized phase III clinical trials
and observational studies, from years 2000 to May 2015 that evaluated the
associations between change in 6-minute walking distance (6MWD), 6MWD
thresholds, change in World Health Organization functional class (WH0-FC),
and time to clinical worsening with outcomes of patients with PAH and
CTEPH. Based on this review of published literature, a reduction in 6MWD
as a criterion for PAH worsening, a deterioration in WH0-FC, and delay in
the time to clinical worsening are clinically meaningful trial endpoints
and are associated with outcomes of patients with PAH and CTEPH.
Utilization and standardization of these endpoints will be useful for
comparing interventions of clinical trials and therapies. Hospitalizations
are frequent among patients with PAH and CTEPH, and total health care
costs are high. From a U.S. payer perspective, clinical worsening is an
important composite endpoint in that it includes hospitalization, which
can be transformed into a preventative cost value associated with
efficacious treatment of patients with PAH and CTEPH. In view of the
greater number of medications available to treat PAH, the introduction of
the first approved therapy to treat CTEPH, and the increasing use of
combination pharmacotherapy, reliable prognostic markers of treatment
responsiveness are important to help guide appropriate management. As new
clinical trials and observational studies are conducted, it will be
important to maintain universal endpoints so that health care providers,
decision makers, and payers can better understand the value of targeted
pharmacotherapies and combination therapies for the treatment of patients
with PAH and CTEPH. Copyright &#xa9; 2017, Academy of Managed Care
Pharmacy.

<45>
Accession Number
613579638
Author
Schuyler Jones W.; Baumgartner I.; Hiatt W.R.; Heizer G.; Conte M.S.;
White C.J.; Berger J.S.; Held P.; Katona B.G.; Mahaffey K.W.; Norgren L.;
Blomster J.; Millegard M.; Reist C.; Patel M.R.; Fowkes F.G.R.
Institution
(Schuyler Jones, Heizer, Reist, Patel) Duke Clinical Research Institute,
Duke University, School of Medicine, Department of Medicine, Box 3330,
Durham, NC 27710, United States
(Baumgartner) Swiss Cardiovascular Centre, Inselspital, Bern University
Hospital, University of Bern, Switzerland
(Hiatt) University of Colorado, School of Medicine, CPC Clinical Research,
Aurora, United States
(Conte) Department of Surgery, University of California San Francisco,
United States
(White) Department of Cardiology, Ochsner Clinical School, University of
Queensland, Australia
(White) Ochsner Medical Center, New Orleans, LA, United States
(Berger) Departments of Medicine and Surgery, New York University, School
of Medicine, United States
(Held, Blomster, Millegard) AstraZeneca Gothenburg, Molndal, Sweden
(Katona) AstraZeneca Gaithersburg, MD, United States
(Mahaffey) Stanford Center for Clinical Research, Stanford University,
School of Medicine, CA, United States
(Norgren) Faculty of Medicine and Health, Orebro University, Sweden
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, United Kingdom
Title
Ticagrelor Compared with Clopidogrel in Patients with Prior Lower
Extremity Revascularization for Peripheral Artery Disease.
Source
Circulation. 135 (3) (pp 241-250), 2017. Date of Publication: 17 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: In patients with symptomatic peripheral artery disease with a
history of limb revascularization, the optimal antithrombotic regimen for
long-term management is unknown. Methods: The EUCLID trial (Examining Use
of Ticagrelor In PAD) randomized 13 885 patients with peripheral artery
disease to treatment with ticagrelor 90 mg twice daily or clopidogrel 75
mg daily. Patients were enrolled based on an abnormal ankle-brachial index
<0.80 or a previous lower extremity revascularization. This analysis
focuses on the 7875 (57%) patients enrolled based on the previous lower
extremity revascularization criterion. Patients could not be enrolled
within 30 days of most recent revascularization, and patients with an
indication for dual antiplatelet therapy were excluded. The primary
efficacy end point was a composite of cardiovascular death, myocardial
infarction, or ischemic stroke. The primary safety end point was major
bleeding. Results: Patients with a previous revascularization had a mean
age of 66 years, 73% were male, and the median baseline ankle-brachial
index was 0.78. After adjustment for baseline characteristics, patients
enrolled based on previous revascularization had similar rates of the
primary composite end point (hazard ratio [HR] 1.10, 95% confidence
interval [CI] 0.98-1.23, P=0.12) and statistically significantly higher
rates of myocardial infarction (HR 1.29, 95% CI 1.08-1.55, P=0.005) and
acute limb ischemia (HR 4.23, 95% CI 2.86-6.25, P<0.001) when compared
with patients enrolled based on ankle-brachial index criteria. No
differences in ticagrelor- versus clopidogrel-treated patients were found
for the primary efficacy end point (11.4% vs 11.3%; HR 1.01, 95% CI
0.88-1.15; P=0.90), all-cause mortality (9.2% vs 9.2%; HR 0.99, 95% CI
0.86-1.15; P=0.93), acute limb ischemia (2.5% vs 2.5%; HR 1.03, 95% CI
0.78-1.36; P=0.84), or major bleeding (1.9% vs 1.8%; HR 1.15, 95% CI
0.83-1.59; P=0.41). The median duration of follow-up was =30 months.
Conclusions: After adjustment for baseline characteristics, patients
enrolled based on previous revascularization for peripheral artery disease
had higher rates of myocardial infarction and acute limb ischemia, with
similar composite rates of cardiovascular death, myocardial infarction,
and stroke when compared with patients enrolled based on the
ankle-brachial index criterion. No significant differences were found
between ticagrelor and clopidogrel for reduction of cardiovascular or
acute limb events. Copyright &#xa9; 2017 American Heart Association, Inc.

<46>
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.

<47>
Accession Number
614078988
Author
Smits P.C.; Assaf A.; Richardt G.; Omerovic E.; Abdel-Wahab M.; Neumann
F.-J.
Institution
(Smits, Assaf) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Richardt, Abdel-Wahab) Herzzentrum Segeberger Kliniken, Bad Segeberg,
Germany
(Omerovic) University of Gothenburg, Goteborg, Sweden
(Neumann) Herzzentrum Bad Krozingen, Bad Krozingen, Germany
Title
Design and rationale of the COMPARE-ACUTE trial: Fractional flow
reserve-guided primary multivessel percutaneous coronary intervention to
improve guideline indexed actual standard of care for treatment of
ST-elevation myocardial infarction in patients with multivessel coronary
disease.
Source
American Heart Journal. 186 (pp 21-28), 2017. Date of Publication: 01 Apr
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
What the best strategy is for nonculprit lesions in ST-elevation
myocardial infarction (STEMI) patients presenting with multivessel disease
remains a clinical dilemma. Based on recent clinical studies suggesting
that complete revascularization in the acute phase is beneficial, the
European Society of Cardiology and American College of Cardiology/American
Heart Association guidelines have been recently changed from class 3
discouragement to a class 2B recommendation concerning the treatment of
the nonculprit lesions in the acute index procedure. However, in these
recent studies, nonculprit lesion treatment was guided by angiography,
which is known for its poor accuracy in determining ischemia. Fractional
flow reserve (FFR) guidance for treatment of nonculprit vessels seems to
be a reasonable approach, and in the acute setting of STEMI, it is not yet
investigated. The COMPARE-ACUTE trial aims to investigate FFR-guided
complete revascularization in comparison to a culprit lesion
treatment-only strategy in STEMI patients with multivessel disease
presenting for primary percutaneous coronary intervention. Methods and
results COMPARE-ACUTE is an investigator-initiated, prospective
multicenter randomized controlled trial. After successful primary
percutaneous coronary intervention, patients will be randomized in a 1:2
fashion toward FFR-guided complete revascularization or culprit lesion
treatment-only strategies. The chosen primary end point is a composite of
all-cause mortality, nonfatal myocardial infarction, any
revascularization, and cerebrovascular events (major adverse cardiac and
cerebrovascular events) at 12 months, with 3-year follow-up. Based on
estimated event rates, a sample size of 885 patients is needed to show
superiority of the FFR-guided revascularization with 80% power. Conclusion
The aim of the COMPARE-ACUTE trial is to assess whether FFR-guided
complete revascularization in the acute setting is superior to culprit
lesion treatment-only therapy. Copyright &#xa9; 2017 The Authors

<48>
Accession Number
613274103
Author
Quyyumi A.A.; Vasquez A.; Kereiakes D.J.; Klapholz M.; Schaer G.L.;
Abdel-Latif A.; Frohwein S.; Henry T.D.; Schatz R.A.; DIb N.; Toma C.;
Davidson C.J.; Barsness G.W.; Shavelle D.M.; Cohen M.; Poole J.; Moss T.;
Hyde P.; Kanakaraj A.M.; Druker V.; Chung A.; Junge C.; Preti R.A.; Smith
R.L.; Mazzo D.J.; Pecora A.; Losordo D.W.
Institution
(Quyyumi, Poole) Emory Clinical Cardiovascular Research Institute,
Cardiology Division, Emory University School of Medicine, 1364 Clifton Rd
NE, Atlanta, GA 30322, United States
(Poole) Athens Regional Cardiology, GA, United States
(Vasquez) Division of Cardiology, Huntsville Hospital, Huntsville, AL,
United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Klapholz) Rutgers University, New Jersey Medical School, Newark, United
States
(Schaer) Division of Cardiology, Rush University Medical Center, Chicago,
IL, United States
(Abdel-Latif) Department of Medicine, Division of Cardiology, University
of Kentucky, Lexington, United States
(Frohwein) Emory St. Joseph's Hospital, Atlanta, GA, United States
(Henry) Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles,
CA, United States
(Schatz) Scripps Health, San Diego, CA, United States
(DIb) Heart Sciences Center, Gilbert, AZ, United States
(Toma) University of Pittsburgh Medical Center, PA, United States
(Davidson) Bluhm Cardiovascular Institute Northwestern Memorial Hospital,
Chicago, IL, United States
(Barsness) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Shavelle) Cardiovascular Medicine, University of Southern California, Los
Angeles, CA, United States
(Cohen) Westchester Heart and Vascular, Westchester Medical Center,
Valhalla, NY, United States
(Moss, Hyde, Kanakaraj, Druker, Chung, Junge, Preti, Smith, Mazzo, Pecora,
Losordo) Caladrius Biosciences Inc, Basking Ridge, NJ, United States
(Preti) PCT, LLC, A Caladrius Company, Allendale, NJ, United States
Title
PreSERVE-AMI: A Randomized, Double-Blind, Placebo-Controlled Clinical
Trial of Intracoronary Administration of Autologous CD34+ Cells in
Patients with Left Ventricular Dysfunction Post STEMI.
Source
Circulation Research. 120 (2) (pp 324-331), 2017. Date of Publication: 20
Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: Despite direct immediate intervention and therapy,
ST-segment-elevation myocardial infarction (STEMI) victims remain at risk
for infarct expansion, heart failure, reinfarction, repeat
revascularization, and death. Objective: To evaluate the safety and
bioactivity of autologous CD34+ cell (CLBS10) intracoronary infusion in
patients with left ventricular dysfunction post STEMI. Methods and
Results: Patients who underwent successful stenting for STEMI and had left
ventricular dysfunction (ejection fraction<48%) >4 days poststent were
eligible for enrollment. Subjects (N=161) underwent mini bone marrow
harvest and were randomized 1:1 to receive (1) autologous CD34+ cells
(minimum 10 mol/L+/-20% cells; N=78) or (2) diluent alone (N=83), via
intracoronary infusion. The primary safety end point was adverse events,
serious adverse events, and major adverse cardiac event. The primary
efficacy end point was change in resting myocardial perfusion over 6
months. No differences in myocardial perfusion or adverse events were
observed between the control and treatment groups, although increased
perfusion was observed within each group from baseline to 6 months
(P<0.001). In secondary analyses, when adjusted for time of ischemia, a
consistently favorable cell dose-dependent effect was observed in the
change in left ventricular ejection fraction and infarct size, and the
duration of time subjects was alive and out of hospital (P=0.05). At 1
year, 3.6% (N=3) and 0% deaths were observed in the control and treatment
group, respectively. Conclusions: This PreSERVE-AMI (Phase 2, randomized,
double-blind, placebo-controlled trial) represents the largest study of
cell-based therapy for STEMI completed in the United States and provides
evidence supporting safety and potential efficacy in patients with left
ventricular dysfunction post STEMI who are at risk for death and major
morbidity. Copyright &#xa9; 2016 American Heart Association, Inc.

<49>
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

<50>
Accession Number
613213864
Author
Schneider U.; Hofmann C.; Aicher D.; Takahashi H.; Miura Y.; Schafers
H.-J.
Institution
(Schneider, Hofmann, Aicher, Takahashi, Miura, Schafers) Department of
Thoracic and Cardiovascular Surgery, Saarland University Medical Center,
Homburg/Saar, Germany
Title
Suture Annuloplasty Significantly Improves the Durability of Bicuspid
Aortic Valve Repair.
Source
Annals of Thoracic Surgery. 103 (2) (pp 504-510), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier USA
Abstract
Background Isolated repair of the regurgitant bicuspid aortic valve (BAV)
has yielded suboptimal durability, with annular dilatation being important
risk factor for recurrent aortic regurgitation. We hypothesized that
adding a suture annuloplasty (SA) should lead to improved repair
stability. Methods Between July 1999 and September 2014, 268 patients
(mean age, 41 +/- 13 years, 249 male) underwent isolated BAV repair. From
January 2009 to September 2014, 164 consecutive patients (study group)
underwent SA using either braided polyester (n = 37) or expanded
polytetrafluorethylene (PTFE) (n = 127). Patients who underwent surgery
prior to January 2009 served as controls (n = 104). All patients were
followed (98.9% complete, 1 week to 181 months). Results Annular size was
larger in the study group (p < 0.001) and age was lower (p < 0.001). There
were no differences between the groups regarding other clinical data.
Hospital mortality was 0.7% (n = 2), 10-year survival was 94.2%.
Thirty-six patients required valve-related reoperations (8 days to 94
months postoperatively; controls = 32, study = 4). Complications related
to SA (ventricular septal defect, interference with coronary artery)
occurred in 6 (3.7%) patients, in 4 (10.8%) patients with polyester SA and
in 2 (1.6%) patients with PTFE. In the control group freedom from
reoperation at 5 and 10 years was 73.2% and 63.7%, respectively. With SA,
5-year stability was significantly improved to 92.6% (p = 0.0006); it was
96.7% for PTFE versus 83.5% for polyester SA (p = 0.0132). Conclusions
Annular dilatation is a risk factor for failure after repair of
regurgitant BAV. Its elimination through the use of SA significantly
improves repair stability. With PTFE as material for SA optimal repair
stability and minimal local complications are achieved. Copyright &#xa9;
2017 The Society of Thoracic Surgeons

<51>
Accession Number
614028466
Author
Vener D.F.; Gaies M.; Jacobs J.P.; Pasquali S.K.
Institution
(Vener) Department of Anesthesiology, Perioperative and Pain Medicine,
Pediatric Cardiovascular Anesthesia, Texas Children's Hospital, Baylor
College of Medicine, Houston, TX, United States
(Gaies, Pasquali) Department of Pediatric Cardiology, C. S. Mott
Children's Hospital, University of Michigan, Ann Arbor, MI, United States
(Jacobs) Cardiovascular Surgery, Johns Hopkins All Children's Hospital, St
Petersburg, FL, United States
Title
Clinical Databases and Registries in Congenital and Pediatric Cardiac
Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 8 (1) (pp
77-87), 2017. Date of Publication: 01 Jan 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The growth in large-scale data management capabilities and the successful
care of patients with congenital heart defects have coincidentally
paralleled each other for the last three decades, and participation in
multicenter congenital heart disease databases and registries is now a
fundamental component of cardiac care. This manuscript attempts for the
first time to consolidate in one location all of the relevant databases
worldwide, including target populations, specialties, Web sites, and
participation information. Since at least 1,992 cardiac surgeons and
cardiologists began leveraging this burgeoning technology to create
multi-institutional data collections addressing a variety of specialties
within this field. Pediatric heart diseases are particularly well suited
to this methodology because each individual care location has access to
only a relatively limited number of diagnoses and procedures in any given
calendar year. Combining multiple institutions data therefore allows for a
far more accurate contemporaneous assessment of treatment modalities and
adverse outcomes. Additionally, the data can be used to develop outcome
benchmarks by which individual institutions can measure their progress
against the field as a whole and focus quality improvement efforts in a
more directed fashion, and there is increasing utilization combining
clinical research efforts within existing data structures. Efforts are
ongoing to support better collaboration and integration across data sets,
to improve efficiency, further the utility of the data collection
infrastructure and information collected, and to enhance return on
investment for participating institutions. Copyright &#xa9; 2016, &#xa9;
The Author(s) 2016.

<52>
Accession Number
608106073
Author
den Harder A.M.; de Heer L.M.; Maurovich-Horvat P.; Merkely B.; de Jong
P.A.; Das M.; de Wit G.A.; Leiner T.; Budde R.P.J.
Institution
(den Harder, de Jong, Leiner) Department of Radiology, University Medical
Center, P.O. Box 85000, Utrecht 3508GA, Netherlands
(de Heer) Department of Cardiothoracic Surgery, University Medical Center,
P.O. Box 85000, Utrecht 3508GA, Netherlands
(Maurovich-Horvat, Merkely) MTA-SE Cardiovascular Imaging Research Group,
Heart and Vascular Center, Semmelweis University, 68 Varosmajor ut,
Budapest 1122, Hungary
(Das) Department of Radiology, Maastricht University Medical Center, P.O.
Box 5800, Maastricht 6202 AZ, Netherlands
(Das) CARIM School for Cardiovascular Diseases, Maastricht University
Medical Center, P.O. Box 5800, Maastricht 6202AZ, Netherlands
(de Wit) Department of Epidemiology, Julius Center for Health Sciences and
Primary Care, P.O. Box 85000, Utrecht 3508GA, Netherlands
(de Wit) National Institute of Public Health and the Environment, P.O. Box
1, Bilthoven 3720 BA, Netherlands
(Budde) Department of Radiology, Erasmus Medical Center, P.O. Box 2040,
Rotterdam 3000CA, Netherlands
Title
Ultra low-dose chest ct with iterative reconstructions as an alternative
to conventional chest x-ray prior to heart surgery (CRICKET study):
Rationale and design of a multicenter randomized trial.
Source
Journal of Cardiovascular Computed Tomography. 10 (3) (pp 242-245), 2016.
Date of Publication: 01 Jun 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Stroke after cardiac surgery is a severe complication with a
persistently high incidence of 1.4 - 9.7%. Postoperative strokes are
mainly embolic and can be provoked by manipulation and clamping of the
aorta during cardiac surgery, resulting in the mobilization of
atherothrombotic material and calcifications from the aortic wall.
Computed tomography (CT) can offer preoperative visualization of aortic
calcifications with low radiation exposure. We hypothesize that
preoperative knowledge regarding the location and extent of aortic
calcifications can be used to optimize surgical strategy and decrease
postoperative stroke rate. Methods/design The CRICKET study (ultra
low-dose chest CT with iterative reconstructions as an alternative to
conventional chest x-ray prior to heart surgery) is a prospective
multicenter randomized clinical trial to evaluate whether non-contrast
chest CT before cardiac surgery can decrease postoperative stroke rate by
optimizing surgical strategy. Patients scheduled to undergo cardiac
surgery aged 18 years and older are eligible for inclusion. Exclusion
criteria are pregnancy, a chest/cardiac CT in the past three months,
emergency surgery, concomitant or prior participation in a study with
ionizing radiation and unwillingness to be informed about incidental
findings. Subjects (n = 1.724) are randomized between routine care,
including a chest x-ray, or routine care with an additional low dose chest
CT. The primary objective is to investigate whether the postoperative
in-hospital stroke rate is reduced in the CT arm compared to the routine
care arm of the randomized trial. The secondary outcome measures are
altered surgical approach based on CT findings and cost-effectiveness.
Copyright &#xa9; 2016 Society of Cardiovascular Computed Tomography

<53>
Accession Number
614063505
Author
Shojaei S.; Farhadloo R.; Aein A.; Vahedian M.
Institution
(Shojaei) Nekoei Hospital, Qom University of Medical Sciences, Qom, Iran,
Islamic Republic of
(Farhadloo) Qom University of Medical Sciences, Qom, Iran, Islamic
Republic of
(Aein) School of Health, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Vahedian) Clinical Research Development Center, Qom University of Medical
Sciences, Qom, Iran, Islamic Republic of
Title
Effects of the Health Belief Model (HBM)-based educational program on the
nutritional knowledge and behaviors of CABG patients.
Source
Journal of Tehran University Heart Center. 11 (4) (pp 181-186), 2016. Date
of Publication: 2016.
Publisher
Tehran Heart Center (E-mail: abbasi.hesam@gmail.com)
Abstract
Background: Reducing blood pressure through diet decreases the possibility
of heart attacks, and lowering blood cholesterol can reduce the risk of
coronary artery disease. The aim of the present study was to examine the
effects of education based on the Health Belief Model on the dietary
behavior of patients following coronary artery bypass graft surgery (CABG)
at the Heart Surgery Department of Shahid Beheshti Hospital of Qom.
Methods: In this semi-experimental clinical trial, data were collected on
64 patients, at an average age of 59.9 +/- 7.26 years in the intervention
group and 58.5 +/- 7.6 years in the control group. Seventy percent of the
study subjects were male and 30% were female. Intervention and control
groups were given a questionnaire, comprising 56 questions in 5 parts. The
educational intervention was aimed at creating perceived susceptibility
and perceived severity in the intervention group. After 1 month. Both
groups were tested, and the resulting data were analyzed to investigate
the effects of the educational intervention on the nutritional knowledge
and behavior of the patients. Results: According to the results,
educational intervention caused a significant increase in the mean scores
of knowledge (p value = 0.001), perceived severity (p value = 0.007), and
perceived benefits and barriers (p value = 0.003) in the intervention
group but did not cause a significant increase in the mean score of
nutritional behavior (p value = 0.390). Conclusion: Education based on the
Health Belief Model seems to be effective in improving nutritional
knowledge, but more consistent and comprehensive educational programs are
necessary in order to change behavior and improve nutritional behavior.
Copyright &#xa9; 2016, Tehran Heart Center. All rights reserved.

<54>
Accession Number
613742983
Author
Ebadi A.; Kavei P.; Moradian S.T.; Saeid Y.
Institution
(Ebadi) Behavioral Sciences Research Center (BSRC), Nursing Faculty,
Baqiyatallah University of Medical Sciences, Tehran, Iran. Electronic
address: ebadi1347@bmsu.ac.ir
(Kavei) Behavioral Sciences Research Center (BSRC), Nursing Faculty,
Baqiyatallah University of Medical Sciences, Tehran, Iran. Electronic
address: pkavei52@gmail.com
(Moradian) Behavioral Sciences Research Center (BSRC), Nursing Faculty,
Baqiyatallah University of Medical Sciences, Tehran, Iran. Electronic
address: t.moradyan@yahoo.com
(Saeid) Behavioral Sciences Research Center (BSRC), Nursing Faculty,
Baqiyatallah University of Medical Sciences, Tehran, Iran. Electronic
address: yasernurse84@yahoo.com
Title
The effect of foot reflexology on physiologic parameters and mechanical
ventilation weaning time in patients undergoing open-heart surgery: A
clinical trial study.
Source
Complementary therapies in clinical practice. 21 (3) (pp 188-192), 2015.
Date of Publication: 01 Aug 2015.
Abstract
The aim of this study was to investigate the efficacy of foot reflexology
on physiological parameters and mechanical ventilation weaning time in
patients undergoing open-heart surgery. This was a double blind
three-group randomized controlled trial. Totally, 96 patients were
recruited and randomly allocated to the experimental, placebo, and the
control groups. Study groups respectively received foot reflexology,
simple surface touching, and the routine care of the study setting.
Physiological parameters (pulse rate, respiratory rate, systolic and
diastolic blood pressures, mean arterial pressure, percutaneous oxygen
saturation) and weaning time were measured. The study groups did not
differ significantly in terms of physiological parameters (P value >
0.05). However, the length of weaning time in the experimental group was
significantly shorter than the placebo and the control groups (P value <
0.05). The study findings demonstrated the efficiency of foot reflexology
in shortening the length of weaning time. Copyright &#xa9; 2015 Elsevier
Ltd. All rights reserved.

<55>
Accession Number
613740909
Author
Deininger M.O.; Moreira L.F.; Dallan L.A.; Oliveira O.G.; Magalhaes D.M.;
Coelho J.R.; Deininger Ed.; Lopes Nd.eS.; Queiroga R.W.; Belmont E.F.
Institution
(Deininger) Hospital Unimed Joao Pessoa, Joao Pessoa, PB, Brasil
(Moreira) Instituto do Coracao, Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
(Dallan) Instituto do Coracao, Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
(Oliveira) Hospital Unimed Joao Pessoa, Joao Pessoa, PB, Brasil
(Magalhaes) Hospital Unimed Joao Pessoa, Joao Pessoa, PB, Brasil
(Coelho) Hospital Unimed Joao Pessoa, Joao Pessoa, PB, Brasil
(Deininger) Hospital Unimed Joao Pessoa, Joao Pessoa, PB, Brasil
(Lopes) Hospital Unimed Joao Pessoa, Joao Pessoa, PB, Brasil
(Queiroga) Hospital Unimed Joao Pessoa, Joao Pessoa, PB, Brasil
(Belmont) Hospital Unimed Joao Pessoa, Joao Pessoa, PB, Brasil
Title
Comparative analysis of the patency of the internal thoracic artery in the
CABG of left anterior descending artery: 6-month postoperative coronary CT
angiography evaluation.
Source
Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade
Brasileira de Cirurgia Cardiovascular. 29 (2) (pp 192-201), 2014. Date of
Publication: 01 Apr 2014.
Abstract
OBJECTIVE: To assess the patency of the pedicled right internal thoracic
artery with an anteroaortic course and compare it to the patency of the
left internal thoracic artery , in anastomosis to the left anterior
descending artery in coronary artery bypass grafting by using coronary CT
angiography at 6 months postoperatively.
METHODS: Between December 2008 and December 2011, 100 patients were
selected to undergo a prospective coronary artery bypass grafting
procedure without cardiopulmonary bypass. The patients were randomly
divided by a computer-generated list into Group-1 (G-1) and Group-2 (G-2),
comprising 50 patients each, the technique used was known at the beginning
of the surgery. In G-1, coronary artery bypass grafting was performed
using the left internal thoracic artery for the left anterior descending
and the free right internal thoracic artery for the circumflex, and in
G-2, coronary artery bypass grafting was performed using the right
internal thoracic artery pedicled to the left anterior descending and the
left internal thoracic artery pedicled to the circumflex territory.
RESULTS: The groups were similar with regard to the preoperative clinical
data. A male predominance of 75.6% and 88% was observed in G-1 and G-2,
respectively. Five patients migrated from G-1 to G-2 because of
atheromatous disease in the ascending aorta. The average number of distal
anastomoses was 3.48 (SD=0.72) in G-1 and 3.20 (SD=0.76) in G-2. Coronary
CT angiography in 96 re-evaluated patients showed that all ITAs, right or
left, used in situ for the left anterior descending were patent. There
were no deaths in either group.
CONCLUSION: Coronary artery bypass grafting surgery involving anastomosis
of the anteroaortic right internal thoracic artery to the left anterior
descending artery has an outcome similar to that obtained using the left
internal thoracic artery for the same coronary site.

<56>
Accession Number
613719331
Author
Berben L.; Denhaerynck K.; Dobbels F.; Engberg S.; Vanhaecke J.;
Crespo-Leiro M.G.; Russell C.L.; De Geest S.
Institution
(Berben, Denhaerynck, Dobbels, Engberg, Vanhaecke, Crespo-Leiro, Russell,
De Geest) Institute of Nursing Science, University of Basel, Switzerland;
Health Services and Nursing Research, KU Leuven, Belgium
Title
Building research initiative group: chronic illness management and
adherence in transplantation (BRIGHT) study: study protocol.
Source
Journal of advanced nursing. 71 (3) (pp 642-654), 2015. Date of
Publication: 01 Mar 2015.
Abstract
AIM: This article describes the rationale, design and methodology of the
Building research initiative group: chronic illness management and
adherence in transplantation (BRIGHT) study. This study of heart
transplant patients will: (1) describe practice patterns relating to
chronic illness management; (2) assess prevalence and variability of
non-adherence to the treatment regimen; (3) determine the multi-level
factors related to immunosuppressive medication non-adherence.
BACKGROUND: The unaltered long-term prognosis after heart transplantation
underscores an urgent need to identify and improve factors related to
survival outcomes. The healthcare system (e.g. level of chronic illness
management implemented) and patient self-management are major drivers of
outcome improvement.
DESIGN: The study uses a survey design in 40 heart transplant centres
covering 11 countries in four continents.
METHODS: Theoretical frameworks informed variable selection, which are
measured by established and investigator-developed instruments. Heart
transplant recipients, outpatient clinicians and programme's directors
complete a survey. A staged convenience sampling strategy is implemented
in heart transplant centres, countries and continents. Depending on the
centre's size, a random sample of 25-60 patients is selected (N estimated
1680 heart transplant recipients). Five randomly selected clinicians and
the medical director from each centre will be invited to participate.
CONCLUSION: This is the first multi-centre, multi-continental study
examining healthcare system and heart transplant centres chronic illness
management practice patterns and potential correlates of immunosuppressive
medication non-adherence. The knowledge gained will inform clinicians,
researchers and healthcare policy makers at which level(s) interventions
need to be implemented to improve long-term outcomes for transplant
recipients. Copyright &#xa9; 2014 John Wiley & Sons Ltd.

<57>
Accession Number
614190423
Author
Poorolajal J.; Ashtarani F.; Alimohammadi N.
Institution
(Poorolajal) Modeling of Noncommunicable Diseases Research Center and
Department of Epidemiology & Biostatistics, School of Public Health,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Ashtarani) Clinical Research Development Unit of Farshchian Heart Center,
Hamadan University of Medical Sciences, Hamadan 6517838695, Iran, Islamic
Republic of
(Alimohammadi) Department of Nursing, School of Nursing and Midwifery,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
Title
Effect of Benson relaxation technique on the preoperative anxiety and
hemodynamic status: A single blind randomized clinical trial.
Source
Artery Research. 17 (pp 33-38), 2017. Date of Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Preoperative anxiety is a challenge in most surgical
interventions that needs to be taken into consideration. This trial
assessed the effect of relation technique on the anxiety and hemodynamic
response in patients undergoing surgical procedures. Methods This single
blind, randomized clinical trial was conducted on patients who were
candidates for coronary artery bypass graft, coronary angiography,
percutaneous intervention, or general surgery at Ekbatan and Besat
Hospitals, Hamadan University of Medical Sciences, from March to August
2014. Patients were randomly assigned to intervention and control groups.
The intervention group received Benson's relaxation technique, a half an
hour before surgical procedures. The preoperative anxiety and hemodynamic
status (systolic and diastolic blood pressure, pulse pressure, heart rate,
and respiratory rate) were evaluated before and after intervention.
Results Of 166 patients identified, 144 patients enrolled into the study.
No patient declined follow-up. The baseline clinical characteristics of
the patients in the intervention and control groups were nearly the same.
The mean systolic and diastolic blood pressure, pulse pressure, the
average number of heart rates and respiratory rates declined significantly
in the intervention group compared to the control group (P < 0.001). The
mean score of hospital anxiety was significantly lower in the intervention
group than in the control group (P < 0.001). The intervention was
effective in both males and female patients. Conclusion This trial
indicated that Benson's relaxation technique is a safe method with no
adverse effects with significant beneficial effect on preoperative anxiety
and hemodynamic responses in patients who were candidates for surgical
procedures. Trial registration Iranian Registry of Clinical Trials
registration number: IRCT201312249014N19.
http://www.irct.ir/searchresult.php?id=9014&number=19. Copyright &#xa9;
2017 Association for Research into Arterial Structure and Physiology

<58>
Accession Number
614206742
Author
Reyes-Umpierrez D.; Davis G.; Cardona S.; Pasquel F.J.; Peng L.; Jacobs
S.; Vellanki P.; Fayfman M.; Haw S.; Halkos M.; Guyton R.A.; Thourani
V.H.; Umpierrez G.E.
Institution
(Reyes-Umpierrez, Davis, Cardona, Pasquel, Jacobs, Vellanki, Fayfman, Haw,
Umpierrez) Department of Medicine, Diabetes and Endocrinology Section,
Grady Health System, Emory University, School of Medicine, 49 Jesse Hill
Jr. Drive, Atlanta, GA 30303, United States
(Peng) Rollins School of Public Health, Emory University, Atlanta, GA
30303, United States
(Halkos, Guyton, Thourani) Joseph B. Whitehead Department of Surgery,
Emory University, Atlanta, GA 30303, United States
Title
Inflammation and oxidative stress in cardiac surgery patients treated to
intensive versus conservative glucose targets.
Source
Journal of Clinical Endocrinology and Metabolism. 102 (1) (pp 309-315),
2017. Date of Publication: 01 Jan 2017.
Publisher
Endocrine Society (E-mail: mzendell@endo-society.org)
Abstract
Objective: We aimed to determine (a) longitudinal changes of inflammatory
and oxidative stress markers and (b) the association between markers of
inflammation and perioperative complications in coronary artery bypass
surgery (CABG) patients treated with intensive vs conservative blood
glucose (BG) control. Methods: Patients with diabetes (n = 152) and
without diabetes with hyperglycemia (n = 150) were randomized to intensive
(n = 151; BG: 100-140 mg/dL) or to conservative (n = 151; BG: 141-180
mg/dL) glycemic targets. Plasma cortisol, high-sensitivity C-reactive
protein (hsCRP), tumor necrosis factor-a, interleukin-6 (IL-6),
thiobarbituric acid-reactive substances, and 2'-7'-dichlorofluorescein
were measured prior to and at days 3, 5, and 30 after surgery. Results:
Intensive glycemic control resulted in lower mean BG (132 +/- 14 mg/dL vs
154 +/- 17 mg/dL, P < 0.001) in the intensive care unit. Plasma cortisol
and inflammatory markers increased significantly from baseline after the
third and fifth day of surgery (P < 0.001), and returned to baseline
levels at 1month of follow-up. Patients with perioperative complications
had higher levels of cortisol, hsCRP, IL-6, and oxidative stress markers
compared with those without complications. There were no significant
differences in inflammatory and oxidative stress markers between patients,
with or without diabetes or complications, treated with intensive or
conventional glucose targets. Conclusion: We report no significant
differences in circulating markers of acute inflammatory and oxidative
stress response in cardiac surgery patients, with or without diabetes,
treated with intensive (100-140 mg/dL) or conservative (141-180 mg/dL)
insulin regimens. Copyright &#xa9; 2017 by the Endocrine Society.

<59>
Accession Number
614157379
Author
Hojskov I.E.; Moons P.; Hansen N.V.; La Cour So.; Olsen P.S.; Gluud C.;
Winkel P.; Lindschou J.; Thygesen L.C.; Egerod I.; Berg S.K.
Institution
(Hojskov, Olsen, Berg) Department of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Moons) KU Leuven Department of Public Health and Primary Care, KU Leuven,
Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Hansen) Interacting Minds Center, Aarhus University, Aarhus, Denmark
(La Cour) Centre for Research in Existence and Society, University of
Copenhagen, Copenhagen, Denmark
(Gluud, Winkel, Lindschou) Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
(Thygesen) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Egerod) Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
Title
SheppHeartCABG trial-comprehensive early rehabilitation after coronary
artery bypass grafting: A protocol for a randomised clinical trial.
Source
BMJ Open. 7 (1) (no pagination), 2017. Article Number: e013038. Date of
Publication: 01 Jan 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Patients undergoing coronary artery bypass graft surgery
often experience a range of symptoms. Studies indicate that
non-pharmacological interventions such as exercise training and
psychoeducation have a positive physiological and psychological effect in
early outpatient rehabilitation. The SheppHeartCABG trial will investigate
the effect of early comprehensive rehabilitation in early phase
rehabilitation versus usual care. The aim of this paper is to present the
protocol for the SheppHeartCABG trial. Methods/analysis SheppHeartCABG is
an investigator-initiated randomised clinical superiority trial with
blinded outcome assessment, employing 1:1 central randomisation to
rehabilitation plus usual care versus usual care alone. On the basis of a
sample size calculation, 326 patients undergoing coronary artery bypass
grafting will be included from two clinical sites. All patients receive
usual care and patients allocated to the experimental intervention follow
4weeks rehabilitation consisting of an exercise programme,
psycho-educative consultations and a compact mindfulness programme. The
primary outcome is physical function measured by the 6-min walk test. The
secondary outcomes are mental health and physical activity measured by the
Medical Outcome Study Short Form (SF-12), anxiety and depression measured
by the Hospital Anxiety and Depression Scale questionnaire, physical,
emotional and global scores by the HeartQoL questionnaire, sleep measured
by the Pittsburgh Sleep Quality Index, pain measured by the Orebro
Musculoskeletal Screening Questionnaire and muscle endurance measured by
the sit-to-stand test. A number of explorative analyses will also be
conducted. Ethics and dissemination SheppHeartCABG is approved by the
regional ethics committee (no. H-4-2014-109) and the Danish Data
Protection Agency (no. 30-1309) and is performed in accordance with good
clinical practice and the Declaration of Helsinki in its latest form.
Positive, neutral and negative results of the trial will be submitted to
international peer-reviewed journals. Furthermore, results will be
presented at national and international conferences relevant to the
subject fields. Copyright &#xa9; Published by the BMJ Publishing Group
Limited.

<60>
[Use Link to view the full text]
Accession Number
614188736
Author
Kapadia S.R.; Mehran R.; Lazar R.M.; Zivadinov R.; Dwyer M.G.; Jilaihawi
H.; Virmani R.; Thourani V.H.; Chakravarty T.; Nakamura M.; McCabe J.M.;
Szeto W.Y.; Svensson L.; Alu M.C.; White R.M.; Kraemer C.; Parhizgar A.;
Leon M.B.; Makkar R.; Al-Jilaihawi H.; Kapadia S.; Krishnaswamy A.; Tuzcu
E.M.; Mick S.; Kodali S.; Nazif T.; Thourani V.; Babaliaros V.; Devireddy
C.; Mavromatis K.; Waksman R.; Satler L.; Pichard A.; Szeto W.; Anwaruddin
S.; Vallabhajosyula P.; Giri J.; Herrmann H.; Zajarias A.; Lasala J.;
Greenbaum A.; O'Neill W.; Eng M.; Rovin J.; Lin L.; Spriggs D.; Wong
S.-C.; Bergman G.; Salemi A.; Smalling R.; Kar B.; Loyalka P.; Lim D.S.;
Ragosta M.; Reisman M.; McCabe J.; Don C.; Sharma S.; Kini A.; Dangas G.;
Mahoney P.; Morse A.; Stankewicz M.; Rodriguez E.; Linke A.; Mangner N.;
Woitek F.; Frerker C.; Cohen D.
Institution
(Kapadia, Krishnaswamy, Mick, Svensson) Cleveland Clinic, Cleveland, Ohio,
United States
(Kodali, Lazar, Nazif, Alu, Leon) Columbia University Medical Center, New
York, New York, United States
(Makkar, Chakravarty, Nakamura) Cedars-Sinai Medical Center, Los Angeles,
California, United States
(Mehran) Mount Sinai School of Medicine, New York, New York, United States
(Zivadinov, Dwyer) Buffalo Neuroimaging Analysis Center, Buffalo, New
York, United States
(Jilaihawi) NYU Langone Medical Center, New York, New York, United States
(Virmani) CV Path Institute, Gaithersburg, Maryland, United States
(Anwaruddin, Szeto) University of Pennsylvania, Philadelphia,
Pennsylvania, United States
(Thourani) Emory University, Atlanta, Georgia
(Mangner, Woitek, Linke) Herzzentrum Leipzig GmbH-Universitatsklinik,
Leipzig, Germany
(McCabe) University of Washington, Seattle, Washington, United States
(Satler) Medstar Washington Hospital Center, Washington, DC, United States
(Zajarias) Washington University School of Medicine, St. Louis, Missouri,
United States
(White) Duke Clinical Research Institute, Durham, North Carolina, United
States
(Kraemer) NAMSA, Minneapolis, Minnesota, United States
(Parhizgar) Claret Medical, Inc., Santa Rosa, California, United States
(Linke) Leipzig Heart Institute, Leipzig, Germany
Title
Protection Against Cerebral Embolism During Transcatheter Aortic Valve
Replacement.
Source
Journal of the American College of Cardiology. 69 (4) (pp 367-377), 2017.
Date of Publication: 31 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Neurological complications after transcatheter aortic valve
replacement (TAVR) may be reduced with transcatheter cerebral embolic
protection (TCEP). Objectives This study evaluated the safety and efficacy
of TCEP during TAVR. Methods Nineteen centers randomized 363 patients
undergoing TAVR to a safety arm (n = 123), device imaging (n = 121), and
control imaging (n = 119). The primary safety endpoint consisted of major
adverse cardiac and cerebrovascular events (MACCE) at 30 days, and the
primary efficacy endpoint was reduction in new lesion volume in protected
brain territories on magnetic resonance imaging scans at 2 to 7 days.
Patients underwent neurocognitive assessments, and the debris captured was
analyzed. Results The rate of MACCE (7.3%) was noninferior to the
performance goal (18.3%, p<inf>noninferior</inf> < 0.001) and not
statistically different from that of the control group (9.9%; p = 0.41).
New lesion volume was 178.0 mm³ in control subjects and 102.8
mm³ in the device arm (p = 0.33). A post hoc multivariable
analysis identified pre-existing lesion volume and valve type as
predictors of new lesion volume. Strokes at 30 days were 9.1% in control
subjects and 5.6% in patients with devices (p = 0.25) Neurocognitive
function was similar in control subjects and patients with devices, but
there was a correlation between lesion volume and neurocognitive decline
(p = 0.0022). Debris found within filters in 99% of patients included
thrombus, calcification, valve tissue, artery wall, and foreign material.
Conclusions TCEP was safe, captured embolic debris in 99% of patients, and
did not change neurocognitive function. Reduction in new lesion volume on
magnetic resonance scans was not statistically significant. (Cerebral
Protection in Transcatheter Aortic Valve Replacement [SENTINEL];
NCT02214277) Copyright &#xa9; 2017 American College of Cardiology
Foundation

<61>
[Use Link to view the full text]
Accession Number
614188499
Author
Yu Y.; Song Z.; Xu Z.; Ye X.; Xue C.; Li J.; Bi H.
Institution
(Yu, Song, Xu) Department of Cardiac Surgery, Second Military Medical
University, Shanghai 200433, China
(Ye) Department of Statistics, Faculty of Medical Services, Second
Military Medical University, Shanghai 200433, China
(Xue, Li, Bi) Department of Plastic Surgery, Changhai Hospital, Second
Military Medical University, 168 Changhai Road, Shanghai 200433, China
Title
Bilayered negative-pressure wound therapy preventing leg incision
morbidity in coronary artery bypass graft patients A randomized controlled
trial.
Source
Medicine (United States). 96 (3) (no pagination), 2017. Article Number:
e5925. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Backgrounds: The harvesting of great saphenous veins for coronary artery
bypass graft (CABG) patients may result in significant complications,
including lymphorrhagia, lymphoedema, incision infection, wound
dehiscence, and skin flap necrosis. We investigated the function of a
self-designed bilayered negative pressure wound therapy (b-NPWT) for
reducing the above-mentioned complications using a clinical randomized
controlled trial. Methods: A single-center, pilot randomized controlled
trial was conducted. From December 2013 to March 2014, a total of 72
coronary heart disease patients (48 men and 24 women) received CABG
therapy, with great saphenous veins were selected as grafts. Patients were
equally randomized into a treatment and a control group. After the
harvesting of the great saphenous veins and direct closure of the wound
with sutures, b-NPWT was used for the thigh incision in the treatment
group for 5 days (treatment thigh). Traditional surgical pads were applied
to both the shank incisions of the treatment group patients (treatment
shank) and the entire incisions of the control group (control thigh,
control shank). Postoperative complications were recorded and
statistically analyzed based on outcomes of thigh treatment, shank
treatment, thigh control, and shank control groups. Results: The incidence
rates of early complications, such as lymphorrhagia, lymphoedema,
infection, wound dehiscence, and skin flap necrosis, of the vascular donor
site in the thigh treatment group was significantly lower than those in
the 3 other groups. Conclusions: The self-designed b-NPWT can effectively
reduce postoperative complications, such as lymphedema, incision
infection, wound dehiscence, and skin flap necrosis, in CABG patients who
underwent great saphenous veins harvesting. Trial registration:
ClinicalTrials.gov. The unique registration number is NCT02010996.
Abbreviations: b-NPWT = bilayered negative pressure wound therapy, CABG =
coronary artery bypass graft, C-shank = control shank, C-thigh = control
thigh, mmHg = millimetre(s) of mercury, RCT = randomized controlled trial,
SAS = statistic analysis system, T-shank = treatment shank, T-thigh =
treatment thigh. &#xa9; Copyright 2017 the Author(s).

<62>
Accession Number
614204401
Author
Wang N.; Tsai Y.-C.; Niles N.; Tchantchaleishvili V.; Di Eusanio M.; Yan
T.D.; Phan K.
Institution
(Wang, Phan) Department of Medicine, University of Sydney, Sydney,
Australia
(Tsai, Niles, Yan, Phan) The Collaborative Research (CORE) Group,
Macquarie University, Sydney, Australia
(Tchantchaleishvili) Department of Cardiothoracic Surgery, Mayo Clinic,
Rochester, MN, United States
(Di Eusanio) Cardiac Surgery Unit, Cardiovascular Department, 'G. Mazzini'
Hospital Piazza Italia, Teramo, Italy
Title
Transcatheter aortic valve implantation (TAVI) versus sutureless aortic
valve replacement (SUAVR) for aortic stenosis: A systematic review and
meta-analysis of matched studies.
Source
Journal of Thoracic Disease. 8 (11) (pp 3283-3293), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: With improving technologies and an increasingly elderly
populations, there have been an increasing number of therapeutic options
available for patients requiring aortic valve replacement. Recent evidence
suggests that transcatheter aortic valve implantation (TAVI) is one
suitable option for high risk inoperable patients, as well as high risk
operable patients. Sutureless valve technology has also been developed
concurrently, with facilitates surgical aortic valve replacement (SUAVR)
by allow resection and replacement of the native aortic valve with minimal
sutures and prosthesis anchoring required. For patients amenable for both
TAVI and SUAVR, the evidence is unclear with regards to the benefits and
risks of either approach. The objectives are to compare the perioperative
outcomes and intermediate-term survival rates of TAVI and SUAVR in matched
or propensity score matched studies. Methods: A systematic literature
search was performed to include all matched or propensity score matched
studies comparing SUAVR versus TAVI for severe aortic stenosis. A
meta-analysis with odds ratios (OR) and mean differences were performed to
compare key outcomes including paravalvular regurgitation and short and
intermediate term mortality. Results: Six studies met our inclusion
criteria giving a total of 741 patients in both the SUAVR and TAVI arm of
the study. Compared to TAVI, SUAVR had a lower incidence of paravalvular
leak (OR =0.06; 95% CI: 0.03-0.12, P<0.01). There was no difference in
perioperative mortality, however SUAVR patients had significantly better
survival rates at 1 (OR =2.40; 95% CI: 1.40-4.11, P<0.01) and 2 years (OR
=4.62; 95% CI: 2.62-8.12, P<0.01). Conclusions: The present study supports
the use of minimally invasive SUAVR as an alternative to TAVI in high risk
patients requiring aortic replacement. The presented results require
further validation in prospective, randomized controlled studies.
Copyright &#xa9; Journal of Thoracic Disease.

<63>
Accession Number
614135995
Author
Cho J.S.; Soh S.; Shim J.-K.; Kang S.; Choi H.; Kwak Y.-L.
Institution
(Cho, Soh, Shim, Choi, Kwak) Yonsei Cardiovascular Hospital, Yonsei
University College of Medicine, Department of Anesthesiology and Pain
Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
(Shim, Kwak) Yonsei University College of Medicine, Anesthesia and Pain
Research Institute, Seoul, South Korea
(Kang) National Health Insurance Corporation Ilsan Hospital, Department of
Anesthesiology and Pain Medicine, Gyeonggi-do, South Korea
Title
Effect of perioperative sodium bicarbonate administration on renal
function following cardiac surgery for infective endocarditis: A
randomized, placebo-controlled trial.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 3. Date of
Publication: 05 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients with infective endocarditis (IE) have an elevated
risk of renal dysfunction because of extensive systemic inflammation and
use of nephrotoxic antibiotics. In this randomized, placebo-controlled
trial, we investigated whether perioperative sodium bicarbonate
administration could attenuate postoperative renal dysfunction in patients
with IE undergoing cardiac surgery. Methods: Seventy patients randomly
received sodium chloride (n = 35) or sodium bicarbonate (n = 35). Sodium
bicarbonate was administered as a 0.5 mmol/kg loading dose for 1 h
commencing with anesthetic induction, followed by a 0.15 mmol/kg/h
infusion for 23 h. The primary outcome was peak serum creatinine (SCr)
level during the first 48 h postoperatively. The incidence of acute kidney
injury, SCr level, estimated glomerular filtration rate, and major
morbidity endpoints were assessed postoperatively. Results: The peak SCr
during the first 48 h postoperatively (bicarbonate vs. control: 1.01
(0.74, 1.37) mg/dl vs. 0.88 (0.76, 1.27) mg/dl, P = 0.474) and the
incidence of acute kidney injury (bicarbonate vs. control: 29% vs. 23%, P
= 0.584) were similar in both groups. The postoperative increase in SCr
above baseline was greater in the bicarbonate group than in the control
group on postoperative day 2 (0.21 (0.07, 0.33) mg/dl vs. 0.06 (0.00,
0.23) mg/dl, P = 0.028) and postoperative day 5 (0.23 (0.08, 0.36) mg/dl
vs. 0.06 (0.00, 0.23) mg/dl, P = 0.017). Conclusions: Perioperative sodium
bicarbonate administration had no favorable impact on postoperative renal
function and outcomes in patients with IE undergoing cardiac surgery.
Instead, it was associated with possibly harmful renal effects,
illustrated by a greater increase in SCr postoperatively, compared to
control. Trial registration: ClinicalTrials.gov, NCT01920126. Registered
on 31 July 2013. Copyright &#xa9; 2017 The Author(s).

<64>
Accession Number
614153938
Author
Sharma A.; Agrawal S.; Goel S.; Borer J.S.
Institution
(Sharma, Borer) Division of Cardiovascular Medicine, State University of
New York Downstate Medical Center, Brooklyn, New York, NY 11203, United
States
(Sharma) Institute of Cardiovascular Research and Technology, Brooklyn,
NY, United States
(Agrawal) Division of Cardiology, St. Luke's University Health Network,
Bethlehem, PA, United States
(Goel) Department of Cardiology, Maimonides Medical Center, New York, NY,
United States
(Borer) The Howard Gilman Institute for Heart Valve Diseases and the
Schiavone Institute for Cardiovascular Translational Research, State
University of New York Downstate Medical Center, Brooklyn, New York, NY,
United States
Title
Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus
Replacement.
Source
Current Cardiology Reports. 19 (1) (no pagination), 2017. Article Number:
3. Date of Publication: 01 Jan 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Ischemic mitral regurgitation (MR), which occurs in
about 20-30% patients with a prior myocardial infarction, is associated
with worsening heart failure and an increase in cardiovascular mortality.
It should be treated surgically if certain hemodynamic severity criteria
are met and in patients who continue to experience symptoms of heart
failure despite optimal medical therapy. However, current guidelines do
not suggest which of the available approaches to mitral valve
surgery-mitral valve (MV) repair or replacement (MVR) is superior for this
indication. While MV repair is reported to confer improved survival, MVR
may provide higher rates of freedom from recurrent MR. This article
attempts to provide the reader with a comprehensive review and comparison
of current techniques of mitral valve surgery in patients with severe
ischemic MR. Recent Findings: The first randomized trial to compare MV
repair versus MVR in patients with severe ischemic MR, the Cardiothoracic
Surgical Trials Network (CTSN) trial, was recently concluded and reported
no significant difference in the primary outcome of left ventricular end
systolic volume index between the two approaches at either 1- or 2-year
follow-ups. Summary: Data comparing approaches of MV repair and MVR for
ischemic MR is largely limited to small, non-randomized retrospective
trials. The only randomized trial data to examine this issue suggested no
difference in mortality with either MVR or MV repair; however, MVR was
shown to be consistently associated with higher rates of MR recurrence.
Certain echocardiographic features have been reported to predict poor
outcomes with MVR and may help refine the selection of the surgical
approach in the individual patient. Copyright &#xa9; 2017, Springer
Science+Business Media New York.

<65>
Accession Number
614212872
Author
Girish G.; D'souza R.E.; D'souza P.; Lewis M.G.; Baker D.M.
Institution
(Girish) Consultant in general and vascular surgery, Department of General
& Vascular Surgery, Watford General Hospital, Watford, UK
(D'souza, Baker) Consultant in general and vascular surgery, Department of
Vascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation
Trust, London, UK
(D'souza) Research Associate, Social Science Research Unit and
EPPI-Centre, UCL Institute of Education, London, UK
(Lewis) Research scholar, Department of statistics, Public Health
Evidence, South Asia (PHESA), Manipal University, Manipal, India
Title
Role of surgical thoracic sympathetic interruption in treatment of facial
blushing: A systematic review.
Source
Postgraduate Medicine. (pp 1-9), 2017. Date of Publication: 26 Jan 2017.
Publisher
Taylor and Francis Inc. (325 Chestnut St, Suite 800, Philadelphia PA
19106, United States)
Abstract
Objectives: This paper aims to review the evidence to support the
effectiveness of sympathectomy as a treatment for facial blushing in terms
of relief of facial blushing, patient satisfaction, recurrence of
blushing, patients regretting treatment and its associated complications.
Methods: A systematic search strategy was performed in Ovid-Medline,
Embase, Cochrane library and NICE. Studies reporting outcomes of
sympathetic interruption in the treatment of facial blushing were
retrieved. Results: Nine studies met the inclusion criteria with 1369
patients included in the final analysis. The age range of patients was 8
to 74 years (from 7 studies) with 56% females. Mean follow up was 21
months in 8 studies (range 6 to 30 months). The pooled proportion of
patients who had good relief of facial blushing was 78.30% (95% C.I.
58.20% - 98.39%). Complete satisfaction was reported in 84.02% (95% C.I.
71.71% - 96.33%). Compensatory sweating and gustatory sweating were the
commonest complications occurring in 74.18% (95% C.I. 58.10% - 90.26%) and
24.42% (95% C.I. 12.22% - 36.61%) respectively. The estimated proportion
of patients regretting surgery was 6.79% (C.I 2.08% 11.50%). Conclusion:
Sympathetic interruption at T2 or T2-3 ganglia appears to be an effective
treatment for facial blushing. However, lack of randomized trials
comparing sympathetic interruption with non-surgical methods of treatment
and heterogeneity of included studies with respect to assessment of
outcome measures preclude strong evidence and definitive recommendations.
Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor & Francis
Group

<66>
Accession Number
614213565
Author
Anantha Narayanan M.; Aggarwal S.; Reddy Y.N.V.; Alla V.M.; Baskaran J.;
Kanmanthareddy A.; Suri R.M.
Institution
(Anantha Narayanan, Baskaran) Division of Cardiology, Department of
Medicine, University of Minnesota School of Medicine, Minneapolis,
Minnesota, United States
(Aggarwal, Alla, Kanmanthareddy) Division of Cardiology, CHI Health
Creighton University Medical Center, Omaha, Nebraska, United States
(Reddy) Division of Cardiovascular Sciences, Mayo Clinic, Rochester,
Minnesota, United States
(Suri) Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic
Foundation, Cleveland, Ohio, United States
Title
Surgical Repair of Moderate Ischemic Mitral Regurgitation-A Systematic
Review and Meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2016. Date of
Publication: 06 Nov 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Introduction Moderate mitral regurgitation (MR) of ischemic etiology has
been associated with worse outcomes after coronary artery bypass grafting
(CABG). Studies comparing concomitant mitral valve replacement/repair
(MVR/Re) with CABG and standalone CABG have reported conflicting results.
We performed a systematic review and meta-analysis of the published
literature. Patients and Methods We searched using PubMed, Cochrane,
EMBASE, CINAHL, and Google scholar databases from January 1960 to June
2016 for clinical trials comparing CABG to CABG + MVR/Re for moderate MR.
Pooled risk ratio or mean difference (MD) with 95% confidence intervals
(CI) for individual outcomes were calculated using random effects model
and heterogeneity was assessed using Cochrane's Q-statistic. Results A
total of 11 studies were included. Mean follow-up was 35.3 months.
All-cause mortality (Mantel-Haenszel [MH] risk ratio [RR]: 0.96, 95% CI:
0.75-1.24, p = 0.775), early mortality (MH RR: 0.65, 95% CI: 0.39-1.07, p
= 0.092), and stroke rates (MH RR 0.65, 95% CI: 0.21-2.03, p = 0.464) were
similar between CABG and CABG + MVR/Re groups. Adverse event at follow-up
was lower with CABG (MH RR: 0.90, 95% CI: 0.61-1.32, p = 0.584). MD of
change from baseline in left ventricular (LV) end-systolic dimension (MD:
- 2.50, 95% CI: - 5.21 to - 0.21, p = 0.071) and LV ejection fraction (MD:
0.48, 95% CI: - 2.48 to 3.44, p = 0.750) were not significantly different
between the groups. Incidence of moderate MR (MH RR: 3.24, 95% CI:
1.79-5.89, p < 0.001) was higher in the CABG only group. Conclusion
Addition of MVR/Re to CABG in patients with moderate ischemic MR did not
result in improvement in early or overall mortality, stroke risk, or
intermediate markers of LV function when compared with CABG alone.
Copyright &#xa9; 2016, Georg Thieme Verlag KG. All rights reserved.

<67>
Accession Number
614211087
Author
Yanagawa B.; Verma S.; Juni P.; Tam D.Y.; Mazine A.; Puskas J.D.;
Friedrich J.O.
Institution
(Yanagawa, Verma, Tam, Mazine) Division of Cardiac Surgery, Department of
Surgery, Toronto, Ontario, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute,
Toronto, Ontario, Canada
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai Beth Israel,
New York, NY
(Friedrich) Critical Care and Medicine Departments, St Michael's Hospital,
University of Toronto, Toronto, Ontario, Canada
Title
A systematic review and meta-analysis of in situ versus composite
bilateral internal thoracic artery grafting.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2016.
Date of Publication: June 02, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: This meta-analysis examines whether there is any advantage of
coronary artery bypass graft with bilateral internal thoracic artery
(BITA) as an in situ versus composite graft. Methods: We searched MEDLINE
and EMBASE Databases from 1996 to 2016 for studies that compared coronary
artery bypass graft with BITA as in situ versus composite graft. Data were
extracted by 2 independent investigators and meta-analyzed with the use of
random effects. Results: Two randomized controlled trials (RCTs; n = 705),
2 matched (n = 1688), and 4 unadjusted observational studies (n = 3517)
met inclusion criteria. Composite grafting trended towards greater distal
anastomoses (+0.22, 95% confidence interval, -0.01 to +0.45
anastomoses/patient; P = .06 [4 unadjusted observational studies]) and
greater distal anastomoses using an internal thoracic artery (+0.80, 95%
confidence interval, 0.41-1.18 anastomoses/patient; P < .001 [1 RCT]).
There were no differences in perioperative or longer-term composite
cardiovascular outcomes comparing in situ versus composite BITA or
individual outcomes of mortality, repeat revascularization, myocardial
infarction, and cardiovascular mortality. Pooled results differed by study
type with pooled results from lower-risk-of-bias RCTs typically showing
increases in events rates, and pooled results from higher-risk-of-bias
unadjusted observational studies typically showing decreases in event
rates of in situ versus composite BITA. Post hoc subgroup analysis
suggested possible improvements in all-cause mortality and
revascularization for in situ BITA in studies with short-term (<5 years)
versus longer-term follow-up, regardless of study type. Conclusions: Our
meta-analysis found that use of BITA as a composite graft configuration
facilitated greater internal thoracic artery revascularization but both
grafting strategies offer similar clinical outcomes. Our study supports
the use of in situ and composite BITA for select patients but
high-quality, long-term prospective trials are needed. Copyright &#xa9;
2016 The American Association for Thoracic Surgery.

<68>
Accession Number
614209668
Author
Yamamoto M.; Shimura T.; Kano S.; Kagase A.; Kodama A.; Sago M.; Tsunaki
T.; Koyama Y.; Tada N.; Yamanaka F.; Naganuma T.; Araki M.; Shirai S.;
Watanabe Y.; Hayashida K.
Institution
(Yamamoto, Shimura, Kagase, Kodama, Sago, Tsunaki) Department of
Cardiology, Toyohashi Heart Center, Toyohashi, Japan
(Kano, Koyama) Department of Cardiology, Nagoya Heart Center, Nagoya,
Japan
(Tada) Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
(Yamanaka) Department of Cardiology, Syonan Kamakura Hospital, Shonan,
Japan
(Naganuma) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Araki) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
(Watanabe) Department of Cardiology, Teikyo University School of Medicine,
Tokyo, Japan
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Title
Prognostic Value of Hypoalbuminemia After Transcatheter Aortic Valve
Implantation (from the Japanese Multicenter OCEAN-TAVI Registry).
Source
American Journal of Cardiology. (no pagination), 2016. Date of
Publication: August 31, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Hypoalbuminemia, a frailty criterion, belongs to a group of co-morbidities
not captured as a traditional risk factor. We assessed its prognostic
value in patients who underwent transcatheter aortic valve implantation
(TAVI). The study included 1,215 consecutive patients from the Optimized
Catheter Valvular Intervention -TAVI Japanese multicenter registry.
Hypoalbuminemia was defined as serum albumin level <3.5 g/dl. Baseline
characteristics, procedural outcomes, and all-cause, cardiovascular and
noncardiovascular mortality rates after TAVI were compared between
patients with albumin level <3.5 g/dl (hypo[h]-ALB group, n = 284) and
those with albumin level >3.5 g/dl (nonhypo[nh]-ALB group, n = 931).
Several baseline characteristics differed significantly between both
groups, including age (85.1 +/- 5.1 vs 84.2 +/- 4.9 years, p = 0.012),
ejection fraction (58.5 +/- 14.3% vs 62.9 +/- 12.4%, p <0.001), baseline
kidney function, or liver disease. The 30-day mortality rate in all
patients showed significant differences between the 2 groups (3.9% vs
1.3%, p = 0.005). During a mean follow-up of 330 days, cumulative
all-cause, cardiovascular, and noncardiovascular mortality rates were
significantly higher in the hALB group than in the nhALB group (log-rank
test, p <0.001, p = 0.0021, and p <0.001, respectively). The groups were
also analyzed using a propensity matching model for adjusting the baseline
differences. The analysis revealed that the poorer prognosis of the hALB
group in terms of cumulative all-cause and noncardiovascular mortality was
retained (p = 0.038, and p = 0.0068, respectively); however, differences
in cardiovascular mortality rates in the 2 groups were attenuated (p =
0.93). In conclusion, hypoalbuminemia was associated with poor prognosis,
highlighted by the increase in noncardiovascular mortality. Baseline
albumin level could be a useful marker for risk stratification before
TAVI. Copyright &#xa9; 2016 Elsevier Inc.

<69>
Accession Number
614158733
Author
Schafer U.; Deuschl F.; Schofer N.; Frerker C.; Schmidt T.; Kuck K.H.;
Kreidel F.; Schirmer J.; Mizote I.; Reichenspurner H.; Blankenberg S.;
Treede H.; Conradi L.
Institution
(Schafer, Deuschl, Schofer, Mizote, Blankenberg) Department for General
and Interventional Cardiology, University Heart Center, University
Hospital Hamburg-Eppendorf, Germany
(Schirmer, Reichenspurner, Treede, Conradi) Department of Cardiovascular
Surgery, University Heart Center, University Hospital Hamburg-Eppendorf,
Germany
(Frerker, Schmidt, Kuck, Kreidel) Department of Cardiology, Asklepios
Clinic St. Georg, 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
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: August 19, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: Transcatheter Aortic Valve Implantation (TAVI) can be
performed via the transaxillary approach, but data about complications and
procedural outcome is limited. Introduction: TAVI is an established
treatment option for patients at high risk for conventional aortic valve
replacement. Nowadays, the transfemoral approach is the most commonly used
access for TAVI. Nevertheless, the transfemoral access is not suitable in
many patients necessitating alternative approaches. Methods: We analyzed
the outcome of 100 consecutive cases receiving percutaneous transaxillary
TAVI at two different hospitals. 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+/-2.1years and the logEuroSCORE I was 24.6+/-13.9%. Transaxillary
TAVI was performed in 85% via the left and in 15% via the right axillary
artery. Device success was achieved in 95%. In general, there was a clear
learning curve with this approach. No patient experienced a major and 11%
a minor access site complication. There was one procedural death (annular
rupture) and one peri-procedural TIA. 23% of the patients received a new
pacemaker. At discharge, effective orifice area was
1.94+/-0.16cm² and the mean aortic gradient was 6.8+/-2.1mmHg.
Moderate aortic regurgitation/paravalvular leakage was documented in two
patients. Mortality rates at 30days and one year were 6% and 14.8%. Last
but not least, 2nd generation devices showed improved procedural outcomes.
Conclusions: The percutaneous transaxillary access for TAVI is technically
feasible and safe thereby yielding excellent clinical results. Condensed
abstract: We investigated In 100 consecutive patients undergoing
percutaneous transaxillary transcatheter aortic valve implantation thereby
demonstrating that this approach is technically feasible and safe with
acceptable numbers of minor vascular complications. Copyright &#xa9; 2017
Elsevier B.V.

<70>
Accession Number
614166133
Author
Elmorsy A.; Abdel-Wahab A.; Sabry M.; Wahby E.
Institution
(Elmorsy, Abdel-Wahab, Sabry, Wahby) Cardiothoracic Surgery Dept, Tanta
University, Tanta, Egypt
Title
Bone wax versus oxidized regenerated cellulose in preventing sternal
intramedullary bleeding in cardiac surgery.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2016. Date of Publication: December 06, 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Bone wax (BW) or oxidized regenerated cellulose (ORC)
concomitant with electrocoagulation is one of the preventive strategies in
controlling sternal intramedullary bleeding post cardiac surgery. The aim
of this study is to compare the difference between these two strategies in
our patients. Materials and methods: 50 of our patients who underwent
conventional open heart surgery in our department were recruited in this
study and were randomized into 2 groups; group I (25 patients) bone wax
and concomitant electrocauterization were used, and group II (25 patients)
oxidized regenerated cellulose and concomitant electrocauterization were
used. The following parameters were compared: the amount of postoperative
hemorrhage in the first 24 h, numbers of units of blood and its products
used, rates of re-exploration for hemorrhage, wound complications in first
3 months follow-up and the difference in cost-effective ratio. Results:
Patient's Demographics and intraoperative variables were comparable in
both groups. There was no statistically significant difference between the
amounts of postoperative hemorrhage in both groups; however, there was
only one case of superficial wound infection and one case with sternal
dehiscence in the short term follow-up in group I. Bone wax is
significantly cheaper than ORC. Conclusion: BW concomitant with
electrocauterization is effective as ORC concomitant with
electrocauterization in preventing sternal intramedullary bleeding in
cardiac surgery and is much cheaper. Copyright &#xa9; 2016 The Egyptian
Society of Cardio-thoracic Surgery.