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Accession Number
613690606
Author
Takase S.; Matoba T.; Nakashiro S.; Mukai Y.; Inoue S.; Oi K.; Higo T.;
Katsuki S.; Takemoto M.; Suematsu N.; Eshima K.; Miyata K.; Yamamoto M.;
Usui M.; Sadamatsu K.; Satoh S.; Kadokami T.; Hironaga K.; Ichi I.; Todaka
K.; Kishimoto J.; Egashira K.; Sunagawa K.
Institution
(Takase, Matoba, Nakashiro, Higo, Egashira, Sunagawa) Department of
Cardiovascular Medicine, Kyushu University Hospital, 3-1-1, Maidashi,
Higashi-ku, Fukuoka 812-8582, Japan
(Takase, Matoba, Nakashiro, Mukai, Inoue, Oi, Higo, Katsuki, Takemoto,
Sunagawa) Department of Cardiovascular Medicine, Kyushu University
Hospital, Fukuoka, Japan
(Suematsu) Japanese Red Cross Fukuoka Hospital, Japan
(Eshima) St. Mary's Hospital, Kurume, Japan
(Miyata) Japan Community Health Care Organization, Kyushu Hospital,
Fukuoka, Japan
(Yamamoto) Harasanshin Hospital, Fukuoka, Japan
(Usui) Hamanomachi Hospital, Fukuoka, Japan
(Sadamatsu) Saga-ken Medical Centre Koseikan, Saga, Japan
(Satoh) National Hospital Organization Kyushu Medical Centre, Fukuoka,
Japan
(Kadokami) Saiseikai Futsukaichi Hospital, Chikushino, Japan
(Hironaga) Saiseikai Fukuoka General Hospital, Japan
(Hironaga) Fukuoka City Hospital, Japan
(Ichi) Graduate School of Humanities and Science, Ochanomizu University,
Tokyo, Japan
(Todaka, Kishimoto) Center for Clinical and Translational Research, Kyushu
University, Fukuoka, Japan
(Kishimoto) Department of Research and Development of Next Generation
Medicine, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan
Title
Ezetimibe in combination with statins ameliorates endothelial dysfunction
in coronary arteries after stenting: the CuVIC trial (effect of
cholesterol absorption inhibitor usage on target vessel dysfunction after
coronary stenting), a multicenter randomized controlled trial.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. 37 (2) (pp 350-358),
2017. Date of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives - We sought to investigate whether treatment with ezetimibe in
combination with statins improves coronary endothelial function in target
vessels in coronary artery disease patients after coronary stenting.
Approach and Results - We conducted a multicenter, prospective,
randomized, open-label, blinded-end point trial among 11 cardiovascular
treatment centers. From 2011 to 2013, 260 coronary artery disease patients
who underwent coronary stenting were randomly allocated to 2 arms (statin
monotherapy, S versus ezetimibe [10 mg/d]+statin combinational therapy,
E+S). We defined target vessel dysfunction as the primary composite
outcome, which comprised target vessel failure during treatment and at the
6- to 8-month follow-up coronary angiography and coronary endothelial
dysfunction determined via intracoronary acetylcholine testing performed
in cases without target vessel failure at the follow-up coronary
angiography. Coadministration of ezetimibe with statins further lowered
low-density lipoprotein cholesterol levels (83+/-23 mg/dL in S versus
67+/-23 mg/dL in E+S; P<0.0001), with significant decreases in oxidized
low-density lipoprotein and oxysterol levels. Among patients without
target vessel failure, 46 out of 89 patients (52%) in the S arm and 34 out
of 96 patients (35%) in the E+S arm were found to have coronary
endothelial dysfunction (P=0.0256), and the incidence of target vessel
dysfunction at follow-up was significantly decreased in the E+S arm
(69/112 (62%) in S versus 47/109 (43%) in E+S; P=0.0059). A post hoc
analysis of post-treatment low-density lipoprotein cholesterol-matched
subgroups revealed that the incidence of both target vessel dysfunction
and coronary endothelial dysfunction significantly decreased in the E+S
arm, with significant reductions in oxysterol levels. Conclusions - The
CuVIC trial (Effect of Cholesterol Absorption Inhibitor Usage on Target
Vessel Dysfunction after Coronary Stenting) has shown that ezetimibe with
statins, compared with statin monotherapy, improves functional prognoses,
ameliorating endothelial dysfunction in stented coronary arteries, and was
associated with larger decreases in oxysterol levels. Copyright &#xa9;
2016 American Heart Association, Inc.

<2>
Accession Number
613981795
Author
Naqvi S.Y.; Klein J.; Saha T.; McCormick D.J.; Goldberg S.
Institution
(Naqvi, Klein, Saha) Department of Internal Medicine, Pennsylvania
Hospital, University of Pennsylvania Health System, Philadelphia,
Pennsylvania, United States
(McCormick, Goldberg) Department of Cardiology, Pennsylvania Hospital,
University of Pennsylvania Health System, Philadelphia, Pennsylvania,
United States
Title
Comparison of Percutaneous Coronary Intervention Versus Coronary Artery
Bypass Grafting for Unprotected Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. 119 (4) (pp 520-527), 2017. Date of
Publication: 15 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Coronary artery bypass grafting (CABG) decreases mortality in patients
with significant left main (LM) coronary artery disease and for years
remained the therapy of choice for patients with this ominous lesion.
Advances in percutaneous coronary intervention (PCI) have enabled it to
become an alternative to CABG. The results of observational registries and
randomized comparisons have shown the safety and efficacy of PCI in
appropriately selected patients with low or intermediate angiographic risk
scores. Furthermore, the use of physiological measures of flow limitation
and the use of intracoronary imaging techniques has added benefit and
improved outcomes. The use of fractional flow reserve to more accurately
evaluate the significance of intermediate lesions and guide the extent of
revascularization has been an important refinement. Intravascular
ultrasound and optical coherence tomography assessment of optimal stent
deployment has led to reductions in restenosis. Newer generation stents,
combined with improvements in specific techniques, especially at the LM
bifurcation have extended PCI to more complex anatomic scenarios. The
availability of left ventricular support devices in patients with complex
coronary anatomy and severely depressed left ventricular function has
added a margin of safety to LM and multivessel intervention. Randomized
comparisons of CABG with PCI in carefully selected patients, using
contemporaneous surgical and interventional techniques and optimal medical
therapy, will further aid heart teams in the decision-making process. In
conclusion, this review will give a concise overview of the management of
unprotected LM disease. Copyright &#xa9; 2016 Elsevier Inc.

<3>
Accession Number
613768398
Author
Erden I.; Golcuk E.; Bozyel S.; Erden E.C.; Balaban Y.; Yalin K.; Turan B.
Institution
(Erden, Erden, Balaban) Department of Cardiology, VM Medicalpark Kocaeli
Hospital, Kocaeli, Turkey
(Golcuk, Bozyel, Turan) Department of Cardiology, Kocaeli Derince Training
and Research Hospital, Kocaeli, Turkey
(Yalin) Department of Cardiology, Bayrampasa Kolan Hospital, Istanbul,
Turkey
Title
Effectiveness of Handmade "Jacky-Like Catheter" As a Single Multipurpose
Catheter in Transradial Coronary Angiography: A Randomized Comparison With
Conventional Two-Catheter Strategy.
Source
Journal of Interventional Cardiology. 30 (1) (pp 24-32), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To investigate safety and efficacy of specialized hand-modified
"Jacky-Like" catheter (JLC) as a single dual-purpose catheter in
transradial coronary angiography. Methods: Patients over 18 years
undergoing diagnostic CAG through right radial artery (RRA) were
prospectively enrolled. Procedures were performed with a single JLC
modified from a left Judkins (JL) 3.5 catheter or by using 2-catheter
approach (2C). Procedures with coronary artery bypass grafts or
ventricular angiographies were excluded from the study. Three hundred and
eighty-seven transradial procedures were performed successfully. One
hundred and ninety-four procedures were performed with 2C and 193
procedures with a JLC. Inability to use intended catheters, total
fluoroscopic time in minutes, the consumption of contrast medium in
milliliter, development of radial artery spasm (RAS), and radial artery
occlusion (RAO) were evaluated. Results: In the 2C group, angiography was
successfully performed on the RCA of 191 patients (98.9%) and on LCA in
192 patients (99.4%). In the JLC group, angiography was successfully
performed on the RCA and LCA of 193 (99.4%) and 174 (89.6%) patients,
respectively. Utilization of supplemental catheters was significantly
greater in the JLC group (21; 10.8%) versus the 2C group (3; 1.5% P =
0.001). Mean fluoroscopy time was shorter in the JLC group (2.0 +/- 2.3
min vs. 2.3 +/- 1.5 min; P = 0.043). Mean procedure time was also
decreased with JLC but did not reach statistical significance (5.7 +/- 3.1
min vs. 6.2 +/- 2.5 min; P = 0.081). When additional time for reshaping
the JLC was not taken into account, mean procedure time was significantly
decreased in the JLC group (5.6 +/- 2.9 min vs. 6.2 +/- 2.4 min; P =
0.031). There was a trend toward lower incidence of consumption of
contrast medium in the 2C group (49 +/- 13 mL vs. 52 +/- 18 mL; P =
0.061). RAS was observed more frequently in the 2C group (11.3% vs. 21.7%,
P = 0.005). There was a trend toward high incidence of RAO in the 2C group
(4.1 vs. 8.3% P = 0.064). Conclusion: In transradial procedures from RRA,
a JLC catheter can be very effective when dedicated dual-purpose catheter
is not available. Copyright &#xa9; 2016, Wiley Periodicals, Inc.

<4>
Accession Number
613955627
Author
Sun Y.; Liu X.; He Y.; Tang M.; Zhu Q.; Xu X.; Guo D.; Shi K.; Hu P.; Wang
L.; Kong H.; Jiang J.; Lin X.; Xu Q.; Gao F.; Wang J.
Institution
(Sun, Zhu, Xu, Guo, Shi, Wang) Zhejiang University School of Medicine,
Hangzhou, China
(Liu, He, Tang, Hu, Wang, Kong, Jiang, Lin, Xu, Gao, Wang) Department of
Cardiology, Second Affiliated Hospital Zhejiang University School of
Medicine, Hangzhou, China
Title
Meta-Analysis of Impact of Diabetes Mellitus on Outcomes After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 119 (4) (pp 623-629), 2017. Date of
Publication: 15 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To date, the impact of diabetes mellitus (DM) on prognosis after
transcatheter aortic valve implantation (TAVI) is still contradictory and
thus merits further investigation. The purpose of this meta-analysis was
to evaluate the impact of DM on outcomes after TAVI. A systematic search
of the PubMed database was performed. Primary end points were 30-day and
1-year all-cause mortality after TAVI. Risk ratios (RRs) and 95% CIs were
calculated using the random-effect or fixed-effect model, depending on
heterogeneity between studies, and p values <0.05 was considered
significant. A total of 16 studies involving 13,253 patients were included
in our meta-analysis. There was no significant difference between the
groups with DM and without DM regarding 30-day (RR 1.07, 95% CI 0.90 to
1.27, p = 0.45) or 1-year (RR 1.04, 95% CI 0.94 to 1.15, p = 0.42)
all-cause mortality. The risks of 30-day complications, including
myocardial infarction, stroke, major vascular complications, major
bleeding, and acute kidney injury, were similar between patients with and
without DM. In conclusion, DM neither affected short- or mid-term
all-cause mortality nor short-term complications after TAVI. Copyright
&#xa9; 2016 Elsevier Inc.

<5>
Accession Number
613785903
Author
Welsby I.J.; Krakow E.F.; Heit J.A.; Williams E.C.; Arepally G.M.;
Bar-Yosef S.; Kong D.F.; Martinelli S.; Dhakal I.; Liu W.W.; Krischer J.;
Ortel T.L.
Institution
(Welsby) Department of Anesthesiology and Critical Care, Durham, NC,
United States
(Krakow, Kong) Department of Medicine, Duke University Medical Center,
Durham, NC, United States
(Heit) Department of Medicine, Division of Cardiovascular Diseases, Mayo
Clinic, Durham, NC, United States
(Williams) Department of Medicine, Division of Hematology, University of
Wisconsin, Durham, NC, United States
(Arepally) Department of Medicine, Division of Hematology, Duke University
Medical Center, Durham, NC, United States
(Bar-Yosef) Department of Anesthesiology, Durham VA Medical Center,
Durham, NC, United States
(Martinelli) Department of Anesthesiology, University of North Carolina,
Durham, NC, United States
(Dhakal, Liu) Department of Biostatistics & Bioinformatics, Duke
University Medical Center, Durham, NC, United States
(Krischer) Pediatric Epidemiology Center, University of South Florida
Morsani College of Medicine, Durham, NC, United States
(Ortel) Department of Pathology, Duke University Medical Center, Durham,
NC, United States
Title
The association of anti-platelet factor 4/heparin antibodies with early
and delayed thromboembolism after cardiac surgery.
Source
Journal of Thrombosis and Haemostasis. 15 (1) (pp 57-65), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials We evaluated antibody status, thromboembolism and survival
after cardiac surgery. Positive antibody tests are common - over 50% are
seropositive at 30 days. Seropositivity did not increase thromboembolism
or impair survival after cardiac surgery. Results show heparin induced
thrombocytopenia antibody screening after surgery is not warranted.
Summary: Background Heparin-induced thrombocytopenia (HIT) is a
prothrombotic response to heparin therapy with platelet-activating,
anti-platelet factor 4 (PF4)/heparin antibodies leading to
thrombocytopenia associated with thromboembolism. Objective We tested the
hypothesis that anti-PF4/heparin antibodies are associated with
thromboembolism after cardiac surgery. Methods This multicenter,
prospective cohort study collected laboratory and clinical data up to 30
days after surgery and longer-term clinical follow-up data. The primary
outcome variable combined new arterial or venous thromboembolic
complications (TECs) with all-cause death until 90 days after surgery.
Laboratory analyses included platelet counts and anti-PF4/heparin antibody
titers (GTI ELISA), with a confirmatory excess heparin step and serotonin
release assay. Chi-square testing was used to test the relationship
between our outcome and HIT antibody seropositivity. Results Initially,
1021 patients were enrolled between August 2006 and May 2009, and
follow-up was completed in December 2014. Seropositivity defined by OD >
0.4 was common, being almost 20% preoperatively, > 30% by discharge, and >
60% by day 30. Death (1.7% within 30 days) or TECs (69 in total) were more
likely if the partient was seronegative (OD < 0.4), but positivity defined
by OD > 1.0 or including an excess heparin confirmatory step resulted in
equal incidence of death or TECs, whether the patient was seronegative or
seropositive. Incorporating the serotonin release assay for
platelet-activating antibodies did not alter these findings. Conclusions
Seropositivity for anti-PF4/heparin antibodies does not increase the risk
of death or thromboembolism after cardiac surgery. Screening is not
indicated, and seropositivity should only be interpreted in the context of
clinical evidence for HIT. Trial registration: Duke IRB Protocol
#00010736. Copyright &#xa9; 2016 International Society on Thrombosis and
Haemostasis

<6>
Accession Number
613928599
Author
Rafiq S.; Steinbruchel D.A.; Lilleor N.B.; Moller C.H.; Lund J.T.; Thiis
J.J.; Kober L.; Olsen P.S.
Institution
(Rafiq, Steinbruchel, Lilleor, Moller, Lund, Thiis, Olsen) Department of
Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen
University Hospital, Blegdamsvej 9, Copenhagen O 2100, Denmark
(Kober) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Blegdamsvej 9, Copenhagen O 2100, Denmark
Title
Antithrombotic therapy after bioprosthetic aortic valve implantation:
Warfarin versus aspirin, a randomized controlled trial.
Source
Thrombosis Research. 150 (pp 104-110), 2017. Date of Publication: 01 Feb
2017.
Publisher
Elsevier Ltd
Abstract
Background The optimal medical strategy for prevention of thromboembolic
events after surgical bioprosthetic aortic valve replacement (BAVR) is
still debated. The objective of this study was to compare warfarin therapy
(target INR of 2.0 to 3.0) with aspirin 150 mg daily as antithrombotic
therapy for the first three months after BAVR with or without concomitant
coronary artery bypass grafting (CABG). The aim was to evaluate
thromboembolic complications, major bleeding complications and death.
Materials and methods Prospective, single-centre, open-label, randomized
controlled trial. 370 patients were enrolled, 328 were available for data
analysis. Results At baseline the warfarin and aspirin groups were
comparable. Thromboembolic events were comparable between groups 11 (6.6%)
vs. 12 (7.5%), p = 0.83. Major bleeding events occurred numerically more
often in warfarin patients 9 (5.4%) vs. 3 (1.9%), p = 0.14. Warfarin was
in multivariate analysis significantly associated with major bleeding OR
5.18 (CI 1.06-25.43), p = 0.043. 90-day mortality was comparable between
groups 8 (4.7%) vs. 6 (3.7%), p = 0.79. Conclusions Our results suggest
that aspirin might be equally effective as warfarin in preventing
thromboembolic events after BAVR, but with less major bleedings. Although
this is numerically the largest trial testing this hypothesis in a
prospective randomized trial, further adequately powered studies are
warranted. Copyright &#xa9; 2016 Elsevier Ltd

<7>
Accession Number
614266638
Author
Hashmi N.K.; Ghadimi K.; Schroder J.; Levy J.; Welsby I.J.
Title
Three factor prothrombin complex concentrates in cardiac surgery: A novel
algorithmic approach to perioperative bleeding.
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: Three component prothrombin complex concentrates (PCCs) are
currently approved to treat bleeding associated with Hemophilia B, and 4
component PCCs for warfarin reversal. They are increasingly used to treat
bleeding in cardiac surgery patients. High dose PCC administration in the
non-surgical setting has been associated with thrombotic complications,
likely due to increased Factor II (Prothrombin) levels. We hypothesized
that the use of low dose 3 factor PCCs (Profilnine, Grifols, CA) reduces
bleeding following cardiopulmonary bypass without increasing the incidence
of postoperative thrombotic complications. Methods: After IRB approval, a
retrospective chart review of patients who underwent cardiac surgery and
received Profilnine for refractory bleeding from February 2014 to February
2015. Demographic information, preoperative lab values, blood product use
before and after PCC, use of rFVIIa, chest tube output and venous and
arterial thromboembolic complications were collected. PCC was dosed
according to an institutional perioperative bleeding algorithm (Figure 1)
after approval by one of the senior authors (KG, JL or IW). Results: 114
patients received Profilnine (Grifols, CA) for postoperative bleeding
following cardiac surgery. The most common procedure that required PCC
administration was elective aortic reconstruction (61, 57%) followed by
acute aortic dissection (13, 12.1%). The mean dose of PCC was 15.8+/-7.1
IU. The chest tube output for the first hour after arriving in the ICU
150.8+/-214.0 ml and quickly decreased to 89.5+/-122.1 ml in the second
hour. The mean total blood product transfusion was 12.4+/-9.9 units prior
to PCC dose and 5+/-6.3 units post dose. The difference is represented in
Figure 2 and was found to be statistically significant on a paired t-test.
(p <0.0001). Only 4 patients (3.7%) of the patients had to return to the
operating room for a re-exploration. Four patients (3.7%) had a
cerebrovascular infarction in the postoperative period, of which two
patients had undergone ventricular assist device (VAD) insertions, one had
an aortic reconstruction and one had central ECMO cannulation performed
following a STEMI. The patient with the aortic reconstruction received a
higher dose of PCC (3000 Units or 33.5U/kg) and recombinant VIIa. One
patient, who had a VAD inserted, had a pulmonary embolism. They received a
low dose of PCC (13.8U/kg) did not receive factor VIIa. The post dose
factor II activity level for this patient was 64%. Six patients (5.6%) had
deep vein thrombosis diagnosed by venous doppler ultrasound. Four of these
patients had received factor VIIa after PCC administration. Post dose
prothrombin levels were measured in 20 patients, with a mean of
85.9%(+/-19.3%). The mean PCC dose in this group was 16.3 (+/-9.0) IU/kg
per actual body weight, and 20.2 (+/-12.1) IU/kg per ideal body weight.
Post dose factor II levels were plotted against PCC dose/kg in this group.
The median factor II level was 87% (Figure 3). 12 out of these 20 patients
received factor VIIa as part of the algorithm, and no postoperative
thrombotic complications were reported in this subgroup. Conclusions: Our
initial findings from this ongoing study revealed a reduction of total
blood products transfused after administration of PCC compared to before
administration. Our series is reporting a higher rate of thrombotic
events. While some of these are associated with factor VIIa administration
following the PCC dose, most are likely to be multifactorial in etiology
and were well tolerated. Additional randomized studies are needed to
determine the safety and efficacy of PCCs in cardiac surgical patients.

<8>
Accession Number
614266422
Author
Albisetti M.; Manastirski I.; Brueckmann M.; Gropper S.; Wang B.;
Tartakovsky I.; Biss B.; Huang F.; Mitchell L.G.; Brandao L.R.; Halton
J.M.L.
Title
Rationale and design of a phase IIb/III open-label, multicenter study of
dabigatran etexilate for venous thromboembolism in children: The diversity
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 Venous thromboembolism (VTE) is increasing in children. The
current standard of care comprises unfractionated heparin (UFH) or
low-molecular-weight heparin (LMWH) for at least 5 days followed by UFH,
LMWH or Vitamin K antagonists (VKA) for approximately 3 months in general.
All of the current options have limitations: UFH and LMWH require
parenteral administration; VKA requires frequent international normalized
ratio (INR) monitoring and is associated with multiple food and drug
interactions. The direct thrombin inhibitor, dabigatran, which is orally
administered as the prodrug, dabigatran etexilate (DE) is effective for
the treatment of VTE in adults and may overcome some of the limitations
associated with standard of care. Objective To describe the design of a
study evaluating the appropriateness of a proposed DE dosing algorithm and
assessing the safety and efficacy of DE versus standard of care in
pediatric patients with VTE. Methods This open-label, randomized,
parallel-group, active-controlled, multi-center, non-inferiority study
(NCT01895777) will be conducted in approximately 100 sites in
approximately 30 countries. Patients aged 0 to < 18 years with an
imaging-confirmed diagnosis of VTE initially receiving parenteral
treatment with UFH or LMWH for 5-7 days (but no more than 21 days) who are
expected to require anticoagulation therapy for at least 3 months will be
eligible for inclusion. Main exclusion criteria include conditions
associated with an increased risk of bleeding, renal dysfunction, active
infective endocarditis, mechanical or biological heart valve prosthesis,
hepatic disease and anemia or thrombocytopenia. Patients will be
stratified into three age groups: stratum 1 (12 to < 18 years), stratum 2
(2 to < 12 years) and stratum 3 (birth to < 2 years). Recruitment will
begin in stratum 1, being subsequently escalated to strata 2 and 3,
respectively based on recommendations from the Data Monitoring Committee.
Patients will be randomized (2:1) to receive DE versus standard of care
(LMWH or VKA). DE will be administered twice daily as capsules, pellets or
an oral liquid formulation depending on patient age and the patient's
ability to swallow pellets or capsules. Upon completion of a 3- month
treatment period (including the initial parenteral treatment phase)
patients will be followed off-study drug for any adverse events. DE will
be dosed to achieve steady-state measured trough circulating plasma
concentrations (>50 and < 250 ng/mL); the initial dose required will be
calculated using a nomogram, which adjusts dosing according to the age and
weight of the child. Dabigatran plasma concentrations will be evaluated at
all study visits (7 scheduled during treatment period); DE will be up- or
down-titrated as required. Results In terms of efficacy, the study will
evaluate the proportion of patients with complete thrombus resolution,
freedom from recurrent VTE (including symptomatic and asymptomatic,
contiguous progression or non-contiguous new thrombus, deep vein
thrombosis, pulmonary and paradoxical embolism, and thrombus progression)
and freedom from VTE-related mortality. With regards to safety, the key
endpoint will be freedom from major bleeding events, as per International
Society on thrombosis and Haemostasis (ISTH) pediatric-specific criteria.
All components of the primary efficacy and key safety endpoints will be
adjudicated by an independent blinded committee. Conclusion This study,
one of the largest controlled pediatric studies for VTE, will provide data
on the safety and efficacy of DE compared with standard of care for the
treatment of VTE in children aged 0 to < 18 years.

<9>
Accession Number
614246869
Author
Chai-Adisaksopha C.; Hillis C.M.; Witt D.M.; Schulman S.; Crowther M.;
Iorio A.
Title
Warfarin resumption after intracranial hemorrhage: A systematic review and
meta-analysis.
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
Objective: To assess the effect of warfarin resumption in patients who
experienced warfarin- associated intracranial hemorrhage. Study design:
Systematic review and meta-analysis Data sources:We searched MEDLINE (1966
to July 2016), EMBASE (1980 to July 2016) and Cochrane Library electronic
database (up to July 2016). Inclusion criteria:Studies were eligible for
inclusion if (1) they were randomized controlled trials, prospective
cohort or retrospective cohort studies, (2) studies that included adult
patients (>18 years), (3) studies that investigated the patients who
experienced warfarin-associated intracranial bleeding, (4) studies that
evaluated incidence of recurrent intracranial hemorrhage, thromboembolic
events, and all-cause mortality, and (5) studies that reported on patients
with warfarin resumption compared to controls (those who did not resume
warfarin). Main outcome and measures: Primary outcome was all-cause
mortality. Secondary outcomes were ischemic stroke, thromboembolic events,
recurrent intracranial hemorrhage and any bleeding. Pooled relative risks
(RRs) were calculated using random-effects model. Results: Seven studies
were included in the meta-analysis, involving 623 patients who resumed
warfarin and 1851 patients who did not resume warfarin after
warfarin-associated intracranial hemorrhage. Majority of patients were
anticoagulated due to atrial fibrillation, prosthetic heart valve and
venous thrombosis. Median time to resume warfarin ranged form 11 days to
39.2 days. Warfarin resumption significantly reduced risk of all-cause
mortality (17.06% vs 35.71%), RR 0.50, 95% confidence interval
[CI];0.33-0.77, I-square=58.7%, Figure 1. Lower ischemic stroke was
observed in patients who resumed warfarin (4.89% vs 7.64%), RR 0.67,
95%CI; 0.45-0.99, I- square=0%, Figure 2. Composite outcome of
thromboembolic event was lower but not significant in patients who resumed
warfarin (7.35% vs 11.48%), RR 0.61, 95%CI; 0.39-1.07, I- square=50.7%.
Recurrent intracranial hemorrhage was not significantly different between
patients who resumed and those who did not resume warfarin (7.33% vs
7.39%), RR 1.14, 95%CI; 0.57-2.27, I-square=51.0%, Figure 3. Any bleeding
was not significantly different between 2 groups (8.23% vs 8.31%), RR
1.03, 95%CI; 0.73-1.43, I-square=50.4%. Conclusions: Major limitation of
this meta-analysis included potential selection bias of the original
studies, specifically, patients with better prognosis tended be selected
to restart warfarin. In summary, , warfarin resumption after
warfarin-associated intracranial hemorrhage was associated with lower risk
of all-cause mortality and ischemic stroke without a significant increase
in recurrent intracranial hemorrhage. (Figure Presented).

<10>
Accession Number
614246864
Author
Arnold D.M.; Ning S.; Barty R.; Liu Y.; Cook R.; Rochberg B.; Iorio A.;
Shih A.W.; Heddle N.M.
Title
The effect of platelet transfusion on death in the intensive care unit.
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: Thrombocytopenia is a common complication of critical illness
and an independent risk factor for death in the intensive care unit (ICU).
Whether platelet transfusions modify the risk of death in critically ill
patients is unknown. Methods: Adult patients admitted to ICU who received
one or more platelet transfusion over a 10-year period (2006 - 2015) from
3 academic hospitals in Canada were analyzed from a blood transfusion
registry. Oncology patients were excluded. Contemporaneous non-transfused
ICU patients were used as controls. Data from the registry were validated
by integrity checks with medical records and laboratory information
systems. We estimated the effect of platelet transfusion on mortality in
ICU adjusted for baseline and time-varying covariates including
multi-organ dysfunction score (MODS) and severity of thrombocytopenia
using a stratified cox proportional hazards model. Significance was set at
p<0.05 for all analyses. Results: Of 43,234 non-oncology patients admitted
to ICU, 5,621 (13.0%) received one or more platelet transfusion. Compared
with non-transfused controls, transfused patients had lower platelet
counts (median, 82 x10⁹/L vs. 163 x10⁹/L); were more
often admitted after surgery (90.7% vs. 46.9%) especially cardiac surgery
(86.8% of surgeries vs. 60.6%); and had higher unadjusted mortality (10.7%
vs. 6.5%). Using regression analysis adjusted for covariates (nadir
platelet count, red blood cell transfusion, need for hemodialysis) and
stratified by age, baseline MODS score (available for 66.2% of patients)
and need for invasive mechanical ventilation, platelet transfusions were
associated with a lower risk of death in ICU [hazard ratio (HR)= 0.66; 95%
confidence interval (CI), 0.46 - 0.96; p= 0.028; n= 26,404 with all
available data]. A similar effect was observed in the subgroup of cardiac
surgery patients (HR= 0.50; 95% CI, 0.26 - 0.98; p=0.044; n= 10,676) but
not all surgical patients (HR = 0.73; 95% CI, 0.46 - 1.17; p= 0.188; n=
14,461). Conclusion:After adjusting for illness severity, thrombocytopenia
and other confounders common among critically ill patients, platelet
transfusions were associated with improved survival in the population of
mostly cardiac surgery patients. This potential protective effect of
platelet transfusions requires further evaluation in prospective studies.

<11>
Accession Number
613963146
Author
Frey N.; Steeds R.P.; Serra A.; Schulz E.; Baldus S.; Lutz M.; Pohlmann
C.; Kurucova J.; Bramlage P.; Messika-Zeitoun D.
Institution
(Frey, Lutz) University of Kiel, Department of Cardiology and Angiology,
Kiel, Germany
(Steeds) University of Birmingham, Queen Elizabeth Hospital and Institute
of Cardiovascular Sciences, Birmingham, United Kingdom
(Serra) University of Barcelona, Hospital de Sant Pau, Cardiology Unit,
Barcelona, Spain
(Schulz) University Clinic Mainz, Cardiology Department I, Mainz, Germany
(Baldus) Heart Center of the University Clinic Cologne, Clinic for
Cardiology, Angiology, and Pneumology and Intensive Care Medicine,
Cologne, Germany
(Pohlmann, Bramlage) Institute for Pharmacology and Preventive Medicine,
Cloppenburg, Germany
(Kurucova) Edwards Lifesciences, Prague, Czech Republic
(Messika-Zeitoun) Bichat Hospital, Department of Cardiology, Paris, France
Title
Quality of care assessment and improvement in aortic stenosis - rationale
and design of a multicentre registry (IMPULSE).
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 5. Date of Publication: 05 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Severe aortic stenosis (AS) is a common, serious valve disease
in which no effective medical therapy is available and, if not treated by
intervention, has a 5-year survival of only 40-60%. Despite the
availability of guidelines supporting the effective use of surgical aortic
valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI)
to treat the majority of these patients, adherence to these guidelines in
clinical practice is still unsatisfactory. Several recent studies have
emphasised the necessity for improved communication between
multidisciplinary teams, with the aim to ensure that severe AS patients
receive appropriate treatment. Methods/design: IMPULSE is a prospective,
multicentre, European registry designed to gather data over 12 months on
the treatment decisions made by referring physicians for patients newly
diagnosed with severe AS. Each patient has a follow-up of 3 months. The
study will consist of two observational phases to assess the
appropriateness and rate of referral based on current guidelines prior to
and after an interventional phase aiming to determine whether a simple
quality of care intervention improves patient management. Discussion: Data
will be analysed firstly, to determine the appropriateness of treatment
decisions for the management of severe AS in current European clinical
practice, and secondly, to evaluate the effectiveness of facilitated data
relay from a designated echocardiography department nurse to the referring
physician early after diagnosis in improving quality of care.
Additionally, variables will be identified that are associated with
inappropriate decision-making. Collectively, the aim will be to design a
clinical pathway that will improve the timely management of patients with
newly diagnosed severe AS. Copyright &#xa9; 2017 The Author(s).

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

<13>
Accession Number
613271864
Author
Alsaied T.; Bokma J.P.; Engel M.E.; Kuijpers J.M.; Hanke S.P.; Zuhlke L.;
Zhang B.; Veldtman G.R.
Institution
(Alsaied, Hanke) Children's Heart Institute, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
(Bokma, Kuijpers) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Bokma, Kuijpers) Netherlands Interuniversity Cardiology Institute of the
Netherlands - Netherlands Heart Institute, Utrecht, Netherlands
(Engel) Department of Medicine, Groote Schuur Hospital, Cape Town, South
Africa
(Zuhlke) Department of Paediatrics, Red Cross War Memorial Children's
Hospital, University of Cape Town, Cape Town, South Africa
(Zhang) Division of Biostatistics and Epidemiology, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
(Veldtman) Adolescent and Adult Congenital Program, Children's Heart
Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet
Avenue, Cincinnati, OH 45229, United States
Title
Factors associated with long-term mortality after Fontan procedures: A
systematic review.
Source
Heart. 103 (2) (pp 104-110), 2017. Date of Publication: 15 Jan 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Despite an ageing Fontan population, data on late outcomes are
still scarce. Reported outcome measures and determinants vary greatly
between studies making comprehensive appraisal of mortality hazard
challenging. Methods We conducted a systematic review to evaluate causes
and factors associated with late mortality in patients with Fontan
circulation. Late mortality was defined as mortality beyond the first
postoperative year. Studies were included if they had >90 patients or >20
late mortalities and/or transplants. Studies with overlapping patients
were rationalised to include only the most recent studies to avoid
duplication. Results From 28 studies, a total of 6707 patients with an
average follow-up time of 8.23+/-5.42 years was identified. There were
1000 deaths. Causes of late death were reported in 697 cases. The five
most common causes were heart/Fontan failure (22%), arrhythmia (16%),
respiratory failure (15%), renal disease (12%) and thrombosis/bleeding
(10%). Factors associated with late mortality were evaluated and
classified into 9 categories. Conclusions Causes and factors associated
with late mortality after the Fontan operation are summarised in this
study. The presented information will aid in identifying patients at
highest risk for mortality and guide our risk stratification efforts in
this patient population. Copyright &#xa9; Published by the BMJ Publishing
Group Limited.

<14>
Accession Number
614197007
Author
Lovinfosse P.; Hustinx R.
Institution
(Lovinfosse, Hustinx) Division of Nuclear Medicine and Oncological
Imaging, University Hospital of Liege, Liege, Belgium
Title
Nuclear medicine techniques in transplantation.
Source
Clinical and Translational Imaging. 5 (1) (pp 45-62), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer-Verlag Italia s.r.l. (E-mail: springer@springer.it)
Abstract
Purpose: To evaluate the indications and perspectives of nuclear medicine
techniques in transplantation. Methods: We performed a systematic review
of the literature using PubMed/Medline and Google scholars, with multiple
research keywords for each organ accompanying the terms "transplant",
"transplantation", "graft", "nuclear imaging", "scintigraphy", "PET" and
"PET/CT". The review considers the following organs/systems: kidney,
liver, pancreas, heart, lung, bone and salivary glands, as well as a
common complication, the post-transplant lymphoproliferative disorder. The
references of the retrieved articles were also considered to find
supplementary articles. The search was limited to English language.
Preoperative workup exploration, preclinical and animal studies were not
included in the review. A total of 146 original articles were considered
for the review, including 118 retrospective and 28 prospective studies.
Results: The functional integrity of the renal graft is safely and
reliably assessed using quantitative dynamic scintigraphy with
^99mTc-DTPA or ^99mTc-MAG3. ¹⁸F-FDG PET/CT
is a promising method for early detection of acute rejection. The
glomerular filtration rate (GFR) of potential donors should ideally be
assessed using ⁵¹Cr-EDTA, and the split renal function could be
quantified using ^99mTc-MAG3 or ^99mTc-DMSA imaging.
In liver transplantation, both ^99mTc-GSA and
^99mTc-HIDA scintigraphies can be used for evaluating the
function of transplanted liver, and ¹⁸F-FDG PET/CT increasingly
appears as a powerful tool for characterising the aggressiveness of
hepatocellular carcinoma and contributes to the decision of
transplantation in selected patients. In heart transplants, the major
indication is the evaluation of cardiac allograft vasculopathy using
myocardial perfusion imaging, either with SPECT or PET. In the context of
lung transplantation, perfusion scanning helps select potential donors and
contributes to the postoperative follow-up, either early on for detecting
primary graft dysfunction or later on in the diagnosis of chronic
rejection. Bone scintigraphy and ¹⁸F-NaF PET/CT are valuable
tools for assessing bone graft viability. This is particularly established
in mandible grafts, but convincing data are available in other types of
graft. Salivary gland transplantation is not frequently performed, but in
such a clinical situation, ^99mTcO4 scintigraphy is an elegant
way to help select the transplant and to verify the viability of the
graft. Finally, ¹⁸F-FDG PET/CT is very effective in patients
with post-transplant lymphoproliferative disorder (PTLD), both at
diagnosis and for evaluating the response to treatment. Conclusion:
Nuclear medicine techniques are strongly established as valuable clinical
tools in a wide variety of indications, before and after organ
transplantation. Furthermore, ¹⁸F-FDG PET/CT in PTLD and
radio-isotopic evaluation of the renal function in putative kidney donors
are recommended in clinical algorithms proposed in international
guidelines. Copyright &#xa9; 2016, Italian Association of Nuclear Medicine
and Molecular Imaging.

<15>
Accession Number
611708010
Author
Mangiacapra F.; Colaiori I.; Ricottini E.; Balducci F.; Creta A.;
Demartini C.; Minotti G.; Di Sciascio G.
Institution
(Mangiacapra, Colaiori, Ricottini, Balducci, Creta, Demartini, Di
Sciascio) Unit of Cardiovascular Science, Department of Medicine, Campus
Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
(Minotti) Unit of Drug Science, Department of Medicine, Campus Bio-Medico
University, Rome, Italy
Title
Heart Rate reduction by IVabradine for improvement of ENDothELial function
in patients with coronary artery disease: the RIVENDEL study.
Source
Clinical Research in Cardiology. 106 (1) (pp 69-75), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Aims: Data from experimental studies suggest that the <inf>f</inf>
current-inhibitor ivabradine may reduce oxidative stress and improve
endothelial function. We aimed to evaluate the effect of ivabradine on
endothelial function in patients with coronary artery disease (CAD) after
complete revascularization with percutaneous coronary angioplasty (PCI).
Methods and results: At least 30 days after PCI, 70 patients were
randomized (T0) to receive ivabradine 5 mg twice daily (ivabradine group,
n = 36) or to continue with standard medical therapy (control group, n =
34). After 4 weeks (T1), ivabradine dose was adjusted up to 7.5 mg twice
daily in patients with heart rate (HR) at rest >60 bpm, and thereafter
continued for additional 4 weeks (T2). At all timings, brachial artery
reactivity was assessed by flow-mediated dilatation (FMD) and
nitroglycerin-mediated dilatation (NMD). No significant differences were
observed at T0 between ivabradine and control groups in terms of HR (68.0
+/- 6.4 vs. 67.6 +/- 6.4 bpm; p = 0.803), FMD (8.7 +/- 4.9 vs. 8.0 +/- 5.5
%; p = 0.577) and NMD (12.7 +/- 6.7 vs. 13.3 +/- 6.2 %; p = 0.715). Over
the study period, a significant reduction of HR (65.2 +/- 5.9 bpm at T1,
62.2 +/- 5.7 bpm at T2; p < 0.001), and improvement of FMD (12.2 +/- 6.2 %
at T1, 15.0 +/- 7.7 % at T2; p < 0.001) and NMD (16.6 +/- 10.4 % at T1,
17.7 +/- 10.8 at T2; p < 0.001) were observed in the ivabradine group,
while no significant changes were observed in the control group. In the
ivabradine group, a moderate negative correlation was observed between the
HR variation and FMD variation from T1 to T3 (r = -0.448; p = 0.006).
Conclusions: In patients with CAD undergoing complete revascularization
with PCI, addition of ivabradine to the standard medical therapy produces
a significant improvement in endothelial function. This effect seems to be
related to HR reduction. ClinicalTrials.gov number, NCT02681978. Copyright
&#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<16>
Accession Number
614135626
Author
Edwards S.J.; Crawford F.; van Velthoven M.H.; Berardi A.; Osei-Assibey
G.; Bacelar M.; Salih F.; Wakefield V.
Institution
(Edwards, Crawford, van Velthoven, Berardi, Osei-Assibey, Bacelar, Salih,
Wakefield) BMJ Technology Assessment Group, London, United Kingdom
Title
The use of fibrin sealant during non-emergency surgery: A systematic
review of evidence of benefits and harms.
Source
Health Technology Assessment. 20 (94) (pp i, 224), 2016. Date of
Publication: December 2016.
Publisher
NIHR Journals Library
Abstract
Background: Fibrin sealants are used in different types of surgery to
prevent the accumulation of post-operative fluid (seroma) or blood
(haematoma) or to arrest haemorrhage (bleeding). However, there is
uncertainty around the benefits and harms of fibrin sealant use.
Objectives: To systematically review the evidence on the benefits and
harms of fibrin sealants in non-emergency surgery in adults. Data sources:
Electronic databases [MEDLINE, EMBASE and The Cochrane Library (including
the Cochrane Database of Systematic Reviews, the Database of Abstracts of
Reviews of Effects, the Health Technology Assessment database and the
Cochrane Central Register of Controlled Trials)] were searched from
inception to May 2015. The websites of regulatory bodies (the Medicines
and Healthcare products Regulatory Agency, the European Medicines Agency
and the Food and Drug Administration) were also searched to identify
evidence of harms. Review methods: This review included randomised
controlled trials (RCTs) and observational studies using any type of
fibrin sealant compared with standard care in non-emergency surgery in
adults. The primary outcome was risk of developing seroma and haematoma.
Only RCTs were used to inform clinical effectiveness and both RCTs and
observational studies were used for the assessment of harms related to the
use of fibrin sealant. Two reviewers independently screened all titles and
abstracts to identify potentially relevant studies. Data extraction was
undertaken by one reviewer and validated by a second. The quality of
included studies was assessed independently by two reviewers using the
Cochrane Collaboration risk-of-bias tool for RCTs and the Centre for
Reviews and Dissemination guidance for adverse events for observational
studies. A fixed-effects model was used for meta-analysis. Results: We
included 186 RCTs and eight observational studies across 14 surgical
specialties and five reports from the regulatory bodies. Most RCTs were
judged to be at an unclear risk of bias. Adverse events were
inappropriately reported in observational studies. Meta-analysis across
non-emergency surgical specialties did not show a statistically
significant difference in the risk of seroma for fibrin sealants versus
standard care in 32 RCTs analysed [n = 3472, odds ratio (OR) 0.84, 95%
confidence interval (CI) 0.68 to 1.04; p = 0.13; I² = 12.7%],
but a statistically significant benefit was found on haematoma development
in 24 RCTs (n = 2403, OR 0.62, 95% CI 0.44 to 0.86; p = 0.01;
I² = 0%). Adverse events related to fibrin sealant use were
reported in 10 RCTs and eight observational studies across surgical
specialties, and 22 RCTs explicitly stated that there were no adverse
events. One RCT reported a single death but no other study reported
mortality or any serious adverse events. Five regulatory body reports
noted death from air emboli associated with fibrin sprays. Limitations: It
was not possible to provide a detailed evaluation of individual RCTs in
their specific contexts because of the limited resources that were
available for this research. In addition, the number of RCTs that were
identified made it impractical to conduct independent data extraction by
two reviewers in the time available. Conclusions: The effectiveness of
fibrin sealants does not appear to vary according to surgical procedures
with regard to reducing the risk of seroma or haematoma. Surgeons should
note the potential risk of gasembolism if spray application of fibrin
sealants is used and not to exceed the recommended pressure and spraying
distance. Future research should be carried out in surgery specialties for
which only limited datawere found, including neurological, gynaecological,
oral and maxillofacial, urology, colorectal and orthopaedics surgery (for
any outcome); breast surgery and upper gastrointestinal (development of
haematoma); and cardiothoracic heart or lung surgery (reoperation rates).
In addition, studies need to use adequate sample sizes, to blind
participants and outcome assessors, and to follow reporting guidelines.
Copyright &#xa9; Queen's Printer and Controller of HMSO 2016.

<17>
Accession Number
611688525
Author
Danzi G.B.; Piccolo R.; Chevalier B.; Urban P.; Fath-Ordoubadi F.; Carrie
D.; Wiemer M.; Serra A.; Wijns W.; Kala P.; Stabile A.; Goicolea Ruigomez
J.; Sagic D.; Laanmets P.; Strupp G.; West N.
Institution
(Danzi, Piccolo) Division of Cardiology, Ospedale Santa Corona, Pietra
Ligure SV, Italy
(Piccolo) Bern University Hospital, Bern, Switzerland
(Chevalier) Institut Cardiovasculaire Paris Sud, Massy/Quincy, France
(Urban) Hopital de la Tour, Geneva, Switzerland
(Fath-Ordoubadi) Royal Infirmary, Manchester, United Kingdom
(Carrie) Centre Hospitalier Universitaire Rangueil, Toulouse, France
(Wiemer) Herz-und Diabeteszentrum North-Rhine Westphalia, Bad Oeynhausen,
Germany
(Wiemer) Department of Cardiology and Intensive Care Medicine, Johannes
Wesling Hospital Minden, Minden, Germany
(Serra) Hospital de la Sta. Creu i St. Pau, Barcelona, Spain
(Wijns) Cardiovascular Research Center OLV Hospital, Aalst, Belgium
(Kala) University Hospital Brno, Brno, Czech Republic
(Stabile) A.R.N.A.S. Ospedale Civico, Palermo, Italy
(Goicolea Ruigomez) Hospital Puerta de Hierro, Madrid, Spain
(Sagic) Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia
(Laanmets) North-Estonia Regional Hospital, Tallinn, Estonia
(Strupp) Klinikum Fulda AG, Fulda, Germany
(West) Papworth Hospital, Cambridge, United Kingdom
Title
Five-year clinical performance of a biodegradable polymer-coated
biolimus-eluting stent in unselected patients.
Source
Heart. 103 (2) (pp 111-116), 2017. Date of Publication: 15 Jan 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate the long-term follow-up of the unrestricted use of a
biodegradable polymer-coated drug-eluting stent in patients undergoing
percutaneous coronary intervention (PCI). Methods The Nobori 2 study was a
prospective, multicentre, observational registry evaluating the safety and
the efficacy of the biodegradable polymer biolimus-eluting stent (BP-BES)
among 3067 patients recruited at 125 international sites. The primary
combined endpoint was a composite of cardiac death, myocardial infarction
and target-lesion revascularisation (TLR). Results Five-year follow-up was
available in 2738 (89.3%) patients. The combined endpoint occurred in 268
patients (10%, 95% CIs 8.9% to 11.3%) at 5 years, with 3.9% of events
during the first year and 6.2% during years 1-5 of follow-up. Cumulative
rates of TLR and definite/probable stent thrombosis were 5.3% (95% CI 4.5%
to 6.3%) and 1.1% (95% CI 0.8% to 1.6%), respectively. Between 1 and 5
years, TLR and very late stent thrombosis rates were 3.5% (95% CI 2.8% to
4.4%) and 0.6% (95% CI 0.3% to 1.1%), respectively. Previous PCI (HR,
2.05, 95% CI 1.68 to 2.50), moderate-to-severe renal disease (HR, 1.89,
95% CI 1.30 to 2.74) and peripheral vascular disease (HR, 1.86, 95% CI
1.38 to 2.52) were the three most powerful independent predictors of the
combined endpoint at 5 years. Conclusions The final 5-year follow-up of
the Nobori 2 registry demonstrates the safety and effectiveness of the
BP-BES in an unselected, broadly inclusive cohort of PCI patients,
highlighting the excellent performance of this coronary stent technology
after polymer biodegradation. Trial registration number ISRCTN81649913;
Results. Copyright &#xa9; Published by the BMJ Publishing Group Limited.

<18>
Accession Number
614112937
Author
Chakravarthy M.; Prabhakumar D.; Thimmannagowda P.; Krishnamoorthy J.;
George A.; Jawali V.
Institution
(Chakravarthy, Prabhakumar, Thimmannagowda, Krishnamoorthy, George,
Jawali) Department of Anesthesia, Critical Care and Pain Relief, Fortis
Hospitals, Bannerughatta Road, Bengaluru, Karnataka 560 076, India
Title
Comparison of two doses of heparin on outcome in off-pump coronary artery
bypass surgery patients: A prospective randomized control study.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 8-13), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: While off pump coronary artery bypass surgery is practiced
with an intention to reduce the morbidity associated with cardiopulmonary
bypass, the resultant 'hypercoagulability' needs to be addressed.
Complications such as cavitary thrombus possibly due to the hyper
coagulability after off pump coronary artery bypass surgery have been
described. Many clinicians use higher doses of heparin - up to 5 mg/kg in
order to thwart this fear. Overall, there appears to be no consensus on
the dose of heparin in off pump coronary artery bypass surgeries. Aim of
the Study: The aim of the study was understand the differences in outcome
of such as transfusion requirement, myocardial ischemia, and morbidity
when two different doses were used for systemic heparinization. Methods:
Elective patients scheduled for off pump coronary artery bypass surgery
were included. Ongoing anti platelet medication was not an exclusion
criteria, however, anti platelet medications were ceased about a week
prior to surgery when possible. Thoracic epidural anesthesia was
administered as an adjunct in patients who qualified for it. By computer
generated randomization chart, patients were chosen to receive either 2 or
3 mg/kg of intravenous unfractioned heparin to achieve systemic
heparinization with activated clotting time targeted at >240 secs.
Intraoperative blood loss, postoperative blood loss, myocardial ischemic
episodes, requirement of intraaortic balloon counter pulsation and
transfusion requirement were analyzed. Results: Sixty two patients
participated in the study. There was one conversion to cardiopulmonary
bypass. The groups had comparable ACT at baseline (138.8 vs. 146.64
seconds, P = 0.12); 3 mg/kg group had significantly higher values after
heparin, as expected. But after reversal with protamine, ACT and need for
additional protamine was similar among the groups. Intraoperative (685.56
+/- 241.42 ml vs. 675.15 +/- 251.86 ml, P = 0.82) and postoperative blood
loss (1906.29 +/- 611.87 ml vs 1793.65 +/- 663.54 ml , p value 0.49) were
similar among the groups [Table 4]. The incidence of ECG changes of
ischemia, arrhythmias, conversion to CPB, or need for intra-aortic balloon
counter pulsation were not different. Conclusions: Use of either 2 or 3
mg/kg heparin for systemic heparinization in patients undergoing OPCAB did
not affect the outcome. Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<19>
Accession Number
614112919
Author
Kapoor P.; Magoon R.; Rawat R.; Mehta Y.; Taneja S.; Ravi R.; Hote M.
Institution
(Kapoor, Magoon) Department of Cardiac Anaesthesia, Cardio Thoracic
Centre, AIIMS, New Delhi 110 029, India
(Rawat) Department of Cardiac Anaesthesiology, Salalah Heart Center,
Salalah, Oman
(Mehta) Department of Critical Care and Anaesthesiology, Medanta - the
Medicity, Gurgaon, Haryana, India
(Taneja) Department of Cardiac Anaesthesia, Naval Base Hospital, Mumbai,
Maharashtra, India
(Ravi) Department of Statistics, Lady Shri Ram College, University of
Delhi, New Delhi, India
(Hote) Department of Cardiothoracic and Vascular Surgery, AIIMS, New
Delhi, India
Title
Goal-directed therapy improves the outcome of high-risk cardiac patients
undergoing off-pump coronary artery bypass.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 83-89), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: There has been a constant emphasis on developing management
strategies to improve the outcome of high-risk cardiac patients undergoing
surgical revascularization. The performance of coronary artery bypass
surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks
associated with extra-corporeal circulation. The preliminary results of
goal-directed therapy (GDT) for hemodynamic management of high-risk
cardiac surgical patients are encouraging. The present study was conducted
to study the outcome benefits with the combined use of GDT with OPCAB as
compared to the conventional hemodynamic management. Material and Method:
Patients with the European System for Cardiac Operative Risk Evaluation >3
scheduled for OPCAB were randomly divided into two groups; the control and
GDT groups. The GDT group included the monitoring and optimization of
advanced parameters, including cardiac index (CI), systemic vascular
resistance index, oxygen delivery index, stroke volume variation;
continuous central venous oxygen saturation (ScVO <inf>2</inf> ), global
end-diastolic volume, and extravascular lung water (EVLW), using
FloTrac^TM , PreSep^TM , and EV-1000 
monitoring panels, in addition to the conventional hemodynamic management
in the control group. The hemodynamic parameters were continuously
monitored for 48 h in Intensive Care Unit (ICU) and corrected according to
GDT protocol. A total of 163 patients consented for the study. Result:
Seventy-five patients were assigned to the GDT group and 88 patients were
in the control group. In view of 9 exclusions from the GDT group and 12
exclusions from control group, 66 patients in the GDT group and 76
patients in control group completed the study. Conclusion: The length of
stay in hospital (LOS-H) (7.42 +/- 1.48 vs. 5.61 +/- 1.11 days, P < 0.001)
and ICU stay (4.2 +/- 0.82 vs. 2.53 +/- 0.56 days, P < 0.001) were
significantly lower in the GDT group as compared to control group. The
duration of inotropes (3.24 +/- 0.73 vs. 2.89 +/- 0.68 h, P = 0.005) was
also significantly lower in the GDT group. The two groups did not differ
in duration of ventilated hours, mortality, and other complications. The
parameters such as ScVO <inf>2</inf> , CI, and EVLW had a strong negative
and positive correlation with the LOS-H with r values of - 0.331, -0.319,
and 0.798, respectively. The study elucidates the role of a goal-directed
hemodynamic optimization for improved outcome in high-risk cardiac
patients undergoing OPCAB. Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

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

<21>
Accession Number
614112849
Author
Baishya J.; George A.; Krishnamoorthy J.; Muniraju G.; Chakravarthy M.
Institution
(Baishya, George, Krishnamoorthy, Muniraju, Chakravarthy) Department of
Anesthesiology and Critical Care, Fortis Hospital, B. G. Road, Bengaluru,
Karnataka, India
Title
Minimally invasive compared to conventional approach for coronary artery
bypass grafting improves outcome.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 57-60), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Minimally invasive (MI) cardiac surgery is a rapidly gaining
popularity, globally as well as in India. We aimed to compare the outcome
of MI to the conventional approach for coronary artery bypass graft (CABG)
surgery. Methods: This prospective, comparative study was conducted at a
tertiary care cardiac surgical center. All patients who underwent CABG
surgery via MI approach (MI group) from July 2015 to December 2015 were
enrolled and were compared against same number of EuroSCORE II matched
patients undergoing CABG through conventional mid-sternotomy approach (CON
group). Demographic, intra- and post-operative variables were collected.
Results: In MI group, duration of the surgery was significantly longer (P
= 0.029). Intraoperative blood loss lesser (P = 0.002), shorter duration
of ventilation (P = 0.002), shorter Intensive Care Unit stay (P = 0.004),
shorter hospital stay (P = 0.003), lesser postoperative analgesic
requirements (P = 0.027), and lower visual analog scale scores on day of
surgery (P = 0.032) and 1 ^st postoperative day (P = 0.025). No
significant difference in postoperative blood loss, blood transfusion, or
duration of inotrope requirement observed. There was no conversion to
mid-sternotomy in any patients, 8% of patients had desaturation
intraoperatively. There was no operative mortality. Conclusion: MI surgery
is associated with lesser intraoperative blood loss, better analgesia, and
faster recovery. Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.

<22>
Accession Number
614112834
Author
Fernandes G.; Araujo Junior R.; Lima A.; Gonzaga I.; De Oliveira R.;
Nicolau R.
Institution
(Fernandes, Lima, Gonzaga, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IPandD, Universidade Do Vale Do
Paraiba, Vitorino Orthiges Fernandes Street, Bairro Uruguai, Teresina, PI
6321, Brazil
(Fernandes, Gonzaga, De Oliveira) Uninovafapi Universitary Center
(UNINOVAFAPI), Brazil
(Araujo Junior) Department of Cardiac Surgery, Santa Maria Hospital,
Bairro Centro, Brazil
(Lima, De Oliveira) Department of Physical Therapy, University of Piaui
State PI, Brazil
Title
Low-intensity laser (660 NM) has analgesic effects on sternotomy of
patients who underwent coronary artery bypass grafts.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 52-56), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: The aim of this study was to evaluate the efficacy of
low-level laser therapy for reducing the acute pain of sternotomy in
patients who underwent a coronary artery bypass graft (CABG). Methods:
This study was conducted with ninety volunteers who electively submitted
to CABG. The volunteers were randomly allocated into three groups of equal
size (n = 30): control, placebo, and laser (lambda of 660 nm and spatial
average energy fluency of 1.06 J/cm ² ). Pain when coughing was
assessed by a visual analog scale (VAS) and McGill Pain Questionnaire,
according to sensory, affective, evaluative, and miscellaneous domains.
The patients were followed for 1 month after the surgery. Results: The
laser group had a greater decrease in pain with analogous results, as
indicated by both the VAS and the McGill questionnaire (P < 0.05) on
sensory and affective scores, on days 6 and 8 postsurgery compared to the
placebo and control groups. Conclusion: Laser seems to be effective
promoting pain reduction after coronary-arterial bypass grafting.
Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia Published by Wolters
Kluwer - Medknow.

<23>
Accession Number
614112809
Author
Safaei N.; Babaei H.; Azarfarin R.; Jodati A.-R.; Yaghoubi A.;
Sheikhalizadeh M.-A.
Institution
(Safaei, Jodati, Sheikhalizadeh) Cardiovascular Research Center, School of
Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Babaei) Drug Applied Research Center, School of Pharmacy, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Azarfarin, Yaghoubi) Echocardiography Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Comparative effect of grape seed extract (Vitis vinifera) and ascorbic
acid in oxidative stress induced by on-pump coronary artery bypass
surgery.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 45-51), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: This study aimed to test the beneficial effect of grape seed
extract (GSE) (Vitis vinifera) and Vitamin C in oxidative stress and
reperfusion injury induced by cardiopulmonary bypass (CPB) in coronary
artery bypass surgery. Patients and Methods: In this randomized trial, 87
patients undergoing elective and isolated coronary bypass surgery
included. The patients were randomly assigned into three groups (n = 29
each): (1) Control group with no treatment, (2) GSE group who received the
extract 24 h before operation, 100 mg every 6 h, orally, (3) Vitamin C
group who received 25 mg/kg Vitamin C through CPB during surgery. Blood
samples were taken from coronary sinus at (T1) just before aortic cross
clamp; (T2) just before starting controlled aortic root reperfusion; and
(T3) 10 min after root reperfusion. Some clinical parameters and
biochemical markers were compared among the groups. Results: There were
significant differences in tracheal intubation times, sinus rhythm return,
and left ventricular function between treatment groups compared with
control (P < 0.05). Total antioxidant capacity was higher (P < 0.05) in
both grape seed and Vitamin C groups at T2 and T3 times. In reperfusion
period, malondialdehyde level was increased in control group; however, it
was significantly lower for the grape seed group (P = 0.04). The
differences in the mean levels of superoxide dismutase and glutathione
peroxidase among the three groups were not significant (P > 0.05 in all
cases). Conclusions: In our patients, GSE and Vitamin C had antioxidative
effects and reduced deleterious effects of CPB during coronary artery
bypass grafting surgery. Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<24>
Accession Number
613804449
Author
Mine S.; Watanabe M.
Institution
(Mine, Watanabe) Department of Gastroenterological Surgery, Cancer
Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
Title
A commentary on "Ten-year follow-up results of a randomized clinical trial
comparing left thoracoabdominal and abdominal transhiatal approaches to
total gastrectomy for adenocarcinoma of the oesophagogastric junction or
gastric cardia".
Source
Translational Gastroenterology and Hepatology. 2016 (MAR) (no pagination),
2016. Date of Publication: 2016.
Publisher
AME Publishing Company (E-mail: info@amepc.org)

<25>
Accession Number
613799386
Author
Nagaraja V.; Ooi S.-Y.; Nolan J.; Large A.; De Belder M.; Ludman P.; Bagur
R.; Curzen N.; Matsukage T.; Yoshimachi F.; Kwok C.S.; Berry C.; Mamas
M.A.
Institution
(Nagaraja, Ooi) Department of Cardiology, Prince of Wales Hospital,
Sydney, NSW, Australia
(Nolan, Large, Kwok, Mamas) Royal Stoke University Hospital, University
Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
(Nolan, Kwok, Mamas) Keele Cardiovascular Research Group, Institute of
Science and Technology in Medicine, University of Keele, Stoke-on-Trent,
United Kingdom
(De Belder) The James Cook University Hospital, Middlesbrough, United
Kingdom
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
(Bagur) Division of Cardiology, Department of Medicine and Department of
Epidemiology and Biostatistics, London Health Sciences Centre, Western
University, London, ON, Canada
(Curzen) University Hospital Southampton and Faculty of Medicine,
University of Southampton, United Kingdom
(Matsukage, Yoshimachi) Division of Cardiology, Tokai University School of
Medicine, Isehara, Japan
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, United Kingdom
Title
Impact of incomplete percutaneous revascularization in patients with
multivessel coronary artery disease: A systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 5 (12) (no pagination), 2016.
Article Number: e004598. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Up to half of patients undergoing percutaneous coronary
intervention have multivessel coronary artery disease (MVD) with
conflicting data regarding optimal revascularization strategy in such
patients. This paper assesses the evidence for complete revascularization
(CR) versus incomplete revascularization in patients undergoing
percutaneous coronary intervention, and its prognostic impact using
meta-analysis. Methods and Results-A search of PubMed, EMBASE, MEDLINE,
Current Contents Connect, Google Scholar, Cochrane library, Science
Direct, and Web of Science was conducted to identify the association of CR
in patients with multivessel coronary artery disease undergoing
percutaneous coronary intervention with major adverse cardiac events and
mortality. Random-effects metaanalysis was used to estimate the odds of
adverse outcomes. Meta-regression analysis was conducted to assess the
relationship with continuous variables and outcomes. Thirty-eight
publications that included 156 240 patients were identified. Odds of death
(OR 0.69, 95% CI 0.61-0.78), repeat revascularization (OR 0.60, 95% CI
0.45-0.80), myocardial infarction (OR 0.64, 95% CI 0.50- 0.81), and major
adverse cardiac events (OR 0.63, 95% CI 0.50-0.79) were significantly
lower in the patients who underwent CR. These outcomes were unchanged on
subgroup analysis regardless of the definition of CR. Similar findings
were recorded when CR was studied in the chronic total occlusion (CTO)
subgroup (OR 0.65, 95% CI 0.53-0.80). A meta-regression analysis revealed
a negative relationship between the OR for mortality and the percentage of
CR. Conclusion-CR is associated with reduced risk of mortality and major
adverse cardiac events, irrespective of whether an anatomical or a
score-based definition of incomplete revascularization is used, and this
magnitude of risk relates to degree of CR. These results have important
implications for the interventional management of patients with
multivessel coronary artery disease. Copyright &#xa9; 2016 The Authors.

<26>
Accession Number
613771830
Author
Salcher M.; Naci H.; Pender S.; Kuehne T.; Kelm M.
Institution
(Salcher, Naci, Pender) Department of Social Policy, LSE Health, London
School of Economics and Political Science, London, United Kingdom
(Pender) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Kuehne, Kelm) Department of Paediatric Cardiology and Congenital Heart
Diseases, German Heart Institute, Berlin, Germany
Title
Bicuspid aortic valve disease: Systematic review and meta-analysis of
surgical aortic valve repair.
Source
Open Heart. 3 (2) (no pagination), 2016. Article Number: e000502. Date of
Publication: 01 Dec 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Aortic valve repair is still emerging, and its role in the treatment of
bicuspid aortic valve disease (BAVD) is not yet fully understood. Our
objective is to synthesise available evidence on outcomes after surgical
aortic valve repair in patients with BAVD. We conducted a systematic
review of clinical studies using prespecified methods for searching,
identifying and selecting eligible studies in 4 databases, and
synthesising results (PROSPERO 2014:CRD42014014415). 2 researchers
independently reviewed full-text articles and extracted data. The results
of included studies were quantitatively synthesised in frequentist
meta-analyses. We included 11 aortic valve repair studies or study arms
with a total of 2010 participants. Pooled estimates for the proportion of
patients surviving at 30 days, 1 year, 5 years and 10 years were 0.995
(95% CI 0.991 to 0.995), 0.994 (0.989 to 0.999), 0.945 (0.898 to 0.993)
and 0.912 (0.845 to 0.979), respectively. The pooled proportion of late
deaths from valve-related causes was 0.008 (0.000 to 0.019) at a mean
follow-up of 3.5 years. Proportion of patients with valve-related
reinterventions was 0.075 (0.037 to 0.113) at a mean follow-up of 3.9
years, and the linearised reintervention rate was 1.3 (0.7 to 1.9) per 100
patient-years. Outcome reporting was insufficient to pool the results for
a number of predefined outcomes. In conclusion, existing evidence on
aortic valve repair in BAVD is limited to mostly small case series,
case-control and small retrospective cohort studies. Despite the low
quality, available evidence suggests favourable survival outcomes after
aortic valve repair in selected patients with BAVD. Valve-related
reinterventions at follow-up are common in all patients undergoing repair
surgery. Copyright &#xa9; Published by the BMJ Publishing Group Limited.
For permission to use (where not already granted under a licence) please
go to http://www.bmj.com/company/products-services/rights-and-licensing/.

<27>
Accession Number
614231887
Author
Ullrich H.; Gori T.
Institution
(Ullrich, Gori) Kardiologie i, Zentrum fur Kardiologie, Center for
Translational Vascular Biology, Universitatsmedizin Mainz, DZHK Standort
Rhein-Main, Langenbeckstr. 1, Mainz 55131, Germany
Title
Antiplatelet therapies in patients with an indication for anticoagulation.
Source
Clinical Hemorheology and Microcirculation. 64 (3) (pp 273-278), 2016.
Date of Publication: 2016.
Publisher
IOS Press (Nieuwe Hemweg 6B, Amsterdam 1013 BG, Netherlands)
Abstract
Triple anticoagulant therapy is necessary in patients who are at increased
risk for both arterial (in stent) and venous thrombosis, or have atrial
fibrillation. Triple therapy however also poses a very high risk for
bleeding events, particularly because this subset of patients is
particularly frail due to the high incidence of comorbidities and advanced
age. Very little randomized studies have tested the impact of the many
possible combinations of anticoagulant/antiaggregant drugs, and surveys
among practicing physicians show that the use of off-label therapies is
very common. In a recent survey from our group, we observed that
physicians are very divided in terms of what therapy should be recommended
to patients with indication to anticoagulation and with a history of
stenting. The use of novel anticoagulants was as frequent as that of
vitamin K antagonists, and the duration of triple therapy was very
variable. While these data probably show that decisions are usually taken
on an individual basis, considering the patient's risk of ischemia and
hemorrhagic events, much of this variability probably depends on the fact
that, failing randomized trials, guidelines in this area are relatively
less specific than in other ones. Copyright &#xa9; 2016 - IOS Press and
the authors. All rights reserved.

<28>
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

<29>
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

<30>
Accession Number
613182314
Author
Shaffer E.E.; Pham A.; Woldman R.L.; Spiegelman A.; Strassels S.A.; Wan
G.J.; Zimmerman T.
Institution
(Shaffer, Woldman, Spiegelman) The Advisory Board Company, Washington, DC,
United States
(Pham, Wan) Mallinckrodt Pharmaceuticals, Hampton, NJ, United States
(Strassels) Optum Hospice Pharmacy Services, St Louis, MO, United States
(Zimmerman) BernardsvilleNJUnited States
Title
Estimating the Effect of Intravenous Acetaminophen for Postoperative Pain
Management on Length of Stay and Inpatient Hospital Costs.
Source
Advances in Therapy. 33 (12) (pp 2211-2228), 2017. Date of Publication: 01
Jan 2017.
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: The provision of safe, effective, cost-efficient
perioperative inpatient acute pain management is an important concern
among clinicians and administrators within healthcare institutions.
Overreliance on opioid monotherapy in this setting continues to present
health risks for patients and increase healthcare costs resulting from
preventable adverse events. The goal of this study was to model length of
stay (LOS), potential opioid-related complications, and costs for patients
reducing opioid use and adding intravenous acetaminophen (IV APAP) for
management of postoperative pain. Methods: Data for this study were
de-identified inpatient encounters from The Advisory Board Company across
297 hospitals from 2012-2014, containing 2,238,433 encounters (IV APAP
used in 12.1%). Encounters for adults >18 years of age admitted for
cardiovascular, colorectal, general, obstetrics and gynecology,
orthopedics, or spine surgery were included. The effects of reducing
opioids and adding IV APAP were estimated using hierarchical statistical
models. Costs were estimated by multiplying modeled reductions in LOS or
complication rates by observed average volumes for medium-sized
facilities, and by average cost per day or per complication (LOS:
US$2383/day; complications: derived from observed charges). Results:
Across all surgery types, LOS showed an average reduction of 18.5%
(10.7-32.0%) for the modeled scenario of reducing opioids by one level
(high to medium, medium to low, or low to none) and adding IV APAP, with
an associated total LOS-related cost savings of $4.5 M. Modeled
opioid-related complication rates showed similar improvements, averaging a
reduction of 28.7% (5.4-44.0%) with associated cost savings of $0.2 M. In
aggregate, costs decreased by an estimated $4.7 M for a medium-sized
hospital. The study design demonstrates associations only and cannot
establish causal relationships. The cost impact of LOS is modeled based on
observed data. Conclusions: This investigation indicates that reducing
opioid use and including IV APAP for postoperative pain management has the
potential to decrease LOS, opioid-related complication rates, and costs
from a hospital perspective. Funding: Mallinckrodt Pharmaceuticals.
Copyright &#xa9; 2016, The Author(s).

<31>
Accession Number
614093266
Author
Picano E.; Ciampi Q.; Citro R.; D'Andrea A.; Scali M.C.; Cortigiani L.;
Olivotto I.; Mori F.; Galderisi M.; Costantino M.F.; Pratali L.; Di Salvo
G.; Bossone E.; Ferrara F.; Gargani L.; Rigo F.; Gaibazzi N.; Limongelli
G.; Pacileo G.; Andreassi M.G.; Pinamonti B.; Massa L.; Torres M.A.R.;
Miglioranza M.H.; Daros C.B.; De Castro E Silva Pretto J.L.; Beleslin B.;
Djordjevic-Dikic A.; Varga A.; Palinkas A.; Agoston G.; Gregori D.;
Trambaiolo P.; Severino S.; Arystan A.; Paterni M.; Carpeggiani C.;
Colonna P.
Institution
(Picano, Pratali, Gargani, Andreassi, Paterni, Carpeggiani) Institute of
Clinical Physiology, National Research Council, Pisa, Italy
(Ciampi) Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
(Citro, Bossone, Ferrara) Heart Department, University Hospital San
Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
(D'Andrea, Pacileo) Division of Cardiology, Monaldi Hospital, Second
University of Naples, Naples, Italy
(Scali) Cardiology Department, Pisa University, Nottola (Siena) Hospital,
Pisa, Italy
(Cortigiani) Cardiology Department, San Luca Hospital, Lucca, Italy
(Olivotto, Mori) Cardiology Department, Careggi Hospital, Florence, Italy
(Galderisi) Department of Advanced Biomedical Sciences, Federico II
University Hospital, Naples, Italy
(Costantino) Cardiology Department, San Carlo Hospital, Potenza, Italy
(Di Salvo) Pediatric Cardiology Department, Brompton Hospital, London,
United Kingdom
(Rigo) Division of Cardiology, Ospedale dell'Angelo Mestre-Venice, Mestre,
Italy
(Gaibazzi) Cardiology Department, Parma University Hospital, Parma, Italy
(Limongelli) Pediatric Cardiology Department, Monaldi Hospital Clinics,
Naples, Italy
(Pinamonti, Massa) Cardiology Department, University Hospital Ospedale
Riuniti, Trieste, Italy
(Torres) Hospital de Clinicas de Porto Alegre, Universidade Federal Do Rio
Grande Do sul, Porto Alegre, Brazil
(Miglioranza) Cardiology Institute of Rio Grande Do sul, Porto Alegre,
Brazil
(Daros) Cardiology Division, Hospital San Jose, Criciuma, Brazil
(De Castro E Silva Pretto) Hospital Sao Vicente de Paulo, Hospital de
Cidade, Passo Fundo, Brazil
(Beleslin, Djordjevic-Dikic) Cardiology Clinic, Clinical Center of Serbia,
Medical School, University of Belgrade, Belgrade, Serbia
(Varga, Agoston) Institute of Family Medicine, University of Szeged,
Szeged, Hungary
(Palinkas) Department of Internal Medicine, Elisabeth Hospital,
Hodmezovasarhely, Hungary
(Gregori) Department of Biostatistics, University of Padua, Padua, Italy
(Trambaiolo) Department of Cardiology, Sandro Pertini Hospital, Rome,
Italy
(Severino) Cardiology Department, Monaldi Hospital, Naples, Italy
(Arystan) RSE, Medical Centre Hospital of the President's Affairs
Administration of the Republic of Kazakhstan, Astana, Kazakhstan
(Colonna) Cardiology Hospital, Policlinico of Bari, Bari, Italy
Title
Stress echo 2020: The international stress echo study in ischemic and
non-ischemic heart disease.
Source
Cardiovascular Ultrasound. 15 (1) (no pagination), 2017. Article Number:
3. Date of Publication: 18 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Stress echocardiography (SE) has an established role in
evidence-based guidelines, but recently its breadth and variety of
applications have extended well beyond coronary artery disease (CAD). We
lack a prospective research study of SE applications, in and beyond CAD,
also considering a variety of signs in addition to regional wall motion
abnormalities. Methods: In a prospective, multicenter, international,
observational study design, > 100 certified high-volume SE labs (initially
from Italy, Brazil, Hungary, and Serbia) will be networked with an
organized system of clinical, laboratory and imaging data collection at
the time of physical or pharmacological SE, with structured follow-up
information. The study is endorsed by the Italian Society of
Cardiovascular Echography and organized in 10 subprojects focusing on:
contractile reserve for prediction of cardiac resynchronization or medical
therapy response; stress B-lines in heart failure; hypertrophic
cardiomyopathy; heart failure with preserved ejection fraction; mitral
regurgitation after either transcatheter or surgical aortic valve
replacement; outdoor SE in extreme physiology; right ventricular
contractile reserve in repaired Tetralogy of Fallot; suspected or initial
pulmonary arterial hypertension; coronary flow velocity, left ventricular
elastance reserve and B-lines in known or suspected CAD; identification of
subclinical familial disease in genotype-positive, phenotype- negative
healthy relatives of inherited disease (such as hypertrophic
cardiomyopathy). Results: We expect to recruit about 10,000 patients over
a 5-year period (2016-2020), with sample sizes ranging from 5,000 for
coronary flow velocity/ left ventricular elastance/ B-lines in CAD to
around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of
Fallot. This data-base will allow to investigate technical questions such
as feasibility and reproducibility of various SE parameters and to assess
their prognostic value in different clinical scenarios. Conclusions: The
study will create the cultural, informatic and scientific infrastructure
connecting high-volume, accredited SE labs, sharing common criteria of
indication, execution, reporting and image storage of SE to obtain
original safety, feasibility, and outcome data in evidence-poor diagnostic
fields, also outside the established core application of SE in CAD based
on regional wall motion abnormalities. The study will standardize
procedures, validate emerging signs, and integrate the new information
with established knowledge, helping to build a next-generation SE lab
without inner walls. Copyright &#xa9; 2017 The Author(s).

<32>
Accession Number
613194594
Author
Jackson L.R.; Piccini J.P.; Cyr D.D.; Roe M.T.; Neely M.L.; Martinez F.;
Luscher T.F.; Lopes R.D.; Winters K.J.; White H.D.; Armstrong P.W.; Fox
K.A.A.; Prabhakaran D.; Bhatt D.L.; Magnus Ohman E.; Corbalan R.
Institution
(Jackson, Piccini, Roe, Lopes, Magnus Ohman) Division of Cardiology,
Department of Medicine, Duke University School of Medicine, Durham, NC,
United States
(Jackson, Piccini, Cyr, Roe, Neely, Lopes, Magnus Ohman) Duke Clinical
Research Institute, Durham, NC, United States
(Martinez) Department of Cardiology, Cordoba National University, Cordoba,
Argentina
(Luscher) University Heart Center, Cardiology, University Hospital Zurich,
Zurich, Switzerland
(Winters) Department of Research and Development, Research Cardiologist,
Indianapolis, IN, United States
(Winters) Eli Lilly and Company, Indianapolis, IN, United States
(White) Green Lane Cardiovascular Service, Department of Medicine,
Division of Cardiology, Auckland, New Zealand
(White, Armstrong) Auckland City Hospital, Auckland, New Zealand
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Prabhakaran) Centre for Chronic Disease Control and Public Health
Foundation of India, New Delhi, India
(Bhatt) Division of Cardiology, Department of Medicine, Boston, MA, United
States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Corbalan) Department of Medicine, Division of Cardiology, Santiago, Chile
(Corbalan) Pontificia Universidad Catolica de Chile, Santiago, Chile
Title
Dual Antiplatelet Therapy and Outcomes in Patients With Atrial
Fibrillation and Acute Coronary Syndromes Managed Medically Without
Revascularization: Insights From the TRILOGY ACS Trial.
Source
Clinical Cardiology. 39 (9) (pp 497-506), 2016. Date of Publication: 01
Sep 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Associations between atrial fibrillation (AF), outcomes, and response to
antiplatelet therapies in patients with acute coronary syndrome (ACS)
managed medically without revascularization remain uncertain. We examined
these associations for medically managed ACS patients randomized to dual
antiplatelet therapy (DAPT) using patient data from the TRILOGY ACS trial.
DAPT included aspirin plus clopidogrel 75 mg/d or prasugrel 10 mg/d (5
mg/d for those <60 kg or age >75 years). Patients receiving oral
anticoagulants were excluded. Cox proportional hazards regression modeling
was used to characterize associations between patients with AF (AF+) vs
those without (AF-) and risk of ischemic and bleeding events, and to
explore effects of randomized treatment on outcomes. Among 9101 patients
with baseline AF status, 710 (7.8%) had AF. AF+ patients were older and
had more comorbidities. Unadjusted associations of the composite of
cardiovascular death/myocardial infarction/stroke were significantly
higher among AF patients at 30 months (31.1% vs 18.4%; HR: 1.61, 95% CI:
1.35-1.92, P < 0.001), but differences did not persist after adjustment
(HR: 1.16, 95% CI: 0.97-1.39, P = 0.11). When individual components of the
composite endpoint were evaluated, 30-month risk of events in AF+ patients
was significantly higher. Thirty-month risk of all-cause death was
significantly higher in AF+ patients: 18.1% vs 11.1% (HR: 1.62, 95% CI:
1.30-2.02, P < 0.001). There was no significant interaction with
randomized treatment and AF for the primary endpoint. Among medically
managed high-risk ACS patients receiving DAPT, AF was associated with
higher unadjusted risks of ischemic and bleeding outcomes that were
similar by treatment group. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<33>
Accession Number
612978344
Author
Ando T.; Takagi H.
Institution
(Ando) Department of Internal Medicine, Mount Sinai Beth Israel Medical
Center, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Title
The Prognostic Impact of New-Onset Persistent Left Bundle Branch Block
Following Transcatheter Aortic Valve Implantation: A Meta-analysis.
Source
Clinical Cardiology. 39 (9) (pp 544-550), 2016. Date of Publication: 01
Sep 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
New-onset persistent left bundle branch block (NOP-LBBB) is one of the
most common conduction disturbances after transcatheter aortic valve
implantation (TAVI). We hypothesized that NOP-LBBB may have a clinically
negative impact after TAVI. To find out, we conducted a systematic
literature search of the MEDLINE/PubMed and Embase databases.
Observational studies that reported clinical outcomes of NOP-LBBB patients
after TAVI were included. The random-effects model was used to combine
odds ratios, risk ratios, or hazard ratios (HRs) with 95% confidence
intervals. Adjusted HRs were utilized over unadjusted HRs or risk ratios
when available. A total of 4049 patients (807 and 3242 patients with and
without NOP-LBBB, respectively) were included. Perioperative (in-hospital
or 30-day) and midterm all-cause mortality and midterm cardiovascular
mortality were comparable between the groups. The NOP-LBBB patients
experienced a higher rate of permanent pacemaker implantation (HR: 2.09,
95% confidence interval: 1.12-3.90, P = 0.021, I² = 83%) during
midterm follow-up. We found that NOP-LBBB after TAVI resulted in higher
permanent pacemaker implantation but did not negatively affect the midterm
prognosis. Therefore, careful observation during the follow-up is
required. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<34>
Accession Number
614047865
Author
Tomoi Y.; Soga Y.; Fujihara M.; Iida O.; Shintani Y.; Zen K.; Ando K.
Institution
(Tomoi, Soga, Ando) Department of Cardiology, Kokura Memorial Hospital,
3-2-1 Asano, Kokurakita-ku, Kitakyushu 802-0001, Japan
(Fujihara) Department of Cardiology, Kishiwada Tokushukai Hospital,
Kishiwada, Japan
(Iida) Department of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan
(Shintani) Department of Cardiology, Shin-Koga Hospital, Kurume, Japan
(Zen) Department of Cardiovascular Medicine, Omihachiman Community Medical
Center, Shiga, Japan
Title
Outcomes of Endovascular Therapy for Upper Extremity Peripheral Artery
Disease with Critical Hand Ischemia.
Source
Journal of Endovascular Therapy. 23 (5) (pp 717-722), 2016. Date of
Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: setac@allenpress.com)
Abstract
Purpose: To investigate the clinical outcomes of endovascular therapy
(EVT) for upper extremity peripheral artery disease (PAD) with critical
hand ischemia (CHI). Methods: A subanalysis was performed of multicenter
registry data on 36 consecutive patients (mean age 65.7+/-10.3 years; 19
men) who underwent EVT from January 2003 to December 2013 for
angiographically diagnosed de novo upper limb PAD with CHI in 40 limbs.
Fifty percent of patients had diabetes, and two-thirds were on
hemodialysis. Technical success of EVT was straight-line flow to the hand
and final residual diameter stenosis <50% for balloon angioplasty alone
and <30% without flow-limiting dissection for subclavian artery stenting.
The primary outcome was 12-month amputation-free survival [AFS; freedom
from a composite of major (above-the-wrist) amputation and death]. The
12-month secondary outcomes were overall survival, limb salvage, freedom
from major adverse limb events (MALE; major amputation or any repeat
revascularization of the limb), and wound healing (complete
epithelialization without death or major amputation). Results: Initial
success was achieved in 87% (35 of 40 limbs); 1 patient experienced
puncture site problems, and 3 (8%) of 36 patients (4 treated limbs) died
within 30 days. Hand symptoms were alleviated in 37 (92%) limbs. The mean
follow-up was 26.8+/-27.8 months. Seven fingers (5 limbs) underwent
phalanx amputations and 2 limbs had an amputation above the wrist.
Complete wound healing was achieved in only 5 (19%) of 26 surviving
patients at 12 months. At 1 year, the Kaplan-Meier estimates for AFS,
overall survival, limb salvage, and freedom from MALE were 56.4%, 59.4%,
93.1%, and 78.5%, respectively. Univariate analysis revealed that the
predictors of AFS at 1 year were diabetes (p=0.03), hemodialysis
(p<0.001), PAD (p=0.003), and the presence of a wound (p<0.001). During
follow-up, 20 (56%) patients died; a cardiovascular cause accounted for
40% of deaths. Conclusion: Endovascular therapy for upper limb PAD with
CHI was technically successful and alleviated symptoms in the majority of
cases, but the prognosis of patients with CHI was extremely poor in
real-world clinical practice. Copyright &#xa9; The Author(s) 2016.

<35>
[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).

<36>
Accession Number
614187261
Author
Candy N.; Ng E.; Velu R.
Institution
(Candy, Ng, Velu) Department of Vascular and Endovascular Surgery, The
Townsville Hospital, Townsville, Queensland, Australia
Title
Paclitaxel-coated balloon reduces target lesion revascularization compared
with standard balloon angioplasty.
Source
Journal of Vascular Surgery. 65 (2) (pp 558-570), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Peripheral arterial disease (PAD) is a highly prevalent
condition that contributes significantly to the morbidity and mortality of
affected patients. PAD creates a significant economic burden on health
care systems around the world. We reviewed all available literature to
provide a meta-analysis assessing the outcome of patients treated with
drug-eluting balloons (DEBs) compared with percutaneous transluminal
balloon angioplasty (PTA) through measuring the rate of target lesion
revascularization (TLR). Methods An electronic search of the MEDLINE,
Scopus, Embase, Web of Science, and Cochrane Library databases was
performed. Articles reporting randomized controlled trials that compared
treatment with DEBs vs PTA were selected for inclusion. A meta-analysis
was performed by pooling data on rates of TLR, binary restenosis (BR), and
late lumen loss (LLL). Results The 10 included articles comprised a sample
size of 1292 patients. Meta-analysis demonstrated the rate of TLR in
DEB-treated patients was significantly lower compared with patients
treated with PTA at 6 months (odds ratio [OR], 0.24; 95% confidence
interval [CI], 0.11-0.53; P = .0004), 12 months (OR, 0.28; 95% CI,
0.13-0.62; P = .002), and 24 months (OR, 0.25; 95% CI, 0.10-0.61; P =
.002). Decreased LLL and BR was demonstrated at 6 months in patients
treated with DEBs compared with patients treated with PTA (mean
difference, -0.74; 95% CI, -0.97 to -0.51; P = .00001; OR, 0.34; 95% CI,
0.23-0.49; P = .00001). Conclusions This meta-analysis demonstrates that
treatment with DEBs compared with PTA results in reduced rates of
reintervention in patients with PAD. Comparison of DEBs to other emerging
treatments to determine which method results in the lowest reintervention
rates and in the greatest improvement in quality of life should be the
focus of future trials. Copyright &#xa9; 2016

<37>
Accession Number
614187156
Author
Teeuwen K.; van der Schaaf R.J.; Adriaenssens T.; Koolen J.J.; Smits P.C.;
Henriques J.P.S.; Vermeersch P.H.M.J.; Tjon Joe Gin R.M.; Scholzel B.E.;
Kelder J.C.; Tijssen J.G.P.; Agostoni P.; Suttorp M.J.
Institution
(Teeuwen, Agostoni, Suttorp) Department of Cardiology, St. Antonius
Hospital, Nieuwegein, Netherlands
(van der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Adriaenssens) Department of Cardiology, University Hospital Leuven,
Belgium
(Koolen) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Smits) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Henriques, Tijssen) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Vermeersch) Department of Cardiology, Middelheim Hospital, Antwerp,
Belgium
(Tjon Joe Gin) Department of Cardiology, Rijnstate Hospital, Arnhem,
Netherlands
(Scholzel) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Kelder) Department of Research and Statistics, St. Antonius Hospital,
Nieuwegein, Netherlands
Title
Randomized Multicenter Trial Investigating Angiographic Outcomes of Hybrid
Sirolimus-Eluting Stents With Biodegradable Polymer Compared With
Everolimus-Eluting Stents With Durable Polymer in Chronic Total
Occlusions: The PRISON IV Trial.
Source
JACC: Cardiovascular Interventions. 10 (2) (pp 133-143), 2017. Date of
Publication: 23 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to investigate the efficacy and
safety of the hybrid ultrathin-strut sirolimus-eluting stent (SES) with
biodegradable polymer compared with the thin-strut everolimus-eluting
stent (EES) with durable polymer in successfully recanalized chronic total
occlusions (CTOs). Background The introduction of drug-eluting stents
revolutionized the treatment of CTOs. However, limited data are available
on new-generation drug-eluting stents with biodegradable polymer in CTOs.
Methods In this multicenter trial, patients were randomized, after
successful CTO recanalization, to either SES or EES. The primary
noninferiority endpoint was in-segment late lumen loss (noninferiority
margin 0.2 mm). Secondary endpoints included in-stent late lumen loss and
clinical endpoints. Results Overall, 330 patients were included. At 9
months, angiography was available in 281 patients (85%). Duration of
occlusion >3 months was 92.5%, with mean stent length of 52.4 +/- 28.1 mm
versus 52.3 +/- 26.5 mm in the SES and EES groups. The primary
noninferiority endpoint, in-segment late lumen loss, was not met for SES
versus EES (0.13 +/- 0.63 mm vs. 0.02 +/- 0.47 mm; p = 0.08, 2-sided;
difference 0.11 mm; 95% confidence interval: -0.01 to 0.25 mm;
p<inf>noninferiority</inf> = 0.11, 1-sided). In-stent late lumen loss was
comparable between SES and EES (0.12 +/- 0.59 mm vs. 0.07 +/- 0.46 mm; p =
0.52). The incidence of in-stent and in-segment binary restenosis was
significantly higher with SES compared with EES (8.0% vs. 2.1%; p =
0.028), with comparable rates of reocclusions (2.2% vs. 1.4%; p = 0.68).
Clinically indicated target lesion and target vessel revascularization
(9.2% vs. 4.0% [p = 0.08] and 9.2% vs. 6.0% [p = 0.33]), target vessel
failure (9.9% vs. 6.6%; p = 0.35), and definite or probable stent
thrombosis (0.7% vs. 0.7%; p = 1.00) were comparable between the SES and
EES groups. Conclusions This randomized trial failed to show
noninferiority of hybrid SES relative to EES in terms of in-segment late
lumen loss in successfully recanalized CTOs. Furthermore, a statistically
significantly higher rate of binary restenosis was found with SES.
Copyright &#xa9; 2017 American College of Cardiology Foundation

<38>
Accession Number
611124195
Author
Ledonio C.G.T.; Rosenstein B.E.; Johnston C.E.; Regelmann W.E.; Nuckley
D.J.; Polly D.W.
Institution
(Ledonio, Nuckley, Polly) Department of Orthopaedic Surgery, University of
Minnesota, 2450 Riverside Avenue South, Minneapolis, MN 55454, United
States
(Rosenstein) Medical School, University of Minnesota, Minneapolis, MN,
United States
(Johnston) Department of Pediatric Orthopedic Surgery, Texas Scottish Rite
Hospital for Children, Dallas, TX, United States
(Regelmann) Department of Pediatrics-Pediatric Pulmonology, University of
Minnesota, Minneapolis, MN, United States
(Nuckley) Zimmer Spine, Minneapolis, MN, United States
Title
Pulmonary function tests correlated with thoracic volumes in adolescent
idiopathic scoliosis.
Source
Journal of Orthopaedic Research. 35 (1) (pp 175-182), 2017. Date of
Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Scoliosis deformity has been linked with deleterious changes in the
thoracic cavity that affect pulmonary function. The causal relationship
between spinal deformity and pulmonary function has yet to be fully
defined. It has been hypothesized that deformity correction improves
pulmonary function by restoring both respiratory muscle efficiency and
increasing the space available to the lungs. This research aims to
correlate pulmonary function and thoracic volume before and after
scoliosis correction. Retrospective correlational analysis between
thoracic volume modeling from plain x-rays and pulmonary function tests
was conducted. Adolescent idiopathic scoliosis patients enrolled in a
multicenter database were sorted by pre-operative Total Lung Capacities
(TLC) % predicted values from their Pulmonary Function Tests (PFT). Ten
patients with the best and ten patients with the worst TLC values were
included. Modeled thoracic volume and TLC values were compared before and
2 years after surgery. Scoliosis correction resulted in an increase in the
thoracic volume for patients with the worst initial TLCs (11.7%) and those
with the best initial TLCs (12.5%). The adolescents with the most severe
pulmonary restriction prior to surgery strongly correlated with
post-operative change in total lung capacity and thoracic volume
(r² = 0.839; p < 0.001). The mean increase in thoracic volume
in this group was 373.1 cm³ (11.7%) which correlated with a
21.2% improvement in TLC. Scoliosis correction in adolescents was found to
increase thoracic volume and is strongly correlated with improved TLC in
cases with severe restrictive pulmonary function, but no correlation was
found in cases with normal pulmonary function. &#xa9; 2016 Orthopaedic
Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
35:175-182, 2017. Copyright &#xa9; 2016 Orthopaedic Research Society.
Published by Wiley Periodicals, Inc.

<39>
Accession Number
614112417
Author
Zhao B.-C.; Huang T.-Y.; Deng Q.-W.; Liu W.-F.; Liu J.; Deng W.-T.; Liu
K.-X.; Li C.
Institution
(Zhao, Liu, Deng, Liu, Li) Department of Anesthesiology, Nanfang Hospital,
Southern Medical University, Guangzhou, China
(Zhao, Deng, Liu) Department of Anesthesiology, the First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, China
(Huang) Department of Ultrasonography, the First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
Title
Prophylaxis Against Atrial Fibrillation After General Thoracic Surgery:
Trial Sequential Analysis and Network Meta-Analysis.
Source
Chest. 151 (1) (pp 149-159), 2017. Date of Publication: 01 Jan 2017.
Publisher
Elsevier Inc
Abstract
Background Postoperative atrial fibrillation/flutter (POAF) is associated
with significant morbidity and mortality after general thoracic surgery,
but the need for and the best agent for prophylaxis remains obscure.
Methods A systematic literature search was performed to identify
randomized controlled trials that compared regimens for POAF prophylaxis
after general thoracic surgery. Random-effects meta-analyses with trial
sequential analyses were performed to compare the effects of medical
prophylaxis vs placebo/usual care. The risk of POAF among patients
receiving various prophylactic regimens was subjected to Bayesian network
meta-analysis. Results Twenty-two trials (2,891 patients and 11 regimens)
were included. Overall, medical prophylaxis reduced the incidence of POAF
(OR, 0.33; 95% CI, 0.22-0.49) but not short-term mortality (OR, 0.85; 95%
CI, 0.41-1.73). There was no significant difference in patient withdrawal
due to adverse events (OR, 1.67; 95% CI, 0.67-4.16). Trial sequential
analysis showed that as of 2012, sufficient evidence had accrued in
support of the effectiveness of medical prophylaxis in reducing POAF after
general thoracic surgery. In network meta-analysis, beta-blockers,
angiotensin-converting enzyme inhibitors, amiodarone, magnesium, and
calcium channel blockers significantly reduced the risk of POAF compared
with placebo/usual care. beta-Blockers had the highest probability of
being the most effective agents (OR, 0.12; 95% credible interval [CrI],
0.05-0.27; probability of being best, 77.7%; number needed to treat, 5.2).
Conclusions The current literature supports the effectiveness and
tolerability of medical prophylaxis and the superiority of beta-blockers
in preventing POAF after general thoracic surgery. beta-Blockers are
recommended, taking into consideration the status of the bronchopulmonary
system. Copyright &#xa9; 2016 American College of Chest Physicians

<40>
Accession Number
614093226
Author
Cho Y.J.; Kim T.K.; Hong D.M.; Seo J.-H.; Bahk J.-H.; Jeon Y.
Institution
(Cho, Kim, Hong, Seo, Bahk, Jeon) Seoul National University Hospital,
Department of Anesthesiology and Pain Medicine, 101 Daehak-ro, Jongno-gu,
Seoul 03068, South Korea
Title
Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on
arterial oxygenation during one-lung ventilation for thoracoscopic
surgery: A prospective randomized trial.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 9. Date
of Publication: 18 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: One-lung ventilation during thoracic surgery frequently
disturbs normal systemic oxygenation. However, the effect of anesthetics
on arterial oxygenation during one-lung ventilation has not been well
established in human study. In this clinical trial, we investigated
whether a difference between desflurane-remifentanil and
propofol-remifentanil anesthesia can be observed with regard to
oxygenation during one-lung ventilation for thoracoscopic surgery.
Methods: Adult patients with lung cancer, scheduled for video-assisted
thoracoscopic lobectomy without preoperative oxygen support, were screened
and randomized to receive desflurane or propofol, with remifentanil
continuous infusion in both groups. Mechanical ventilation was performed
with tidal volume of 8 ml/kg and F<inf>I</inf>O<inf>2</inf> 0.5 during
two-lung ventilation, and 6 ml/kg and 1.0 during one-lung ventilation,
both with positive end-expiratory pressure of 5 cmH<inf>2</inf>O. Arterial
blood gas analysis was performed preoperatively, during two-lung
ventilation, and after 15, 30, 45, and 60 min of one-lung ventilation. The
primary endpoint was PaO<inf>2</inf> at 30 min after initiating one-lung
ventilation. Statistical analyses included the independent t-test for the
primary endpoint and a mixed model with a post-hoc analysis to evaluate
the serial changes in values. Results: Patients were recruited between
July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52
in desflurane group and n = 51 in propofol group). The primary endpoint,
PaO<inf>2</inf> at 30 min of one-lung ventilation was lower in the
desflurane group than the propofol group (170 +/- 72 vs. 202 +/- 82 mmHg;
p = 0.039). Serial changes in PaO<inf>2</inf> during one-lung ventilation
showed lower levels during desflurane anesthesia compared with propofol
anesthesia (mean difference, 45 mmHg; 95% confidence interval, 16-75 mmHg;
p = 0.003). Conclusions: In conclusion, desflurane-remifentanil anesthesia
resulted in decreased arterial oxygenation compared with that of
propofol-remifentanil anesthesia during one-lung ventilation for
thoracoscopic surgery in patients with lung cancer. Trial registration:
ClinicalTrials.gov identifier: NCT02191371, registered on July 7, 2014
Copyright &#xa9; 2017 The Author(s).

<41>
Accession Number
610936945
Author
Chowdhury S.M.; Graham E.M.; Atz A.M.; Bradley S.M.; Kavarana M.N.; Butts
R.J.
Institution
(Chowdhury, Graham, Atz, Butts) Department of Pediatrics, Medical
University of South Carolina, Charleston, South Carolina, United States
(Bradley, Kavarana) Division of Pediatric Cardiothoracic Surgery,
Department of Surgery, Medical University of South Carolina, Charleston,
South Carolina, United States
Title
Validation of a Simple Score to Determine Risk of Hospital Mortality After
the Norwood Procedure.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (2) (pp 425-433),
2016. Date of Publication: 02 Feb 2016.
Publisher
W.B. Saunders
Abstract
The ability to quantify patient-specific hospital mortality risk before
the Norwood procedure remains elusive. This study aimed to develop an
accurate and clinically feasible score to assess the risk of hospital
mortality in neonates undergoing the Norwood procedure. All patients (n =
549) in the publically available Pediatric Heart Network Single Ventricle
Reconstruction trial database were included in the analysis. Patients were
randomly divided into a derivation (75%) and validation (25%) cohort.
Preoperative factors found to be associated with mortality upon
univariable analysis (P < 0.2) were included in the logistic regression
model. The score was derived by including variables independently
associated with mortality (P < 0.05). A 20-point score using 6 variables
(birth weight, clinical syndrome or abnormal karyotype, surgeon Norwood
volume or year, anatomic subtype, ascending aorta size, and obstructed
pulmonary venous return) was developed using relative magnitudes of the
covariates odds ratio. The score was then tested in the validation cohort.
In weighted regression analysis, model predicted risk of mortality
correlated closely with actual rates of mortality in the derivation
(R² = 0.87, P < 0.01) and validation cohorts (R² =
0.82, P < 0.01). Patients were classified as low (score: 0-5), medium
(6-10), or high risk (>10). Mortality differed significantly between risk
groups in both the derivation (6% vs 22% vs 77%, P < 0.01) and validation
(4% vs 30% vs 53%, P < 0.01) cohorts. This mortality score is accurate in
determining risk of hospital mortality in neonates undergoing planned
Norwood operations. The score has the potential to be used in clinical
practice to aid in risk assessment before surgery. Clinical trial
registration URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00115934. Copyright &#xa9; 2016 Elsevier Inc.

<42>
Accession Number
611440414
Author
Weaver F.A.; Abraham W.T.; Little W.C.; Butter C.; Ducharme A.; Halbach
M.; Klug D.; Lovett E.G.; Madershahian N.; Muller-Ehmsen J.; Schafer J.E.;
Senni M.; Swarup V.; Wachter R.; Zile M.R.
Institution
(Weaver) Division of Vascular Surgery and Endovascular Therapy, Keck
School of Medicine, University of Southern California, Los Angeles,
California, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, Ohio, United States
(Little) Division of Cardiology, University of Mississippi Medical Center,
Jackson, Mississippi, United States
(Butter) Department of Cardiology, Immanuel Heart Center Bernau-Medical
School, Brandenburg, Bernau, Germany
(Ducharme) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Halbach) Department of Internal Medicine III, University Hospital of
Cologne, Cologne, Germany
(Klug) Department of Cardiology, University HospitalLilleFrance
(Lovett) Department of Research, CVRx, Inc.%, Minneapolis, Minnesota,
United States
(Madershahian) Department of Cardiothoracic Surgery, Cologne University
Heart Centre, Cologne, Germany
(Muller-Ehmsen) Department of Medicine, Asklepios Klinik Altona, Hamburg,
Germany
(Schafer) Department of Statistics, NAMSA, Inc.%, Minneapolis, Minnesota,
United States
(Senni) Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo,
Italy
(Swarup) Department of Electrophysiology, Arizona Heart Hospital, Phoenix,
Arizona, United States
(Wachter) Clinic for Cardiology and Pneumology, German Cardiovascular
Research Center (DZHK), University Medicine Gottingen, Gottingen, Germany
(Zile) Medical University of South Carolina, Charleston, South Carolina,
United States
(Zile) Ralph H. Johnson Department of Veterans Affairs Medical Center,
Charleston, South Carolina, United States
Title
Surgical Experience and Long-term Results of Baroreflex Activation Therapy
for Heart Failure With Reduced Ejection Fraction.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (2) (pp 320-328),
2016. Date of Publication: 02 Feb 2016.
Publisher
W.B. Saunders
Abstract
The purpose of this publication is to describe the intraoperative
experience along with long-term safety and efficacy of the
second-generation baroreflex activation therapy (BAT) system in patients
with heart failure (HF) and reduced ejection fraction HF (HFrEF). In a
randomized trial of New York Heart Association Class III HFrEF, 140
patients were assigned 1:1 to receive BAT plus medical therapy or medical
therapy alone. Procedural information along with safety and efficacy data
were collected and analyzed over 12 months. Within the cohort of 71
patients randomized to BAT, implant procedure time decreased with
experience, from 106 +/- 37 minutes on the first case to 83 +/- 32 minutes
on the third case. The rate of freedom from system- and procedure-related
complications was 86% through 12 months, with the percentage of days alive
without a complication related to system, procedure, or underlying
cardiovascular condition identical to the control group. The complications
that did occur were generally mild and short-lived. Overall, 12 months
therapeutic benefit from BAT was consistent with previously reported
efficacy through 6 months: there was a significant and sustained
beneficial treatment effect on New York Heart Association functional
Class, quality of life, 6-minute hall walk distance, plasma N-terminal
pro-brain natriuretic peptide, and systolic blood pressure. This was true
for the full trial cohort and a predefined subset not receiving cardiac
resynchronization therapy. There is a rapid learning curve for the
specialized procedures entailed in a BAT system implant. BAT system
implantation is safe with the therapeutic benefits of BAT in patients with
HFrEF being substantial and maintained for at least 1 year. Copyright
&#xa9; 2016 The Authors

<43>
Accession Number
611172851
Author
Buratto E.; Shi W.Y.; Konstantinov I.E.
Institution
(Buratto, Shi, Konstantinov) Cardiac Surgery Unit, Royal Children's
Hospital, Melbourne, Victoria, Australia
(Buratto, Shi, Konstantinov) Department of Paediatrics, University of
Melbourne, Melbourne, Victoria, Australia
(Buratto, Shi, Konstantinov) Murdoch Childrens Research Institute,
Melbourne, Victoria, Australia
Title
The Pearls and Perils of Settling Scores in Public.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (2) (pp 434-435),
2016. Date of Publication: 02 Feb 2016.
Publisher
W.B. Saunders

<44>
Accession Number
613413273
Author
Aronow W.S.
Institution
(Aronow) Department of Medicine, Division of Cardiology, Westchester
Medical Center/New York Medical College, Macy Pavilion, Room 141,
Valhalla, NY 10595, United States
Title
Current treatment of heart failure with reduction of left ventricular
ejection fraction.
Source
Expert Review of Clinical Pharmacology. 9 (12) (pp 1619-1631), 2016. Date
of Publication: 01 Dec 2016.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Heart failure is the commonest cause of hospitalization and
of rehospitalization This review paper is a comprehensive review of
current treatment of heart failure in 2016. The target of this review is
all health care professionals who treat patients with heart failure. Areas
covered: This article discusses stages of heart failure, treatment of
heart failure with general measures, and drug therapy with diuretics,
angiotensin-converting enzyme inhibitors, angiotensin receptor blockers,
beta blockers, aldosterone antagonists, isosorbide dinitrate plus
hydralazine, digoxin, other neurohormonal antagonists,
sacubitril/valsartan, calcium channel blockers, and ivabradine. This
article also discusses treatment of heart failure with use of cardiac
resynchronization therapy, implantable cardioverter-defibrillators, and
surgical therapy, and management of end-stage heart failure. This paper
was written after an extensive Medline search reviewing articles written
from 1970 through May, 2016. Expert commentary: Our approach as physicians
must emphasize prevention of heart failure as well as treating it. Risk
factors for developing heart failure, especially hypertension, must be
better controlled starting in childhood. I concur with the current heart
failure treatment guidelines (Tables 1 and 2 in this paper). Copyright
&#xa9; 2016 Informa UK Limited, trading as Taylor & Francis Group.

<45>
Accession Number
613354797
Author
Qi Y.; Uchida T.; Yamamoto M.; Yamamoto Y.; Kido K.; Ito H.; Ohno N.;
Asahara M.; Yamada Y.; Yamaguchi O.; Mitaka C.; Tomita M.; Makita K.
Institution
(Qi, Uchida, Yamamoto, Yamamoto, Kido, Ito, Mitaka, Makita) Department of
Anesthesiology, Tokyo Medical and Dental University, Graduate School of
Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519,
Japan
(Ohno, Asahara, Yamada) Department of Anesthesiology, University of Tokyo,
Graduate School of Medicine, Tokyo, Japan
(Yamaguchi) Department of Critical Care Medicine, Yokohama City University
Medical Center, Kanagawa, Japan
(Tomita) Clinical Research Center, Tokyo Medical and Dental University,
Hospital of Medicine, Tokyo, Japan
Title
Perioperative elevation in cell-free DNA levels in patients undergoing
cardiac surgery: Possible contribution of neutrophil extracellular traps
to perioperative renal dysfunction.
Source
Anesthesiology Research and Practice. 2016 (no pagination), 2016. Article
Number: 2794364. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. This study aimed to determine the perioperative change in
serum double-strand DNA (dsDNA) as a marker potentially reflecting
neutrophil extracellular trap concentration in samples from patients
undergoing cardiac surgery and to analyze a relationship between serum
dsDNA concentrations and perioperative renal dysfunction. Methods. Serum
dsDNA concentrations in samples that were collected during a previously
conducted, prospective, multicenter, observational study were measured.
Eighty patients undergoing elective cardiac surgery were studied. Serum
samples were collected at baseline, immediately after surgery, and the day
after surgery (POD-1). Results. Serum dsDNA concentration was
significantly increased from baseline (median, 398 ng/mL [interquartile
range, 372-475 ng/mL]) to immediately after surgery (median, 540 ng/mL
[437-682 ng/mL], p < 0.001), and they were reduced by POD-1 (median, 323
ng/mL [256-436 ng/mL]). The difference in serum creatinine concentration
between baseline and POD-1 was correlated with dsDNA concentration on
POD-1 (r s = 0.61, p < 0.001). Conclusions. In patients undergoing cardiac
surgery, serum dsDNA concentration is elevated postoperatively. Prolonged
elevation in dsDNA concentration is correlated with perioperative renal
dysfunction. Further large-scale studies are needed to determine the
relationship between serum concentration of circulating dsDNA and
perioperative renal dysfunction. Copyright &#xa9; 2016 Yu Qi et al.

<46>
Accession Number
607683846
Author
Horton J.D.; Kolbel T.; Haulon S.; Khoynezhad A.; Green R.M.; Borger M.A.;
Mussa F.F.
Institution
(Horton) Department of Surgery, New York University School of Medicine,
New York, New York, United States
(Kolbel) University Heart Center Hamburg, Hamburg, Germany
(Haulon) Aortic Center, Universite Lille Nord de France, Lille, France
(Khoynezhad) Department of Cardio-thoracic Surgery, Cedars-Sinai Heart
Institute, Los Angeles, California, United States
(Green, Borger, Mussa) Department of Surgery, Columbia University Medical
Center Surgery, New York, New York, United States
Title
Endovascular Repair of Type A Aortic Dissection: Current Experience and
Technical Considerations.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (2) (pp 312-317),
2016. Date of Publication: 02 Feb 2016.
Publisher
W.B. Saunders
Abstract
Dissection of the ascending aorta, type A aortic dissection (TAAD),
represents a surgical emergency with high morbidity and mortality. Current
open surgical techniques, although state-of-the-art procedures and having
improved outcomes for patients with TAAD over the last decades, confer
significant risk of complications and death. Recently, endovascular
techniques for repair of both the abdominal and thoracic aorta have gained
acceptance within the vascular and cardiovascular surgical communities as
a useful tool in select pathologies and patient populations. As
development of endovascular technology proceeds ever closer to the aortic
valve, thoracic endovascular repair for TAAD deserves special
investigation. A comprehensive literature search for studies reporting
outcomes of endovascular repair in the ascending aorta was performed. In
this review, we compile the worldwide experience of thoracic endovascular
repair for TAAD as well as imaging studies for patient selection and the
use of hybrid (open plus endovascular) techniques. The authors discuss the
remaining challenges that preclude its broader adoption in this role,
namely patient selection and device specificity. Copyright &#xa9; 2016
Elsevier Inc.

<47>
Accession Number
614271770
Author
Xu X.; Hu J.; Song N.; Chen R.; Zhang T.; Ding X.
Institution
(Xu, Hu, Song, Chen, Zhang, Ding) Department of Nephrology, Zhongshan
Hospital, Fudan University, No.180 Fenglin Road, Shanghai 200032, China
(Xu, Hu, Song, Chen, Zhang, Ding) Shanghai Institute of Kidney Disease and
Dialysis, No.180 Fenglin Road, Shanghai 200032, China
(Xu, Hu, Song, Chen, Zhang, Ding) Shanghai Key Laboratory of Kidney
Disease and Blood Purification, No.180 Fenglin Road, Shanghai 200032,
China
Title
Hyperuricemia increases the risk of acute kidney injury: A systematic
review and meta-analysis.
Source
BMC Nephrology. 18 (1) (no pagination), 2017. Article Number: 27. Date of
Publication: 17 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Mounting evidence indicated that the elevated serum uric acid
level was associated with an increased risk of acute kidney injury (AKI).
Our goal was to systematically evaluate the correlation of serum uric acid
(SUA) level and incidence of AKI by longitudinal cohort studies. Methods:
We searched electronic databases and the reference lists of relevant
articles. 18 cohort studies with 75,200 patients were analyzed in this
random-effect meta-analysis. Hyperuricemia was defined as SUA levels
greater than 360-420 mumol/L (6-7 mg/dl), which was various according to
different studies. Data including serum uric acid, serum creatinine, and
incidence of AKI and hospital mortality were summarized using
random-effects meta-analysis. Results: The hyperuricemia group
significantly exerted a higher risk of AKI compared to the controls (odds
ratio OR 2.24, 95% CI 1.76-2.86, p < 0.01). Furthermore, there is less
difference of the pooled rate of AKI after cardiac surgery between
hyperuricemia and control group (34.3% vs 29.7%, OR 1.24, 95% CI
0.96-1.60, p = 0.10), while the rates after PCI were much higher in
hyperuricemia group than that in control group (16.0% vs 5.3%, OR 3.24,
95% CI 1.93-5.45, p < 0.01). In addition, there were significant
differences in baseline renal function at admission between hyperuricemia
and control groups in most of the included studies. The relationship
between hyperuricemia and hospital mortality was not significant. The
pooled pre-operative SUA levels were higher in AKI group than that in the
non-AKI group. Conclusions: Elevated SUA level showed an increased risk
for AKI in patients and measurements of SUA may help identify risks for
AKI in these patients. Copyright &#xa9; 2017 The Author(s).

<48>
Accession Number
614291279
Author
Kahraman A.; Mutlu E.; Aldag M.
Institution
(Kahraman) Firat University, Faculty of Medicine, Department of
Cardiovascular Surgery, Elazig, Turkey
(Mutlu) Firat University, Faculty of Medicine, Department of Pharmacology,
Elazig 23100, Turkey
(Aldag) Siyami Ersek Thoracic and Cardiovascular Surgery Training and
Research Hospital, Istanbul, Turkey
Title
ADMA, SDMA and L-Arginine may be Novel Targets in Pharmacotherapy for
Complications due to Cardiopulmonary Bypass.
Source
Journal of Medical Biochemistry. 36 (1) (pp 8-17), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Society of Medical Biochemists of Serbia and Montenegro
Abstract
Background: In this study, the effects of olmesartan therapy on asymmetric
dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), L-arginine and
inducible nitric oxide synthase (iNOS) levels were investigated in
patients undergoing cardiopulmonary bypass. Methods: Patients were
randomly allocated to two groups, control and olmesartan. Olmesartan was
administered 30 mg once a day beginning from preoperative day 5 to
postoperative day 28 and on operation day. Blood was drawn from all
patients and ADMA, SDMA, L-arginine and iNOS levels were analyzed at six
time points (T1: before anesthesia induction, T2: during cardiopulmonary
bypass, T3: five min after the cross-clamp was removed, T4: after
protamine infusion, T5: on postoperative day 3 and T6: on postoperative
day 28). Results: In the olmesartan treated group, iNOS levels exhibited
significant decreases at T2, T3, T4, T5 and T6 time points compared with
control group (p<0.001, p<0.05, p<0.001, p<0.01, p<0.05 respectively).
ADMA levels were significantly lower in olmesartan treated group than in
control group at T3, T4, T5 and T6 time points (p<0.05, p<0.05, p<0.05,
p<0.01 respectively). SDMA levels at T2, T3 and T6 time points were higher
in control group than olmesartan group. L-Arginine levels were
significantly higher at T2 and T3 time points in olmesartan treated group
than control group (p<0.001, p<0.01). Conclusions: It was concluded that
administration of olmesartan reduced plasma ADMA, SDMA, iNOS levels and
enhanced L-arginine level in CPB time and it could reduce potential
postoperative complications through reducing oxidative stress and
inflammatory response in the postoperative period after coronary bypass
surgery. Copyright &#xa9; 2017 Aydln Kahraman et al., published by De
Gruyter Open.

<49>
Accession Number
614291909
Author
Zuchinali P.; Souza G.C.; Pimentel M.; Chemello D.; Zimerman A.; Giaretta
V.; Salamoni J.; Fracasso B.; Zimerman L.I.; Rohde L.E.
Institution
(Zuchinali, Fracasso, Rohde) Postgraduate Program in Health Science:
Cardiology and Cardiovascular Sciences, Medical School, Federal University
of Rio Grande Do sul, Porto Alegre, Brazil
(Souza) Department of Nutrition, Medical School, Federal University of Rio
Grande Do sul, Porto Alegre, Brazil
(Pimentel, Salamoni, Zimerman, Rohde) Cardiovascular Division, Servico de
Cardiologia, Hospital de Clinicas de Porto Alegre, Ramiro Barcelos 2350,
Porto Alegre, RS 90035-003, Brazil
(Chemello) Cardiovascular Division, University Hospital, Federal
University of Santa Maria, Santa Maria, Brazil
(Zimerman, Giaretta) Medical School, Federal University of Rio Grande Do
sul, Porto Alegre, Brazil
(Zimerman, Rohde) Department of Internal Medicine, Medical School, Federal
University of Rio Grande Do sul, Porto Alegre, Brazil
Title
Short-term effects of high-dose caffeine on cardiac arrhythmias in
patients with heart failure: A randomized clinical trial.
Source
JAMA Internal Medicine. 176 (12) (pp 1752-1759), 2016. Date of
Publication: 01 Dec 2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The presumed proarrhythmic action of caffeine is controversial.
Few studies have assessed the effect of high doses of caffeine in patients
with heart failure due to left ventricular systolic dysfunction at high
risk for ventricular arrhythmias. OBJECTIVE To compare the effect of
high-dose caffeine or placebo on the frequency of supraventricular and
ventricular arrhythmias, both at rest and during a symptom-limited
exercise test. DESIGN, SETTING, AND PARTICIPANTS Double-blinded randomized
clinical trial with a crossover design conducted at the heart failure and
cardiac transplant clinic of a tertiary-care university hospital. The
trial included patients with chronic heart failure with moderate-to-severe
systolic dysfunction (left ventricular ejection fraction <45%) and New
York Heart Association functional class I to III between March 5, 2013,
and October 2, 2015. INTERVENTIONS Caffeine (100mg) or lactose capsules,
in addition to 5 doses of 100 mL decaffeinated coffee at 1-hour intervals,
for a total of 500mg of caffeine or placebo during a 5-hour protocol.
After a 1-week washout period, the protocol was repeated. MAIN OUTCOMES
AND MEASURES Number and percentage of ventricular and supraventricular
premature beats assessed by continuous electrocardiographic monitoring.
RESULTS We enrolled 51 patients (37 [74%] male; mean [SD] age, 60.6 [10.9]
years) with predominantly moderate-to-severe left ventricular systolic
dysfunction (mean [SD] left ventricular ejection fraction, 29% [7%]); 31
[61%] had an implantable cardioverterdefibrillator device. No significant
differences between the caffeine and placebo groups were observed in the
number of ventricular (185 vs 239 beats, respectively; P = .47) and
supraventricular premature beats (6 vs 6 beats, respectively; P = .44), as
well as in couplets, bigeminal cycles, or nonsustained tachycardia during
continuous electrocardiographic monitoring. Exercise test-derived
variables, such as ventricular and supraventricular premature beats,
duration of exercise, estimated peak oxygen consumption, and heart rate,
were not influenced by caffeine ingestion.We observed no increases in
ventricular premature beats (91 vs 223 vs 207 beats, respectively) in
patients with higher levels of plasma caffeine concentration compared with
lower plasma levels (P = .91) or with the placebo group (P = .74).
CONCLUSIONS AND RELEVANCE Acute ingestion of high doses of caffeine did
not induce arrhythmias in patients with systolic heart failure and at high
risk for ventricular arrhythmias. Copyright &#xa9; 2016 American Medical
Association. All rights reserved.

<50>
Accession Number
614241906
Author
Hemila H.; Suonsyrja T.
Institution
(Hemila) University of Helsinki, Department of Public Health, POB 20,
Tukholmankatu 8 B 2B, Helsinki FI-00014, Finland
(Suonsyrja) Helsinki University Central Hospital, Meilahti Hospital,
Emergency Clinic, Helsinki, Finland
Title
Vitamin C for preventing atrial fibrillation in high risk patients: A
systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 49. Date of Publication: 01 Feb 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial fibrillation (AF), a common arrhythmia contributing
substantially to cardiac morbidity, is associated with oxidative stress
and, being an antioxidant, vitamin C might influence it. Methods: We
searched the Cochrane CENTRAL Register, MEDLINE, and Scopus databases for
randomised trials on vitamin C that measured AF as an outcome in high risk
patients. The two authors independently assessed the trials for inclusion,
assessed the risk of bias, and extracted data. We pooled selected trials
using the Mantel-Haenszel method for the risk ratio (RR) and the inverse
variance weighting for the effects on continuous outcomes. Results: We
identified 15 trials about preventing AF in high-risk patients, with 2050
subjects. Fourteen trials examined post-operative AF (POAF) in cardiac
surgery patients and one examined the recurrence of AF in cardioversion
patients. Five trials were carried out in the USA, five in Iran, three in
Greece, one in Slovenia and one in Russia. There was significant
heterogeneity in the effect of vitamin C in preventing AF. In 5 trials
carried out in the USA, vitamin C did not prevent POAF with RR=1.04 (95%
CI: 0.86-1.27). In nine POAF trials conducted outside of the USA, vitamin
C decreased its incidence with RR=0.56 (95% CI: 0.47-0.67). In the single
cardioversion trial carried out in Greece, vitamin C decreased the risk of
AF recurrence by RR=0.13 (95% CI: 0.02-0.92). In the non-US cardiac
surgery trials, vitamin C decreased the length of hospital stay by 12.6%
(95% CI 8.4-16.8%) and intensive care unit (ICU) stay by 8.0% (95% CI
3.0-13.0%). The US trials found no effect on hospital stay and ICU stay.
No adverse effects from vitamin C were reported in the 15 trials.
Conclusions: Our meta-analysis indicates that vitamin C may prevent
post-operative atrial fibrillation in some countries outside of the USA,
and it may also shorten the duration of hospital stay and ICU stay of
cardiac surgery patients. Vitamin C is an essential nutrient that is safe
and inexpensive. Further research is needed to determine the optimal
dosage protocol and to identify the patient groups that benefit the most.
Copyright &#xa9; 2017 The Author(s).

<51>
Accession Number
614261467
Author
Kreuziger L.B.; Massicotte M.P.
Institution
(Kreuziger) BloodCenter of Wisconsin; Division of Hematology and Oncology,
Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI
53226, United States
(Massicotte) Department of Pediatrics, University of Alberta, Edmonton,
AB, Canada
Title
Mechanical circulatory support: Balancing bleeding and clotting in
high-risk patients.
Source
Hematology. 2015 (1) (pp 61-68), 2015. Date of Publication: 05 Dec 2015.
Publisher
American Society of Hematology (E-mail: publishing@hematology.org)
Abstract
Mechanical circulatory support (MCS) provides a bridge to heart transplant
in children and adults with life-threatening heart failure and sustains
patients ineligible for transplant. Extracorporeal membrane oxygenation
(ECMO) provides temporary support for patients in cardiac or pulmonary
failure through external gas exchange and continuous flow of blood.
Because the median time to heart transplant exceeds event-free time on
ECMO, pulsatile left ventricular assist devices (LVADs) are used to
support infants and children. Continuous flow LVADs are preferred in
adolescents and adults due to increased pump durability and improved
overall survival. The shear stress created by the mechanical pumps cause
changes in the hematologic system; acquired von Willebrand syndrome occurs
in almost all patients treated with MCS. Despite the improvements in
survival, major bleeding occurs in one-third of patients with a LVAD and
ischemic stroke and LVAD thrombosis can affect 12% of adults and 29% of
children. An antithrombotic strategy to mitigate LVAD bleeding and
thrombotic complications has been tested in a randomized trial in
children, but intensity of antithrombotic therapy in adults varies widely.
Consensus guidelines for antithrombotic therapy during ECMO were created
due to significant differences in management across centers. Because of
the high risk for both bleeding and thrombotic complications, experts in
hemostasis can significantly impact care of patients requiring mechanical
circulatory support and are a necessary part of the management team.

<52>
Accession Number
614197149
Author
Akowuah E.; Goodwin A.T.; Owens W.A.; Hancock H.C.; Maier R.; Kasim A.;
Mellor A.; Khan K.; Murphy G.; Mason J.
Institution
(Akowuah, Goodwin, Owens, Mellor, Khan) The James Cook University
Hospital, South Tees Hospitals NHS Foundation Trust, Cardiothoracic
Division, Marton Road, Middlesbrough TS4 3BW, United Kingdom
(Hancock, Maier, Kasim) Durham University, Durham Clinical Trials Unit,
School of Medicine, Pharmacy and Health, Queen's Campus, University
Boulevard, Thornaby, Stockton-on-Tees TS17 6BH, United Kingdom
(Murphy) University of Leicester, Clinical Sciences Wing, Glenfield
General Hospital, Department of Cardiovascular Sciences, Leicester LE3
9QP, United Kingdom
(Mason) University of Warwick, Warwick Medical School, Coventry CV4 7AL,
United Kingdom
Title
Manubrium-limited ministernotomy versus conventional sternotomy for aortic
valve replacement (MAVRIC): Study protocol for a randomised controlled
trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 46. Date of
Publication: 28 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Aortic valve replacement is one of the most common cardiac
surgical procedures performed worldwide. Conventional aortic valve
replacement surgery is performed via a median sternotomy; the sternum is
divided completely from the sternal notch to the xiphisternum. Minimally
invasive aortic valve replacement, using a new technique called
manubrium-limited ministernotomy, divides only the manubrium from the
sternal notch to 1 cm below the manubrio-sternal junction. More than one
third of patients undergoing conventional sternotomy develop clinically
significant bleeding requiring post-operative red blood cell transfusion.
Case series data suggest a potentially clinically significant difference
in red blood cell transfusion requirements between the two techniques.
Given the implications for National Health Service resources and patient
outcomes, a definitive trial is needed. Methods/design: This is a
single-centre, single-blind, randomised controlled trial comparing aortic
valve replacement surgery using manubrium-limited ministernotomy
(intervention) and conventional median sternotomy (usual care). Two
hundred and seventy patients will be randomised in a 1:1 ratio between the
intervention and control arms, stratified by baseline logistic EuroSCORE
and haemoglobin value. Patients will be followed for 12 weeks from
discharge following their index operation. The primary outcome is the
proportion of patients who receive a red blood cell transfusion
post-operatively within 7 days of surgery. Secondary outcomes include red
blood cell and blood product transfusions, blood loss, re-operation rates,
sternal wound pain, quality of life, markers of inflammatory response,
hospital discharge, health care utilisation, cost and cost effectiveness
and adverse events. Discussion: This is the first trial to examine aortic
valve replacement via manubrium-limited ministernotomy versus conventional
sternotomy when comparing red blood cell transfusion rates following
surgery. Surgical trials present significant challenges; strengths of this
trial include a rigorous research design, standardised surgery performed
by experienced consultant cardiothoracic surgeons, an agreed anaesthetic
regimen, patient blinding and consultant-led patient recruitment. The
MAVRIC trial will demonstrate that complex surgical trials can be
delivered to exemplary standards and provide the community with the
knowledge required to inform future care for patients requiring aortic
valve replacement surgery. Trial registration: International Standard
Randomised Controlled Trial Number (ISRCTN) ISRCTN29567910. Registered on
3 February 2014. Copyright &#xa9; 2017 The Author(s).

<53>
Accession Number
614252762
Author
Tarricone R.; Callea G.; Ogorevc M.; Prevolnik Rupel V.
Institution
(Tarricone) Department of Policy Analysis and Public Management, Bocconi
University, Milan, Italy
(Tarricone, Callea) Centre for Research on Health and Social Care
Management (CERGAS), Bocconi University, Milan, Italy
(Ogorevc, Prevolnik Rupel) Institute for Economic Research, Ljubljana,
Slovenia
Title
Improving the Methods for the Economic Evaluation of Medical Devices.
Source
Health Economics (United Kingdom). 26 (pp 70-92), 2017. Date of
Publication: 01 Feb 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Medical devices (MDs) have distinctive features, such as incremental
innovation, dynamic pricing, the learning curve and organisational impact,
that need to be considered when they are evaluated. This paper
investigates how MDs have been assessed in practice, in order to identify
methodological gaps that need to be addressed to improve the
decision-making process for their adoption. We used the Consolidated
Health Economic Evaluation Reporting Standards (CHEERS) checklist
supplemented by some additional categories to assess the quality of
reporting and consideration of the distinctive features of MDs. Two case
studies were considered: transcatheter aortic valve implantation (TAVI)
representing an emerging technology and implantable cardioverter
defibrillators (ICDs) representing a mature technology. Economic
evaluation studies published as journal articles or within Health
Technology Assessment reports were identified through a systematic
literature review. A total of 19 studies on TAVI and 41 studies on ICDs
were analysed. Learning curve was considered in only 16% of studies on
TAVI. Incremental innovation was more frequently mentioned in the studies
of ICDs, but its impact was considered in only 34% of the cases. Dynamic
pricing was the most recognised feature but was empirically tested in less
than half of studies of TAVI and only 32% of studies on ICDs. Finally,
organisational impact was considered in only one study of ICDs and in
almost all studies on TAVI, but none of them estimated its impact. By
their very nature, most of the distinctive features of MDs cannot be fully
assessed at market entry. However, their potential impact could be
modelled, based on the experience with previous MDs, in order to make a
preliminary recommendation. Then, well-designed post-market studies could
help in reducing uncertainties and make policymakers more confident to
achieve conclusive recommendations. &#xa9; 2017 The Authors. Health
Economics published by John Wiley & Sons, Ltd. Copyright &#xa9; 2017 The
Authors. Health Economics published by John Wiley & Sons, Ltd.

<54>
Accession Number
614293550
Author
Visveswaran G.K.; Cohen M.; Seliem A.; Divita M.; Mcnamara J.K.R.; Dave
A.; Wasty N.; Baran D.A.
Institution
(Visveswaran, Cohen, Seliem, Divita, Wasty, Baran) Division of
CardiologyNewark Beth Israel Medical CenterNewark, New Jersey
(Mcnamara, Dave) Division of Internal MedicineNewark Beth Israel Medical
CenterNewark, New Jersey
Title
A single center tertiary care experience utilizing the large volume mega
50cc intra-aortic balloon counterpulsation in contemporary clinical
practice.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: Clinical outcomes and adverse events utilizing the large volume
50cc intra-aortic balloon (IAB) in contemporary clinical practice.
Background: The newer large volume 50cc IAB, recently introduced into
clinical practice offers improved diastolic augmentation and better left
ventricular (LV) unloading compared to the older 40cc IAB. Methods: In 150
consecutive patients who received intra-aortic balloon counterpulsation
(IABC) with a 50cc balloon from 2011 to 2015, we retrospectively analyzed
demographic, clinical, laboratory, and hemodynamic variables, adverse
events and survival to discharge from index hospitalization. Results:
Median LVEF was 20%. The most common indication was cardiogenic shock (CS)
in 100 patients. Median duration of IABC was 92.5 hr. 95% of patients were
free of any IAB device related complications. Five patients received a
transfusion for bleeding causally related to IABC. 70 of the 150 patients
who received MCS with IABC with no escalation of therapy, recovered and
were discharged alive. Fifteen patients were stabilized on IABC and
bridged to orthotopic heart transplant. All 15 were discharged alive.
Thirty-four patients were initiated on IABC and escalated to VAD and/or
Impella/Tandem Heart, with 24 patients surviving to hospital discharge.
Overall survival to hospital discharge for the 150 patients was 72.7%.
Conclusion: IABC using a larger volume 50cc balloon appears effective as a
first line percutaneous MCS strategy in a large fraction of critically ill
cardiac patients with few adverse events. A large scale registry or
randomized clinical trial utilizing the larger volume IAB is needed to
validate our results. Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<55>
Accession Number
614293524
Author
Montone R.A.; Testa L.; Fraccaro C.; Montorfano M.; Castriota F.; Nerla
R.; Angelillis M.; Tusa M.; Giannini F.; Garatti A.; Tarantini G.; Sonia
Petronio A.; Brambilla N.; Bedogni F.
Institution
(Montone, Testa, Tusa, Brambilla, Bedogni) Interventional Cardiology,
IRCCS Policlinico San DonatoMilan Italy
(Fraccaro, Tarantini) Department of CardiologyUniversity Hospital of
PadovaPadova Italy
(Montorfano, Giannini) Department of CardiologyIRCCS Ospedale San
RaffaeleMilan Italy
(Castriota, Nerla) Interventional CardiologyMaria Cecilia Hospital, GVM
care and researchCotignola Italy
(Angelillis, Sonia Petronio) Department of CardiologyOspedale Cisanello,
University of PisaPisa Italy
(Garatti) IRCCS Policlinico San DonatoCardiac SurgeryMilan Italy
Title
Procedural and 30-day clinical outcomes following transcatheter aortic
valve replacement with lotus valve: Results of the RELEVANT study.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We report procedural and 30-day clinical outcomes following
transcatheter aortic valve replacement (TAVR) with Lotus Valve system in a
high-risk population. Background: Lotus valve is a second-generation TAVR
fully repositionable and retrievable device. RELEVANT (REgistry of Lotus
valvE for treatment of aortic VAlve steNosis with Tavr) study is an
Italian prospective multicentre registry. Methods: Five major centers
performing TAVR using Lotus participated. All high-risk symptomatic
patients with severe aortic stenosis were evaluated by a heart team and
screened for eligibility for TAVR. Primary end-points were procedural and
30-day mortality. Secondary endpoints included procedural and 30-day
safety/effectiveness metrics according to Valve Academic Research
Consortium (VARC)-2 criteria. Results: Two hundred and twenty-five
patients undergoing TAVR with Lotus were enrolled. Mean age was 82.6+/-6.3
years, 51.6% females. Mean STS score for mortality was 8.3+/-5.6.
Procedural success was achieved in 98.7% of patients. All-cause mortality
was 2.2% at discharge and 2.7% at 30-day. Stroke rate was 2.2% at
discharge and 3.1% at 30-day. Patients requiring a new permanent pacemaker
implantation were 30.7% at discharge and 31.8% at 30-day. Paravalvular
regurgitation (PVR) was trace/mild in 99.1% of patients at discharge. Only
two patients (0.9%) had moderate PVR at discharge and at 30-day, whereas
none had severe PVR. Conclusions: RELEVANT study showed that TAVR using
Lotus, in a real-world population of patients with severe aortic stenosis
at high surgical risk, was associated with excellent device success
implantation and early safety according to VARC-2 definition. The
pacemaker implantation rate was about a third of patients. Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<56>
Accession Number
614298055
Author
Wendler O.; Schymik G.; Treede H.; Baumgartner H.; Dumonteil N.; Ihlberg
L.; Neumann F.-J.; Tarantini G.; Zamarano J.L.; Vahanian A.
Institution
(Wendler) 1King's Health Partners, London, UK; 2Municipal Hospital,
Karlsruhe, Germany; 3University Heart Centre, Hamburg, Germany;
4Department of Cardiovascular Medicine, University Hospital Muenster,
Germany; 5Clinique Pasteur, Toulouse, France; 6University Central
Hospital, Helsinki, Finland; 7University Heart Centre, Bad Krozingen,
8University Padua, Department of Cardiac, Thoracic and Vascular Sciences,
Padua, Italy; 9University Hospital Ramon y Cajal, Madrid, Spain; 10Hopital
Bichat, Paris, France
Title
SOURCE 3 Registry: Design and 30-Day Results of the European Post Approval
Registry of the Latest Generation of the Sapien 3TM Transcatheter Heart
Valve.
Source
Circulation. (no pagination), 2017. Date of Publication: 30 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: The SOURCE 3 Registry is a European multicentre,
observational registry of the latest generation of transcatheter heart
valve, the SAPIEN 3TM (Edwards Lifesciences, Irvine, CA/USA). Its purpose
is to document outcomes of clinical safety and performance after European
approval was given. METHODS-: In this manuscript we present the 30-day
outcome of the SOURCE 3 Registry. All data is self-reported and all
participating centres have committed to support their consecutive
experience with the SAPIEN 3TM transcatheter heart valve, dependent on
patients consent, before the start of the study. Adverse events are
defined using Valve Academic Research Consortium 2 criteria and
adjudicated by an independent clinical events committee. RESULTS-: A total
of 1950 patients from 80 centres in 10 countries were enrolled between
07/2014-10/2015. Of those 1947 patients underwent transcatheter aortic
valve implantation (TAVI) using the SAPIEN 3TM (mean age 81.6 +/-6.6
years, 48.1% female). Main comorbidities included coronary artery disease
(51.5%), renal insufficiency (27.4%), diabetes (29.5%), chronic
obstructive pulmonary disease (16.0%), reporting a mean logistic EuroSCORE
of 18.3 +/-13.2. Transfemoral access was used in 87.1% (n=1695),
non-transfemoral in 252 patients. Conscious sedation was employed in 59.9%
of transfemoral procedures and in 50% of patients TAVI was performed
without aortic balloon valvuloplasty.Implantation success (one valve in
the intended location) was 98.3%. Conversion to conventional surgery
(0.6%) and use of cardiopulmonary bypass (0.7%) were rare. Adverse events
were low with site reported 30-day all-cause mortality at 2.2%,
cardiovascular mortality 1.1%, stroke 1.4%, major vascular complication
4.1%, life-threatening bleeding 5% and post TAVI pacemaker 12%. Moderate
or greater paravalvular regurgitation was observed in 3.1% of reporting
patients. CONCLUSIONS-: Results from the SOURCE 3 Registry demonstrate
contemporary European trends and good outcomes of TAVI in daily practice
when using this third generation TAVI device. Copyright &#xa9; 2017 by the
American College of Cardiology Foundation and the American Heart
Association, Inc.

<57>
Accession Number
614297940
Author
Gaudino M.; Puskas J.D.; Di Franco A.; Ohmes L.B.; Iannaccone M.; Barbero
U.; Glineur D.; Grau J.B.; Benedetto U.; D'Ascenzo F.; Gaita F.; Girardi
L.N.; Taggart D.P.
Institution
(Gaudino) 1Department of Cardio-Thoracic Surgery, Weill Cornell Medicine,
New York, NY; 2Department of Cardiovascular Surgery, Icahn School of
Medicine at Mount Sinai, New York, 3Citta della Scienza e della Salute,
Department of Cardiology, University of Turin, Turin, Italy; 4Division of
Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario,
Canada; 5Bristol Heart Institute, University of Bristol, Bristol, UK;
6University of Oxford, Department of Cardiac Surgery, John Radcliffe
Hospital, Oxford, UK
Title
Three Arterial Grafts Improve Late Survival: A Meta-Analysis of Propensity
Matched Studies.
Source
Circulation. (no pagination), 2017. Date of Publication: 30 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: There is little evidence whether a third arterial graft
provides superior outcomes in comparison to the use of two arterial grafts
in patients undergoing coronary artery bypass grafting (CABG). A
meta-analysis of all the propensity score matched (PSM) observational
studies comparing the long-term outcomes of CABG with the use of two
(2-ART) vs. three arterial (3-ART) grafts was performed. METHODS-: A
literature search was conducted using MEDLINE, EMBASE, and Web of Science
to identify relevant articles. Long-term mortality in the PSM populations
was the primary endpoint. Secondary endpoints were in-hospital/30-day
mortality for the PSM populations and long-term mortality for the
unmatched populations. In the matched population, time-to-event outcome
for long-term mortality was extracted as hazard ratios (HRs) along with
their variance. Statistical pooling of survival (time-to-event) was
performed according to a random effect model, computing risk estimates
with 95% confidence intervals (CI). RESULTS-: A total of 8 PSM studies
reporting on 10,287 matched patients (2-ART: 5346; 3-ART: 4941) were
selected for final comparison. The mean follow-up time ranged from 37.2 to
196.8 months. The use of three arterial grafts was not statistically
associated with early mortality (HR, 0.93; 95% CI, 0.71-1.22; p= .62). The
use of three arterial grafts was associated with statistically
significantly lower hazard for late death (HR, 0.8; 95% CI, 0.75-0.87; p<
.001), irrespective of sex and diabetic status. This result was
qualitatively similar in the unmatched population (HR, 0.57; 95% CI,
0.33-0.98; p= .04). CONCLUSIONS-: The use of a third arterial conduit in
CABG patients is not associated with higher operative risk and is
associated with superior long-term survival, irrespective of sex and
diabetic status. Copyright &#xa9; 2017 by the American College of
Cardiology Foundation and the American Heart Association, Inc.

<58>
Accession Number
614297390
Author
Dobbels F.; De Bleser L.; Berben L.; Kristanto P.; Dupont L.; Nevens F.;
Vanhaecke J.; Verleden G.; De Geest S.
Institution
(Dobbels, De Bleser, De Geest) Academic Centre for Nursing and Midwifery,
KU Leuven, Leuven, Belgium
(Dobbels, Berben, De Geest) Institute of Nursing Science, University of
Basel, Basel, Switzerland
(Kristanto) AARDEX Group, a WestRock Healthcare Company, Vise, Belgium
(Dupont, Verleden) Lung Transplant Program, University Hospitals of
Leuven, Leuven, Belgium
(Nevens) Liver Transplant Program, University Hospitals of Leuven, Leuven,
Belgium
(Vanhaecke) Heart Transplant Program, University Hospitals of Leuven,
Leuven, Belgium
Title
Efficacy of a medication adherence enhancing intervention in
transplantation: The MAESTRO-Tx trial.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier USA
Abstract
Background: Well-designed randomized controlled trials (RCTs) testing
efficacy of post-transplant medication adherence enhancing interventions
and clinical outcomes are scarce. Methods: This randomized controlled
trial enrolled adult heart, liver, and lung transplant recipients who were
>1 year post-transplant and on tacrolimus twice daily (convenience sample)
(visit 1). After a 3-month run-in period, patients were randomly assigned
1:1 to intervention group (IG) or control group (CG) (visit 2), followed
by a 6-month intervention (visits 2-4) and a 6-month adherence follow-up
period (visit 5). All patients used electronic monitoring for 15 months
for adherence measurement, generating a daily binary adherence score per
patient. Post-intervention 5-year clinical event-free survival (mortality
or retransplantation) was evaluated. The IG received staged multicomponent
tailored behavioral interventions (visits 2-4) building on social
cognitive theory and trans-theoretical model (e.g., electronic monitoring
feedback, motivational interviewing). The CG received usual care and
attended visits 1-5 only. Intention-to-treat analysis used generalized
estimating equation modeling and Kaplan-Meier survival analysis. Results:
Of 247 patients, 205 were randomly assigned (103 IG, 102 CG). At baseline,
average daily proportions of patients with correct dosing (82.6% IG, 78.4%
CG) and timing adherence (75.8% IG, 72.2% CG) were comparable. The IG had
a 16% higher dosing adherence post-intervention (95.1% IG, 79.1% CG; p <
0.001), resulting in odds of adherence being 5 times higher in the IG than
in the CG (odds ratio 5.17, 95% confidence interval 2.86-9.38). This
effect was sustained at end of follow-up (similar results for timing
adherence). In the IG, 5-year clinical event-free survival was 82.5% vs
72.5% in the CG (p = 0.18). Conclusion: Our intervention was efficacious
in improving adherence and sustainable. Further research should
investigate clinical impact, cost-effectiveness, and scalability.
Copyright &#xa9; 2017 International Society for Heart and Lung
Transplantation.

<59>
Accession Number
614296341
Author
Clarke B.; Ducharme A.; Giannetti N.; Kim D.; McDonald M.; Pflugfelder P.;
Rajda M.; Senechal M.; Stadnick E.; Toma M.; Zieroth S.; Isaac D.
Institution
(Clarke, Isaac) Division of Cardiac Sciences, Libin Cardiovascular
Institute, Foothills Medical Center, University of Calgary, Calgary,
Alberta; Canada
(Ducharme) Division of Cardiology, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada
(Giannetti) Division of Cardiology, McGill University Medical Center,
McGill University, Montreal, Quebec, Canada
(Kim) Division of Cardiology, University of Alberta Hospital, University
of Alberta, Edmonton, Alberta, Canada
(McDonald) Division of Cardiology, Peter Munk Cardiac Centre, University
Health Network, Toronto, Ontario, Canada
(Pflugfelder) Division of Cardiology, London Health Science Center,
University of Western Ontario, London, Ontario, Canada
(Rajda) Division of Cardiology, Queen Elizabeth II Health Science Center,
Dalhousie University, Halifax, Nova Scotia, Canada
(Senechal) Division of Cardiology, Institut Universitaire de Cardiologie
et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(Stadnick) Division of Cardiology, Ottawa Heart Institute, University of
Ottawa, Ottawa, Ontario, Canada
(Toma) Division of Cardiology, St. Paul's Hospital, University of British
Columbia, Vancouver, British Columbia, Canada
(Zieroth) Division of Cardiology, St. Boniface Hospital, University of
Manitoba, Winnipeg, Manitoba, Canada
Title
Multicenter evaluation of a national organ sharing policy for highly
sensitized patients listed for heart transplantation in Canada.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier USA
Abstract
Background: Transplantation of sensitized recipients has been associated
with increased risk of post-transplant complications. In 2010, the
Canadian Cardiac Transplant Network (CCTN) created a unique status listing
for highly sensitized heart transplant candidates. Status 4S listing
requires calculated panel-reactive antibody (cPRA) level >80% as the sole
listing criteria and enables geographic expansion of the donor pool by
providing national access. In this study, we describe patient
characteristics and outcomes of those transplanted as Status 4S in Canada.
Methods: Patients' characteristics and clinical outcomes were
retrospectively collected from all 11 adult heart transplant centers in
Canada. Results: Ninety-six patients were listed Status 4S from January
2010 to September 2015. Fifty-two were transplanted as Status 4S. Of these
52 transplants, mean cPRA level was 93.4%, mean age was 47 years, 46% were
male, 44% had dilated cardiomyopathy and 17% were re-transplanted for
cardiac allograft vasculopathy (CAV). Blood group O comprised 42% and 53%
had a left ventricular assist device as a bridge to transplant.
Desensitization therapy occurred in 9 patients (17%). Over a mean
follow-up period of 28 months (1 week to 5.3 years), 9 patients died
(17%). Kaplan-Meier 1-year year survival is 86%. Two patients were treated
for antibody-mediated rejection (AMR) in the first year post-transplant
and 33% of patients had at least 1 ISHLT Grade >2R cellular rejection in
the first year. Twenty-nine percent of patients developed de novo
door-specific antibodies and demonstrated no correlation with AMR. Freedom
from CAV at 1 year is 88.5% and at 5 years is 81.0%. Fifty-two percent of
donor hearts originated from outside the recipients' geographic and organ
donation organization. Conclusions: A national strategy of prioritizing
highly sensitized heart transplant recipients has demonstrated effective
expansion of the donor pool, acceptable short-term survival, freedom from
CAV and low rates of clinically relevant AMR. However, we observed
significantly higher rates of cellular rejection and de novo
donor-specific antibody development in this population. It is currently
unknown whether this will translate into poorer long-term outcome.
Copyright &#xa9; 2017 International Society for Heart and Lung
Transplantation.

<60>
Accession Number
614272322
Author
Tang L.H.; Kikkenborg Berg S.; Christensen J.; Lawaetz J.; Doherty P.;
Taylor R.S.; Langberg H.; Zwisler A.-D.
Institution
(Tang, Kikkenborg Berg, Lawaetz) Department of Cardiology, The Heart
Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Tang, Christensen, Lawaetz, Langberg) CopenRehab, Section of Social
Medicine, Department of Public Health, University of Copenhagen, Denmark
(Tang, Lawaetz) Bachelor's Degree Program in Physiotherapy, Dept. of
Rehabilitation and Nutrition, Faculty of Health and Technology,
Metropolitan University College, Copenhagen, Denmark
(Christensen) Department of Occupational Therapy and Physiotherapy,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Doherty) Department of Health Sciences, University of York, England,
United Kingdom
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, England, United Kingdom
(Taylor) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Taylor, Zwisler) National Centre for Rehabilitation and Palliative Care,
University of Southern Denmark, Denmark
(Taylor, Zwisler) Odense University Hospital, Denmark
Title
Patients' preference for exercise setting and its influence on the health
benefits gained from exercise-based cardiac rehabilitation.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: July 13, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: To assess patient preference for exercise setting and examine
if choice of setting influences the long-term health benefit of
exercise-based cardiac rehabilitation. Methods: Patients participating in
a randomised controlled trial following either heart valve surgery, or
radiofrequency ablation for atrial fibrillation were given the choice to
perform a 12-week exercise programme in either a supervised centre-based,
or a self-management home-based setting. Exercise capacity and physical
and mental health outcomes were assessed for up to 24. months after
hospital discharge. Outcomes between settings were compared using a time.
x. setting interaction using a mixed effects regression model. Results:
Across the 158 included patients, an equivalent proportion preferred to
undertake exercise rehabilitation in a centre-based setting (55%, 95% CI:
45% to 63%) compared to a home-based setting (45%, 95% CI: 37% to 53%, p =
0.233). At baseline, those who preferred a home-based setting reported
better physical health (mean difference in physical component score: 5.0,
95% CI 2.3 to 7.4; p = 0.001) and higher exercise capacity (mean between
group difference 15.9. watts, 95% CI 3.7 to 28.1; p = 0.011). With the
exception of the depression score in the Hospital Anxiety and Depression
Score (F(3.65), p = 0.004), there was no evidence of a significant
difference in outcomes between settings. Conclusion: The preference of
patients to participate in home-based and centre-based exercise programmes
appears to be equivalent and provides similar health benefits. Whilst
these findings support that patients should be given the choice between
exercise-settings when initiating cardiac rehabilitation, further
confirmatory evidence is needed. Copyright &#xa9; 2017.

<61>
Accession Number
614272324
Author
de Souza Brito F.; Mehta R.H.; Lopes R.D.; Harskamp R.E.; Lucas B.D.;
Schulte P.J.; Tardif J.-C.; Alexander J.H.
Institution
(de Souza Brito, Mehta, Lopes, Harskamp, Alexander) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC
(Lucas) Clinical Research, Charleston Area Medical Center Health Education
and Research Institute, Charleston, WVa
(Schulte) Department of Health Sciences Research, Mayo Clinic, Rochester,
Minn
(Tardif) Montreal Heart Institute, Quebec, Canada
Title
Nonsteroidal Anti-Inflammatory Drugs and Clinical Outcomes in Patients
Undergoing Coronary Artery Bypass Surgery.
Source
American Journal of Medicine. (no pagination), 2016. Date of Publication:
2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly
used in perioperative pain management of patients undergoing coronary
artery bypass graft surgery. However, the association of periprocedural
use of NSAIDs and clinical outcomes after coronary artery bypass graft is
understudied. Methods: We conducted a retrospective analysis using pooled
data from 2 multicenter randomized controlled trials (PREVENT IV [n =
3014] and MEND-CABG II [n = 3023]). Rates of death, death or myocardial
infarction, and death, myocardial infarction, or stroke in the 30 days
following coronary artery bypass graft surgery were compared in patients
using or not using perioperative NSAIDs. Inverse probability of treatment
weighting and Cox proportional hazards regression models were used to
adjust for confounding. Results: A total of 5887 patients were studied.
Median age was 65 years, 78% were male, and 91% were White. NSAIDs were
used in 2368 (40.2%) patients. The majority of patients (1822 [30.9%])
received NSAIDs after coronary artery bypass graft surgery; 289 (4.9%)
used them prior to and after the surgery; and 257 (4.4) received NSAIDs
prior to the surgery only. Adjusted 30-day outcomes were similar in
patients receiving and not receiving NSAIDs (death: hazard ratio [HR]
1.18; 95% confidence interval [CI], 0.48-2.92; death or myocardial
infarction: HR 0.87; 95% CI, 0.42-1.79; death, myocardial infarction, or
stroke: HR 0.87; 95% CI, 0.46-1.65). Conclusion: In this pooled data
analysis, perioperative NSAID use was common among patients undergoing
coronary artery bypass graft surgery and was not associated with an
increased short-term risk for major adverse clinical outcomes. Copyright
&#xa9; 2016 Elsevier Inc.

<62>
Accession Number
614259143
Author
Howitt S.H.; Grant S.W.; Riding D.M.; Malagon I.; McCollum C.N.
Institution
(Howitt, Grant, Riding, McCollum) Academic Surgery Unit, Institute of
Cardiovascular Sciences, University of Manchester, University Hospital of
South Manchester, Manchester, UK
(Howitt, Malagon) Department of Cardiothoracic Anaesthesia and Critical
Care, University Hospital of South Manchester, Manchester, UK
(Grant) National Institute for Cardiovascular Outcomes Research,
University College London, Institute of Cardiovascular Science, London, UK
Title
Risk Models That Use Postoperative Patient Monitoring Data to Predict
Outcomes in Adult Cardiac Surgery: A Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders

<63>
Accession Number
614230602
Author
Tamura T.; Mori S.; Mori A.; Ando M.; Yokota S.; Shibata Y.; Nishiwaki K.
Institution
(Tamura, Yokota) Division of Anesthesia, Japanese Red Cross Nagoya Daiichi
Hospital, Nagoya, Japan
(Tamura, Shibata, Nishiwaki) Department of Anesthesiology, Nagoya
University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya
466-8550, Japan
(Mori) Division of Thoracic Surgery, Japanese Red Cross Nagoya Daiichi
Hospital, Nagoya, Japan
(Mori) Department of Perioperative Management System, Nagoya University
Graduate School of Medicine, Nagoya, Japan
(Ando) Center for Advanced Medicine and Clinical Research, Nagoya
University Hospital, Nagoya, Japan
Title
A randomized controlled trial comparing paravertebral block via the
surgical field with thoracic epidural block using ropivacaine for
post-thoracotomy pain relief.
Source
Journal of Anesthesia. (pp 1-8), 2017. Date of Publication: 23 Jan 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: We conducted a comparative study to evaluate analgesic efficacy
between paravertebral block via the surgical field (PVB-sf), in which the
catheter was inserted into the ventral side of the sympathetic trunk in
the paravertebral space by a thoracic surgeon under thoracoscopic
visualization, and epidural block (Epi) using ropivacaine for
post-thoracotomy pain relief. Methods: Lung cancer patients scheduled for
lobectomy via thoracotomy were randomly allocated to receive either PVB-sf
or Epi (n = 36 per group). Before thoracotomy closure, 0.375% ropivacaine
was administered as a bolus (PVB-sf, 20 mL; Epi, 5 mL), followed by a
300-mL continuous infusion of 0.2% ropivacaine at 5 mL/h. Postoperative
pain was assessed using a visual analog scale (VAS) score at various time
points, including the primary endpoint of 2 h after ropivacaine bolus
injection. Sensory block area, vital signs, serum ropivacaine
concentrations, and side effects were also evaluated. Results: The Epi
group showed significantly lower VAS scores and blood pressure and a wider
sensory block area than the PVB-sf group at all evaluation time points.
While the mean serum ropivacaine concentration in the PVB-sf group was
significantly higher than that in the Epi group until 1 h after injection
of the ropivacaine bolus, there was no significant difference at any
subsequent assessment point. The incidence of side effects was similar
between the groups. Conclusion: The Epi was superior to PVB-sf for the
management of post-thoracotomy pain in this patient cohort. The number of
dermatomes anaesthetized by Epi was greater than that anaesthetized by
PVB-sf. No difference in complication rates was observed between the two
groups. Copyright &#xa9; 2017 Japanese Society of Anesthesiologists

<64>
Accession Number
614229287
Author
Guinot P.-G.; Abou-Arab O.; Guilbart M.; Bar S.; Zogheib E.; Daher M.;
Besserve P.; Nader J.; Caus T.; Kamel S.; Dupont H.; Lorne E.
Institution
(Guinot, Abou-Arab, Guilbart, Bar, Zogheib, Daher, Besserve, Dupont,
Lorne) Department of Anaesthesiology and Critical Care Medicine, Amiens
University Hospital, Place Victor Pauchet, Amiens 80054, France
(Guinot, Nader, Caus, Kamel, Dupont, Lorne) INSERM U1088, Jules Verne
University of Picardy, Amiens 80054, France
(Nader, Caus) Department of Cardiac Surgery, Amiens University Hospital,
Amiens 80054, France
Title
Monitoring dynamic arterial elastance as a means of decreasing the
duration of norepinephrine treatment in vasoplegic syndrome following
cardiac surgery: a prospective, randomized trial.
Source
Intensive Care Medicine. (pp 1-9), 2017. Date of Publication: 24 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: To evaluate the ability of an algorithm based on dynamic arterial
elastance to decrease the duration of norepinephrine treatment. Methods:
We performed a prospective, open-label, randomized study in patients
requiring norepinephrine for vasoplegic syndrome after cardiac surgery
with cardiopulmonary bypass. Patients were randomized to an
algorithm-based intervention group or a control group. The primary outcome
was the duration of norepinephrine treatment. The secondary outcomes
included the total dose of norepinephrine, the length of stay (LOS) in the
ICU, central venous oxygen saturation, arterial lactate levels, arrhythmia
and diuresis. Results: Of 130 included patients, 118 were analysed on an
intention-to-treat basis (intervention group: n = 59; control group: n =
59). On inclusion, the intervention and control groups did not differ
significantly in terms of demographic characteristics, surgical data or
the prior duration of norepinephrine treatment [5 h (4-10) vs. 5 h (5-7),
respectively; P = 0.543]. The cumulative duration of norepinephrine
treatment after inclusion was shorter in the intervention group than in
the control group [17 h (13-26)] vs. 39 h (19-58), respectively; (P <
0.001). The cumulative dose of norepinephrine and the LOS in the ICU were
also lower in the intervention group (P < 0.05). There were no intergroup
differences for other outcomes (the sepsis-related organ failure score,
central venous oxygen saturation, arrhythmia, and arterial lactate
levels). Conclusion: A haemodynamic algorithm based on dynamic arterial
elastance was associated with a shorter duration of norepinephrine
treatment and a shorter LOS in the ICU. Use of the algorithm did not alter
perfusion parameters or increase the volume of fluid infused.
ClinicalTrials.gov Identifier: NCT02479529. Copyright &#xa9; 2017
Springer-Verlag Berlin Heidelberg and ESICM