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<1>
Accession Number
363072982
Author
Sunderland N.; Nagendran M.; Maruthappu M.
Institution
(Sunderland) St Hugh's College, University of Oxford, St Margaret's Road,
Oxford, OX2 6LE, United Kingdom
(Nagendran, Maruthappu) Green Templeton College, University of Oxford,
Oxford, OX2 6H6, United Kingdom
Title
In patients with an enlarged left atrium does left atrial size reduction
improve maze surgery success?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 635-641),
2011. Date of Publication: December 2011.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was: In [adults undergoing a
maze procedure for Atrial Fibrillation (AF)], [does Left Atrial size
reduction] compared to [maze surgery alone] improve [maze surgery
success]? A total of 58 papers were found using the reported search, of
which eight represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group
studied, study type, relevant outcomes and results of these papers are
tabulated. Four out of eight papers compared a volume reduction technique
as an adjunct to the maze procedure to a maze procedure alone - all four
papers reported that atrial volume reduction significantly increased
restoration of sinus rhythm: 89.3% vs. 67.2%, P<0.001; 85% vs. 68%,
P<0.05; 84% vs. 68%, P<0.05; 90% vs. 69%, P<0.05. Three out of eight
papers had no control group but reported good rates of sinus rhythm
restoration at last follow-up - 90%, 92% and 89%, respectively - despite
the study population including atrial enlargement, a risk factor for
failure of a maze procedure. One paper reported no benefit of an atrial
reduction plasty in patients with a left atrium (LA) >70mm. An enlarged LA
is a risk factor for failure of a maze procedure, and various models of AF
suggest that reducing atrial mass and/or diameter may help to abolish the
re-entry circuits underlying AF. Furthermore, AF is uncommon when left
atrial diameter is <40mm, so there is at least some physiological basis
for atrial reduction surgery in aiding the success of a maze procedure.
The evidence suggests that patients with an enlarged (>55mm) or giant
(>75mm) LA who are at risk of failing to obtain sinus conversion after a
standard maze procedure may derive benefit from concomitant atrial
reduction surgery using either a tissue excision or a tissue plication
technique. However, the evidence is not strong since the papers available
are not readily comparable owing to substantial variations in the
populations and procedures involved. We therefore, emphasise the need for
prospective randomised studies in this area. &#xa9;2011 Published by
European Association for Cardio-Thoracic Surgery. All rights reserved.

<2>
Accession Number
611377774
Author
Bablekos G.D.; Analitis A.; Michaelides S.A.; Charalabopoulos K.A.; Tzonou
A.
Institution
(Bablekos) Technological Educational Institute of Athens, Faculty of
Health and Caring Professions, Agiou Spyridonos, Egaleo, Athens 12243,
Greece
(Bablekos, Charalabopoulos) Department of Physiology, Medical School,
Democritus University of Thrace, Dragana, Alexandroupolis 68100, Greece
(Analitis, Tzonou) Department of Hygiene, Epidemiology and Medical
Statistics, Medical School, National and Kapodistrian University of
Athens, Goudi, Athens 11527, Greece
(Michaelides) Department of Occupational Lung Diseases and Tuberculosis,
'Sismanogleio' General Hospital, Maroussi, Athens 15126, Greece
Title
Management and postoperative outcome in primary lung cancer and heart
disease co-morbidity: A systematic review and metaanalysis.
Source
Annals of Translational Medicine. 4 (11) (no pagination), 2016. Article
Number: 213. Date of Publication: June 2016.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: Co-morbidity of primary lung cancer (LC) and heart disease
(HD), both requiring surgical therapy, characterizes a high risk group of
patients necessitating prompt diagnosis and treatment. The aim of this
study is the review of available evidence guiding the management of these
patients. Methods: Postoperative outcome of patients operated for primary
LC (first meta-analysis) and for both primary LC and HD co-morbidity
(second meta-analysis), were studied. Parameters examined in both
meta-analyses were thirty-day postoperative mortality, postoperative
complications, three- and five-year survival probabilities. The last 36
years were reviewed by using the PubMed data base. Thirty-seven studies
were qualified for both meta-analyses. Results: The pooled 30-day
mortality percentages (%) were 4.16% [95% confidence interval (CI):
2.68-5.95] (first meta-analysis) and 5.26% (95% CI: 3.47-7.62) (second
meta-analysis). Higher percentages of squamous histology and lobectomy,
were significantly associated with increased (P=0.001) and decreased
(P<0.001) thirty-day postoperative mortality, respectively (first
meta-analysis). The pooled percentages for postoperative complications
were 34.32% (95% CI: 24.59-44.75) (first meta-analysis) and 45.59% (95%
CI: 35.62-55.74) (second metaanalysis). Higher percentages of squamous
histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were
associated with higher proportions of postoperative complications (second
meta-analysis). The pooled threeand five- year survival probabilities were
68.25% (95% CI: 45.93-86.86) and 52.03% (95% CI: 34.71-69.11),
respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009)
significantly reduced the five-year survival probability. Conclusions:
Lobectomy and age were both accompanied by reduced five-year survival
rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy
for squamous pT1 or pT2 LC displayed a higher risk of postoperative
complications. Moreover, medical decision between combined or staged
surgery is suggested to be individualized based on adequacy of coronary
arterial perfusion, age, patient's preoperative performance status (taking
into account possible co-morbidities per patient), tumor's staging and
extent of lung resection. Copyright &#xa9; Annals of Translational
Medicine.

<3>
Accession Number
613365541
Author
Calafiore A.M.; Prapas S.; Abukoudair W.; Di Mauro M.
Institution
(Calafiore, Prapas) Department of Cardiac Surgery, Henry Dunant Hospital,
Athens, Greece
(Abukoudair) Division of Cardiac Surgery, King Fahd Military Hospital,
Jeddah, Saudi Arabia
(Di Mauro) University G. D'Annunzio, Chieti, Italy
Title
Has moderate ischemic mitral regurgitation to be corrected?-Analysis of a
randomized trial.
Source
Annals of Translational Medicine. 4 (no pagination), 2016. Article Number:
S66. Date of Publication: October 2016.
Publisher
AME Publishing Company (E-mail: info@amepc.org)

<4>
Accession Number
610480150
Author
Boureau A.S.; Trochu J.N.; Rouaud A.; Hureau R.; Jaafar P.; Manigold T.;
Letocart V.; Guerin P.; Berrut G.; de Decker L.
Institution
(Boureau, Rouaud, Berrut, de Decker) Department of Geriatrics, EA 1156-12,
Nantes University Hospital, Nantes, France
(Trochu, Jaafar, Manigold, Letocart, Guerin) Inserm, UMR 1087, Department
of Cardiology and Vascular diseases, Institut du Thorax, Nantes University
Hospital, Nantes, France
(Hureau) Department of Geriatrics, Angers University Hospital, Angers,
France
(Boureau) Department of Geriatrics, Nantes University Hospital, boulevard
Jacques Monod, Nantes Cedex 1 44093, France
Title
Predictors of health-related quality of life decline after transcatheter
aortic valve replacement in older patients with severe aortic stenosis.
Source
Journal of Nutrition, Health and Aging. 21 (1) (pp 105-111), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Springer-Verlag France (22, Rue de Palestro, Paris 75002, France. E-mail:
york@springer-paris.fr)
Abstract
Background: Transcatheter aortic-valve implantation (TAVI) has been shown
to improve survival and quality of life in patients with severe aortic
stenosis. However, one-third of patients have poor outcome as death,
functional decline or quality of life (QoL) decline. The aim of this study
was to determine cardiac and geriatric predictors of physical and mental
QoL decline 6 months after a TAVI procedure in patients aged 75 and older.
Methods: Between January 2013 and June 2014, we did a prospective and
multicenter study including patients > 75 years old referred for TAVI. The
primary outcome was the measure of QoL, assessed by the Short Form 36
survey (SF-36), before and 6 months after the intervention. Association
between QoL decline and baseline characteristics including cardiac and
geriatric factors was analysed by logistic regression models. Results:
Mean age of the 150 patients studied was 83.7 years old and 56% were men.
The primary end point, mean SF-36 physical summary score, significantly
improved between baseline and 6-month (33.6 vs. 36.4, p=0.003) whereas
mental component score significantly decreased (48.2 vs. 36.4,
p-value<0.001). However, patients with presence of depressive symptoms
before the intervention had mental QoL improvement at six months (OR 0.04
[0.01-0.19], p-value<0.001) and no significant geriatric predictors were
associated with physical QoL decline. Conclusion: The mental QoL
significantly decreased and patients with preoperative depressive symptoms
had mental QoL improvement at six months. Researches are needed to confirm
that mental QoL of patients with depressive symptoms can be improved by
TAVI. Copyright &#xa9; 2017, Serdi and Springer-Verlag France.

<5>
Accession Number
614099211
Author
Godino C.; Chiarito M.; Donahue M.; Testa L.; Colantonio R.; Cappelletti
A.; Monello A.; Magni V.; Milazzo D.; Parisi R.; Nicolino A.; Moshiri S.;
Fattori R.; Aprigliano G.; Palloshi A.; Caramanno G.; Montorfano M.;
Bedogni F.; Briguori C.; Margonato A.; Colombo A.
Institution
(Godino, Chiarito, Cappelletti, Monello, Magni, Montorfano, Margonato,
Colombo) San Raffaele Scientific Institute, Milan, Italy
(Donahue, Briguori) Clinica Mediterranea, Naples, Italy
(Testa, Bedogni) IRCCS Policlinico San Donato, San Donato M.ne, Milan,
Italy
(Colantonio) Ospedale San Pietro FBF, Rome, Italy
(Milazzo, Caramanno) Ospedale San Giovanni di Dio, Agrigento, Italy
(Parisi, Fattori) Ospedali Riuniti Marche Nord, Pesaro, Italy
(Nicolino, Moshiri) Ospedale Santa Corona, Pietra Ligure, Italy
(Aprigliano, Palloshi) Istituto Clinico Citta Studi, Milan, Italy
(Colombo) EMO-GVM Centro Cuore Columbus, Milan, Italy
Title
Midterm and one-year outcome of amphilimus polymer free drug eluting stent
in patients needing short dual antiplatelet therapy. Insight from the
ASTUTE registry (AmphilimuS iTalian mUlticenTer rEgistry).
Source
International Journal of Cardiology. 231 (pp 54-60), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background To assess clinical outcomes of patients needing short dual
antiplatelet therapy (S-DAPT) after PCI with Cre8 polymer-free amphilimus
eluting-stent (AES). The Cre8-AES with pure i-Carbofilm coating was
supposed to induce faster stent endothelialization and reduce device
thrombogenicity. Methods We performed a sub-analysis of unrestricted
consecutive patients treated with Cre8-AES between August 2011 and January
2015. Two groups were formed: 1) patients discharged with S-DAPT (<
3-month), because of high bleeding risk or attending urgent non-cardiac
surgery; and 2) patients discharged with Recommended DAPT duration
(R-DAPT; > 6-month). The primary ischemic- and bleeding-safety endpoints
were Target Vessel Failure (TVF, composite endpoint of cardiac-death,
target vessel-myocardial infarction and target vessel-revascularization),
and major-bleeding (BARC > type-3a) at 6-month and 1-year. Results 106
patients (8.7%) were discharged with < 3-month DAPT (83 +/- 19 days;
S-DAPT group) and 1102 patients (90.6%) with > 6-month DAPT (342 +/- 62
days; R-DAPT group). Between S-DAPT and R-DAPT groups no significant
differences were observed in TVF at 1-year (5.7% vs 5.1%); 1-year BARC
major bleeding rate was higher in S-DAPT group (3.4% vs 0.2%, p = 0.007)
with all bleeding events occurred within 3 months. The landmark analysis
(started at 90 days, ended at 1 year) showed no differences in BARC major
bleedings between groups (0% vs. 0.3%). Conclusions The results of this
multicenter registry show that the use of Cre8 AES in patients needing
short DAPT (< 3-month) was safe regarding ischemic events and could favor
a reduction of bleeding events related to the recommended DAPT. A large
randomized trial is necessary to support these preliminary findings.
Copyright &#xa9; 2017 Elsevier B.V.

<6>
Accession Number
613967152
Author
Kahlert P.; Hildebrandt H.A.; Patsalis P.C.; Al-Rashid F.; Janosi R.A.;
Nensa F.; Schlosser T.W.; Schlamann M.; Wendt D.; Thielmann M.; Kottenberg
E.; Frey U.; Neuhauser M.; Forsting M.; Jakob H.G.; Rassaf T.; Peters J.;
Heusch G.; Kleinbongard P.
Institution
(Kahlert, Hildebrandt, Patsalis, Al-Rashid, Janosi, Rassaf) Department of
Cardiology and Vascular Medicine, West-German Heart and Vascular Center
Essen, Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Nensa, Schlosser, Schlamann, Forsting) Institute for Diagnostic and
Interventional Radiology and Neuroradiology, Universitatsklinikum Essen,
Universitat Duisburg-Essen, Germany
(Wendt, Thielmann, Jakob) Department of Thoracic and Cardiovascular
Surgery, West-German Heart and Vascular Center Essen, Universitatsklinikum
Essen, Universitat Duisburg-Essen, Germany
(Kottenberg, Frey, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Neuhauser) Institute for Medical Informatics, Biometry, and Epidemiology,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Heusch, Kleinbongard) Institute for Pathophysiology, West-German Heart
and Vascular Center Essen, Universitatsklinikum Essen, Universitat
Duisburg-Essen, Germany
(Schlamann) Department of Neuroradiology, University Hospital Giesen,
Giesen, Germany
(Kottenberg) Klinik fur Anasthesiologie, Intensivmedizin und
Schmerztherapie, Evangelisches Krankenhaus Mulheim, Germany
(Neuhauser) Department of Mathematics and Technology, Koblenz, University
of Applied Science, Remagen, Germany
Title
No protection of heart, kidneys and brain by remote ischemic
preconditioning before transfemoral transcatheter aortic valve
implantation: Interim-analysis of a randomized single-blinded,
placebo-controlled, single-center trial.
Source
International Journal of Cardiology. 231 (pp 248-254), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic preconditioning (RIPC) reduces myocardial
injury and improves clinical outcome in patients undergoing coronary
revascularization, but only in the absence of propofol-anesthesia. We
investigated whether RIPC provides protection of heart, kidneys and brain
and improves outcome in patients undergoing transfemoral transcatheter
aortic valve implantation (TF-TAVI). Methods Patients undergoing TF-TAVI
were randomized to receive RIPC (3 cycles of 5 min left upper arm ischemia
and 5 min reperfusion) or placebo. The primary endpoint was myocardial
injury, reflected by the area under the curve for serum troponin I
concentrations (AUC-TnI) over the first 72 h. Secondary endpoints included
the incidences of periprocedural myocardial infarction, delayed gadolinium
enhancement on postprocedural cardiac MRI, acute kidney injury,
periprocedural stroke, and the incidence and volume of new lesions on
postprocedural cerebral MRI. All-cause and cardiovascular mortality and
major adverse cardiac and cerebrovascular events (MACCE) were assessed
over 1-year follow-up. A prespecified interim-analysis was performed after
the last patient had completed 1-year follow-up (NCT02080299). Results 100
consecutive patients were enrolled between September 2013 and June 2015.
There were no significant between-group differences in the primary
endpoint of peri-interventional myocardial injury (ratio RIPC/placebo
AUC-TnI: 0.87, 95% CI: 0.57-1.34, p = 0.53) or the secondary endpoints of
cardiac, renal and cerebral impairment. There was no significant treatment
effect in subgroup-analyses of patients undergoing cardiac or cerebral
MRI. Mortality and MACCE did not differ. No RIPC-related adverse events
were observed. Conclusions RIPC did neither protect heart, kidneys and
brain nor improve clinical outcome in patients undergoing TF-TAVI.
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<7>
Accession Number
607899783
Author
Ihmsen H.; Rohde D.; Schuttler J.; Jeleazcov C.
Institution
(Ihmsen, Rohde, Schuttler, Jeleazcov) Anasthesiologische Klinik,
Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat
Erlangen-Nurnberg, Krankenhausstrasse 12, Erlangen 91054, Germany
Title
External Validation of a Recently Developed Population Pharmacokinetic
Model for Hydromorphone During Postoperative Pain Therapy.
Source
European Journal of Drug Metabolism and Pharmacokinetics. 42 (1) (pp
17-28), 2017. Date of Publication: 01 Feb 2017.
Publisher
Springer-Verlag France (22, Rue de Palestro, Paris 75002, France. E-mail:
york@springer-paris.fr)
Abstract
Background and Objective: We recently developed a new population
pharmacokinetic model for hydromorphone in patients including age and
bodyweight as covariates. The aim of the present study was to evaluate
prospectively the predictive performance of this new model during
postoperative pain therapy. Methods: This was a prospective,
single-blinded, randomized, single-center study with two parallel arms.
Fifty patients aged 40-85 years undergoing cardiac surgery involving
thoracotomy were enrolled. Hydromorphone was administered postoperatively
on the intensive care unit as target controlled infusion (TCI) for patient
controlled analgesia (TCI-PCA) using the new pharmacokinetic model, or as
conventional patient controlled analgesia (PCA). Arterial blood samples
were taken for measurement of the hydromorphone plasma concentration. The
predictive performance of the pharmacokinetic model was assessed by the
median performance error (MDPE), the median absolute performance error
(MDAPE), wobble and divergence. For comparison, the performance indices
were also determined for three older models from the literature. Results:
903 plasma concentrations of 41 patients were analyzed. The mean values
(95 % CI) of MDPE, MDAPE, wobble and divergence for the new
pharmacokinetic model were 11.2 % (3.9 to 18.7 %), 28.5 % (23.9 to 33.0
%), 21.4 % (18.0 to 24.9 %) and -1.6 %/h (-2.3 to -0.8 %/h). When compared
with older models from the literature, performance was better with less
overshoot after bolus doses. Conclusion: The new pharmacokinetic model of
hydromorphone showed a good precision and a better performance than older
models. It is therefore suitable for TCI with hydromorphone during
postoperative pain therapy. Trial Registration: EudraCT 2013-002875-16,
Clinical Trials NCT02035709. Copyright &#xa9; 2016, Springer International
Publishing Switzerland.

<8>
Accession Number
613094478
Author
Farag M.; Patil N.P.; Sabashnikov A.; Arif R.; Szabo G.; Kallenbach K.;
Ruhparwar A.; Karck M.; Brenner T.; Hofer S.; Weymann A.
Institution
(Farag, Arif, Szabo, Kallenbach, Ruhparwar, Karck, Weymann) Department of
Cardiac Surgery, Heart and Marfan Center, University of Heidelberg,
Heidelberg, Germany
(Patil) Department of Cardiothoracic Surgery, Royal Brompton and Harefield
NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
(Sabashnikov) Department of Cardiothoracic Surgery, Heart Center,
University of Cologne, Cologne, Germany
(Brenner, Hofer) Department of Anesthesiology, Heidelberg University
Hospital, Heidelberg, Germany
(Kallenbach) INCCI HAERZ ZENTER, Luxembourg, Germany
Title
Comparison of Two Miniaturized Cardiopulmonary Bypass Systems Regarding
Inflammatory Response.
Source
Artificial Organs. 41 (2) (pp 139-145), 2017. Date of Publication: 01 Feb
2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Cardiopulmonary bypass (CPB) is a known mediator of systemic inflammatory
response. Extracorporeal circulations are undergoing continuous
modifications and optimizations to achieve better results. Hence we aim to
compare the inflammatory response associated with two recent miniature
extracorporeal circulation systems during normothermic CPB. We measured
plasma levels of cytokines including interleukin (IL)-1beta, IL-6, IL-10,
tumor necrosis factor-alpha, migration inhibitory factor (MIF), receptor
for advanced glycation endproduct, and cluster of differentiation 40
ligand in 60 consecutive patients during the first 24 h after CPB. The
patients were prospectively randomized to one of three trial groups:
patients in group A were operated with the minimal extracorporeal
circulation circuit (MECC, Maquet, Rastatt, Germany), group B operated
with the extracorporeal circulation circuit optimized (ECC.O, Sorin,
Italy), and group C operated with a conventional extracorporeal circuit
(CECC, Maquet). Arterial blood samples were collected at intervals before,
30 min after initiation, and after termination of CPB. Further samples
were collected 6 and 24 h after CPB. IL-10 levels were significantly
raised in the CECC group as compared with either of the mini ECC-circuits
with a peak concentration at 6 h postoperatively. Human MIF concentrations
were significantly higher in the CECC group starting 30 min after CPB and
peaking at the end of CPB. The overall reduction in cytokine
concentrations in the mini-ECC groups correlated with a lower need for
blood transfusion in MECC and a shorter mechanical ventilation time for
ECC.O. Normothermic CPB using minimally invasive extracorporeal
circulation circuits can reduce the inflammatory response as measured by
cytokine levels, which may be beneficial for perioperative preservation of
pulmonary function and hemostasis in low risk patients. Copyright &#xa9;
2016 International Center for Artificial Organs and Transplantation and
Wiley Periodicals, Inc.

<9>
Accession Number
614095871
Author
Cho Y.J.; Lee E.-H.; Lee K.; Kim T.K.; Hong D.M.; Chin J.-H.; Choi D.-K.;
Bahk J.-H.; Sim J.-Y.; Choi I.-C.; Jeon Y.
Institution
(Cho, Lee, Kim, Hong, Bahk, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
(Lee, Chin, Choi, Sim, Choi) Department of Anesthesiology and Pain
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
Title
Long-term clinical outcomes of Remote Ischemic Preconditioning and
Postconditioning Outcome (RISPO) trial in patients undergoing cardiac
surgery.
Source
International Journal of Cardiology. 231 (pp 84-89), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic conditioning has been shown to confer
myocardial protection. However, there is still no sufficient data on its
long-term clinical outcomes. We analyzed the long-term results of the
Remote Ischemic Preconditioning and Postconditioning Outcome (RISPO) trial
in cardiac surgery patients. Methods In the RISPO trial, 1280 patients
were randomized to receive remote ischemic preconditioning (RIPC) with
postconditioning (RIPostC, upper arm ischemia by four cycles of 5-min
inflation followed by 5-min deflation of a pneumatic cuff, N = 644) or
sham (N = 636) during cardiac surgery. Patient follow-up data were
collected by review of medical records, telephone interviews, and from the
National Statistical Office. The primary endpoint was major adverse
cardiac and cerebrovascular events (MACCE; a composite of all-cause
mortality, myocardial infarction (MI), stroke, and revascularization), and
the secondary endpoints were the individual components of the primary
endpoint. Results At completion of follow-up (mean 44 months), there was
no difference in MACCE between the groups (90 [14.0%] versus 101 [15.9%]
in the RIPC with RIPostC versus control groups; hazard ratio [HR], 0.893;
95% confidence interval [CI], 0.672-1.187; P = 0.435). However, MI was
reduced to half in the RIPC with RIPostC group (10 [1.6%] versus 23
[3.6%]; HR, 0.468; 95% CI, 0.222-0.984; P = 0.045). Conclusions Remote
ischemic preconditioning with RIPostC did not improve long-term MACCE
after cardiac surgery. However, MI was reduced in the RIPC with RIPostC
group compared with the control group during the follow-up period.
Clinical trial registration ClinicalTrials.gov identifier, NCT00997217
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<10>
[Use Link to view the full text]
Accession Number
612988452
Author
Hsu C.H.; Haac B.; McQuillan K.A.; Tisherman S.A.; Scalea T.M.; Stein D.M.
Institution
(Hsu, Haac, McQuillan, Tisherman, Scalea, Stein) R Adams Cowley Shock
Trauma Center, University of Maryland School of Medicine, North Campus
Research Complex B026-319N Plymouth Road, Ann Arbor, MI, United States
Title
Outcome of suicidal hanging patients and the role of targeted temperature
management in hanging-induced cardiac arrest.
Source
Journal of Trauma and Acute Care Surgery. 82 (2) (pp 387-391), 2017. Date
of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: No specific treatment is available for hanging-induced cardiac
arrest (CA). We hypothesized that targeted temperature management (TTM)
may improve the outcome of hanging-induced CA patients at hospital
discharge. METHODS: A retrospective chart review of our trauma registry
from January 1999 to September 2015 was conducted to identify patients 18
years or older with hanging as their injury type. All TTMs were performed
to achieve 32degreeC to 34degreeC for 24 hours. The survival and Cerebral
Performance Category scores at hospital discharge were determined.
RESULTS: We identified 138 patients. Their average age was 32.1 +/- 10.0
years; 81.3% were men, and 69.8% were white. The mortality rate was 15.2%
(21 of 138). Overall, 79.7% (110 of 138) of the near-hanging patients did
not sustain out-of-hospital CA (non-CA), and 1.8% of them (2 of 110)
received TTM. All 110 non-CA patients survived to hospital discharge and
99.1% (109 of 110) had good neurologic outcome. The remaining 20.3% (28 of
138) of hanging patients suffered out-of-hospital CA; six of these
patients were dead on arrival and thus excluded from further analysis. TTM
was performed for 40.9% (9 of 22) of the remaining CA patients; 44.4% (4
of 9) of TTM CA patients survived to hospital discharge versus 23.1% (3 of
13) of non-TTM CA patients. There were no significant differences between
the overall survival and patients discharged with good neurologic outcome
between the TTM and non-TTM CA groups. CONCLUSION: Non-CA near-hanging
patients are more likely to have favorable outcome than the CA patients.
Our study was not large enough to detect survival and neurologic outcome
differences between the TTM and non-TTM CA groups. A multicenter
retrospective study is underway to determine the impact of TTM on the
outcome of hanging-induced CA patients. Copyright &#xa9; 2017 Wolters
Kluwer Health, Inc. All rights reserved.

<11>
[Use Link to view the full text]
Accession Number
612817458
Author
Daoulah A.; Alama M.N.; Elkhateeb O.E.; Al-Murayeh M.; Al-Kaabi S.;
Al-Faifi S.M.; Alosaimi H.M.; Lotfi A.; Asiri K.S.; Elimam A.M.;
Abougalambo A.S.; Murad W.; Haddara M.M.; Dixon C.M.; Alsheikh-Ali A.A.
Institution
(Daoulah, Alosaimi) Cardiovascular Department, King Faisal Specialist
Hospital and Research Center, Jeddah, Saudi Arabia
(Al-Faifi) Internal Medicine Department, Section of Pulmonology, King
Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
(Asiri) Internal Medicine Department, King Faisal Specialist Hospital and
Research Center, Jeddah, Saudi Arabia
(Alama, Elimam) Cardiology Unit, King Abdul Aziz University Hospital,
Jeddah, Saudi Arabia
(Elkhateeb, Abougalambo) Cardiac Center, King Abdullah Medical City,
Makkah, Saudi Arabia
(Al-Murayeh) Cardiovascular Department, Armed Forces Hospital Southern
Region, Khamis Mushayt, Saudi Arabia
(Al-Kaabi, Murad) Cardiology Department, Zayed Military Hospital, Abu
Dhabi, United Arab Emirates
(Alsheikh-Ali) Division of Adult Cardiology, College of Medicine, Mohammed
Bin Rashid University of Medicine and Health Sciences, Abu Dhabi, United
Arab Emirates
(Alsheikh-Ali) Division of Adult Cardiology, College of Medicine, Sheikh
Khalifa Medical City, Abu Dhabi, United Arab Emirates
(Haddara) Anesthesia Department, King Faisal Specialist Hospital and
Research Centre, Riyadh, Saudi Arabia
(Dixon) Emergency Department, King Faisal Specialist Hospital and Research
Centre, Riyadh, Saudi Arabia
(Lotfi) Department of Cardiology, Tufts University, School of Medicine,
Springfield, MA, United States
(Daoulah) Cardiovascular Department, Section of Adult Cardiology, King
Faisal Specialist Hospital and Research Center, PO Box 40047, Jeddah
21499, Saudi Arabia
Title
Widowhood and severity of coronary artery disease: A multicenter study.
Source
Coronary Artery Disease. 28 (2) (pp 98-103), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objectives The aim of this study was to assess the association of
widowhood with the severity and extent of coronary artery disease (CAD),
and whether it is modified by sex or socioeconomic status. Patients and
methods A total of 1068 patients undergoing coronary angiography at five
centers in Saudi Arabia and the United Arab Emirates were included in the
study. CAD was defined as more than 70% lumen stenosis in a major
epicardial vessel or more than 50% in the left main coronary artery.
Multivessel disease was defined as more than one diseased vessel. Results
Of 1068 patients, 65 (6%) were widowed. Widowed patients were older
(65+/-15 vs. 59+/-12), more likely to be female (75 vs. 25%), less likely
to be smokers (18 vs. 47%), of lower economic and education status, and
more likely to have undergone coronary angiography for urgent/emergent
indications (75 vs. 61%) (P<0.05 for all). There was a significant
association between widowhood and the number of coronary arteries with
more than 70% lumen stenosis. Consequently, such a high degree of lumen
stenosis in those who were widowed was more likely to require coronary
artery bypass graft surgery (38 vs. 16%; P<0.01). After adjusting for
baseline differences, widowhood was associated with a significantly higher
odds of CAD [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI)
1.2-10.5] and multivessel disease (adjusted OR 4.6; 95% CI 2.2-9.6), but
not left main disease (adjusted OR 1.3; 95% CI 0.5-3.1). All associations
were consistent in men and women and not modified by age, community
setting (urban vs. rural), employment, income, or educational levels (P
interaction >0.1 for all). Conclusion Widowhood is associated with the
severity and extent of CAD. The association is not modified by sex or
socioeconomic status. Copyright &#xa9; 2017 Wolters Kluwer Health, Inc.

<12>
[Use Link to view the full text]
Accession Number
613085635
Author
Gil-Juanmiquel L.; Gratacos M.; Castilla-Fernandez Y.; Piqueras J.; Baust
T.; Raguer N.; Balcells J.; Perez-Hoyos S.; Abella R.F.; Sanchez-De-Toledo
J.
Institution
(Gil-Juanmiquel, Balcells) Pediatric Intensive Care Unit, Department of
Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
(Gratacos, Raguer) Department of Clinical Neurophysiology, Hospital
Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona,
Spain
(Castilla-Fernandez) Department of Neonatology, Universitari Vall
d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
(Piqueras) Department of Pediatric Radiology, Hospital Universitari Vall
d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
(Baust, Sanchez-De-Toledo) Cardiac Intensive Care Unit, Department of
Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA,
United States
(Perez-Hoyos) Unit of Clinical Research Support, Vall d'Hebron Research
Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
(Abella) Department of Pediatric Cardiothoracic Surgery, Hospital
Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona,
Spain
(Sanchez-De-Toledo) Department of Pediatric Cardiology, Sant Joan de Deu
Barcelona Children's, University of Barcelona, Barcelona, Spain
Title
Bedside Ultrasound for the Diagnosis of Abnormal Diaphragmatic Motion in
Children after Heart Surgery.
Source
Pediatric Critical Care Medicine. 18 (2) (pp 159-164), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To assess the utility of bedside ultrasound combining B-and
M-mode in the diagnosis of abnormal diaphragmatic motion in children after
heart surgery. Design: Prospective post hoc blinded comparison of
ultrasound performed by two different intensivists and fluoroscopy results
with electromyography. Setting: Tertiary university hospital. Subjects:
Children with suspected abnormal diaphragmatic motion after heart surgery.
Interventions: None. Measurements and Main Results: Abnormal diaphragmatic
motion was suspected in 26 children. Electromyography confirmed the
diagnosis in 20 of 24 children (83.3%). The overall occurrence rate of
abnormal diaphragmatic motion during the study period was 7.5%. Median
patient age was 5 months (range, 16 d to 14 yr). Sensitivity and
specificity of chest ultrasound performed at the bedside by the two
intensivists (91% and 92% and 92% and 95%, respectively) were higher than
those obtained by fluoroscopy (87% and 83%). Interobserver agreement (k)
between both intensivists was 0.957 (95% CI, 0.87-100). Conclusions: Chest
ultrasound performed by intensivists is a valid tool for the diagnosis of
diaphragmatic paralysis, presenting greater sensitivity and specificity
than fluoroscopy. Chest ultrasound should be routinely used after
pediatric heart surgery given its reliability, reproducibility,
availability, and safety. Copyright &#xa9; 2017 by the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies.

<13>
Accession Number
612731695
Author
Som A.; Maitra S.; Bhattacharjee S.; Baidya D.K.
Institution
(Som, Maitra, Bhattacharjee, Baidya) Department of Anaesthesiology, Pain
Medicine and Critical Care, All India Institute of Medical Sciences, New
Delhi 110029, India
Title
Goal directed fluid therapy decreases postoperative morbidity but not
mortality in major non-cardiac surgery: a meta-analysis and trial
sequential analysis of randomized controlled trials.
Source
Journal of Anesthesia. 31 (1) (pp 66-81), 2017. Date of Publication: 01
Feb 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background and aims: Optimum perioperative fluid administration may
improve postoperative outcome after major surgery. This meta-analysis and
systematic review has been aimed to determine the effect of dynamic goal
directed fluid therapy (GDFT) on postoperative morbidity and mortality in
non-cardiac surgical patients. Material and methods: Meta-analysis of
published prospective randomized controlled trials where GDFT based on
non-invasive flow based hemodynamic measurement has been compared with a
standard care. Data from 41 prospective randomized trials have been
included in this study. Results: Use of GDFT in major surgical patients
does not decrease postoperative hospital/30-day mortality (OR 0.70, 95 %
CI 0.46-1.08, p = 0.11) length of post-operative hospital stay (SMD -0.14;
95 % CI -0.28, 0.00; p = 0.05) and length of ICU stay (SMD -0.12; 95 % CI
-0.28, 0.04; p = 0.14). However, number of patients having at least one
postoperative complication is significantly lower with use of GDFT (OR
0.57; 95 % CI 0.43, 0.75; p < 0.0001). Abdominal complications (p =
0.008), wound infection (p = 0.002) and postoperative hypotension (p =
0.04) are also decreased with used of GDFT as opposed to a standard care.
Though patients who received GDFT were infused more colloid (p < 0.0001),
there is no increased risk of heart failure or pulmonary edema and renal
failure. Conclusion: GDFT in major non- cardiac surgical patients has
questionable benefit over a standard care in terms of postoperative
mortality, length of hospital stay and length of ICU stay. However,
incidence of all complications including wound infection, abdominal
complications and postoperative hypotension is reduced. Copyright &#xa9;
2016, Japanese Society of Anesthesiologists.

<14>
Accession Number
613853263
Author
Lin C.-Y.; Yaseri M.; Pakpour A.H.; Malm D.; Brostrom A.; Fridlund B.;
Burri A.; Webb T.L.
Institution
(Lin) Department of Rehabilitation Sciences, Faculty of Health and Social
Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
(Yaseri) Department of Epidemiology and Biostatistics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Pakpour) Social Determinants of Health Research Center, Qazvin University
of Medical Sciences, Shahid Bahounar BLV, Qazvin 3419759811, Iran, Islamic
Republic of
(Pakpour, Malm, Brostrom) Department of Nursing, School of Health and
Welfare, Jonkoping University, Jonkoping, Sweden
(Malm) Department of Internal Medicine, Country Hospital Ryhov, Jonkoping,
Sweden
(Fridlund) School of Health and Welfare, Jonkoping University, Jonkoping,
Sweden
(Burri) Health and Rehabilitation Research Institute, Auckland University
of Technology, Auckland, New Zealand
(Burri) Department of Anaesthesia and Perioperative Medicine, Waitemata
Pain Service, North Shore Hospital, Auckland, New Zealand
(Webb) Department of Psychology, The University of Sheffield, Sheffield,
United Kingdom
Title
Can a Multifaceted Intervention Including Motivational Interviewing
Improve Medication Adherence, Quality of Life, and Mortality Rates in
Older Patients Undergoing Coronary Artery Bypass Surgery? A Multicenter,
Randomized Controlled Trial with 18-Month Follow-Up.
Source
Drugs and Aging. 34 (2) (pp 143-156), 2017. Date of Publication: 01 Feb
2017.
Publisher
Springer International Publishing
Abstract
Background: Patients undergoing coronary artery bypass graft (CABG)
surgery are required to take a complex regimen of medications for extended
periods, and they may have negative outcomes because they struggle to
adhere to this regimen. Designing effective interventions to promote
medication adherence in this patient group is therefore important.
Objective: The present study aimed to evaluate the long-term effects of a
multifaceted intervention (psycho-education, motivational interviewing,
and short message services) on medication adherence, quality of life
(QoL), and mortality rates in older patients undergoing CABG surgery.
Methods: Patients aged over 65 years from 12 centers were assigned to the
intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups
using cluster randomization at center level. Medication adherence was
evaluated using the Medication Adherence Rating Scale (MARS), pharmacy
refill rate, and lipid profile; QoL was evaluated using Short Form-36.
Data were collected at baseline; 3, 6, and 18 months after intervention.
Survival status was followed up at 18 months. Multi-level regressions and
survival analyses for hazard ratio (HR) were used for analyses. Results:
Compared with patients who received TAU, the MARS, pharmacy refill rate,
and lipid profile of patients in the EXP group improved 6 months after
surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL
also increased among patients in the EXP group as compared with those who
received TAU at 18 months post-surgery (physical component summary score p
= 0.02; mental component summary score p = 0.04). HR in the EXP group
compared with the TAU group was 0.38 (p = 0.04). Conclusion: The findings
suggest that a multifaceted intervention can improve medication adherence
in older patients undergoing CABG surgery, with these improvements being
maintained after 18 months. QoL and survival rates increased as a function
of better medication adherence. ClinicalTrials.gov NCT02109523. Copyright
&#xa9; 2016, Springer International Publishing Switzerland.

<15>
Accession Number
612357080
Author
Dionne A.; Bakloul M.; Manlhiot C.; McCrindle B.W.; Hosking M.; Houde C.;
Pepelassis D.; Dahdah N.
Institution
(Dionne, Bakloul, Dahdah) Division of Pediatric Cardiology (6 - Bloc 9),
CHU Sainte-Justine, 3175, Cote Sainte-Catherine, Montreal, QC H3T 1C5,
Canada
(Manlhiot, McCrindle) Division of Pediatric Cardiology, Department of
Pediatrics, University of Toronto, The Hospital for Sick Children,
Toronto, ON, Canada
(Hosking) Division of Pediatric Cardiology, BC Children's Hospital,
Vancouver, BC, Canada
(Houde) Division of Pediatric Cardiology, CHUQ, Quebec, QC, Canada
(Pepelassis) Division of Pediatric Cardiology, Health Science Center,
Winnipeg, MB, Canada
Title
Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention
after Kawasaki Disease: The Pediatric Canadian Series.
Source
Pediatric Cardiology. 38 (1) (pp 36-43), 2017. Date of Publication: 01 Jan
2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Coronary artery (CA) aneurysms are serious complications of Kawasaki
disease (KD) responsible for ischemic events. Percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) are reported
with limited data on indications and comparative efficacy. Retrospective
multicenter comparison of CA intervention following KD is performed in
this study. Twenty two cases were available from 5 centers, of whom 11
underwent CABG, 10 PCI and 1 systemic thrombolysis. Age at intervention
(8.3 +/- 3.9 vs 11.3 +/- 4.9 years, p = 0.14) and interval from diagnosis
(5.6 +/- 4.1 vs 6.5 +/- 4.7 years, p = 0.64) were similar between CABG and
PCI. Interventions were based on angiography in 15 patients or cardiac
event in 7, with no difference between CABG and PCI (p = 0.24). Patients
with CABG were more likely to undergo multivessel intervention (73 vs 10
%, p = 0.006). None of the patients needed reintervention after CABG,
compared to 6 after PCI and 1 after systemic thrombolysis (p = 0.004).
Signs of ischemia on stress testing or MIBI were present in 15 patients
before intervention and persisted in 9 patients following last
intervention, in a significantly higher proportion after CABG than PCI (80
vs 17 %, p = 0.01). In this series, CABG, which mostly involved
multivessel intervention, was superior to PCI. Nevertheless, larger-scale
studies may help define patient selection criteria for a beneficial PCI
approach. Copyright &#xa9; 2016, Springer Science+Business Media New York.

<16>
Accession Number
610654032
Author
Biancari F.; D'Errigo P.; Rosato S.; Pol M.; Tamburino C.; Ranucci M.;
Seccareccia F.
Institution
(Biancari) Department of Surgery, Oulu University Hospital, Oulu, Finland
(D'Errigo, Rosato, Seccareccia) National Center for Epidemiology,
Surveillance and Health Promotion, Istituto Superiore di Sanita, Via Giano
della Bella 34, Rome 00161, Italy
(Pol) First Faculty of Medicine, Institute of Anatomy, Charles University
in Prague, Prague, Czech Republic
(Tamburino) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia, ICU-IRCCS
Policlinico San Donato, San Donato Milanese, Milan, Italy
Title
Transcatheter aortic valve replacement in nonagenarians: early and
intermediate outcome from the OBSERVANT study and meta-analysis of the
literature.
Source
Heart and Vessels. 32 (2) (pp 157-165), 2017. Date of Publication: 01 Feb
2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
The purpose of this study was to evaluate the outcome of nonagenarians
after transcatheter aortic valve replacement (TAVR) from the OBSERVANT
study and to pool the results of the literature on this topic. Aortic
stenosis is the most common acquired valvular heart disease in the Western
countries, and its prevalence is linked to the phenomenon of population
aging. TAVR can be considered as a wise approach to treat nonagenarians,
but data on its safety and effectiveness are scarce. Data on 80 patients
aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A
systematic review and meta-analysis of published data were performed.
Thirty-day mortality in the OBSERVANT series was 6.3 %. None of these
patients experienced stroke. Permanent pacemaker implantation was
necessary in 20 % of patients. Paravalvular regurgitation was observed in
57.5 %. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 %. Ten
series provided data on 1227 nonagenarians who underwent TAVR. Pooled
30-day mortality rate was 7.1 %, stroke 2.8 %, vascular access
complication 8.8 %, and permanent pacemaker implantation 10.6 %.
Paravalvular regurgitation was observed in 60.1 % of patients. Pooled 1-,
2-, and 3-year survival rates were 79.2, 68.2, and 55.6 %. Transapical
TAVR was associated with a significantly higher risk of early mortality
compared with transfemoral TAVR. The results of OBSERVANT study and
aggregate data meta-analysis suggest that in nonagenarians, TAVR is
associated with low postoperative morbidity and excellent intermediate
survival. Transapical TAVR in these very elderly is associated with high
postoperative mortality. Copyright &#xa9; 2016, Springer Japan.

<17>
Accession Number
611990361
Author
Kayvanpour E.; Sedaghat-Hamedani F.; Amr A.; Lai A.; Haas J.; Holzer D.B.;
Frese K.S.; Keller A.; Jensen K.; Katus H.A.; Meder B.
Institution
(Kayvanpour, Sedaghat-Hamedani, Amr, Lai, Haas, Holzer, Frese, Katus,
Meder) Department of Medicine III, University of Heidelberg, INF 410,
Heidelberg 69120, Germany
(Kayvanpour, Sedaghat-Hamedani, Amr, Haas, Frese, Katus, Meder) DZHK
(German Centre for Cardiovascular Research), Berlin, Germany
(Keller) Clinical Bioinformatics, Saarland University, Saarbrucken,
Germany
(Jensen) Institute of Medical Biometry and Informatics, University of
Heidelberg, Heidelberg, Germany
Title
Genotype-phenotype associations in dilated cardiomyopathy: meta-analysis
on more than 8000 individuals.
Source
Clinical Research in Cardiology. 106 (2) (pp 127-139), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Aims: Routine genetic testing in Dilated Cardiomyopathy (DCM) has recently
become reality using Next-Generation Sequencing. Several studies have
explored the relationship between genotypes and clinical phenotypes to
support risk estimation and therapeutic decisions, however, most studies
are small or restricted to a few genes. This study provides to our
knowledge the first systematic meta-analysis on genotype-phenotype
associations in DCM. Methods and results: We retrieved PubMed/Medline
literature on genotype-phenotype associations in patients with DCM and
mutations in LMNA, PLN, RBM20, MYBPC3, MYH7, TNNT2 and TNNI3. We
summarized and extensively reviewed all studies that passed selection
criteria and performed a meta-analysis on key phenotypic parameters.
Together, 48 studies with 8097 patients were included. Furthermore, we
reviewed recent studies investigating genotype-phenotype associations in
DCM patients with TTN mutations. The average frequency of mutations in the
investigated genes was between 1 and 5 %. The mean age of DCM onset was
the beginning of the fifth decade for all genes. Heart transplantation
(HTx) rate was highest in LMNA mutation carriers (27 %), while RBM20
mutation carriers were transplanted at a markedly younger age (mean 28.5
years). While 73 % of DCM patients with LMNA mutations showed cardiac
conduction diseases, low voltage was the reported ECG hallmark in PLN
mutation carriers. The frequency of ventricular arrhythmia in DCM patients
with LMNA (50 %) and PLN (43 %) mutations was significantly higher. The
penetrance of DCM phenotype in subjects with TTN truncating variants
increased with age and reached 100 % by age of 70. Conclusion: A pooled
analysis of available genotype-phenotype data shows a higher prevalence of
sudden cardiac death (SCD), cardiac transplantation, or ventricular
arrhythmias in LMNA and PLN mutation carriers compared to sarcomeric gene
mutations. This study will further support the clinical interpretation of
genetic findings. Copyright &#xa9; 2016, Springer-Verlag Berlin
Heidelberg.

<18>
Accession Number
612111171
Author
Grzymala-Lubanski B.; Svensson P.J.; Renlund H.; Jeppsson A.; Sjalander A.
Institution
(Grzymala-Lubanski, Sjalander) Department of Public Health and Clinical
Medicine, Umea University, Skogsstjarnevagen 61, Gavle 806 46, Sweden
(Svensson) Department of Coagulation Disorders, University of Lund, Malmo,
Sweden
(Renlund) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Goteborg, Sweden
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, University of Gothenburg, Goteborg, Sweden
Title
Warfarin treatment quality and prognosis in patients with mechanical heart
valve prosthesis.
Source
Heart. 103 (3) (pp 198-203), 2017. Date of Publication: 01 Feb 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To study the impact of time in therapeutic range (TTR) and
international normalised ratio (INR) variability on the risk of
thromboembolic events, major bleeding complications and death after
mechanical heart valve (MHV) implantation. Additionally, the importance of
different target INR levels was elucidated. Methods A retrospective,
non-randomised multicentre cohort study including all patients with
mechanical heart valve (MVH) prosthesis registered in the Swedish National
Quality Registry Auricula from 2006 to 2011. Data were merged with the
Swedish National Patient Registry, SWEDEHEART and Cause of Death Registry.
Results In total 4687 ordination periods, corresponding to 18 022
patient-years on warfarin, were included. High INR variability (above mean
=0.40) or lower TTR (=70%) was associated with a higher risk of bleeding
(rate per 100 years 4.33 (95% CI 3.87 to 4.82) vs 2.08 (1.78 to 2.41); HR
2.15 (1.75 to 2.61) and 5.13 (4.51 to 5.82) vs 2.30 (2.03 to 2.60); HR
2.43 (2.02 to 2.89)), respectively. High variability and low TTR combined
was associated with an even higher risk of bleedings (rate per 100 years
4.12 (95% CI 3.68 to 4.51) vs 2.02 (1.71 to 2.30); HR 2.16 (1.71 to 2.58)
and 4.99 (4.38 to 5.52) vs 2.36 (2.06 to 2.60); HR 2.38 (2.05 to 2.85))
compared with the best group. Higher treatment intensity (mean INR 2.8-3.2
vs 2.2-2.7) was associated with higher rate of bleedings (2.92 (2.39 to
3.47) vs 2.48 (2.21 to 2.77); HR 1.29 (1.06 to 1.58)), death (3.36 (2.79
to 4.02) vs 1.89 (1.64 to 2.17), HR 1.65 (1.31 to 2.06)) and complications
in total (6.61 (5.74 to 7.46) vs 5.65 (5.20 to 6.06); HR 1.24 (1.06 to
1.41)) after adjustment for MHV position, age and comorbidity. Conclusions
A high warfarin treatment quality improves outcome after MHV implantation,
both measured with TTR and INR variability. No benefit was found with
higher treatment intensity (mean INR 2.8-3.2 vs 2.2-2.7).

<19>
Accession Number
612098253
Author
Harle T.; Zeymer U.; Hochadel M.; Zahn R.; Kerber S.; Zrenner B.;
Schachinger V.; Lauer B.; Runde T.; Elsasser A.
Institution
(Harle, Elsasser) Klinik fur Kardiologie, Klinikum Oldenburg gGmbH,
European Medical School Oldenburg-Groningen, Carl von Ossietzky
Universitat Oldenburg, Rahel-Straus-Str. 10, Oldenburg 26133, Germany
(Zeymer, Zahn) Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen,
Germany
(Zeymer, Hochadel) Stiftung Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Kerber) Klinik fur Kardiologie, Herz- und Gefas-Klinik GmbH, Bad Neustadt
a. d., Haale, Germany
(Zrenner) Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Landshut,
Germany
(Schachinger) Klinikum Fulda, Medizinische Klinik I, Fulda, Germany
(Lauer) Klinik fur Kardiologie, Zentralklinik Bad Berka, Bad Berka,
Germany
(Runde) Klinikum Wetzlar, Medizinische Klinik I, Wetzlar, Germany
Title
Real-world use of fractional flow reserve in Germany: results of the
prospective ALKK coronary angiography and PCI registry.
Source
Clinical Research in Cardiology. 106 (2) (pp 140-150), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: There is growing evidence for beneficial prognostic and
economic effects of FFR-guided treatment of stable coronary artery
disease. We sought to evaluate the real-world use of FFR measurements in
patients undergoing elective coronary angiography. Methods and results: We
analyzed the data of the prospective ALKK coronary angiography and PCI
registry including data of 38 hospitals from January 2010 to December
2013. A total of 100,977 patients undergoing coronary angiography were
included. In 3240 patients (3.2 %) intracoronary pressure measurement was
performed. There was a wide range of use of FFR measurement in the
different analyzed ALKK hospitals from 0.1 to 8.8 % in elective patients
with suspected or known coronary artery disease (median 2.7 %, quartiles
0.9 and 5.3 %), with a successive increase of use over time during the
study period. Overall, it was performed in 3.2 % of coronary
angiographies. Use in patients with three-vessel disease (2.5 %) and
recommendation for bypass surgery (1.6 %) was less frequent. In procedures
without PCI, dose area product was higher in the FFR group (2641 cGy x
cm² vs. 2368 cGy x cm², p < 0.001), while it was
lower in procedures with ad hoc PCI (4676 cGy x cm² vs. 5143
cGy x cm², p < 0.001). The performing center turned out to be
the strongest predictor. Conclusions: The use of FFR measurement was very
heterogeneous between different hospitals and in general relatively low,
in particular in patients with multivessel disease or recommendation for
bypass surgery, but there was a positive trend during the study period.
Technically, FFR measurement was not associated with an increased
periprocedural complication rate. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<20>
Accession Number
614325410
Author
Van Den Bergh W.M.; Slooter J.C.; Van Dijk D.
Institution
(Van Den Bergh) University Medical Center Groningen, Groningen,
Netherlands
(Slooter, Van Dijk) University Medical Center Utrecht, Utrecht,
Netherlands
Title
Cardiac surgery with cardiopulmonary bypass in patients with an
asymptomatic intracranial aneurysm.
Source
Cerebrovascular Diseases. Conference: 23th European Stroke Conference.
France. Conference Start: 20140506. Conference End: 20140509. 37 (pp 223),
2014. Date of Publication: May 2014.
Publisher
S. Karger AG
Abstract
Background Physicians often vent the opinion that an intracranial aneurysm
is an unacceptable risk during cardiopulmonary bypass (CPB) with full
heparinization. Therefore cardiac surgery is cancelled or postponed until
the aneurysm is protected by means of endovascular coiling or
neurosurgical clipping. However, the risk for aneurysm rupture during
cardiac surgery is not yet being studied Methods Data from a randomized
controlled trial in 4482 patients undergoing cardiac surgery with CPB is
being used to estimate the risk for aneurysm rupture during such a
procedure. Results: The overall prevalence of unruptured intracranial
aneurysms is 3.2%. 1 In our RCT on dexamethason in 4482 patients
undergoing cardiac surgery with CPB, we followed the participants during
the first year after surgery for major morbidity including stroke. Not a
single hemorrhagic stroke occurred during cardiac surgery. 2 Only one of
the 4482 patients had a subarachnoid haemorrhage (SAH) during follow-up,
but this occurred 3 weeks after cardiac surgery when the patient was
already home. In our study population 143 persons are expected to harbour
an intracranial aneurysm. When we assume that the SAH in the participant
of the trial was still somehow related to the procedure, the CPB
associated risk for aneurysm rupture would be 1/143 or 0.7%. However, the
patients were followed one year, and a risk of rupture of 0.7% per year is
quite comparable to the natural history of intracranial aneurysms for
which the overall 1-year risk of aneurysm rupture was assessed to be 1.4%
(95% CI 1.1-1.6) 3 Conclusion Cardiopulmonary bypass is not a major risk
factor for rupture of an intracranial aneurysm as illustrated by the
absence of SAH in any of our 4482 patients during cardiac surgery with
full heparinization. An unruptured intracranial aneurysm should not hinder
life saving surgery for which CPB is required.

<21>
Accession Number
614325043
Author
Han M.; Wang X.; Lin J.; Zhou J.; Chen C.
Institution
(Han, Wang, Lin, Zhou, Chen) 1st Affiliated Hospital, Sun Yat-Sen
University, Guangzhou, China
Title
The experience of 15 cases of DBD donor chest combined multiple organ
donation.
Source
Transplantation. Conference: 22nd Annual International Congress of the
International Liver Transplantation Society, ILTS 2016. South Korea.
Conference Start: 20160504. Conference End: 20160507. 100 (5 Supplement 1)
(pp S244), 2016. Date of Publication: May 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective To explore DBD donor organs function evaluation, donor
maintenance and organ procurement experience and methods with combined
heart/lung, liver, kidney and more organs donation Methods For the DBD
donors with combined heart/lung, liver, kidney and more organ donation,
organ function evaluation, donor maintenance, obtain process, and the use
of organ were retrospectively analyzed. Screening of donor age, excluding
basic diseases, perfect auxiliary examination. Follow the principle of
four 100 for donors maintenance. All procurements were finished in surgery
room. Two groups procured the organs of chest and abdomen at the same
time. Results Since May 2011 to 2014, we have finished 15 cases of
combined heart/lung, liver, kidney and other organ donation in DBD. 12
cases of male and 3 cases of female, the largest age is 40, and minimum is
3 years old. No one experienced cardiac arrest and CPR process, no
tracheal aspiration, lung infection, chest trauma, surgical history. 13
cases of combined heart, liver and kidney procurement, 1 case of combined
lung, liver and kidney, and 1 case of four organs above together. 15 cases
of liver, 29 cases of kidney (1 case of pediatric - adult),13 cases of
heart, and 2 cases of lung transplantation were done. All recipients of
liver and kidney transplant recovered smoothly, and there was no
complications happened. 2 cases of delayed graft heart function and 1
chronic rejection in 13 cases of heart transplant. Conclusion Combined
heart/lung, liver, kidney and more organs donation can be positive and
effective expanding source for organs and realize the maximum utilization
of organ donors. Strictly grasp the donation indications, supplemented by
active organ maintain and multicenter group precise cooperation is the key
to successful implementation for both multiple organ donation and
transplantation.

<22>
Accession Number
614326842
Author
Boswell L.; Adde L.; Russow A.; Weck M.; Fjortoft T.; Patrick C.; Stoen
R.; Weissbourd M.; Gaebler-Spira D.; Deregnier R.
Institution
(Boswell, Russow, Weck, Patrick) Ann and Robert H. Lurie Children's
Hospital of Chicago, Chicago, IL, United States
(Adde) Norwegian University of Science and Technology, Trondheim, Norway
(Fjortoft) Norwegian University of Science and Technology, St. Olav
University Hospital, Trondheim, Norway
(Stoen) St. Olav's University Hospital, Norwegian University of Science
and Technology, Trondheim, Norway
(Weissbourd) Ann and Robert H. Lurie Children's Hospital of Chicago,
Northwestern University, Feinberg School of Medicine, Chicago, IL, United
States
(Gaebler-Spira) Ann and Robert H. Lurie Children's Hospital of Chicago,
Rehabilitation Institute of Chicago, Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
(Deregnier) Northwestern University, Feinberg School of Medicine, River
Forest, IL, United States
Title
General movements during the fidgety period correlate with neurologic
abnormalities and motor delays at 18-24 months in a high risk United
States (USA) population.
Source
Developmental Medicine and Child Neurology. Conference: 70th Annual
Meeting of the American Academy for Cerebral Palsy and Developmental
Medicine, AACPDM 2016. United States. Conference Start: 20160920.
Conference End: 20160924. 58 (pp 8), 2016. Date of Publication: September
2016.
Publisher
Blackwell Publishing Ltd
Abstract
Background and Objective(s): Assessment of General Movements (GMA) appears
to be predictive of neuromotor function in preterm infants but it has not
been studied in diverse groups of infants from the USA. The objective of
this study was to to evaluate the association between the GMA during the
fidgety period & neurologic abnormalities (cerebral palsy and suspect
neurologic examinations) as well as motor delays at 18- 24 months
corrected age (CA) in infants from the USA with a variety of high risk
biomedical & neurologic conditions. Study Design: This was a prospective
longitudinal study of infants enrolled at hospital discharge and followed
through 18-24 months corrected age. Study Participants & Setting: Infants
were included if they were preterm (< 30 wks GA, n = 47), had significant
brain injury/ abnormality (n = 56), neonatal cardiac surgery (n = 41) or
prolonged hospitalization through 10 weeks post-term (n = 20). Of the 134
infants studied, 28 (21%) had more than one of these risk factors.
Materials/Methods: Infants were videotaped in a quiet alert state &
evaluated by 2 blinded, certified GMA observers. Fidgety Movements (FM)
were classified as continual, intermittent, sporadic, absent, or abnormal
(exaggerated). At 18- 24 months CA, infants had a standard neurologic
examination that was coded as normal, suspect neurologic abnormalities or
cerebral palsy (CP). The diagnosis of definite CP was confirmed by a
pediatric physiatrist. Motor abilities were categorized using the Gross
Motor Functional Classification System (GMFCS) & the Bayley III Motor
Composite Score. Results: Twelve children had CP & 10 had suspect
neurologic examinations. Fidgety movement classification was significantly
correlated with CP/Suspect neurologic exams, Motor delays (Bayley Motor
Composite < 70) & GMFCS level 2-5 (Table). Infants in a combined category
of absent, sporadic or abnormal (exaggerated) FMs had significantly higher
rates of CP/suspect neurologic examinations than infants with continual or
intermittent FM (p < 0.001), though the highest rate of CP/suspect
examination was associated with absent FM. The sensitivity of Absent FM in
predicting definite CP at 18- 24 months CA was 75%, with a specificity of
91%, positive predictive value of 45% & negative predictive value of
97.4%. The Positive Likelihood Ratio was 8.32 and the negative Likelihood
Ratio was 0.27. Conclusions/Significance: Fidgety movement classifications
correlated with CP and suspect neurologic abnormalities as well as motor
delays at 18-24 months CA in this group of medically complex children. The
sensitivity of absent FM for definite CP at 18-24 months appears to be
less in this group of medically complex children than reported in previous
studies. The children will be followed longitudinally to determine the
outcome of the suspect neurologic examinations. However, the likelihood
ratios indicate moderate to high likelihood of CP with absent FM and
moderate to high likelihood of no CP when FM are present, suggesting that
early assessment of FM may be useful in identifying patients for early
therapy services as well as clinical trials of new treatments. (Table
Presented).

<23>
Accession Number
614322826
Author
Spithouraki E.; Nieri A.-S.; Manousaki K.
Institution
(Spithouraki, Nieri, Manousaki) National and Kapodistrian University of
Athens, School of Health Science, Faculty of Nursing, Athens, Greece
Title
Dexmedetomidine and Risperidone for the reduction of delirium after
cardiac surgery: Systematic review.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare
2016. Greece. Conference Start: 20160415. Conference End: 20160416. 15 (pp
S51), 2016. Date of Publication: April 2016.
Publisher
SAGE Publications Inc.
Abstract
Background/Introduction: Cardiac surgery is associated with a high risk of
cardiovascular and other complications that lead to increased mortality
and healthcare costs. Delirium is a common complication after cardiac
surgery and may be partly related to the systemic inflammatory response
triggered by the surgery and the use of cardiopulmonary bypass. Purpose:
The current systematic review aims to indicate the evidence on the use of
dexmedetomidine and risperidone for the reduction of the incidence of
delirium after cardiac surgery. Methods: The research was conducted
through electronic database research up to October 2015. Randomized
controlled trials relevant to the use of dexmedetomidine and risperidone
used for the reduction of delirium after cardiac surgery were selected,
with selection criteria studies with concern to adults and published in
English. Results: Six studies were finally included in the current
systematic review, four relevant to the use of dexmedetomidine and two
relevant to risperidone for the reduction of delirium. Postoperative use
of dexmedetomidine as sedative agent after cardiac valve surgery leads to
lower incidence of delirium compared to the use of propofol or midazolam.
However, when dexmedetomidine was administered in continuous infusion for
short-term sedation after cardiovascular surgery did not reduce the
incidence of postoperative delirium but limited its duration compared to
propofol or morphine infusion. Moreover, perioperative dexmedetomidine use
was associated with decreased incidence of postoperative delirium in
patients undergoing cardiac surgery. A single dose of risperidone soon
after cardiac surgery with cardiopulmonary bypass reduced the incidence of
postoperative delirium and it was also associated with significantly lower
incidence of delirium when administered to elderly patients who
experienced subsyndromal delirium after on-pump cardiac surgery.
Conclusion: Although the postoperative administration of dexmedetomidine
does not reduce the incidence of delirium after cardiac surgery, it limits
its duration. A decrease in postoperative delirium incidence is achieved
when dexmedetomidine is administered perioperatively. Risperidone has
positive effects on postoperative delirium reduction.

<24>
Accession Number
614322709
Author
Ala A.; Donna F.; Paul S.; Brenda O.
Institution
(Ala) Hashemite University, Faculty of Nursing, Zarqa, Jordan
(Donna, Paul, Brenda) University of Ulster, Jordanstown, United Kingdom
Title
Secondary preventionin Jordan is underdeveloped and requires urgent
improvement to meet the guidelines.
Source
European Journal of Cardiovascular Nursing. Conference: EuroHeartCare
2016. Greece. Conference Start: 20160415. Conference End: 20160416. 15 (pp
S6-S7), 2016. Date of Publication: April 2016.
Publisher
SAGE Publications Inc.
Abstract
Purpose: CHD is a major health problem in Jordan and the leading cause of
death, but little is known about the current provision and perceptions of
Jordanian health care professionals' towards secondary prevention (SP)
strategies. This study is designed to evaluate risk factors, explore the
current provision of SP and health professionals' perceptions of SP for
patients treated for established CHD in Jordan. Method: A mixed methods
repeated measures research design was used. 180 patients were recruited
from 3 interventional hospitals after: acute myocardial infarction (AMI)
treated medically; Percutaneous Coronary Intervention (PCI); and coronary
artery bypass graft (CABG); then followed up 6 months later. The European
guidelines on CHD prevention 2012 were used to compare against recommended
targets. Semi-structured interviews with a purposive sample of 20 doctors
and nurses from the 3 hospitals explored their perceptions of SP
strategies. Results: Of the 180 patients at discharge, 77% were obese or
overweight, 59% were smokers, 59% had low levels of physical activity, 51%
had elevated LDL, 58%had not controlled blood glucose and, 11% had not
controlled blood pressure. Of the 169 patients at follow up 75% were obese
or overweight, 47% continued to smoke, 41% had low levels of physical
activity, 64%had not controlled blood glucoseand 25% had not controlled
blood pressure. Recording of risk factor measurement at follow up was
insufficient to evaluate achievement of therapeutic targets. Recording of
risk factor history and current status was incomplete. There was no
cardiac rehabilitation, smoking cessation or secondary prevention
available post discharge. The majority received brief physician advice
about medications (72%) and smoking (49%). The use of prophylactic drug
therapies was as follows: Aspirin 92%, lipid lowering drug 88%,
beta-blockers 78%, ACE inhibitors 52% and statin 88%. Interviews confirmed
that while health professionals expressed the importance of secondary
prevention, multiple barriers existed. They were generally unsatisfied
with current SP provision and wanted to improve it, but identified
particular training and other issues that need to be addressed in order to
achieve this. Conclusion: These findings confirm that despite extremely
high prevalence of risk factors in this population, the provision of SP is
poor and obstacles to its development are widespread. SP of CHD in Jordan
requires urgent improvement and the contribution of nurses' to prevention
should be enhanced to provide an effective, convenient and culturally
sensitive SP services.

<25>
Accession Number
614323309
Author
Pers Y.M.; Chatre C.; Jorgensen C.
Institution
(Pers, Chatre, Jorgensen) Therapeutique Osteo-Articulaire, CHRU
Lapeyronie, Montpellier, France
Title
Cardiac complications induced by anti-malarial drugs: A review of the
literature.
Source
Fundamental and Clinical Pharmacology. Conference: 20th Annual Meeting of
French Society of Pharmacology and Therapeutics, 37th Pharmacovigilance
Meeting, 17th APNET Seminar, 14th CHU CIC Meeting. France. Conference
Start: 20160419. Conference End: 20160421. 30 (pp 77), 2016. Date of
Publication: April 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Chloroquine (CQ) and hydroxychloroquine (HCQ) are widely
used in long term treatment of connective tissue disease and usually
considered as safe. However, it is known that this therapy may cause
exceptionally adverse events. We performed a literature review aiming to
study cardiac complications inuced by anti-malarial drugs. Material and
methods: PubMed, Embase, Cochrane Databases, and Medline were searched.
Full text English and French publications were identified. Results: In the
literature, 23 patients with HCQ or CQ cardiotoxicity were reported. They
were frequently women and the duration of treatment was between 9 and 35
years. Regarding heart presentation, almost all the patients had left
ventricular hypertrophy. The other cardiac events were conduction
disorders, rhythm disorders, congestive heart failure, and ischemia with
hypokinesis, diastolic dysfunction. Several patients presented chest pain,
increasing dyspnea and elevated cardiac enzymes. Treatment withdrawal
could have beneficial effects in some patients with recovery of heart
function, but sometimes evolution was unfavourable with irreversible
damage, deaths or heart transplant. The pathology of myocardial tissue is
extremely close between HCQ toxicity and Fabry Disease, a genetic storage
disorder which causes a deficiency of a lysosomal enzyme (alpha
galactosidase A). In their study, Roos et al. compared both cardiac
disorders [1]. They observed the same clinical presentation and the same
pathological features with myelin figures and glycogen accumulation in
both biopsies. Discussion/Conclusion: Anti-malarial drugs are generally
safe and well tolerated. However, clinicians should be warned about this
possible cardiotoxicity. Cardiac biopsies should be performed in atypical
cardiac involvement occurring with HCQ or CQ therapy.

<26>
Accession Number
614325624
Author
Roubec M.; Hurtikova E.; Kuliha M.; Skoloudik D.; Goldirova A.; Havelka
J.; Brat R.; Bortlicek M.; Langova K.
Institution
(Roubec, Hurtikova, Kuliha, Skoloudik, Goldirova) Comprehensive Stroke
Center, University Hospital Ostrava, Ostrava, Czech Republic
(Havelka) Department of Radiology, University Hospital Ostrava, Ostrava,
Czech Republic
(Brat, Bortlicek) Department of Cardiosurgery, University Hospital
Ostrava, Ostrava, Czech Republic
(Langova) Department of Biophysics, Palacky University Olomouc, Olomouc,
Czech Republic
Title
Risk reduction of brain infarction during heart surgery using sonolysis -
A pilot study.
Source
Cerebrovascular Diseases. Conference: 23th European Stroke Conference.
France. Conference Start: 20140506. Conference End: 20140509. 37 (pp 514),
2014. Date of Publication: May 2014.
Publisher
S. Karger AG
Abstract
Background: Heart surgery is associated with a high risk of stroke. Silent
ischemic lesions can be found in up to 32% of these patients. Sonolysis is
a new therapeutic option for the acceleration of arterial recanalisation.
The aim of this study was to confirm risk reduction of brain infarction
during heart surgery using sonolysis. Methods: Patients indicated to
coronary artery bypass graft or to intervention on a heart valve were
enrolled to the prospective study after signing of informed consent.
Patients were randomized into 2 groups: Group 1 with sonolysis during
intervention (transcranial Doppler monitoring of right middle cerebral
artery (MCA) using 2MHz probe during procedure) and Group 2 without
sonolysis during the procedure. Brain magnetic resonance imaging (MRI) was
performed before and 24 hours after intervention in all patients.
Occurrence of new brain infarctions (including infarctions >= 0.5 cm3)
were statistically evaluated using T-test. Results: Totally 61 patients
were enrolled to the study (46 males, mean age 68.0 +/- 7.9 years) during
16 months. 29 patients were randomized to the Group 1 and 32 patients to
the Group 2. New brain infarctions on control MRI were found in 8 (27.6%)
patients in Group 1, in 4 (13.8%) of these patients was new lesion located
in a monitored side but only 1 (3.4%) patient had new ischemic lesion >
0.5 cm3. In Group 2 new brain infarctions were found in 8 (25%) patients,
in 6 (18.8%) of them was new lesion located in the right MCA territorry, 4
(12.5%) patients had new ischemic lesion > 0.5 cm3 (P > 0.05 in all
cases). Conclusion: Study results show a trend in new ischemic lesions
volume reduction in patients treated by sonolysis during heart surgery.
Totally 120 patients will be enrolled.

<27>
Accession Number
613941946
Author
Brown E.G.; Anderson J.E.; Burgess D.; Bold R.J.; Farmer D.L.
Institution
(Brown, Anderson, Burgess, Bold, Farmer) University of California, Davis
Health System, Sacramento, CA, United States
Title
Pediatric surgical readmissions: Are they truly preventable?.
Source
Journal of Pediatric Surgery. 52 (1) (pp 161-165), 2017. Date of
Publication: 01 Jan 2017.
Publisher
W.B. Saunders
Abstract
Background/purpose Reimbursement penalties for excess hospital
readmissions have begun for the pediatric population. Therefore, research
determining incidence and predictors is critical. Methods A retrospective
review of University HealthSystem Consortium database (N = 258 hospitals;
2,723,621 patients) for pediatric patients (age 0-17 years) hospitalized
from 9/2011 to 3/2015 was performed. Outcome measures were 7-, 14-, and
30-day readmission rates. Hospital and patient characteristics were
evaluated to identify predictors of readmission. Results Readmission rates
at 7, 14, and 30 days were 2.1%, 3.1%, and 4.4%. For pediatric surgery
patients (N = 260,042), neither index hospitalization length of stay (LOS)
nor presence of a complication predicted higher readmissions. Appendectomy
was the most common procedure leading to readmission. Evaluating
institutional data (N = 5785), patients admitted for spine surgery,
neurosurgery, transplant, or surgical oncology had higher readmission
rates. Readmission diagnoses were most commonly infectious (37.2%) or for
nausea/vomiting/dehydration (51.1%). Patients with chronic medical
conditions comprised 55.8% of patients readmitted within 7 days. 92.0% of
patients requiring multiple rehospitalizations had comorbidities.
Conclusions Readmission rates for pediatric patients are significantly
lower than adults. Risk factors for adult readmissions do not predict
pediatric readmissions. Readmission may be a misnomer for the pediatric
surgical population, as most are related to chronic medical conditions and
other nonmodifiable risk factors. Level of Evidence Level IV. Copyright
&#xa9; 2017

<28>
Accession Number
614135995
Author
Cho J.S.; Soh S.; Shim J.-K.; Kang S.; Choi H.; Kwak Y.-L.
Institution
(Cho, Soh, Shim, Choi, Kwak) Yonsei Cardiovascular Hospital, Yonsei
University College of Medicine, Department of Anesthesiology and Pain
Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
(Shim, Kwak) Yonsei University College of Medicine, Anesthesia and Pain
Research Institute, Seoul, South Korea
(Kang) National Health Insurance Corporation Ilsan Hospital, Department of
Anesthesiology and Pain Medicine, Gyeonggi-do, South Korea
Title
Effect of perioperative sodium bicarbonate administration on renal
function following cardiac surgery for infective endocarditis: A
randomized, placebo-controlled trial.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 3. Date of
Publication: 05 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients with infective endocarditis (IE) have an elevated
risk of renal dysfunction because of extensive systemic inflammation and
use of nephrotoxic antibiotics. In this randomized, placebo-controlled
trial, we investigated whether perioperative sodium bicarbonate
administration could attenuate postoperative renal dysfunction in patients
with IE undergoing cardiac surgery. Methods: Seventy patients randomly
received sodium chloride (n = 35) or sodium bicarbonate (n = 35). Sodium
bicarbonate was administered as a 0.5 mmol/kg loading dose for 1 h
commencing with anesthetic induction, followed by a 0.15 mmol/kg/h
infusion for 23 h. The primary outcome was peak serum creatinine (SCr)
level during the first 48 h postoperatively. The incidence of acute kidney
injury, SCr level, estimated glomerular filtration rate, and major
morbidity endpoints were assessed postoperatively. Results: The peak SCr
during the first 48 h postoperatively (bicarbonate vs. control: 1.01
(0.74, 1.37) mg/dl vs. 0.88 (0.76, 1.27) mg/dl, P = 0.474) and the
incidence of acute kidney injury (bicarbonate vs. control: 29% vs. 23%, P
= 0.584) were similar in both groups. The postoperative increase in SCr
above baseline was greater in the bicarbonate group than in the control
group on postoperative day 2 (0.21 (0.07, 0.33) mg/dl vs. 0.06 (0.00,
0.23) mg/dl, P = 0.028) and postoperative day 5 (0.23 (0.08, 0.36) mg/dl
vs. 0.06 (0.00, 0.23) mg/dl, P = 0.017). Conclusions: Perioperative sodium
bicarbonate administration had no favorable impact on postoperative renal
function and outcomes in patients with IE undergoing cardiac surgery.
Instead, it was associated with possibly harmful renal effects,
illustrated by a greater increase in SCr postoperatively, compared to
control. Trial registration: ClinicalTrials.gov, NCT01920126. Registered
on 31 July 2013. Copyright &#xa9; 2017 The Author(s).

<29>
Accession Number
614330437
Author
Cotti E.; Arrica M.; Di Lenarda A.; Serri S.B.; Bassareo P.; Padeletti L.;
Mercuro G.
Institution
(Cotti, Serri) Department of Conservative Dentistry and Endodontics,
University of Cagliari, Cagliari, Italy
(Arrica) Department of Surgery, Microsurgery and Medical Sciences,
University of Sassari, Sassari, Italy
(Di Lenarda) Cardiovascular Centre of Trieste, University of Trieste,
Trieste, Italy
(Bassareo, Mercuro) Department of Cardiology, University of Cagliari,
Cagliari, Italy
(Padeletti) Department of Cardiology, University of Florence, Florence,
Italy
Title
The perioperative dental screening and management of patients undergoing
cardiothoracic, vascular surgery and other cardiovascular invasive
procedures: A systematic review.
Source
European Journal of Preventive Cardiology. 24 (4) (pp 409-425), 2017. Date
of Publication: 01 Mar 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background One controversial issue in the relationship between oral care
and cardiovascular diseases is how and whether to manage oral infections
prior to cardiovascular surgery or other cardiovascular invasive
procedures. Design We designed a systematic review to assess the
information available on three main questions. Is there an agreement on
the need for dental evaluation and treatment before cardiovascular
interventions? Are consistent clinical recommendations or protocols
available? Is dental treatment prior to cardiovascular interventions
effective? Methods A systematic electronic search of MEDLINE, Scopus and
Web of Science was performed from the database inceptions up to 31 April
2016. Searches were performed using Boolean operators to combine medical
subject headings and free text words. Because this review included a
large, heterogeneous group of study designs and sources, the results were
synthesised in a narrative approach. Results In total, 2447 studies were
identified: 2099 (+241 duplicates) were excluded after screening; 107 were
included for full-text assessment; 55 were excluded for not meeting the
inclusion criteria; and 11 were not available. Thus, 44 studies meeting
the inclusion criteria were analysed. We found that, for patients
undergoing cardiovascular surgery, there is a general agreement on the
need for screening and treatment of dental infections, but not on the
protocols. We also found that there are conflicting indications on when
and to what extent to perform the treatment and that the risk-to-benefit
ratios for these treatments are controversial. Conclusion No satisfactory
answers regarding dental care before cardiovascular invasive procedures
are available. Copyright &#xa9; European Society of Cardiology.

<30>
Accession Number
614345957
Author
White C.M.; Nguyen E.
Institution
(White, Nguyen) University of Connecticut School of Pharmacy, Hartford,
CT, United States
Title
Novel Use of Ranolazine as an Antiarrhythmic Agent in Atrial Fibrillation.
Source
Annals of Pharmacotherapy. 51 (3) (pp 245-252), 2017. Date of Publication:
01 Mar 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To review the limitations of current antiarrhythmic drugs in
atrial fibrillation (AF) and discuss the rationale and clinical trials
supporting the use of ranolazine in AF. Data Sources: MEDLINE was searched
from 1980 to September 2016 using the terms ranolazine, atrial
fibrillation, coronary artery bypass grafting, and valve surgery. Study
Selection and Data Extraction: English-language studies and reviews
assessing antiarrhythmic drugs, including ranolazine, were incorporated.
Data Synthesis: The use of ranolazine monotherapy has been evaluated in 2
clinical trials. In the RAFFAELLO trial, higher doses of ranolazine showed
a trend toward lower AF recurrence versus placebo (P = 0.053), but further
evidence is needed to support its use as a sole therapeutic agent.
Ranolazine has shown utility in a limited number of studies as an
adjunctive agent, which is critical for those in whom standard therapy is
inadequate or the adverse event profile precludes optimized standard
therapy. In the HARMONY trial, ranolazine 750 mg and dronedarone 225 mg
twice daily reduced the AF burden by 59.1% from baseline (P = 0.008 vs
placebo). In a trial by Koskinas and colleagues, patients receiving
ranolazine 1500 mg once and intravenous amiodarone had a higher conversion
rate than those receiving amiodarone alone (P = 0.024). There are also
promising studies for the prevention and treatment of post-cardiothoracic
surgery AF, which require further investigation. Conclusions: Ranolazine's
pharmacological properties and available evidence suggest potential for
its use in AF. Copyright &#xa9; 2016, &#xa9; The Author(s) 2016.

<31>
[Use Link to view the full text]
Accession Number
611807824
Author
Li Y.; Wang X.; Lv Q.; Wang J.; Yang Y.; He L.; Yuan L.; Zhang L.; Xie M.
Institution
(Li, Wang, Lv, Wang, Yang, He, Yuan, Zhang, Xie) Department of Ultrasound,
Union Hospital, Tongji Medical College, Huazhong University of Science and
Technology, 1277# Jiefang Ave, Wuhan 430022, China
Title
Impact of surgical correction of tetralogy of fallot on short-term right
and left ventricular function as determined by 2-dimensional speckle
tracking echocardiography.
Source
Medicine (United States). 95 (31) (no pagination), 2016. Article Number:
e4426. Date of Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Right ventricular (RV) and left ventricular (LV) dysfunction is an
important determinant of poor clinical status in repaired patients with
tetralogy of Fallot (TOF). The purpose of our study is to assess the
impact of surgical repair on short-term RV and LV function by
2-dimensional speckle tracking echocardiography (STE). Sixty-seven
patients (median age 12 months) with TOF before and 6 months after repair
and 35 healthy subjects were studied. The patients were divided into the
younger (age at surgery <12 months) and older (age at surgery >12 months)
subgroups. RV and LV global longitudinal systolic strain and strain rate
(SR), and LV global circumferential and radial systolic strain and SR were
measured by STE. After repair, RV longitudinal strain and SR increased in
the younger patients, whereas RV longitudinal SR was decreased in the
older patients. LV deformation parameters were unchanged in all patients.
In the multivariate analysis, patients with better RV and LV deformation
parameters preoperatively were identified to have better RV and LV strain
and SR postoperatively (P < 0.05 for all). The surgical approach of the
pulmonary valve ring was predictive of RV and LV systolic function
postoperatively (P < 0.05 for all). After TOF repair, short-term RV
function improvement is identified in the younger but not in the older
patients, whereas LV function is unchanged in all patients. The
preoperative RV and LV deformational indices are the determinant of
postoperative biventricular function improvement. STE appears to be a
valuable tool for assessment of biventricular function after congenital
heart disease surgery. Copyright &#xa9; 2016 the Author(s). Published by
Wolters Kluwer Health, Inc. All rights reserved.

<32>
Accession Number
614321458
Author
Ahmadizad S.; Nouri-Habashi A.; Rahmani H.; Maleki M.; Naderi N.; Lotfian
S.; Salimian M.
Institution
(Ahmadizad, Nouri-Habashi, Rahmani) Department of Sport and Exercise
Physiology, Faculty of Sports Sciences, Shahid Beheshti University,
Velenjak Square, Tehran 1983963113, Iran, Islamic Republic of
(Maleki, Naderi, Lotfian) Rajaie Cardiovascular Medical and Research
Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Salimian) Platelet Research Laboratory, Kashan University of Medical
Sciences, Kashan, Iran, Islamic Republic of
Title
Platelet activation and function in response to high intensity interval
exercise and moderate continuous exercise in CABG and PCI patients.
Source
Clinical Hemorheology and Microcirculation. 64 (4) (pp 911-919), 2016.
Date of Publication: 2016.
Publisher
IOS Press (Nieuwe Hemweg 6B, Amsterdam 1013 BG, Netherlands)
Abstract
BACKGROUND: The effects of high intensity interval training (HIIT) on
inflammatory markers and endothelial function have been extensively shown.
However, the acute effect of HIIT on platelet activation and function in
patients with recent revascularization is unclear. OBJECTIVE: The purpose
of present study was to compare the responses of platelet activation
(CD62P) and function (platelet aggregation) to high intensity interval
exercise (HIIE) and moderate continuous exercise (MCE) in coronary artery
bypass grafting (CABG) and percutaneous coronary interventions (PCI)
patients. METHODS: Thirty patients who had CABG or PCI were randomly
divided into HIIE, MCE and control groups. After determining the
VO<inf>2peak</inf>, subjects in the MCE group carried out 30min of
continuous exercise at 60 of VO<inf>2peak</inf>, whereas, the subjects in
HIIE group performed an interval protocol consisted of 8 repetitions of
2min activity (running on treadmill) at 90 of VO<inf>2peak</inf>
interspersed by 2min of active recovery between repetitions at 30 of
VO<inf>2peak</inf> Subjects in control group were seated and had no
activity for the same period of time. Two blood samples were collected
before and immediately after exercise and were analyzed for markers of
platelet activation and function. RESULTS: Data analyzes revealed that
increases in platelet aggregation induced by ADP and corrected for
increases in platelet count in response to MCE trial was significantly
lower than HIIE group (P<0.05). In addition, responses of CD62P to MCE
trial was significantly lower compared to HIIE group (P<0.05). Changes in
plateletcrit and platelet distribution width were significantly different
among the three trials where the PCT and PDW following the HIIE were
higher than MCE. Platelet count increased significantly (P<0.05) by 13
following HIIE trial. CONCLUSIONS: Based on the findings of the present
study it could be concluded that the risk of exercise-induced thrombosis
is higher during HIIE than MCE in patients with recent revascularization.
Copyright &#xa9; 2016 - IOS Press and the authors. All rights reserved.

<33>
Accession Number
611418394
Author
Jabbary Moghaddam M.; Barkhori A.; Mirkheshti A.; Hashemian M.; Amir
Mohajerani S.
Institution
(Jabbary Moghaddam, Mirkheshti, Amir Mohajerani) Department of
Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Barkhori, Hashemian) Department of Anesthesiology and Pain Medicine,
Kerman University of Medical Sciences, Kerman, Iran, Islamic Republic of
Title
The effect of pre-emptive dexmedetomidine on the incidence of
post-thoracotomy pain syndrome in patients undergoing coronary artery
bypass grafting.
Source
Anesthesiology and Pain Medicine. 6 (3) (no pagination), 2016. Article
Number: e36344. Date of Publication: June 2016.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Post-thoracotomy pain syndrome (PTPS) is pain that recurs or
persists along a thoracotomy incision for at least two months following
surgery. Dexmedetomidine (dex) is an alpha-2 agonist that also has
analgesic, sedative-hypnotic, and sympatholytic properties. Objectives: To
determine the effect of pre-emptive dexmedetomidine on the incidence of
PTPS in patients undergoing coronary artery bypass grafting (CABG).
Patients and Methods: This randomized clinical trial enrolled 104
candidates for elective coronary artery bypass grafting (CABG) and
randomly assigned them to either a dex group or a control group. In the
dex group, dexmedetomidine 0.5 micro&#32;g/kg/hour was infused from the
initiation of anesthesia until postoperative extubation in the
intensive-care unit. Two months after surgery, the patients were contacted
by telephone and interviewed to determine the presence of pain at the
thoracotomy scars. Results: Fifty-four patients were placed in the control
group, and 50 patients were assigned to the dex group. The age, sex, and
body mass index were not significantly different between the two groups of
study (P> 0.05). The incidence of PTPS was 11/50 (22%) patients in the dex
group and 28/54 patients (52%) in the control group. A chi-square test
revealed a significant difference in the incidence of PTPS after two
months between the dex and control groups (P = 0.032). Conclusions: PTPS
is a common problem following CABG, and pre-emptive therapy with dex may
decrease neuropathic pain. Copyright &#xa9; 2016, Iranian Society of
Regional Anesthesia and Pain Medicine (ISRAPM).

<34>
Accession Number
610059603
Author
Lee M.S.; Shlofmitz E.; Kaplan B.; Shlofmitz R.
Institution
(Lee) Division of Interventional Cardiology, UCLA Medical Center, Los
Angeles, CA, United States
(Shlofmitz, Kaplan) Division of Cardiology, North Shore University
Hospital, Manhasset, NY, United States
(Shlofmitz) Division of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
Title
Percutaneous Coronary Intervention in Severely Calcified Unprotected Left
Main Coronary Artery Disease: Initial Experience with Orbital Atherectomy.
Source
Journal of Invasive Cardiology. 28 (4) (pp 147-150), 2016. Date of
Publication: April 2016.
Publisher
HMP Communications
Abstract
Objective: We report the clinical outcomes of patients who underwent
percutaneous coronary intervention (PCI) with orbital atherectomy for
severely calcified unprotected left main coronary artery (ULMCA) disease.
Background: Although surgical revascularization is the gold standard for
patients with ULMCA disease, not all patients are candidates for this. PCI
is increasingly used to treat complex coronary artery disease, including
ULMCA disease. The presence of severely calcified lesions increases the
complexity of PCI. Orbital atherectomy can be used to facilitate stent
delivery and expansion in severely calcified lesions. The clinical
outcomes of patients treated with orbital atherectomy for severely
calcified ULMCA disease have not been reported. METHODS: From May 2014 to
July 2015, a total of 14 patients who underwent PCI with orbital
atherectomy for ULMCA disease were retrospectively evaluated. The primary
endpoint was major cardiac and cerebrovascular event (cardiac death,
myocardial infarction, stroke, and target-lesion revascularization) at 30
days. RESULTS: The mean age was 78.2 +/- 5.8 years. The mean ejection
fraction was 41.8 +/- 19.8%. Distal bifurcation disease was present in 9
of 14 patients. Procedural success was achieved in all 14 patients. The
30-day major adverse cardiac and cerebrovascular event rate was 0%. One
patient had coronary dissection that was successfully treated with
stenting. No patient had perforation, slow flow, or thrombosis.
CONCLUSIONS: Orbital atherectomy in patients with severely calcified ULMCA
disease is feasible, even in high-risk patients who were considered poor
surgical candidates. Randomized trials are needed to determine the role of
orbital atherectomy in ULMCA disease.

<35>
Accession Number
611567023
Author
Heydari B.; Abdullah S.; Pottala J.V.; Shah R.; Abbasi S.; Mandry D.;
Francis S.A.; Lumish H.; Ghoshhajra B.B.; Hoffmann U.; Appelbaum E.; Feng
J.H.; Blankstein R.; Steigner M.; McConnell J.P.; Harris W.; Antman E.M.;
Jerosch-Herold M.; Kwong R.Y.
Institution
(Heydari, Abdullah, Shah, Abbasi, Mandry, Feng, Blankstein, Steigner,
Jerosch-Herold, Kwong) Department of Medicine, Noninvasive Cardiovascular
Imaging Section, Cardiovascular Division, Harvard Medical School, Brigham
and Women's Hospital, 75 Francis St, Boston, MA 02115, United States
(Heydari, Abdullah, Shah, Abbasi, Mandry, Feng, Antman, Kwong)
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Boston, MA, United States
(Pottala, Harris) Department of Internal Medicine, Sanford School of
Medicine, University of South Dakota, Sioux Fall, SD, United States
(Shah, Francis) Division of Cardiology, Department of Medicine,
Massachusetts General Hospital, Boston, MA, United States
(Lumish, Ghoshhajra, Hoffmann) Department of Radiology, Massachusetts
General Hospital, Boston, MA, United States
(Appelbaum) Cardiovascular Division, Department of Medicine, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(McConnell) Health Diagnostic Laboratory Inc., Richmond, VA, United States
(Harris) OmegaQuant Analytics, LLC, Sioux Falls, SD, United States
Title
Effect of omega-3 acid ethyl esters on left ventricular remodeling after
acute myocardial infarction.
Source
Circulation. 134 (5) (pp 378-391), 2016. Date of Publication: 02 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Omega-3 fatty acids from fish oil have been associated with
beneficial cardiovascular effects, but their role in modifying cardiac
structures and tissue characteristics in patients who have had an acute
myocardial infarction while receiving current guideline-based therapy
remains unknown. Methods: In a multicenter, double-blind,
placebo-controlled trial, participants presenting with an acute myocardial
infarction were randomly assigned 1:1 to 6 months of high-dose omega-3
fatty acids (n=180) or placebo (n=178). Cardiac magnetic resonance imaging
was used to assess cardiac structure and tissue characteristics at
baseline and after study therapy. The primary study endpoint was change in
left ventricular systolic volume index. Secondary endpoints included
change in noninfarct myocardial fibrosis, left ventricular ejection
fraction, and infarct size. Results: By intention-to-treat analysis,
patients randomly assigned to omega-3 fatty acids experienced a
significant reduction of left ventricular systolic volume index (-5.8%,
P=0.017), and noninfarct myocardial fibrosis (-5.6%, P=0.026) in
comparison with placebo. Per-protocol analysis revealed that those
patients who achieved the highest quartile increase in red blood cell
omega-3 index experienced a 13% reduction in left ventricular systolic
volume index in comparison with the lowest quartile. In addition, patients
in the omega-3 fatty acid arm underwent significant reductions in serum
biomarkers of systemic and vascular inflammation and myocardial fibrosis.
There were no adverse events associated with high-dose omega-3 fatty acid
therapy. Conclusions: Treatment of patients with acute myocardial
infarction with high-dose omega-3 fatty acids was associated with
reduction of adverse left ventricular remodeling, noninfarct myocardial
fibrosis, and serum biomarkers of systemic inflammation beyond current
guideline-based standard of care. Copyright &#xa9; 2016 American Heart
Association, Inc.

<36>
Accession Number
614279210
Author
Lee S.-E.; Lin F.Y.; Lu Y.; Chang H.-J.; Min J.K.
Institution
(Lee, Chang) Division of Cardiology, Severance Cardiovascular Hospital,
Integrative Cardiovascular Imaging Center, Yonsei University College of
Medicine, Yonsei University Health System, Seoul, South Korea
(Lin, Lu, Min) Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medical College, New York,
NY, United States
Title
Rationale and design of the Coronary Computed Tomographic Angiography for
Selective Cardiac Catheterization: Relation to Cardiovascular Outcomes,
Cost Effectiveness and Quality of Life (CONSERVE) trial.
Source
American Heart Journal. 186 (pp 48-55), 2017. Date of Publication: 01 Apr
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Although coronary computed tomography angiography (CCTA) has shown promise
as a "gatekeeper" to invasive coronary angiography (ICA) in longitudinal
cohort studies, it remains unknown whether the strategy of selective ICA
by initial performance of CCTA is either safe or effective when compared
with a direct ICA strategy in patients with an American Heart Association
(AHA)/American College of Cardiology (ACC) guideline-directed indication
for ICA. Objectives The CONSERVE trial is a prospective randomized
multicenter trial to determine the clinical effectiveness of "selective
catheterization" vs "direct catheterization" strategies for stable
patients with suspected but without known coronary artery disease, who
meet AHA/ACC guideline indication for ICA. Methods Patients being referred
for clinically indicated nonemergent ICA with an AHA/ACC class II
guideline indication for ICA will be randomized to either direct
catheterization or selective catheterization strategy. Patients in the
direct catheterization arm will proceed directly to ICA as planned,
whereas patients in the select catheterization arm will undergo initial
CCTA, followed by ICA at the discretion of the site physician. All CCTAs
and ICAs will be interpreted on site. Follow-up testing and/or therapy
after CCTA or ICA will be at the discretion of the site physician. Results
This trial will report a primary clinical end point of noninferiority
rates of major adverse cardiac events, as defined by the composite of
death, nonfatal myocardial infarction, unstable angina, stroke, urgent or
emergent coronary revascularization, or cardiac hospitalization.
Conclusion The CONSERVE trial will determine whether selective
catheterization strategy, based on initial CCTA in patients being referred
to ICA, is safe and effective. Copyright &#xa9; 2016 Elsevier Inc.

<37>
Accession Number
610546434
Author
Martin S.S.; Albrecht M.H.; Wichmann J.L.; Husers K.; Scholtz J.-E.; Booz
C.; Bodelle B.; Bauer R.W.; Metzger S.C.; Vogl T.J.; Lehnert T.
Institution
(Martin, Albrecht, Wichmann, Husers, Scholtz, Booz, Bodelle, Bauer,
Metzger, Vogl, Lehnert) Department of Diagnostic and Interventional
Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt
60590, Germany
Title
Value of a noise-optimized virtual monoenergetic reconstruction technique
in dual-energy CT for planning of transcatheter aortic valve replacement.
Source
European Radiology. 27 (2) (pp 705-714), 2017. Date of Publication: 01 Feb
2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objectives: To evaluate objective and subjective image quality of a
noise-optimized virtual monoenergetic imaging (VMI+) reconstruction
technique in dual-energy computed tomography (DECT) angiography prior to
transcatheter aortic valve replacement (TAVR). Methods: Datasets of 47
patients (35 men; 64.1 +/- 10.9 years) who underwent DECT angiography of
heart and vascular access prior to TAVR were reconstructed with standard
linear blending (F_0.5), VMI+, and traditional monoenergetic (VMI)
algorithms in 10-keV intervals from 40-100 keV. Signal-to-noise ratio
(SNR) and contrast-to-noise ratio (CNR) of 564 arterial segments were
evaluated. Subjective analysis was rated by three blinded observers using
a Likert scale. Results: Mean SNR and CNR were highest in 40 keV VMI+
series (SNR, 27.8 +/- 13.0; CNR, 26.3 +/- 12.7), significantly (all p <
0.001) superior to all VMI series, which showed highest values at 70 keV
(SNR, 18.5 +/- 7.6; CNR, 16.0 +/- 7.4), as well as linearly-blended F_0.5
series (SNR, 16.8 +/- 7.3; CNR, 13.6 +/- 6.9). Highest subjective image
quality scores were observed for 40, 50, and 60 keV VMI+ reconstructions
(all p > 0.05), significantly superior to all VMI and standard
linearly-blended images (all p < 0.01). Conclusions: Low-keV VMI+
reconstructions significantly increase CNR and SNR compared to VMI and
standard linear-blending image reconstruction and improve subjective image
quality in preprocedural DECT angiography in the context of TAVR planning.
Key Points: * VMI+ combines increased contrast with reduced image noise. *
VMI+ shows substantially less image noise than traditional VMI. * 40-keV
reconstructions show highest SNR/CNR of the aortic and iliofemoral access
route. * Observers overall prefer 60 keV VMI+ images. * VMI+ DECT imaging
helps improve image quality for TAVR planning. Copyright &#xa9; 2016,
European Society of Radiology.

<38>
Accession Number
614321489
Author
Kvisvik B.; Morkrid L.; Rosjo H.; Cvancarova M.; Rowe A.D.; Eek C.; Bendz
B.; Edvardsen T.; Gravning J.
Institution
(Kvisvik, Rosjo, Cvancarova, Gravning) Department of Cardiology, Division
of Medicine, Akershus University Hospital, Lorenskog N-1478, Norway
(Kvisvik, Rosjo, Edvardsen, Gravning) Center for Heart Failure Research,
University of Oslo, Norway
(Morkrid, Rowe) Department of Medical Biochemistry, Oslo University
Hospital, Rikshospitalet, and Institute for Clinical Medicine, University
of Oslo, Norway
(Rowe) Norwegian National Unit for Newborn Screening, Womanand Children's
Division, Oslo University Hospital, Rikshospitalet, Norway
(Eek, Bendz, Edvardsen) Department of Cardiology, Oslo University
Hospital, Rikshospitalet, Norway
Title
High-sensitivity troponin T vs i in acute coronary syndrome: Prediction of
significant coronary lesions and long-term prognosis.
Source
Clinical Chemistry. 63 (2) (pp 552-562), 2017. Date of Publication:
February 2017.
Publisher
American Association for Clinical Chemistry Inc.
Abstract
BACKGROUND: High-sensitivity cardiac troponin (hscTn) T and I assays are
established as crucial tools for the diagnosis of acute myocardial
infarction (AMI), as they have been found superior to old troponin assays.
However, eventual differences between the assays in prediction of
significant coronary lesions and long-term prognosis in patients with
acute coronary syndrome (ACS) have not been fully unraveled. METHODS:
Serum concentrations of hs-cTnT (Roche), hs-cTnI (Abbott), and
amino-terminal pro-B-type natriuretic peptide (NT-proBNP; Roche) in 390
non-STelevation (NSTE) ACS patients were evaluated in relation to
significant coronary lesions on coronary angiography (defined as a
stenosis <50% of the luminal diameter, with need for revascularization)
and prognostic accuracy for cardiovascular mortality, all-cause mortality,
as well as the composite end point of cardiovascular mortality and
hospitalizations for AMI or heart failure. RESULTS: The mean (SD)
follow-up was 2921 (168) days. Absolute hs-cTnI concentrations were
significantly higher than the hs-cTnT concentrations. The relationship
between analyzed biomarkers and significant coronary lesions on coronary
angiography, as quantified by the area under the ROC curve (AUC), revealed
no difference between hs-cTnT [AUC, 0.81; 95% CI, 0.77- 0.86] and hs-cTnI
(AUC, 0.81; 95% CI, 0.76-0.86; P = NS). NT-proBNP was superior to both
hs-cTn assays regarding prognostic accuracy for both cardiovascular and
all-cause mortality and for the composite end point during follow-up, also
in multivariate analyses. CONCLUSIONS: The hs-cTnT and hs-cTnI assays
displayed a similar ability to predict significant coronary lesions in
NSTE-ACS patients. NT-proBNP was superior to both hscTn assays as a marker
of long-term prognosis in this patient group. Copyright &#xa9; 2016
American Association for Clinical Chemistry.

<39>
Accession Number
614320283
Author
Eichler S.; Salzwedel A.; Reibis R.; Nothroff J.; Harnath A.; Schikora M.;
Butter C.; Wegscheider K.; Voller H.
Institution
(Eichler, Salzwedel, Voller) Centre of Rehabilitation Research, University
of Potsdam, Am Neuen Palais 10, Potsdam D-14469, Germany
(Reibis) Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam,
Germany
(Nothroff) MediClin Rehabilitation Centre Spreewald, Burg, Germany
(Harnath) Sana Heart-Centre Cottbus, Cottbus, Germany
(Schikora) Brandenburgklinik Berlin-Brandenburg, Bernau, Germany
(Butter) Heart Centre Brandenburg, Bernau, Germany
(Wegscheider) Department of Medical Biometry and Epidemiology, University
Medical Centre, Hamburg-Eppendorf, Germany
(Voller) Klinik Am See, Rehabilitation Centre for Internal Medicine,
Rudersdorf, Germany
Title
Multicomponent cardiac rehabilitation in patients after transcatheter
aortic valve implantation: Predictors of functional and psychocognitive
recovery.
Source
European Journal of Preventive Cardiology. 24 (3) (pp 257-264), 2017. Date
of Publication: 01 Feb 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background In the last decade, transcatheter aortic valve implantation has
become a promising treatment modality for patients with aortic stenosis
and a high surgical risk. Little is known about influencing factors of
function and quality of life during multicomponent cardiac rehabilitation.
Methods From October 2013 to July 2015, patients with elective
transcatheter aortic valve implantation and a subsequent inpatient cardiac
rehabilitation were enrolled in the prospective cohort multicentre study.
Frailty-Index (including cognition, nutrition, autonomy and mobility),
Short Form-12 (SF-12), six-minute walk distance (6MWD) and maximum work
load in bicycle ergometry were performed at admission and discharge of
cardiac rehabilitation. The relation between patient characteristics and
improvements in 6MWD, maximum work load or SF-12 scales were studied
univariately and multivariately using regression models. Results One
hundred and thirty-six patients (80.6 +/- 5.0 years, 47.8% male) were
enrolled. 6MWD and maximum work load increased by 56.3 +/- 65.3 m (p <
0.001) and 8.0 +/- 14.9 watts (p < 0.001), respectively. An improvement in
SF-12 (physical 2.5 +/- 8.7, p = 0.001, mental 3.4 +/- 10.2, p = 0.003)
could be observed. In multivariate analysis, age and higher education were
significantly associated with a reduced 6MWD, whereas cognition and
obesity showed a positive predictive value. Higher cognition, nutrition
and autonomy positively influenced the physical scale of SF-12.
Additionally, the baseline values of SF-12 had an inverse impact on the
change during cardiac rehabilitation. Conclusions Cardiac rehabilitation
can improve functional capacity as well as quality of life and reduce
frailty in patients after transcatheter aortic valve implantation. An
individually tailored therapy with special consideration of cognition and
nutrition is needed to maintain autonomy and empower octogenarians in
coping with challenges of everyday life. Copyright &#xa9; European Society
of Cardiology.

<40>
Accession Number
614320247
Author
Claes J.; Buys R.; Budts W.; Smart N.; Cornelissen V.A.
Institution
(Claes, Buys, Budts) Department of Cardiovascular Sciences, Division of
Cardiology, Herestraat 49 Box 7003, KU Leuven 3000, Belgium
(Buys, Cornelissen) Department of Rehabilitation Sciences, Research Group
of Cardiovascular Rehabilitation, KU Leuven, Belgium
(Budts) Department of Cardiology, University Hospitals Leuven, Belgium
(Smart) School of Science and Technology, University of New England,
Armidale, NSW, Australia
Title
Longer-term effects of home-based exercise interventions on exercise
capacity and physical activity in coronary artery disease patients: A
systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 24 (3) (pp 244-256), 2017. Date
of Publication: 01 Feb 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Exercise-based cardiovascular rehabilitation (CR) improves
exercise capacity (EC), lowers cardiovascular risk profile and increases
physical functioning in the short term. However, uptake of and adherence
to a physically active lifestyle in the long run remain problematic.
Home-based (HB) exercise programmes have been introduced in an attempt to
enhance long-term adherence to recommended levels of physical activity
(PA). The current systematic review and meta-analysis aimed to compare the
longer-term effects of HB exercise programmes with usual care (UC) or
centre-based (CB) CR in patients referred for CR. Design Systematic review
and meta-analysis. Methods Non-randomised controlled trials (RCTs) or
randomised trials comparing the effects of HB exercise programmes with UC
or CB rehabilitation on EC and/or PA, with a follow-up period of >12
months and performed in coronary artery disease patients, were searched in
four databases (PubMed, EMBASE, the Cumulative Index to Nursing and Allied
Health Literature (CINAHL) and the Cochrane Central Register of Controlled
trials (CENTRAL)) from their inception until September 7, 2016.
Standardised mean differences (SMDs) were calculated and pooled by means
of random effects models. Risk of bias, publication bias and heterogeneity
among trials were also assessed. Results Seven studies could be included
in the meta-analysis on EC, but only two studies could be included in the
meta-analysis on PA (total number of 1440 patients). The results showed no
significant differences in EC between HB rehabilitation and UC (SMD 0.10,
95% confidence interval (CI) -0.13 to 0.33). There was a small but
significant difference in EC in favour of HB compared to CB rehabilitation
(SMD 0.25, 95% CI 0.02-0.48). No differences were found for PA (SMD 0.37,
95% CI -0.18 to 0.92). Conclusions HB exercise is slightly more effective
than CB rehabilitation in terms of maintaining EC. The small number of
studies warrants the need for more RCTs evaluating the long-term effects
of different CR interventions on EC and PA behaviour, as this is the
ultimate goal of CR. Copyright &#xa9; European Society of Cardiology.

<41>
Accession Number
614120550
Author
Sverre E.; Peersen K.; Husebye E.; Gjertsen E.; Gullestad L.; Moum T.;
Otterstad J.E.; Dammen T.; Munkhaugen J.
Institution
(Sverre, Husebye, Gjertsen, Munkhaugen) Drammen Hospital, Department of
Medicine, Drammen 3004, Norway
(Peersen, Otterstad) Vestfold Hospital, Department of Medicine, Tonsberg,
Norway
(Gullestad) University of Oslo, Department of Cardiology, Oslo University
Hospital Rikshospitalet, Medical Faculty, Oslo, Norway
(Moum, Dammen) University of Oslo, Department of Behavioural Sciences in
Medicine, Oslo, Norway
Title
Unfavourable risk factor control after coronary events in routine clinical
practice.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 40. Date of Publication: 21 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Risk factor control after a coronary event in a recent
European multi-centre study was inadequate. Patient selection from
academic centres and low participation rate, however, may underscore
failing risk factor control in routine clinical practice. Improved
understanding of the patient factors that influence risk factor control is
needed to improve secondary preventive strategies. The objective of the
present paper was to determine control of the major risk factors in a
coronary population from routine clinical practice, and how risk factor
control was influenced by the study factors age, gender, number of
coronary events, and time since the index event. Methods: A
cross-sectional study determined risk factor control and its association
with study factors in 1127 patients (83% participated) aged 18-80 years
with acute myocardial infarction and/or revascularization identified from
medical records. Study data were collected from a self-report
questionnaire, clinical examination, and blood samples after 2-36 months
(median 16) follow-up. Results: Twenty-one percent were current smokers at
follow-up. Of those smoking at the index event 56% continued smoking.
Obesity was found in 34%, and 60% were physically inactive. Although 93%
were taking blood-pressure lowering agents and statins, 46% were still
hypertensive and 57% had LDL cholesterol >1.8 mmol/L at follow-up.
Suboptimal control of diabetes was found in 59%. The patients failed on
average to control three of the six major risk factors, and patients with
>1 coronary events (p < 0.001) showed the poorest overall control. A
linear increase in smoking (p < 0.01) and obesity (p < 0.05) with
increasing time since the event was observed. Conclusions: The majority of
coronary patients in a representative Norwegian population did not achieve
risk factor control, and the poorest overall control was found in patients
with several coronary events. New strategies for secondary prevention are
clearly needed to improve risk factor control. Even modest advances will
provide major health benefits. Trial registration: Registered at
ClinicalTrials.gov (ID NCT02309255). Copyright &#xa9; 2017 The Author(s).

<42>
Accession Number
614120537
Author
Steppich B.; Groha P.; Ibrahim T.; Schunkert H.; Laugwitz K.-L.;
Hadamitzky M.; Kastrati A.; Ott I.
Institution
(Steppich, Groha, Hadamitzky, Kastrati, Ott) Deutsches Herzzentrum der
Technischen Universitat Munchen, Lazarettstr. 36, Munich 80636, Germany
(Ibrahim, Schunkert, Laugwitz) Medizinische Klinik Klinikum rechts der
Isar der Technischen Universitat Munchen, Ismaningerstr. 22, Munich 81675,
Germany
Title
Effect of Erythropoietin in patients with acute myocardial infarction:
Five-year results of the REVIVAL-3 trial.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 38. Date of Publication: 21 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Erythropoietin (EPO) has been suggested to promote cardiac
repair after MI. However, the randomized, double-blind, placebo controlled
REVIVAL-3 trial showed that short term high dose EPO in timely reperfused
myocardium does not improve left ventricular ejection fraction after 6
months. Moreover, the study raised safety concerns due to a trend towards
a higher incidence of adverse clinical events as well as a increase in
neointima formation after treatment with EPO. The present study therefore
aimed to assess the 5-year clinical outcomes. Methods: After successful
reperfusion 138 patients with STEMI were randomly assigned to receive
epoetin beta (3.33x10⁴ U, n = 68) or placebo (n = 70)
immediately, 24 and 48 h after percutaneous coronary intervention. The
primary outcome of the present study- the combined incidence of MACE 5
years after randomization - occurred in 25% of the patients assigned to
epoetin beta and 17% of the patients assigned to placebo (RR 1.5; 95% CI
0.8-3.5; p = 0.26). Target lesion revascularization was required in 15
patients (22.1%) treated with epoetin-s and 9 patients (12.9%) treated
with placebo (p = 0.15). Analysis of patients in the upper and lower
quartile of baseline hemoglobin as an indirect estimate of endogenous
erythropoietin levels revealed no significant impact of endogenous
erythropoietin on efficiency of exogen administered epoetin-s in terms of
death and MACE. Conclusion: These long-term follow-up data show that
epoetin beta does not improve clinical outcomes of patients with acute
myocardial infarction. Trial registration: URL www.clinicaltrials.gov ;
Unique identifier NCT00390832; trial registration date October 19th 2006
Copyright &#xa9; 2017 The Author(s).

<43>
Accession Number
614307143
Author
Ong M.E.H.; Hao Y.; Yap S.; Pek P.P.; Chua T.S.J.; Ng F.S.P.; Lim S.H.
Institution
(Ong, Yap, Pek, Lim) Department of Emergency Medicine, Singapore General
Hospital, Singapore
(Hao) Division of Research, Singapore General Hospital, Singapore
(Chua) National Heart Centre Singapore, Singapore General Hospital,
Singapore
(Ong) Health Services and Systems Research, Duke-NUS Graduate Medical
School, Singapore
(Chua) Singapore Health Services, Singapore
(Ng) Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
Title
Validation of the new vancouver chest pain rule in asian chest pain
patients presenting at the emergency department.
Source
Canadian Journal of Emergency Medicine. 19 (1) (pp 18-25), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Cambridge University Press (E-mail: info@bcdecker.com)
Abstract
Objectives: The new Vancouver Chest Pain (VCP) Rule recommends early
discharge for chest pain patients who are at low risk of developing acute
coronary syndrome (ACS), and thus can be discharged within 2 hours of
arrival at the emergency department (ED). This study aimed to assess the
performance of the new VCP Rule for Asian patients presenting with chest
pain at the ED. Methods: This prospective cohort study involved patients
attended to at the ED of a large urban centre. Patients of at least 25
years old, presenting with stable chest pain and a non-diagnostic ECG, and
with no history of active coronary artery disease were included in the
study. The main outcome measures were cardiac events, angioplasty, or
coronary artery bypass within 30 days of enrolment. Results: The study
included 1690 patients from 27 August 2000 to 1 May 2002, with 661
patients fulfilling the VCP criteria. Of those for early discharge, 24 had
cardiac events and 13 had angioplasty or bypass at 30 days, compared to 91
and 41, respectively, for those unsuitable for discharge. This gave the
rule a sensitivity of 78.1% for cardiac events, including angioplasty and
bypass. Specificity was 41.0%, and negative predictive value (NPV) was
94.4%. Conclusion: We found the new VCP Rule to have moderate sensitivity
and poor specificity for adverse cardiac events in our population. With an
NPV of less than 100%, this means that a small proportion of patients sent
home with early discharge would still have adverse cardiac events.
Copyright &#xa9; Canadian Association of Emergency Physicians.

<44>
Accession Number
614027359
Author
Vaduganathan M.; Harrington R.A.; Stone G.W.; Deliargyris E.N.; Steg P.G.;
Gibson C.M.; Hamm C.W.; Price M.J.; Prats J.; Elkin S.; Mahaffey K.W.;
White H.D.; Bhatt D.L.; Ballarino M.; Damonte A.A.; Grinfeld D.; Alvarez
C.A.; Fernandez A.; Farshid A.; Gunalingam B.; Jeurgens C.; Lowe H.;
Hallani H.; Nelson G.; New G.; Dick R.; Lefkovits J.; Duffy S.; Bett N.;
Yadav R.; Garrahy P.; Lehman R.; Aylward P.; Horowitz J.; Worthley M.;
Rankin J.; Thompson P.; Roberts-Thomson P.; Cross D.; Jayasinghe R.;
Aroney C.; Altenberger J.; Gaul G.; Neunteufl T.; Weidinger F.; Schuchlenz
H.; Weber H.; Rossi P.; Almeida B.; Vacanti L.; Serpa R.; Jatene J.A.;
Reis G.; Marino M.; Costantini C.; Wang R.; Rati M.; Bodanese L.; Manenti
E.; Zouvi J.P.; Carvalho A.; Franken R.; Title L.; Olbrich H.-G.;
Moebius-Winkler S.; Buerke M.; Moellmann H.; Katus H.; Voehringer H.-F.;
Hengstenberg C.; Klauss V.; Brachmann J.; Khan A.; Chandra P.; Rao M.;
Ramesh S.S.; Srinivas A.; Sinha N.; Prakash V.S.; Mishra A.; Roy S.; Sethi
K.; Bhandari S.; Cortese B.; Marenzi G.; De Caterina R.; Harding S.;
Elliott J.; Wilkins G.; Dobrzycki S.; Dorniak W.; Dudek D.; Hiczkiewicz
J.; Kubik L.; Kuc K.; Kuzniar J.; Mazurek W.; Ostrowski J.; Tendera M.;
Wisniewski A.; Zmudka K.; Pawla J.; Kosmider M.; Seweryna; Iniguez A.;
Melgares R.; Goicolea F.; Hernandez J.; Zueco J.; Kraiz I.; Vatutin M.;
Polyakov A.; Sokolov Y.; House K.; Campbell C.; Trageser T.; Baran K.;
Kleiman N.; Medina R.; Hill R.; Drenning D.; Ladley H.; Niederman A.;
Goyal A.; Abernethy W.; Jaffrani N.; Zelman R.; Marquez J.; Mahmud E.;
Paulowski J.; Pollack C.; Mines M.; Federici R.; Schweiger M.; Habet K.;
Quintana O.; Chavez I.; Warner M.; Hirsch C.; Virmani A.; Soukas P.;
Srivastava N.; Kini A.; Greenberg M.; Herrmann H.; Fernandes V.; Bertolet
B.; Waksman R.; Henderson J.; Mastali K.; Hui P.; Pacifico L.; Caulfield
T.; Misra V.; Andreou C.; Batchelor W.; Gips S.; Kramer J.; Wang J.;
Winters R.; MacKenzie G.; Jenkins S.; Teirstein P.; Krauss S.; Rohrbeck
S.; Martin R.; Grieco G.; Westerhausen D.; Fortuin F.D.; Schulman S.;
Wozniak R.; Hall J.; Marzo K.; Krolick M.; Attubato M.; Quesada R.;
Kereiakes D.; Raymond R.; Amidon T.; Lee D.; King S.; Kleaveland J.P.;
Driesman M.; Kowalchuk G.; Taghizadeh B.; Barr L.; Benzuly K.; Pinto D.;
Aragon J.; Sachdeva R.; Wong S.; Shaikh S.R.; Reitman A.; Lawrence M.;
Cura F.; Escudero A.G.; Poy C.; Miceli M.; Pocovi A.; Londero H.; Baccaro
J.; Polonetsky L.; Karotkin A.; Shubau L.; Maffini E.; Machado B.; Airton
J.; Lima V.; Filho E.M.; Herdy A.; Tumelero R.; Precoma D.; Botelho R.;
Saad J.; Jatene J.; Vilas-Boas F.; Godinho A.; Perin M.; Caramori P.;
Castro I.; Manukov I.; Grigorov M.; Milkov P.; Jorgova J.; Georgiev S.;
Rifai N.; Doganov A.; Hui W.; Lazzam C.; Reeves F.; Tanguay J.-F.; Richter
M.; Klimsa Z.; Padour M.; Branny M.; Rozsival V.; Pleva L.; Groch L.;
Khintibidze I.; Mohanan P.; Jain R.; Parikh K.; Patel T.; Kumar S.; Mehta
A.; Banker D.; Krishna L.; Gadkari M.; Joshi H.; Arneja J.; Hiremath S.;
Grinius V.; Norkiene S.; Petrauskiene B.; Michels R.; Tjon M.; de Swart
H.; de Winter R.; White H.; Abernethey M.; Osiev A.; Baum S.; Boldueva S.;
Kostenko V.; Gruzdev A.; Lusov V.; Dovgalevsky P.; Azarin O.; Chernov S.;
Smolenskaya O.; Duda A.; Fridrich V.; Hranai M.; Studencan M.; Kurray P.;
Bennett J.; Blomerus P.; Disler L.; Engelbrecht J.; Routier R.; Venter T.;
Klug E.; Van Der Merwe N.; Becker A.; Cha K.-S.; Lee S.-H.; Han S.-J.;
Youn T.J.; Hur S.-H.; Seo H.S.; Park H.-S.; Rhim C.-Y.; Pyun W.-B.; Choe
H.; Jeong M.-H.; Park J.-S.; Shin E.-K.; Hernandez F.; Figueras J.;
Hernandez R.; Lopez-Minguez J.R.; Gonzalez Juanatey J.R.; Palop R.L.;
Galeote G.; Buddhari W.; Sansanayudh N.; Penny W.; Lui C.; Grimmett G.;
Srinivasan V.; Ariani K.; Khan W.; Cannon L.; Eisenberg S.; Jafar M.Z.;
Mahoney P.; Greenberg J.; Breall J.; Chandna H.; Hockstad E.; Tolerico P.;
Kao J.; Greenbaum A.; Cohn J.; Nahhas A.; Istfan P.; Orlow S.; Sklar J.;
Cochran D.; Smith R.; Ferrier L.N.; Xenopoulos N.; Mulumudi M.; Hoback J.;
Ginete W.; Ballard W.; Stella J.; Staniloae C.; Eaton G.; Griffin J.;
Kumar K.; Ebrahimi R.; O'Shaughnessy C.; Lundstrom R.; Tam K.; Raval A.;
Kaufman J.; Quealy K.; Nunez B.; Pow T.; Samuels B.; Argenal A.; Srinivas
V.; Rosenthal A.; Tummala P.; Myers P.; Nseir G.; LaMarche N.; Bach R.;
Simon D.; Kettelkamp R.; Helmy T.; Schaer G.; Kosinski E.; Buchbinder M.;
Sharma M.; Goodwin M.; Horwitz P.; Mann J.T.; Holmes D.; Rao S.; Azrin M.;
Gammon R.; Mavromatis K.; Ahmed A.; Kent K.; Zughaib M.; Westcott R.J.;
Jain A.; LeGalley T.; Benzer W.; Delle-Karth G.; Huber K.; Leisch F.; Saad
J.A.; Abizaid A.; Areas C.A.F.; Ribeiro E.E.; Dos Santos F.R.; Tumelero
R.T.; Botelho R.V.; Atzev B.; Boichev B.; Grigorov G.; Penkov N.; Petrov
I.; Zehirov B.; Cervinka P.; Coufal Z.; Hajek P.; Horak D.; Kala P.;
Kmonicek P.; Kocka V.; Mrozek J.; Simek S.; Sitar J.; Stasek J.; Tousek
F.; Chapidze G.; Emukhvari N.; Khabeishvili G.; Mamatsashvili M.;
Shaburishvili T.; Behrens S.; Darius H.; Dissmann M.; Fichtlscherer S.;
Franz W.; Geisler T.; Genth-Zotz S.; Goldmann B.; Heuer H.; Hoffmann S.;
Mugge A.; Poerner T.; Radke P.; Richardt G.; Stellbrink C.; Werner N.;
Bramucci E.; De Servi S.; Galasso G.; Menozzi A.; Musumeci G.; Picchi A.;
Presbitero P.; Devlin G.; Sasse A.; Scott D.; Stewart R.; Andrzej S.;
Dubaniewicz W.; Gasior Z.; Kasprzak J.; Kleinrok A.; Kornacewicz-Jach Z.;
Rynkiewicz A.; Sosnowski C.; Targonski R.; Trebacz J.; Witkowski A.; Zinka
E.; Barbarash O.; Dovgalevsky Y.; Gordeev I.; Kalinina S.; Kosmachova E.;
Linev K.; Markov V.; Pavlov P.; Shalaev S.; Shogenov Z.; Sukmanova I.;
Vasilieva E.; Yakovlev A.; Boonbaichaiyapruck S.; Chamnarnphol N.;
Kaewsuwanna P.; Kuanprasert S.; Piyayotai D.; Amine M.; Angiolillo D.;
Arif I.; Blankenship J.; Brilakis E.; Chan M.; Cinderella J.; Davis B.;
Devireddy C.; Dorogy M.; Douglas J.; Ferrier N.; Fisher D.; Foster R.;
French W.; Galla J.; Gimple L.; Gogia H.; Gogo P.; Gollapudi R.; Gruberg
L.; Hermiller J.; Heuser R.; Iwaoka R.; Jafar Z.; Kimmelstiel C.; Kinlay
S.; Leggett J.; Leimgruber P.; Letts D.; Lipsitt M.; Low R.;
Martinez-Arraras J.; Mayhew M.; McLaurin B.; McWhirter P.; Mirza A.; Negus
B.; Nygaard T.; O'Riordan W.; Paulus R.; Petersen J.; Picon H.; Picone M.;
Price M.; Rivera E.; Rizik D.; Rodriguez A.; Saucedo J.; Scott J.C.; Sethi
V.; Shroff A.; Siegel C.; Spriggs D.; Steinberg D.; Stillabower M.;
Stuckey T.; Suarez J.; Tauth J.; Temizer D.; Vidovich M.; Voeltz M.;
Waltman J.; Wilensky M.
Institution
(Vaduganathan, Bhatt) Brigham and Women's Hospital Heart & Vascular Center
and Harvard Medical School, Boston, Massachusetts, United States
(Harrington, Mahaffey) Stanford University Medical School, Stanford,
California, United States
(Stone) Columbia University Medical Center and the Cardiovascular Research
Foundation, New York, New York, United States
(Deliargyris, Prats, Elkin) The Medicines Company, Parsippany, New Jersey,
United States
(Steg) FACT (French Alliance for Cardiovascular clinical Trials), DHU
FIRE, INSERM Unite 1148, Universite Paris-Diderot, Hopital Bichat,
Assistance-Publique-Hopitaux de Paris, Paris, France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Gibson) Division of Cardiology, Beth Israel Deaconess Medical Center,
Boston, Massachusetts, United States
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Price) Scripps Clinic and Scripps Translational Science Institute, La
Jolla, California, United States
(Menozzi) Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
(White) Green Lane Cardiovascular Service, Auckland, New Zealand
Title
Cangrelor With and Without Glycoprotein IIb/IIIa Inhibitors in Patients
Undergoing Percutaneous Coronary Intervention.
Source
Journal of the American College of Cardiology. 69 (2) (pp 176-185), 2017.
Date of Publication: 17 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Cangrelor, an intravenous, reversible P2Y<inf>12</inf>
antagonist, is approved for use in patients undergoing percutaneous
coronary intervention (PCI). Objectives This study sought to evaluate the
efficacy and safety of cangrelor compared with clopidogrel in subgroups
that did and did not receive glycoprotein IIb/IIIa inhibitors (GPIs).
Methods This pooled, patient-level analysis of the 3 CHAMPION (Cangrelor
versus Standard Therapy to Achieve Optimal Management of Platelet
Inhibition) trials analyzed all randomized patients who underwent PCI and
received the study drug (n = 24,902). Only bailout/rescue GPI use was
permitted, except in CHAMPION PCI, in which routine or bailout/rescue GPI
use was at the site investigator's discretion. The primary efficacy
endpoint was the composite of all-cause mortality, myocardial infarction,
ischemia-driven revascularization, or stent thrombosis at 48 h after
randomization. Results Overall, 3,173 patients (12.7%) received a GPI,
most commonly eptifibatide (69.4%). Despite variation in indications for
GPIs, baseline characteristics were well balanced between the cangrelor
and clopidogrel arms in subsets receiving and not receiving GPIs. Rates of
the primary composite endpoint were lower with cangrelor compared with
clopidogrel in patients who did (4.9% vs. 6.5%; odds ratio [OR]: 0.74; 95%
confidence interval [CI]: 0.55 to 1.01) or did not receive a GPI (3.6% vs.
4.4%; OR: 0.82; 95% CI: 0.72 to 0.94; P<inf>int</inf> = 0.55). Cangrelor
did not increase the primary safety endpoint, GUSTO-defined
severe/life-threatening bleeding, in patients who did (0.4% vs. 0.5%; OR:
0.71; 95% CI: 0.25 to 1.99) or did not receive GPIs (0.2% vs. 0.1%; OR:
1.56; 95% CI: 0.80 to 3.04; P<inf>int</inf> = 0.21). GPI use was
associated with increased risk of bleeding in both treatment arms.
Conclusions Cangrelor's efficacy in reducing ischemic complications in
patients undergoing PCI was maintained irrespective of GPI administration.
GPI use was associated with substantially higher bleeding rates,
regardless of the randomization to cangrelor or clopidogrel. (A Clinical
Trial to Demonstrate the Efficacy of Cangrelor [PCI]: NCT00305162;
Cangrelor Versus Standard Therapy to Achieve Optimal Management of
Platelet Inhibition [PLATFORM]: NCT00385138; A Clinical Trial Comparing
Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require
Percutaneous Coronary Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION]:
NCT01156571) Copyright &#xa9; 2017 American College of Cardiology
Foundation

<45>
Accession Number
614027351
Author
van Diepen S.; Fuster V.; Verma S.; Hamza T.H.; Siami F.S.; Goodman S.G.;
Farkouh M.E.
Institution
(van Diepen) Department of Critical Care and Division of Cardiology,
University of Alberta, Edmonton, Alberta, Canada
(van Diepen, Goodman) Canadian VIGOUR Centre, University of Alberta,
Edmonton, Alberta, Canada
(Fuster) Icahn School of Medicine at Mount Sinai, New York, New York,
United States
(Verma) Division of Cardiac Surgery, St. Michael's Hospital, University of
Toronto, Toronto, Ontario, Canada
(Hamza, Siami) New England Research Institutes Inc., Watertown,
Massachusetts, United States
(Goodman) Terrence Donnelly Heart Centre, Division of Cardiology, St.
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Ontario, Canada
Title
Dual Antiplatelet Therapy Versus Aspirin Monotherapy in Diabetics With
Multivessel Disease Undergoing CABG: FREEDOM Insights.
Source
Journal of the American College of Cardiology. 69 (2) (pp 119-127), 2017.
Date of Publication: 17 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Clinical practice guidelines recommend post-operative dual
antiplatelet therapy (DAPT) in patients who undergo coronary artery bypass
grafting (CABG) following acute coronary syndromes (ACS). Objectives The
authors have evaluated DAPT utilization rates and associated outcomes
among post-CABG patients with diabetes. Methods In a post hoc,
nonrandomized analysis from the FREEDOM (Future REvascularization
Evaluation in patients with Diabetes mellitus: Optimal management of
Multivessel disease) trial, we compared patients receiving DAPT (aspirin
plus thienopyridine) and aspirin monotherapy at 30 days post-operatively.
The primary outcome was the risk adjusted 5-year FREEDOM composite of
all-cause mortality, nonfatal myocardial infarction, or stroke. Safety
outcomes included major bleeding, blood transfusion, and hospitalization
for bleeding. Results At 30 days post-CABG, 544 (68.4%) patients received
DAPT and 251 (31.6%) patients received aspirin alone. The median (25th,
75th percentile) duration of clopidogrel therapy was 0.98 (0.23 to 1.91)
years. There was no significant difference in the 5-year primary composite
outcome between DAPT- and aspirin-treated patients (12.6% vs. 16.0%;
adjusted hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.54 to
1.27; p = 0.39). The 5-year primary composite outcomes were similar for
patients receiving DAPT versus aspirin monotherapy respectively, in
subgroups with pre-CABG ACSs (15.2% vs. 16.5%; HR: 1.06; 95% CI: 0.53 to
2.10; p = 0.88) and those with stable angina (11.6% vs. 15.8%; HR: 0.82;
95% CI: 0.50 to 1.343; p = 0.42). The composite outcomes of both treatment
groups were also similar by SYNTAX score, duration of DAPT therapy,
completeness of revascularization, and in off-pump CABG. No
treatment-related differences in major bleeding (5.6% vs. 5.7%; HR: 1.00;
95% CI: 0.50 to 1.99; p = 0.99), blood transfusions (4.8% vs. 4.5%; HR:
1.09; 95% CI: 0.51 to 2.34; p = 0.82), or hospitalization for bleeding
(2.6% vs. 3.3%; HR: 0.85; 95% CI: 0.34 to 2.17; p = 0.74) were observed
between aspirin- and DAPT-treated patients, respectively. Conclusions The
use of DAPT in patients with diabetes post-CABG in our cohort was high.
Compared with aspirin monotherapy, no associated differences were observed
in cardiovascular or bleeding outcomes, suggesting that routine use of
DAPT may not be clinically warranted. (Future REvascularization Evaluation
in patients with Diabetes mellitus: Optimal management of Multivessel
disease [FREEDOM]; NCT00086450) Copyright &#xa9; 2017 American College of
Cardiology Foundation

<46>
Accession Number
614001760
Author
Debray T.P.A.; Damen J.A.A.G.; Snell K.I.E.; Ensor J.; Hooft L.; Reitsma
J.B.; Riley R.D.; Moons K.G.M.
Institution
(Debray, Damen, Hooft, Reitsma, Moons) Cochrane Netherlands, University
Medical Center Utrecht, PO Box 85500 Str 6.131, Utrecht 3508 GA,
Netherlands
(Debray, Damen, Hooft, Reitsma, Moons) Julius Center for Health Sciences
and Primary Care, University Medical Center Utrecht, PO Box 85500 Str
6.131, Utrecht 3508 GA, Netherlands
(Snell, Ensor, Riley) Research Institute for Primary Care and Health
Sciences, Keele University, Staffordshire, United Kingdom
Title
A guide to systematic review and meta-analysis of prediction model
performance.
Source
BMJ (Online). 356 (no pagination), 2017. Article Number: i6460. Date of
Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Validation of prediction models is highly recommended and increasingly
common in the literature. A systematic review of validation studies is
therefore helpful, with meta-analysis needed to summarise the predictive
performance of the model being validated across different settings and
populations. This article provides guidance for researchers systematically
reviewing and meta-analysing the existing evidence on a specific
prediction model, discusses good practice when quantitatively summarising
the predictive performance of the model across studies, and provides
recommendations for interpreting meta-analysis estimates of model
performance. We present key steps of the meta-analysis and illustrate each
step in an example review, by summarising the discrimination and
calibration performance of the EuroSCORE for predicting operative
mortality in patients undergoing coronary artery bypass grafting.

<47>
Accession Number
614004331
Author
Engoren M.; Brown R.R.; Dubovoy A.
Institution
(Engoren, Dubovoy) Department of Anesthesiology, University of Michigan,
1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
(Brown) Department of Anesthesiology, Mercy St. Vincent Medical Center,
Toledo, OH, United States
(Brown) Department of Information Technology Services, Promedica Health
System, Toledo, OH, United States
Title
A retrospective analysis of the effect of blood transfusion on cerebral
oximetry entropy and acute kidney injury.
Source
Perfusion (United Kingdom). 32 (1) (pp 35-43), 2017. Date of Publication:
01 Jan 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Purpose: Acute anemia is associated with both cerebral dysfunction and
acute kidney injury and is often treated with red blood cell transfusion.
We sought to determine if blood transfusion changed the cerebral oximetry
entropy, a measure of the complexity or irregularity of the oximetry
values, and if this change was associated with subsequent acute kidney
injury. Methods: This was a retrospective, case-control study of patients
undergoing cardiac surgery with cardiopulmonary bypass at a tertiary care
hospital, comparing those who received a red blood cell transfusion to
those who did not. Acute kidney injury was defined as a perioperative
increase in serum creatinine by >3/426.4 mumol/L or by >3/450% increase.
Entropy was measured using approximate entropy, sample entropy, forbidden
word entropy and basescale4 entropy in 500-point sets. Results: Forty-four
transfused patients were matched to 88 randomly selected non-transfused
patients. All measures of entropy had small changes in the transfused
group, but increased in the non-transfused group (p<0.05, for all
comparisons). Thirty-five of 132 patients (27%) suffered acute kidney
injury. Based on preoperative factors, patients who suffered kidney injury
were similar to those who did not, including baseline cerebral oximetry
levels. After analysis with hierarchical logistic regression, the change
in basescale4 entropy (odds ratio = 1.609, 95% confidence interval =
1.057-2.450, p = 0.027) and the interaction between basescale entropy and
transfusion were significantly associated with subsequent development of
acute kidney injury. Conclusions: The transfusion of red blood cells was
associated with a smaller rise in entropy values compared to
non-transfused patients, suggesting a change in the regulation of cerebral
oxygenation, and these changes in cerebral oxygenation are also associated
with acute kidney injury. Copyright &#xa9; The Author(s) 2016.

<48>
Accession Number
613998401
Author
Rief W.; Shedden-Mora M.C.; Laferton J.A.C.; Auer C.; Petrie K.J.;
Salzmann S.; Schedlowski M.; Moosdorf R.
Institution
(Rief, Laferton, Auer, Salzmann) University of Marburg, Division of
Clinical Psychology, Gutenbergstrasse 18, Marburg 35032, Germany
(Shedden-Mora) University Medical Center Hamburg Eppendorf, Department of
Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
(Petrie) University of Auckland, Department of Psychological Medicine,
Auckland, New Zealand
(Schedlowski) Institute of Medical Psychology and Behavioral
Immunobiology, University Hospital Essen, Essen, Germany
(Moosdorf) University of Marburg, Department of Cardiac and Thoracic
Vessel Surgery, Heart Centre, Marburg, Germany
Title
Preoperative optimization of patient expectations improves long-term
outcome in heart surgery patients: Results of the randomized controlled
PSY-HEART trial.
Source
BMC Medicine. 15 (1) (no pagination), 2017. Article Number: 4. Date of
Publication: 10 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Placebo effects contribute substantially to outcome in most
fields of medicine. While clinical trials typically try to control or
minimize these effects, the potential of placebo mechanisms to improve
outcome is rarely used. Patient expectations about treatment efficacy and
outcome are major mechanisms that contribute to these placebo effects. We
aimed to optimize these expectations to improve outcome in patients
undergoing coronary artery bypass graft (CABG) surgery. Methods: In a
prospective three-arm randomized clinical trial with a 6 month follow-up,
124 patients scheduled for CABG surgery were randomized to either a brief
psychological pre-surgery intervention to optimize outcome expectations
(EXPECT); or a psychological control intervention focusing on emotional
support and general advice, but not on expectations (SUPPORT); or to
standard medical care (SMC). Interventions were kept brief to be feasible
with a heart surgery environment; "dose" of therapy was identical for both
pre-surgery interventions. Primary outcome was disability 6 months after
surgery. Secondary outcomes comprised further clinical and immunological
variables. Results: Patients in the EXPECT group showed significantly
larger improvements in disability (-12.6; -17.6 to -7.5) than the SMC
group (-1.9; -6.6 to +2.7); patients in the SUPPORT group (-6.7; -11.8 to
1.7) did not differ from the SMC group. Comparing follow-up scores and
controlling for baseline scores of EXPECT versus SUPPORT on the variable
disability only revealed a trend in favor of the EXPECT group (P = 0.09).
Specific advantages for EXPECT compared to SUPPORT were found for mental
quality of life and fitness for work (hours per week). Both psychological
pre-surgery interventions induced less pronounced increases in
pro-inflammatory cytokine concentrations reflected by decreased
interleukin-8 levels post-surgery compared to changes in SMC patients and
lower interleukin-6 levels in patients of the EXPECT group at follow-up.
Both pre-surgery interventions were characterized by great patient
acceptability and no adverse effects were attributed to them. Considering
the innovative nature of this approach, replication in larger, multicenter
trials is needed. Conclusions: Optimizing patients' expectations
pre-surgery helps to improve outcome 6 months after treatment. This
implies that making use of placebo mechanisms has the potential to improve
long-term outcome of highly invasive medical interventions. Further
studies are warranted to generalize this approach to other fields of
medicine. Trial registration: Ethical approval for the study was obtained
from the IRB of the Medical School, University of Marburg, and the trial
was registered at (NCT01407055) on July 25, 2011. Copyright &#xa9; 2017
The Author(s).

<49>
Accession Number
613993591
Author
Xue C.; Bian L.; Xie Y.S.; Yin Z.F.; Xu Z.J.; Chen Q.Z.; Zhang H.L.; Wang
C.Q.
Institution
(Xue, Bian, Xie, Yin, Xu, Chen, Zhang, Wang) Jiao Tong University School
of Medicine, Department of Cardiology, Shanghai Ninth People's Hospital,
Shanghai 200011, China
Title
Impact of smoking on health-related quality of Life after percutaneous
coronary intervention treated with drug-eluting stents: A longitudinal
observational study.
Source
Health and Quality of Life Outcomes. 15 (1) (no pagination), 2017. Article
Number: 1. Date of Publication: 03 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Smoking has been shown to reduce health-related quality of
life (HRQOL) in patients with coronary artery disease (CAD) undergoing
percutanous coronary intervention (PCI) either by means of balloon
angioplasty or with the use of bare-metal stents (BMS). Drug-eluting
stents (DES) have now been widely used and are related to substantial
reduction of restenosis and significantly improved HRQOL compared with
BMS. This study aimed to evaluate the effects of smoking on HRQOL in
patients after PCI in DES era. Methods: A cohort of 649 patients admitted
for CAD and treated with drug-eluting stents were included in this
prospective, observational study. Patients were classified as non-smokers
(n = 351, 54.1%), quitters (n = 126, 19,4%), or persistent smokers (n =
172, 26.5%) according to their smoking status at the time they first
admitted to hospital and during the first year of follow-up. Each patient
was prospectively interviewed at baseline, 6 months and 1 year following
PCI. HRQOL was assessed with the use of Medical Outcomes Study 36-Item
Short-Form Health Survey (SF-36). Results: For the overall population,
HRQOL scores at 1-year follow-up were significantly higher than baseline
for all 8 domains. At 1-year follow-up, the HRQOL scores in persistent
smokers were still lower than that in non-smokers in 6 domains except for
bodily pain and mental health, and than that in quitters in 5 domains
except for bodily pain, role emotional and mental health. There were no
significant differences with regard to the scores between non-smokers and
quitters except role emotional for which non-smokers had higher scores.
After adjustment, persistent smokers demonstrated significantly less
improvements in HRQOL than non-smokers in 6 domains except for bodily pain
and social functioning and significantly less improvement than quitters
for general health. Improvements of quitters were comparable to that of
non-smokers in all domains. Multivariate linear regression analyses showed
persistent smoking was an independent risk factor for PCS and MCS
improvements. Conclusions: Persistent smoking substantially diminishes the
potential quality-of-life benefits of DES. Efforts should be made to
promote smoking cessation after DES implantation which could greatly
improve the health quality outcomes. Copyright &#xa9; 2017 The Author(s).

<50>
Accession Number
614121262
Author
Feizi B.; Taghdisi S.; Etemadi J.; Feizi A.H.; Asgarzadeh S.; Kamal S.
Institution
(Feizi, Taghdisi, Feizi, Kamal) Clinical Research Development Center,
Bouali Hospital, Islamic Azad University, Tehran Medical Sciences Branch,
Tehran, Iran, Islamic Republic of
(Etemadi) Cardiology Department, Imam Hossein Hospital, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Asgarzadeh) Clinical Research Development Center, Amir-almomenin
Hospital, Islamic Azad University, Tehran Medical Sciences Branch, Tehran,
Iran, Islamic Republic of
Title
Early vs late coronary angiography and intervention following thrombolytic
therapy; a cohort study.
Source
Emergency. 5 (1) (pp 180-184), 2017. Date of Publication: 2017.
Publisher
Shahid Beheshti University of Medical Sciences (E-mail:
mstzbmd@sbmu.ac.ir)
Abstract
Introduction: The precise time of using percutaneous coronary intervention
(PCI) after fibrinolytic therapy for maximum efficiency and minimumside
effects is still undetermined. Therefore, the present study was designed
to compare the outcome of myocardial infarction (MI) patients who
underwent surgical intervention (angiography and PCI) within 48 hours of
thrombolytic therapy or after that. Methods: The present study is a
prospective cohort study aiming to compare the occurrence of no-reflow
phenomenon, unstable angina, bleeding during intervention, and one month
major adverse cardiac outcomes (recurrent MI, need for repeating surgical
intervention, andmortality) between MI patents undergoing surgical
intervention within the first 48 hours of or after 48 hours of
thrombolytic therapy. Results: 90 patients with the mean age of 54.97 +/-
10.54 were studied (86.67% male). 50 (56%) patients underwent surgical
intervention within 48 hours and 40 (44%) after that. The 2 groups were
not significantly different regarding baseline characteristics. No-reflow
phenomenon in the < 48 hours group was about twice the > 48 hours group
(OR = 0.35; 95% confidence interval: 0.14 - 0.92; p = 0.03), other
outcomes were not significantly different. No case of mortality was seen
in the 1 month follow up. Conclusion: Based on the results of the present
study, it seems that no-reflow phenomenon rate is significantly lower in
patients undergoing surgical intervention after 48 hours of fibrinolytic
therapy. The difference between the two groups regarding prevalence
ofmajor adverse cardiac outcomes was not statistically significant.
Copyright &#xa9; (2016) Shahid Beheshti University ofMedical Sciences.

<51>
Accession Number
614121089
Author
Valadkhani S.; Jalili M.; Hesari E.; Mirfazaelian H.
Institution
(Valadkhani, Hesari) Emergency Medicine Department, Kermanshah University
of Medical Sciences, Kermanshah, Iran, Islamic Republic of
(Jalili, Mirfazaelian) Emergency Medicine Department, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Validation of the north american chest pain rule in prediction of very
low-risk chest pain; Adiagnostic accuracy study.
Source
Emergency. 5 (1) (pp 60-65), 2017. Date of Publication: 2017.
Publisher
Shahid Beheshti University of Medical Sciences (E-mail:
mstzbmd@sbmu.ac.ir)
Abstract
Introduction: Acute coronary syndrome accounts formore than 15% of the
chest pains. Recently, Hess et al. developedNorth American Chest Pain Rule
(NACPR) to identify very low-risk patientswho can be safely discharged
from emergency department (ED). The present study aimed to validate this
rule in EDs of two academic hospitals. Methods: A prospective diagnostic
accuracy study was conducted on consecutive patients 24 years of age and
older presenting to the ED with the chief complaint of acute chest pain,
during March 2013 to June 2013. Chest pain characteristics, cardiac
history, electrocardiogram findings, and cardiac biomarker measurement of
patients were collected and screening performance characteristics of NACPR
with 95% confidence interval were calculated using SPSS 21. Results: From
400 eligible patients with completed follow up, 69 (17.25 %) developed
myocardial infarction, 121 (30.25%) underwent coronary revascularization,
and 4 (2%) died because of cardiac or unidentifiable causes. By using
NACPR, 34 (8.50%) of all the patients could be considered very low- risk
and discharged after a brief ED assessment. Among these patients, none
developed above-mentioned adverse outcomes within 30 days. Sensitivity,
specificity, positive prediction value, and negative prediction value of
the rule were 100% (95% CI: 87.35 - 100.00), 45.35 (95% CI: 40.19 -
50.61), 14.52 (95% CI: 10.40 - 19.85), and 100 (95% CI: 97.18 - 100.00),
respectively. Conclusion: The present multicenter study showed that NACPR
is a good screening tool for early discharge of patients with very
low-risk chest pain from ED. Copyright &#xa9; (2016) Shahid Beheshti
University ofMedical Sciences.

<52>
Accession Number
614112312
Author
Taksaudom N.; Siwachat S.; Tantraworasin A.
Institution
(Taksaudom, Siwachat, Tantraworasin) Department of Surgery, Faculty of
Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, 110
Suthep Rd, Chiang Mai 50200, Thailand
Title
Additional effects of topical tranexamic acid in on-pump cardiac surgery.
Source
Asian Cardiovascular and Thoracic Annals. 25 (1) (pp 24-30), 2017. Date of
Publication: 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective Postoperative bleeding after cardiac surgery is commonly
associated with hyperfibrinolysis. This study was designed to evaluate the
efficacy of topical tranexamic acid in addition to intravenous tranexamic
acid in reducing bleeding in cardiac surgery cases. Methods From July 1,
2014 to September 30, 2015, 82 patients who underwent elective on-pump
cardiac surgery were randomized into a tranexamic acid group and a placebo
group. In the tranexamic acid group, 1 g of tranexamic acid dissolved in
100 mL of normal saline solution was poured into the pericardium during
sternal closure; the placebo group had 100 mL of saline only. Two patients
were excluded from the study due to obvious surgical bleeding. The primary
endpoint was total blood loss 24 h after surgery. Repeated measures with
mixed models was used to analyze bleeding over time. Results There was no
significant difference in demographic and intraoperative data except for a
significantly lower platelet count preoperatively in the tranexamic acid
group (p = 0.030). There was no significant difference in postoperative
drainage volumes at 8, 16, and 24 h, postoperative bleeding over time
(coefficient = 0.713, p = 0.709), or blood product transfusion between the
groups. There were no serious complications. Conclusions Topical
tranexamic acid is safe but it adds no additional efficacy to the
intravenous application in reducing postoperative blood loss. Intravenous
tranexamic acid administration alone is sufficient antifibrinolytic
treatment to enhance the hemostatic effects during on-pump cardiac
surgery. Copyright &#xa9; The Author(s) 2016.

<53>
Accession Number
613365639
Author
Windecker S.; Tijssen J.; Giustino G.; Guimaraes A.H.C.; Mehran R.;
Valgimigli M.; Vranckx P.; Welsh R.C.; Baber U.; van Es G.-A.; Wildgoose
P.; Volkl A.A.; Zazula A.; Thomitzek K.; Hemmrich M.; Dangas G.D.
Institution
(Windecker, Valgimigli) Bern University Hospital, Bern, Switzerland
(Windecker, Tijssen, Valgimigli, Vranckx, van Es) European Cardiovascular
Research Institute (ECRI), Rotterdam, Netherlands
(Tijssen) Academic Medical Center-University of Amsterdam, Amsterdam,
Netherlands
(Giustino, Mehran, Baber, Dangas) The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New
York City, NY, United States
(Guimaraes, van Es) Cardialysis, Clinical Research Organization,
Rotterdam, Netherlands
(Vranckx) Hartcentrum Hasselt, Hasselt, Belgium
(Welsh) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
(Wildgoose, Volkl) Janssen Pharmaceuticals Inc, Raritan, NJ, United States
(Zazula) Bayer, Sao Paulo, Brazil
(Thomitzek, Hemmrich) Bayer Pharma AG, Berlin, Germany
Title
Trial design: Rivaroxaban for the prevention of major cardiovascular
events after transcatheter aortic valve replacement: Rationale and design
of the GALILEO study.
Source
American Heart Journal. 184 (pp 81-87), 2017. Date of Publication: 01 Feb
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Optimal antithrombotic treatment after transcatheter aortic
valve replacement (TAVR) is unknown and determined empirically. The direct
factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related
thrombotic complications and premature valve failure. Design GALILEO is an
international, randomized, open-label, event-driven, phase III trial in
more than 1,520 patients without an indication for oral anticoagulation
who underwent a successful TAVR (ClinicalTrials.gov NCT02556203). Patients
are randomized (1:1 ratio), 1 to 7 days after a successful TAVR, to either
a rivaroxaban-based strategy or an antiplatelet-based strategy. In the
experimental arm, subjects receive rivaroxaban (10 mg once daily [OD])
plus acetylsalicylic acid (ASA, 75-100 mg OD) for 90 days followed by
rivaroxaban alone. In the control arm, subjects receive clopidogrel (75 mg
OD) plus ASA (as above) for 90 days followed by ASA alone. In case
new-onset atrial fibrillation occurs after randomization, full oral
anticoagulation will be implemented with maintenance of the original
treatment assignment. The primary efficacy end point is the composite of
all-cause death, stroke, myocardial infarction, symptomatic valve
thrombosis, pulmonary embolism, deep venous thrombosis, and systemic
embolism. The primary safety end point is the composite of
life-threatening, disabling, and major bleeding, according to the Valve
Academic Research Consortium definitions. Conclusions GALILEO will test
the hypothesis that a rivaroxaban-based antithrombotic strategy reduces
the risk of thromboembolic complications post-TAVR with an acceptable risk
of bleeding compared with the currently recommended antiplatelet
therapy-based strategy in subjects without need of chronic oral
anticoagulation. Copyright &#xa9; 2016 The Authors

<54>
Accession Number
614141495
Author
Bangalore S.; Fakheri R.; Wandel S.; Toklu B.; Wandel J.; Messerli F.H.
Institution
(Bangalore, Fakheri) New York University School of Medicine, New York, NY,
United States
(Toklu) Mount Sinai Beth Israel Medical Center, New York, NY, United
States
(Wandel) Novartis Pharma AG, Basel, Switzerland
(Wandel) Institute for Risks and Extremes, Bern University of Applied
Sciences, Switzerland
(Messerli) University Hospital, Bern, Switzerland
(Messerli) Mount Sinai, Icahn School of Medicine, New York, NY, United
States
(Messerli) Jagiellonian University, Krakow, Poland
Title
Renin angiotensin system inhibitors for patients with stable coronary
artery disease without heart failure: Systematic review and meta-analysis
of randomized trials.
Source
BMJ (Online). 356 (no pagination), 2017. Article Number: j4. Date of
Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To critically evaluate the efficacy of renin angiotensin system
inhibitors (RASi) in patients with coronary artery disease without heart
failure, compared with active controls or placebo. Design: Meta-analysis
of randomized trials. Data sources: PubMed, EMBASE, and CENTRAL databases
until 1 May 2016. Eligibility criteria for selecting studies: Randomized
trials of RASi versus placebo or active controls in patients with stable
coronary artery disease without heart failure (defined as left ventricular
ejection fraction >40% or without clinical heart failure). Each trial had
to enroll at least 100 patients with coronary artery disease without heart
failure, with at least one year's follow-up. Studies were excluded if they
were redacted or compared use of angiotensin converting enzyme inhibitors
with angiotensin receptor blockers. Outcomes were death, cardiovascular
death, myocardial infarction, angina, stroke, heart failure,
revascularization, incident diabetes, and drug withdrawal due to adverse
effects. Results: 24 trials with 198 275 patient years of follow-up were
included. RASi reduced the risk of all cause mortality (rate ratio 0.84,
95% confidence interval 0.72 to 0.98), cardiovascular mortality (0.74,
0.59 to 0.94), myocardial infarction (0.82, 0.76 to 0.88), stroke (0.79,
0.70 to 0.89), angina, heart failure, and revascularization when compared
with placebo but not when compared with active controls (all cause
mortality, 1.05, 0.94 to 1.17; P<inf>interaction</inf> =0.006;
cardiovascular mortality, 1.08, 0.93 to 1.25, P<inf>interaction</inf>
<0.001; myocardial infarction, 0.99, 0.87 to 1.12, P<inf>interaction</inf>
=0.01; stroke, 1.10, 0.93 to 1.31; P<inf>interaction</inf> =0.002).
Bayesian meta-regression analysis showed that the effect of RASi when
compared with placebo on all cause mortality and cardiovascular mortality
was dependent on the control event rate, such that RASi was only
beneficial in trials with high control event rates (>14.10 deaths and
>7.65 cardiovascular deaths per 1000 patient years) but not in those with
low control event rates. Conclusions: In patients with stable coronary
artery disease without heart failure, RASi reduced cardiovascular events
and death only when compared with placebo but not when compared with
active controls. Even among placebo controlled trials in this study, the
benefit of RASi was mainly seen in trials with higher control event rates
but not in those with lower control event rates. Evidence does not support
a preferred status of RASi over other active controls. Copyright &#xa9;
2016 Published by the BMJ Publishing Group Limited.

<55>
Accession Number
613424695
Author
Ivert T.; Dalen M.; Ander C.; Stalesen R.; Nasman P.; Lordkipanidze M.;
Hjemdahl P.
Institution
(Ivert, Dalen) Department of Cardiothoracic Surgery and Anesthesiology,
Karolinska University Hospital and Department of Molecular Medicine and
Surgery, Karolinska Institutet, Stockholm, Sweden
(Ander, Stalesen, Hjemdahl) Department of Clinical Pharmacology,
Karolinska University Hospital and Department of Medicine Solna,
Karolinska Institutet, Stockholm, Sweden
(Nasman) Center for Safety Research, KTH Royal Institute of Technology,
Stockholm, Sweden
(Lordkipanidze) Faculte de pharmacie, Universite de Montreal and Research
Center, Montreal Heart Institute, Montreal, Quebec, Canada
Title
Platelet function one and three months after coronary bypass surgery in
relation to once or twice daily dosing of acetylsalicylic acid.
Source
Thrombosis Research. 149 (pp 64-69), 2017. Date of Publication: 01 Jan
2017.
Publisher
Elsevier Ltd
Abstract
Introduction Current guidelines recommend acetylsalicylic acid (ASA)
treatment after coronary artery bypass grafting (CABG) to reduce
thrombotic vein graft occlusion. The optimal dosage of ASA is not known.
Materials and methods Forty-two patients undergoing elective CABG were
randomized to receive either ASA 75 mg or 160 mg once daily (OD) or 75 mg
twice daily (BID) after the operation. Platelet function testing was
performed before, and one and three months after the operation. Results
White blood cell counts increased during the initial postoperative days
whereas platelet counts were initially slightly reduced after the
operation but increased after one month without any major changes of mean
platelet volumes. Serum thromboxane B<inf>2</inf> was more effectively
suppressed at one and three months after the operation with ASA 75 mg BID
or 160 mg OD than with 75 mg OD (p < 0.001). ASA 75 mg BID and 160 mg OD
were equally effective. Adenosine diphosphate stimulated platelet
aggregation in whole blood (Multiplate) was increased one and three months
after the operation, and this was counteracted by ASA 75 mg BID but not by
75 or 160 mg OD. Arachidonic acid-induced aggregation was more effectively
inhibited by 75 mg BID or 160 mg OD compared to 75 mg OD at three months.
Conclusions Less effective inhibition of platelet activation was obtained
with ASA 75 mg OD than with ASA 160 mg OD or 75 mg BID up to three months
after CABG. Especially the latter dose is of interest for further studies
of efficacy and clinical outcomes after CABG. Copyright &#xa9; 2016
Elsevier Ltd

<56>
Accession Number
614288344
Author
Lee S.M.K.; Leem J.; Park J.H.; Yoon K.H.; Woo J.S.; Lee J.M.; Kim J.-B.;
Kim W.; Lee S.
Institution
(Lee, Leem, Lee) Department of Clinical Korean Medicine, Graduate School,
Kyung Hee University, Seoul, South Korea
(Park, Yoon) Department of Acupuncture and Moxibustion, College of Korean
Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
(Woo, Lee, Kim, Kim) Division of Cardiology, Kyung Hee University
Hospital, Kyung Hee University, Seoul, South Korea
Title
Close look at the experiences of patients enrolled in a clinical trial of
acupuncture treatment for atrial fibrillation in Korea: A qualitative
study nested within a randomised controlled trial.
Source
BMJ Open. 7 (2) (no pagination), 2017. Article Number: e013180. Date of
Publication: 01 Feb 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To explore the experiences of patients with atrial fibrillation
(AF) in the context of a prospective, two-parallel-armed,
participant-blinded and assessorblinded sham-controlled randomised trial.
Design: A nested qualitative study within an ongoing randomised controlled
trial to explore acupuncture's antiarrhythmic effects on drug refractory
acupuncture in persistent atrial fibrillation (AF) (ACU-AF trial).
Participants: Participants were recruited using purposeful sampling and a
maximum variation strategy with regard to treatment allocation (treatment
or control) and protocol completion (completion or non-completion).
Setting: This was a single-centre in-depth interview qualitative study
conducted at a tertiary-level university hospital in Seoul, Republic of
Korea. Results: Data saturation was reached after 8 participants. Thematic
analysis identified that most patients were not aware of their condition
until medical check-up; physician referral was the main reason for trial
participation, and patients had high expectations regardless of previous
acupuncture experiences. Patients tended to depend on their physicians'
opinions because they felt helpless of their condition. No one questioned
their assigned treatment groups and generally believed acupuncture
treatment was different for cardiovascular diseases. A few patients
expressed disappointment in the strict and rigid protocols, in which most
practitioners refrained from explaining their acupuncture procedures.
Conclusions: For cardiovascular patients their physician's advice was one
of the biggest reasons for enrolling in the acupuncture trial therefore
relying on standard recruitment methods may not be effective. Fortunately
both real and sham acupuncture groups in our sample were receiving
treatment as intended, but in the future, designing a more pragmatic trial
(better reflecting clinical settings, expanding the inclusion criteria and
using more treatment points) will allow researchers to better explore the
comprehensive effects of acupuncture. The findings of this study will
allow researchers to improve the currently ongoing ACU-AF trial and to
further help interpretation of main trial outcomes once the trial is
completed.

<57>
Accession Number
611358250
Author
Seiffert M.; Fujita B.; Avanesov M.; Lunau C.; Schon G.; Conradi L.;
Prashovikj E.; Scholtz S.; Borgermann J.; Scholtz W.; Schafer U.; Lund G.;
Ensminger S.; Treede H.
Institution
(Seiffert, Lunau, Schafer) Department of General and Interventional
Cardiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg
20246, Germany
(Fujita, Prashovikj, Borgermann, Ensminger) Department of Thoracic and
Cardiovascular Surgery, Heart and Diabetes CenterNRW, Bad Oeynhausen,
Germany
(Avanesov, Lund) Department of Radiology, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Schon) Department of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Conradi, Treede) Department of Cardiovascular Surgery, University Heart
Center Hamburg, Hamburg, Germany
(Scholtz, Scholtz) Department of Cardiology, Heart and Diabetes Center
NRW, Bad Oeynhausen, Germany
Title
Device landing zone calcification and its impact on residual regurgitation
after transcatheter aortic valve implantation with different devices.
Source
European Heart Journal Cardiovascular Imaging. 17 (5) (pp 576-584), 2016.
Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Calcification of the device landing zone is linked to paravalvular
regurgitation after transcatheter aortic valve implantation (TAVI). The
mechanisms remain incompletely understood and the performance of
next-generation transcatheter heart valves (THV) has not been
investigated. We evaluated the impact of calcification patterns on
residual aortic regurgitation (AR) after TAVI with different THV in
patients with severe aortic stenosis. Methods and Results TAVI was
performed in 537 patients at two centres. Devices implanted were the
Edwards Sapien XT (n 254), Medtronic CoreValve (n 123), JenaValve (n 62),
Medtronic Engager (n 56), and Symetis Acurate (n 42) prostheses.
Calcification of the device landing zone was retrospectively assessed from
contrast-enhanced multidetector computed tomography data and correlated
with echocardiographic and clinical data. Calcium volumes of the aortic
valve and left-ventricular outflow tract were associated with residual AR:
No AR, 604 mm3 (inter-quartile range, IQR 349-916); trace AR, 639 mm3 (IQR
368-948); mild AR, 710 mm3 (IQR 412-2078); moderate AR, 1041 mm3 (IQR
791-1417, P 0.001). Device landing zone calcium, particularly if located
in the left-ventricular outflow tract, and a low cover index were
predictive of AR. Differences in the incidence of AR were observed with
regard to THV type. Higher calcium volume was associated with the need for
post-dilation (n 134, median 852 [IQR 342-945] vs. 604 [IQR 542-1207] mm3,
P , 0.001). Conclusion Calcification of the device landing zone,
particularly if located inferior to the annulus, was independently
associated with residual AR after TAVI with all evaluated THV; however,
the incidence of paravalvular leakage differed significantly between the
devices implanted. Copyright &#xa9; The Author 2015.

<58>
[Use Link to view the full text]
Accession Number
611524991
Author
Ahmed E.A.; Montalti R.; Nicolini D.; Vincenzi P.; Coletta M.; Vecchi A.;
Mocchegiani F.; Vivarelli M.
Institution
(Ahmed, Montalti, Nicolini, Vincenzi, Coletta, Vecchi, Mocchegiani,
Vivarelli) Hepatobiliary and Abdominal Transplantation Surgery, Department
of Experimental and Clinical Medicine, Polytechnic University of Marche,
A.O.U. 'Ospedali Riuniti', via Conca 71, Ancona 60126, Italy
(Ahmed) Hepatobiliary and Pancreatic Surgery Unit, General Surgery
Department, Sohag University, Sohag, Egypt
Title
Fast track program in liver resection: A PRISMA-compliant systematic
review and meta-analysis.
Source
Medicine (United States). 95 (28) (no pagination), 2016. Article Number:
e4154. Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: FT program (FT) is a multimodal approach used to enhance
postoperative rehabilitation and accelerate recovery. It was 1st described
in open heart surgery, then modified and applied successfully in
colorectal surgery. FT program was described in liver resection for the
1st time in 2008. Although the program has become widely accepted, it has
not yet been considered the standard of care in liver surgery. Objectives:
we performed this systematic review and meta-analysis to evaluate the
impact of using the FT program compared to the traditional care (TC), on
the main clinical and surgical outcomes for patients who underwent
elective liver resection. Methods: PubMed/Medline, Scopus, and Cochran
databases were searched to identify eligible articles that compared FT
with TC in elective liver resection to be included in this study. Subgroup
meta-analysis between laparoscopic and open surgical approaches to liver
resection was also conducted. Quality assessment was performed for all the
included studies. Odds ratios (ORs) and mean differences (MDs) were
considered as a summary measure of evaluating the association in this
meta-analysis for dichotomous and continuous data, respectively. A 95%
confidence interval (CI) was reported for both measures. I² was
used to assess the heterogeneity across studies. Results: From 2008 to
2015, 3 randomized controlled trials (RCTs) and 5 cohort studies were
identified, including 394 and 416 patients in the FT and TC groups,
respectively. The length of hospital stay (LoS) was markedly shortened in
both the open and laparoscopic approaches within the FT program (P <
0.00001). The reduced LoS was accompanied by accelerated functional
recovery (P = 0.0008) and decreased hospital costs, with no increase in
readmission, morbidity, or mortality rates. Moreover, significant results
were found within the FT group such as reduced operative time (P = 0.03),
lower intensive care unit admission rate (P < 0.00001), early bowel
opening (P < 0.00001), and rapid normal diet restoration (P < 0.00001).
Conclusion: FT program is safe, feasible, and can be applied successfully
in liver resection. Future RCTs on controversial issues such as multimodal
analgesia and adherence rate are needed. Specific FT guidelines should be
developed for liver resection. Copyright &#xa9; 2016 the Author(s).
Published by Wolters Kluwer Health, Inc. All rights reserved.

<59>
Accession Number
613524995
Author
Miozzo A.P.; Stein C.; Bozzetto C.B.; Plentz R.D.M.
Institution
(Miozzo, Stein, Bozzetto, Plentz) Universidade Federal de Ciencias da
Saude de Porto Alegre, Porto Alegre, RS, Brazil
(Miozzo, Stein) Instituto de Cardiologia do Rio Grande do Sul, Fundacao
Universitaria de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil
Title
Massage therapy reduces pain and anxiety after cardiac surgery: A
systematic review and meta-analysis of randomized clinical trials.
Source
Clinical Trials and Regulatory Science in Cardiology. 23-24 (pp 1-8),
2016. Date of Publication: 01 Nov 2016.
Publisher
Elsevier B.V.
Abstract
Background Cardiac surgery is one of the most frequently performed
surgeries worldwide and its postoperative period is associated with
complications. Studies show that massage therapy alone or accompanied by
other complementary treatments is beneficial in reducing pain and
psychological symptoms. Objective The aim of this study was to review the
effects of treatment with massage therapy on the symptoms of pain and
anxiety reported by patients who underwent heart surgery. Methods The
electronic databases searched were (from inception to March 2016):
MEDLINE, PEDro, Cochrane CENTRAL and EMBASE. In addition, a manual search
of the references on the published papers used in the study was performed.
These included randomized clinical trials with patients who underwent
heart surgery, comparing the postoperative treatment with massage and the
usual treatment. Studies that did not provide necessary information were
excluded from the meta-analysis. The primary outcome extracted was pain
measured by the visual analog scale. The other outcome was anxiety.
Results A number of 962 records was identified in the database search; 10
randomized clinical trials were included in the systematic review,
providing data on 888 individuals. Massage therapy was associated with
decreased pain (- 1.52 [95% CI, - 2.2, - 0.84; I2 91%], p < 0.0001) and
with lower anxiety in the postoperative period when compared to the
control group (- 1.48 [95% CI, - 1.93, - 1.04; I2 0%], p < 0.0001).
Conclusion Massage therapy might be a useful method to reduce pain and
anxiety in patients undergoing cardiac surgery. Copyright &#xa9; 2016

<60>
Accession Number
613982128
Author
Vincent J.-L.; e Silva A.Q.; Couto L.; Taccone F.S.
Institution
(Vincent, e Silva, Couto, Taccone) Department of Intensive Care, Erasme
Hospital, Universite Libre de Bruxelles, Route de Lennik 808, Brussels
1070, Belgium
Title
The value of blood lactate kinetics in critically ill patients: A
systematic review.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 257. Date of
Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The time course of blood lactate levels could be helpful to
assess a patient's response to therapy. Although the focus of published
studies has been largely on septic patients, many other studies have
reported serial blood lactate levels in different groups of acutely ill
patients. Methods: We performed a systematic search of PubMed, Science
Direct, and Embase until the end of February 2016 plus reference lists of
relevant publications. We selected all observational and interventional
studies that evaluated the capacity of serial blood lactate concentrations
to predict outcome. There was no restriction based on language. We
excluded studies in pediatric populations, experimental studies, and
studies that did not report changes in lactate values or all-cause
mortality rates. We separated studies according to the type of patients
included. We collected data on the number of patients, timing of lactate
measurements, minimum lactate level needed for inclusion if present, and
suggested time interval for predictive use. Results: A total of 96 studies
met our criteria: 14 in general ICU populations, five in general surgical
ICU populations, five in patients post cardiac surgery, 14 in trauma
patients, 39 in patients with sepsis, four in patients with cardiogenic
shock, eight in patients after cardiac arrest, three in patients with
respiratory failure, and four in other conditions. A decrease in lactate
levels over time was consistently associated with lower mortality rates in
all subgroups of patients. Most studies reported changes over 6, 12 or 24
hrs, fewer used shorter time intervals. Lactate kinetics did not appear
very different in patients with sepsis and other types of patients. A few
studies suggested that therapy could be guided by these measurements.
Conclusions: The observation of a better outcome associated with
decreasing blood lactate concentrations was consistent throughout the
clinical studies, and was not limited to septic patients. In all groups,
the changes are relatively slow, so that lactate measurements every 1-2
hrs are probably sufficient in most acute conditions. The value of lactate
kinetics appears to be valid regardless of the initial value. Copyright
&#xa9; 2016 The Author(s).

<61>
Accession Number
611418389
Author
Jafari H.; Ariaeifar M.R.; Charati J.Y.; Soleimani A.; Nasiri Formi E.
Institution
(Jafari) Department of Medical Surgical Nursing, School of Nursing and
Midwifery, Traditional and Complementary Medicine Research Center,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Ariaeifar) Student Research Center, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Charati) Department of Biostatistics, School of Health, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Soleimani) Department of Anesthesiology, School of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Nasiri Formi) Department of Anesthesiology, School of Paramedical,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
Title
The effect of green tea gargle solution on sore throat after coronary
artery bypass grafting: A randomized clinical trial.
Source
Anesthesiology and Pain Medicine. 6 (3) (no pagination), 2016. Article
Number: e32108. Date of Publication: June 2016.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Tracheal intubation is an essential method of keeping the
airway open in patients under general anesthesia. Sore throat is a
prevalent complication after endotracheal intubation. Objectives: The aim
of this study was to investigate the effect of green tea gargling on sore
throat after coronary artery bypass grafting (CABG). Patients and Methods:
This was a single-blind, randomized clinical trial, in which 121 patients
who had undergone CABG were divided into two groups: those who gargled
distilled water and those who gargled a green tea solution. An hour after
extubation, the patients of the intervention group were asked to gargle 30
cc of green tea, and the patients of the control group were asked to
gargle 30 cc of distilled water, every 6 hours for up to 24 hours (four
times per patient). A sore throat questionnaire was filled out 6, 12, and
24 hours after endotracheal extubation. Results: The results showed that
there were no significant differences between the two groups with regard
to patient age, sex, body mass index, smoking background, and duration of
anesthesia. There was no significant difference between the two groups in
terms of sore throat before the intervention (P = 0.461) and 6 hours after
the intervention (P = 0.901). However, a significant difference was
observed between the two groups in terms of sore throat 12 hours (P =
0.047) and 24 hours (P < 0.001) after removing the endotracheal tube.
Conclusions: Gargling a green tea solution, an anti-inflammatory, natural,
and harmless substance, can reduce the pain of sore throat in patients
after endotracheal extubation. Copyright &#xa9; 2016, Iranian Society of
Regional Anesthesia and Pain Medicine (ISRAPM).

<62>
Accession Number
611418386
Author
Mosaffa F.; Mohajerani S.A.; Aminnejad R.; Solhpour A.; Dabir S.; Mohseni
G.R.
Institution
(Mosaffa, Mohajerani, Aminnejad, Solhpour, Dabir, Mohseni) Department of
Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Preemptive oral clonidine provides better sedation than intravenous
midazolam in brachial plexus nerve blocks.
Source
Anesthesiology and Pain Medicine. 6 (3) (no pagination), 2016. Article
Number: e28768. Date of Publication: June 2016.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Preemptive analgesia is the blocking of pain perception
afferent pathways before noxious painful stimuli. Clonidine is an alpha
agonist drug that is partially selective for alpha-2 adrenoreceptors.
Clonidine is used as anti-anxiety medication and an, analgesic, and it
prolongs the duration of the block in the brachial plexus block.
Objectives: To compare the effect of preemptive clonidine with midazolam
on intraoperative sedation, duration of block, and postoperative pain
scores. Patients and Methods: In a randomized clinical trial, 80 patients
with orthopedic fractures of an upper extremity who underwent
supraclavicular nerve block were randomly assigned to receive 0.2 mg oral
clonidine or 2 mg oral midazolam. Intraoperative sedation was measured at
one hour after the start of urgery and again in the PACU (Post-Anesthesia
Care Unit) using the Ramsay scale. The duration of sensory blockade was
measured. Postoperative pain scores were measured using the VAS (Visual
Analogue Scale) after entrance to recovery up to 2 hours. Results: The
percentages of patients in the calm and sedated scale were significantly
higher in clonidine group (35 and 42.5%, respectively), compared to the
midazolam group (17.5 and 17.5%, respectively) (P = 0.042, 0.029;
respectively). Those administered fentanyl in the clonidine group
105+/-30.8 was significantly lower than that for the midazolam group
165+/-34.5 (P = 0.0018). The percentages of patients in the calm scale
were significantly higher in the clonidine group (52.5), compared to the
midazolam group (17.5) (P = 0.001) in the post-operative period. VAS
scores were significantly lower at one (P = 0.01) and two hours (P =
0.001) after operation in the clonidine group, compared to the midazolam
group. Conclusions: Preemptive clonidine has many marvelous advantages
over midazolam, including better sedation inside the operating room and
then in the post-operative care unit, lower fentanyl doses are required
during surgery, more stable heart rate and blood pressure are observed
during the procedure, and patients report lower post-operative pain
scores. Copyright &#xa9; 2016, Iranian Society of Regional Anesthesia and
Pain Medicine (ISRAPM).

<63>
Accession Number
610921941
Author
Dadjou Y.; Safavi S.; Kojuri J.
Institution
(Dadjou) Atherosclerosis Research Center, Baqiyatallah University of
Medical Science, Tehran, Iran, Islamic Republic of
(Safavi) Quality Improvement in Clinical Education Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Kojuri) Quality Improvement in Clinical Education Research Center, Shiraz
Cardiovascular Research Center, Zand St Namazi Hosp. Cardiology Office,
Shiraz, Iran, Islamic Republic of
Title
Risks and benefits of dual antiplatelet therapy beyond 12 months after
coronary stenting.
Source
Medicine (United States). 95 (22) (no pagination), 2016. Article Number:
e3663. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The optimal duration of dual antiplatelet therapy (DAT) after coronary
stenting remains poorly define. The aim of this study was to evaluate the
impact of longer than 24 months DAT in patients who received drug-eluting
and bare-metal stents. A total of 1010 individuals who underwent elective,
urgent or emergency coronary angioplasty with intended stent implantation
at reference or specialized cardiac hospitals were randomized to receive
long-term and short-term DAT to determine the benefits and adverse effects
of long-term DAT. Total of 508 patients were randomized to long-term and
502 patients to <1 year DAT, and all of them were followed for more than
36 months for major adverse cardiac and cerebvascular events and bleeding
major adverse cardiac and cerebvascular events (MACCE) Mean age of the
1010 patients (364 women and 646 men) was 60 years. Stent reocclusion
occurred in 15 patients. Mean Syntax score was 23.00+/-5.08 for whole
samples, 25.00+/-5.27 in 28 patients with MACCE and 23+/-5.00 in 982
patients without MACCE (P=0.057). According to all specified bleeding
definitions, clopidogrel therapy for >12 months was not associated with a
greater risk of hemorrhage. A regimen of >12 months of clopidogrel therapy
in patients who had received drug-eluting or bare-metal stents did not
differ significantly from a regimen of <12 months on clopidogrel with
regard to MACCE. Long-term DAT might not significantly affect the
reduction in the risk of death from any cause, myocardial infarction, or
stroke, and not associated with minor or major bleeding events. Copyright
&#xa9; 2016 Wolters Kluwer Health, Inc.

<64>
[Use Link to view the full text]
Accession Number
611009575
Author
Lee S.Y.; Yoo J.Y.; Kim J.Y.; Kim D.H.; Lee J.D.; Rho G.U.; Park H.; Park
S.Y.
Institution
(Lee, Yoo, Kim, Kim, Rho, Park, Park) Department of Anesthesiology and
Pain Medicine, Ajou University, School of Medicine, 5 Wonchon-Dong,
Youngtong-Gu, Suwon 443-721, South Korea
(Lee) Office of Biostatistics, Ajou University, School of Medicine, Suwon,
South Korea
Title
Optimal effect-site concentration of remifentanil for preventing cough
during removal of the double-lumen endotracheal tube from
sevoflurane-remifentanil anesthesia A prospective clinical trial.
Source
Medicine (United States). 95 (24) (no pagination), 2016. Article Number:
e3878. Date of Publication: 21 Jun 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Opioids are used as a treatment for coughing. Recent studies have reported
an antitussive effect of remifentanil during recovery from general
anesthesia by suppressed coughing. The coughing reflex may differ
throughout the respiratory tract from the larynx to the bronchi. But the
proper dose of remifentanil to prevent cough during double-lumen tube
(DLT) extubation is unknown. Twenty-five ASA physical status 1 and 2
patients, 20 to 65 years of age who were undergoing video-assisted
thoracoscopic lung surgery requiring 1-lung ventilation were enrolled. The
effective effect-site concentration (Ce) of remifentanil for 50% and 95%
of patients (EC<inf>50</inf> and EC<inf>95</inf>) for preventing cough was
determined using the isotonic regression method with a bootstrapping
approach, following the Dixon up-and-down method. Recovery profiles and
hemodynamic values after anesthesia were compared between patients with
cough and patients without cough. EC<inf>50</inf> and EC<inf>95</inf> of
remifentanil was 1.670ng/mL [95% confidence interval (95% CI) 1.393-1.806]
and 2.275ng/mL (95% CI 1.950-2.263), respectively. There were no
differences in recovery profiles and hemodynamic values after anesthesia
between patients with/without cough. No patients suffered respiratory
complications during the emergence period. Remifentanil can be a safe and
reliable method of cough prevention during emergence from sevoflurane
anesthesia after thoracic surgery requiring DLT. EC<inf>50</inf> and
EC<inf>95</inf> of remifentanil that suppresses coughing is 1.670 and
2.275 ng/mL, respectively. Copyright &#xa9; 2016 Wolters Kluwer Health,
Inc. All rights reserved.

<65>
Accession Number
612123594
Author
Trikha R.; Kowey P.R.
Institution
(Trikha, Kowey) Lankenau Institute for Medical Research, Medical Office
Building East, 100 East Lancaster Avenue, Wynnewood, PA 19096, United
States
(Kowey) Jefferson Medical College, Philadelphia, PA, United States
Title
Practical Considerations for the Nonvitamin K Antagonist Oral
Anticoagulants.
Source
Cardiology (Switzerland). 136 (2) (pp 115-124), 2017. Date of Publication:
01 Jan 2017.
Publisher
S. Karger AG
Abstract
Objectives: Dabigatran, rivaroxaban, apixaban, and edoxaban are nonvitamin
K antagonist oral anticoagulants (NOACs) approved for stroke prevention in
patients with nonvalvular atrial fibrillation (NVAF). Phase-3 clinical
trials demonstrated NOACs were as effective as warfarin in the prevention
of stroke or systemic embolism and associated with decreased incidences of
intracranial bleeding. Additionally, NOACs provide quicker onset of
action, simpler dosing, more predictable pharmacokinetic profiles, and
decreased food and drug interactions compared with warfarin. Despite the
advantages of NOACs, the lack of knowledge may limit their use in clinical
practice. Methods: A search was performed on the terms 'atrial
fibrillation' and 'dabigatran', 'apixaban', 'edoxaban', or 'rivaroxaban'
to identify relevant papers; large randomized clinical trials,
meta-analyses, and treatment guideline recommendations were given
preference. Searches to identify registries, treatment guidelines, and
meta-analyses relevant to patient subgroups were also employed. Results:
Dosing recommendations, initiation of treatment, and applications in
patients who undergo NVAF procedures, have mechanical heart valves, or
experience other cardiovascular conditions such as myocardial infarction,
previous stroke, and valvular heart disease are summarized. The
NOAC-specific reversal approaches are also discussed. Conclusions: Several
important factors should be considered regarding the adequate use of
NOACs, especially in patients with renal impairment or cardiovascular
conditions other than NVAF. Copyright &#xa9; 2016 S. Karger AG, Basel.

<66>
Accession Number
614024062
Author
Brooks M.; Ellis C.; Gamble G.; Devlin G.; Elliott J.; Hammett C.; Chew
D.; French J.; Briffa T.; Redfern J.; Rankin J.; Hyun K.; D'Souza M.;
Brieger D.
Institution
(Brooks) Concord Medical School, The University of Sydney, Sydney, NSW,
Australia
(Ellis) Department of Cardiology, Auckland City Hospital, Auckland, NZ,
United States
(Gamble) Department of Medicine, University of Auckland, Auckland, NZ,
United States
(Devlin) Cardiology, Waikato Hospital, Waikato, NZ, United States
(Elliott) Cardiology, Christchurch Hospital, Christchurch, NZ, United
States
(Hammett) Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld.,
Australia
(Chew) Cardiology, Department of Cardiovascular Medicine, Flinders
University, Adelaide, SA, Australia
(French) Coronary Care Unit, Liverpool Hospital, Sydney, NSW, Australia
(Briffa) Cardiovascular Research Group, School of Population Health,
University of Western Australia, Perth, WA, Australia
(Redfern) Cardiovascular Division, The George Institute of Global Health,
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
(Rankin) Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
(Hyun) The George Institute for Global Health, Sydney, NSW, Australia
(D'Souza) Concordance Registry, Concord Hospital, Sydney, NSW, Australia
(Brieger) Coronary Care and Coronary Intervention, Department of
Cardiology, Concord Hospital, Sydney, NSW, Australia
Title
A Comparison of Radial and Femoral Coronary Angiography in Patients From
SNAPSHOT ACS, a Prospective Acute Coronary Syndrome Audit in Australia and
New Zealand.
Source
Heart Lung and Circulation. 26 (3) (pp 258-267), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background There is wide variation in the use of radial over femoral
access for patients with ACS. This study evaluates the factors associated
with the selection of radial versus femoral angiography in Australia and
New Zealand and the effect of access site on clinical events in acute
coronary syndrome (ACS) patients. Methods An analysis of the SNAPSHOT ACS
audit was conducted during May 2012 across 286 hospitals in Australia and
New Zealand. Data collected included baseline patient characteristics,
hospital site details, treatment received, clinical events in-hospital and
mortality at 18 months. Univariate and multivariable analyses were
performed. Results Of the 1621 patients undergoing coronary angiography,
access was through the femoral artery in 1043 (63%), and the radial in 578
(36%) patients. Radial access dominated in New Zealand (241 out of 327,
73.7%), compared to Australia (337 out of 1293, 26.1%, p=<0.001), with
interstate variation (6% to 54%, p=<0.001). Independent predictors of
access site included country of admission (Odds of radial, Aus v NZ OR
0.14, 95% CI 0.08-0.24, p=<0.0001), prior CABG surgery (OR 0.16, 95% CI
0.09-0.31, p=<0.0001), high GRACE score (90^th decile) (OR 0.44,
95% CI 0.21-0.91, p=0.026) and admission to a centre with high annual PCI
volume (>209 cases per year) (OR 1.86, 95% CI 1.06-3.26, p=0.03). After
adjustment, there was no difference in clinical events in-hospital or
mortality at 18 months Conclusion Coronary angiography in New Zealand
rather than Australia is the strongest predictor of radial access in ACS
patients. There was no difference in outcomes according to access site in
this population based cohort study. Copyright &#xa9; 2016

<67>
Accession Number
614303172
Author
Redfors B.; He C.-H.; Palmerini T.; Caixeta A.; Giustino G.; Ayele G.M.;
Kirtane A.J.; Mehran R.; Stone G.W.; Genereux P.
Institution
(Redfors, He, Ayele, Kirtane, Mehran, Stone, Genereux) Cardiovascular
Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, United
States
(He) First Affiliated Hospital of Xinjiang Medical University, Urumqi,
Xinjiang, China
(Palmerini) Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna,
Italy
(Caixeta) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Giustino, Mehran) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Kirtane, Stone) NewYork-Presbyterian Hospital, Columbia University
Medical Center, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Genereux) Morristown Medical Center, Morristown, NJ, United States
Title
The SYNTAX score does not predict risk of adverse events in patients with
non-ST elevation acute coronary syndrome who undergo coronary artery
bypass graft surgery.
Source
Journal of Invasive Cardiology. 29 (2) (pp 42-49), 2017. Date of
Publication: February 2017.
Publisher
HMP Communications
Abstract
Objectives. We tested the ability of the SYNTAX score (SS) to predict
1-year adverse outcomes for patients with non-ST segment elevation acute
coronary syndromes (NSTE-ACS) who undergo coronary artery bypass graft
(CABG) surgery. Background. The SS effectively risk stratifies patients
who undergo percutaneous coronary intervention, but not patients with
stable coronary disease who undergo CABG. Methods. We calculated the SS
for 457 patients with NSTE-ACS in the angiographic substudy of the ACUITY
(Acute Catheterization and Urgent Intervention Triage StrategY) trial who
underwent CABG. We stratified and compared patients according to SS
tertiles. We tested the ability of the SS, as a linear covariate, to
predict adverse events by univariate analyses and by univariate and
multivariable Cox proportional hazards model. We also tested the
predictive abilities of the Age, Creatinine Clearance, and Ejection
Fraction (ACEF) score, the clinical SS, and the logistic clinical SS.
Results. The median SS was 23 (interquartile range, 15-30). Baseline
clinical characteristics were similar among the groups. One-year mortality
and major adverse cardiovascular events (all-cause death, myocardial
infarction, any stroke, or urgent revascularization) were similar between
the groups (P=.13 and P=.62, respectively). Receiver operating
characteristic curves, net reclassification indices, and integrated
discrimination indices did not improve with SS, clinical SS, or logistic
clinical SS compared with the ACEF score. Conclusions. The anatomical SS
does not appear to be useful in risk stratifying patients with NSTE-ACS
who undergo CABG. Clinical variables may better risk stratify patients
with complex coronary artery disease considered for CABG.

<68>
Accession Number
613216203
Author
Burrage M.; Moore P.; Cole C.; Cox S.; Lo W.C.; Rafter A.; Garlick B.;
Garrahy P.; Mundy J.; Camuglia A.
Institution
(Burrage, Moore, Cole, Cox, Lo, Garrahy, Mundy, Camuglia) Department of
Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
(Burrage, Moore, Cole, Cox, Lo, Rafter, Garlick, Garrahy, Mundy, Camuglia)
University of Queensland, Brisbane, QLD, Australia
(Cox, Rafter, Garlick, Camuglia) The Wesley Hospital, Brisbane, QLD,
Australia
Title
Transcatheter Aortic Valve Replacement is Associated with Comparable
Clinical Outcomes to Open Aortic Valve Surgery but with a Reduced Length
of In-Patient Hospital Stay: A Systematic Review and Meta-Analysis of
Randomised Trials.
Source
Heart Lung and Circulation. 26 (3) (pp 285-295), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Aortic valve replacement is indicated in patients with severe
symptomatic aortic stenosis (AS). Transcatheter aortic valve replacement
(TAVR) has evolved as a potential strategy in a growing proportion of
patients in preference to surgical aortic valve replacement (SAVR). This
meta-analysis aims to assess the differential outcomes of TAVR and SAVR in
patients enrolled in published randomised controlled trials (RCTs).
Methods A systematic literature search of Cochrane Library, EMBASE, OVID,
and PubMed MEDLINE was performed. Randomised controlled trials of patients
with severe AS undergoing TAVR compared with SAVR were included. Clinical
outcomes and procedural complications were assessed. Results Five RCTs
with a total of 3,828 patients (1,928 TAVR and 1,900 SAVR) were analysed.
There was no statistically significant difference in combined rates of
all-cause mortality and stroke at 30-days for TAVR vs SAVR (6.3% vs 7.5%;
OR 0.83; 95% CI: 0.64-1.08; P = 0.17) or at 12 months (17.2% vs 19.2%; OR
0.87; 95% CI: 0.73-1.03; P = 0.29). No statistically significant
difference was seen for death or stroke separately at any time point
although a numerical trend in favour of TAVR for both was recorded. Length
of in-patient stay was significantly less with TAVR vs SAVR (9.6 +/- 7.7
days vs 12.2 +/- 8.8 days; OR -2.94; 95% CI: -4.64 to -1.24; P = 0.0007).
Major vascular complications were more frequent in patients undergoing
TAVR vs SAVR (8.2% vs. 4.0%; OR 2.15; 95% CI: 1.62-2.86; P <0.00001) but
major bleeding was more common among SAVR patients (20.5% vs 44.2%; OR
0.34; 95% CI: 0.22-0.52; P = <0.00001). Conclusions Transcatheter aortic
valve replacement and SAVR are associated with overall similar rates of
death and stroke among patients in intermediate to high-risk cohorts but
with reduced length of in-patient hospital stay. Copyright &#xa9; 2016

<69>
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.

<70>
Accession Number
614244493
Author
Robertson L.; Paraskevas K.I.; Stewart M.
Institution
(Robertson) Freeman Hospital, Department of Vascular Surgery, Newcastle
upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne
NE7 7DN, United Kingdom
(Paraskevas) Freeman Hospital, Northern Vascular Centre, Newcastle upon
Tyne, United Kingdom
(Stewart) University of Edinburgh, Usher Institute of Population Health
Sciences and Informatics, Medical School, Teviot Place, Edinburgh EH8 9AG,
United Kingdom
Title
Angioplasty and stenting for peripheral arterial disease of the lower
limbs: An overview of Cochrane Reviews.
Source
Cochrane Database of Systematic Reviews. 2017 (2) (no pagination), 2017.
Article Number: CD012542. Date of Publication: 01 Feb 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
This is a protocol for a Cochrane Review (Overview). The objectives are as
follows: To summarise the evidence from relevant Cochrane Reviews
regarding effectiveness of angioplasty and stenting for peripheral
arterial disease of the lower limbs. Copyright &#xa9; 2017 The Cochrane
Collaboration.

<71>
Accession Number
613982512
Author
Andersen L.W.; Holmberg M.J.; Berg K.M.; Chase M.; Cocchi M.N.; Sulmonte
C.; Balkema J.; MacDonald M.; Montissol S.; Senthilnathan V.; Liu D.;
Khabbaz K.; Lerner A.; Novack V.; Liu X.; Donnino M.W.
Institution
(Andersen, Holmberg, Chase, Cocchi, Sulmonte, Balkema, MacDonald,
Montissol, Liu, Donnino) Center for Resuscitation Science, Department of
Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline
Avenue, Boston, MA 02215, United States
(Andersen) Department of Anesthesiology, Aarhus University Hospital,
Norrebrogade 44, Aarhus C 8000, Denmark
(Andersen, Holmberg) Research Center for Emergency Medicine, Aarhus
University Hospital, Norrebrogade 44, Aarhus C 8000, Denmark
(Berg, Donnino) Department of Medicine, Division of Pulmonary and Critical
Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston,
MA 02215, United States
(Cocchi) Department of Anesthesia Critical Care, Division of Critical
Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston,
MA 02215, United States
(Senthilnathan, Liu, Khabbaz) Department of Surgery, Division of
Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, 330
Brookline Avenue, Boston, MA 02215, United States
(Lerner) Department of Anesthesia, Beth Israel Deaconess Medical Center,
330 Brookline Avenue, Boston, MA 02215, United States
(Novack) Clinical Research Center, Soroka University Medical Center, POB
151, Beer-Sheva 84965, Israel
(Novack) Faculty of Health Sciences, Ben-Gurion University, POB 151,
Beer-Sheva 84965, Israel
Title
Thiamine as an adjunctive therapy in cardiac surgery: A randomized,
doubleblind, placebo-controlled, phase II trial.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 92. Date of
Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Thiamine is a vitamin that is essential for adequate aerobic
metabolism. The objective of this study was to determine if thiamine
administration prior to coronary artery bypass grafting would decrease
post-operative lactate levels as a measure of increased aerobic
metabolism. Methods: We performed a randomized, double-blind,
placebo-controlled trial of patients undergoing coronary artery bypass
grafting. Patients were randomized to receive either intravenous thiamine
(200 mg) or placebo both immediately before and again after the surgery.
Our primary endpoint was post-operative lactate levels. Additional
endpoints included pyruvate dehydrogenase activity, global and cellular
oxygen consumption, post-operative complications, and hospital and
intensive care unit length of stay. Results: Sixty-four patients were
included. Thiamine levels were significantly higher in the thiamine group
as compared to the placebo group immediately after surgery (1200 [683,
1200] nmol/L vs. 9 [8, 13] nmol/L, p < 0.001). There was no difference
between the groups in the primary endpoint of lactate levels immediately
after the surgery (2.0 [1.5, 2.6] mmol/L vs. 2.0 [1.7, 2.4], p = 0.75).
Relative pyruvate dehydrogenase activity was lower immediately after the
surgery in the thiamine group as compared to the placebo group (15 % [11,
37] vs. 28 % [15, 84], p = 0.02). Patients receiving thiamine had higher
post-operative global oxygen consumption 1 hour after the surgery
(difference: 0.37 mL/min/kg [95 % CI: 0.03, 0.71], p = 0.03) as well as
cellular oxygen consumption. We found no differences in clinical outcomes.
Conclusions: There were no differences in post-operative lactate levels or
clinical outcomes between patients receiving thiamine or placebo.
Post-operative oxygen consumption was significantly increased among
patients receiving thiamine. Copyright &#xa9; 2016 Andersen et al.

<72>
Accession Number
612123571
Author
Champey J.; Pavese P.; Bouvaist H.; Maillet M.; Kastler A.; Boussat B.;
Francois P.; Schwebel C.; Bonadona A.; Hamiflar R.; Vanzetto G.;
Dessertaine G.; Boignard A.; Augier C.; Pierre I.; Brion J.-P.;
Wintenberger C.; Hincky-Vitrat V.; Forestier E.
Institution
(Champey) Intensive Care Medicine, CHU de Grenoble, BP 218, Grenoble Cedex
9 38043, France
(Pavese, Maillet) Infectious Disease Department, CHU Grenoble, Grenoble,
France
(Bouvaist) Cardiology Department, CHU Grenoble, Grenoble, France
(Kastler) Neuroradiology Department, CHU Grenoble, Grenoble, France
(Boussat, Francois) Public Health Department, CHU Grenoble, Grenoble,
France
Title
Is brain angio-MRI useful in infective endocarditis management?.
Source
European Journal of Clinical Microbiology and Infectious Diseases. 35 (12)
(pp 2053-2058), 2016. Date of Publication: 01 Dec 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
In infective endocarditis (IE), brain magnetic resonance imaging (MRI) is
helpful to diagnose clinically silent neurological events. We assessed the
usefulness of systematic early brain MRI in IE diagnosis and
medico-surgical management. Over a period of 1 year, all patients admitted
in one of the three hospitals participating in and fulfilling the Duke
criteria for definite or possible IE underwent cerebral MRI within 7 days
of IE suspicion. Eight panels of experts analyzed the records a
posteriori. For each case, one record with and one record without the MRI
results were randomly assigned to two panels, which determined the
theoretical diagnosis and treatment. Paired comparisons were performed
using a symmetry test. Thirty-seven brain MRIs were performed within a
median of 5 days after inclusion. MRI was pathological in 26 patients (70
%), showing 62 % microischemia and 58 % microbleeds. The expert advice did
not differ significantly between the two evaluations (with or without the
MRI results). The therapeutic strategies determined diverged in five cases
(13.5 %). Diagnosis differed in two cases (5.4 %), with an upgrading of
diagnosis from possible to definite IE using MRI results. Early brain MRI
did not significantly affect the IE diagnosis and medico-surgical
treatment plan. These results suggest that systematic use of early brain
MRI is irrelevant in IE. Further studies are necessary to define whether
MRI is mandatory in IE management within a multidisciplinary approach,
with particular attention paid to better timing and the subset of patients
in whom this imaging examination could be beneficial. Copyright &#xa9;
2016, Springer-Verlag Berlin Heidelberg.

<73>
Accession Number
614218122
Author
Fakhari S.; Bavil F.M.; Bilehjani E.; Abolhasani S.; Mirinazhad M.;
Naghipour B.
Institution
(Fakhari, Bilehjani) Department of Anesthesiology, Tabriz, Iran, Islamic
Republic of
(Bavil, Mirinazhad, Naghipour) Department of Physiology, Tabriz, Iran,
Islamic Republic of
(Abolhasani) Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
Title
Prophylactic furosemide infusion decreasing early major postoperative
renal dysfunction in on-pump adult cardiac surgery: A randomized clinical
trial.
Source
Research and Reports in Urology. 9 (pp 5-13), 2017. Date of Publication:
19 Jan 2017.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Introduction: Acute renal dysfunction is a common complication of cardiac
surgery. Furosemide is used in prevention, or treatment, of acute renal
dysfunction. This study was conducted to evaluate the protective effects
of intra- and early postoperative furosemide infusion on preventing acute
renal dysfunction in elective adult cardiac surgery. Methods: Eighty-one
patients, candidates of elective cardiac surgery, were enrolled in this
study in either the furosemide (n=41) or placebo (n=40) group. Furosemide
(2 mg/h) or 0.9% saline was administered and continued up to 12 hours
postoperatively. We measured serum creatinine (Scr) at preoperative and on
the second and fifth postoperative days. Then calculated estimated
glomerular filtration rate (eGFR) at these times. An increase in Scr of
>0.5 mg/dL and/or >25%-50%, compared to preoperative values, was
considered as acute kidney injury (AKI). In contrast, an increase in Scr
by >50% and/or the need for hemodialysis was regarded as acute renal
failure (ARF). At the end we compared the AKI or ARF incidence between the
two groups. Results: On the second and fifth postoperative days, Scr was
lower, and the eGFR was higher in the furosemide group. AKI incidence was
similar in the two groups (11 vs 12 cases; P-value 0.622); however, ARF
rate was lower in furosemide group (1 vs 6 cases; P-value 0.044). During
the study period, Scr was more stable in the furosemide group, however in
the placebo group, Scr initially increased and then decreased to its
preoperative value after a few days. Conclusion: This study showed that
intra- and early postoperative furosemide infusion has a renal protective
effect in adult cardiac surgery with cardiopulmonary bypass. Although this
protective effect cannot be discovered in mild renal dysfunctions, it
apparently reduces the rate of the more severe renal dysfunctions. A more
multidisciplinary strategy may be needed in reducing the milder renal
damage. Copyright &#xa9; 2017 Fakhari et al.

<74>
[Use Link to view the full text]
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.

<75>
Accession Number
614103823
Author
Zhu J.; Zhang Q.; Chen L.; Zhang C.; Zhou X.; Yuan Y.; Zhang R.
Institution
(Zhu, Zhang, Zhang) Department of Cardiology, Rui Jin Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai 200025, China
(Chen) Department of Cardiology, Union Hospital, Fujian Medical
University, Fuzhou, Fujian 350005, China
(Zhang) Department of Cardiology, Guizhou Provincial People's Hospital,
Guiyang, Guizhou 550002, China
(Zhou) Department of Cardiology, The First Affiliated Hospital of Dalian
Medical University, Dalian, Liaoning 116011, China
(Yuan) Department of Cardiology, Zhongshan People's Hospital of Guangdong
Province, Guangdong 528400, China
Title
Three-year clinical outcomes of a polymer-free paclitaxel-eluting
microporous stent in real-world practice: Final results of the safety and
efficacy registry of the Yinyi Stent (SERY-I).
Source
Acta Cardiologica Sinica. 33 (1) (pp 28-33), 2017. Date of Publication:
January 2017.
Publisher
Republic of China Society of Cardiology (E-mail: acs@tsoc.org.tw)
Abstract
Background: The safety and efficacy of a China-made polymer-free
paclitaxel-eluting microporous stent (Yinyi) at 1-year has been previously
reported. However, limited evidence exists regarding the long-term
performance of this novel drug-eluting stent (DES). This study
investigated the 3-year efficacy and safety of the Yinyi stent in the
setting of safety and efficacy registry of the Yinyi stent (SERY-I)
clinical trial. Methods: Between June 2008 and August 2009, a total of
1045 patients undergoing percutaneous coronary intervention (PCI) were
implanted with > 1 Yinyi stents at 27 medical centers in mainland China.
Thereafter, clinical follow-up was performed for a period of 3 years after
enrollment. The primary endpoint was the cumulative rate of composite
major adverse cardiac events (MACE) including target lesion
revascularization (TLR), the combined incidence of cardiac death, and
non-fatal myocardial infarction; the second endpoint was the incidence of
stent thrombosis. Results: Overall, 1376 lesions were treated successfully
with 1713 Yinyi stents, and 1019 (98.7%) patients received dual
antiplatelet therapy for at least 12 months. At 3 years, a total of 13
(1.33%) patients had suffered cardiac death. The incidence of non-fatal
myocardial infarction and TLR was 9 (0.92%) and 58 (5.92%) among the
patients. Stent thrombosis occurred in 13 (1.33%) patients, and the rate
of Academic Research Consortium (ARC) definite or probable stent
thrombosis was 0.82%. Conclusions: Given the limitations that SERY-I was a
single arm, nonrandomized study and only telephone followup was performed
without angiographic analysis, the safety and efficacy of Yinyi stent
observed in this extended follow-up Registry needs further verification.
Copyright &#xa9; 2017, Republic of China Society of Cardiology. All rights
reserved.

<76>
Accession Number
614127992
Author
Chen Y.; Fan Y.; Yin Z.; Zhang H.; Zhang Y.; Han Z.; Wang C.
Institution
(Chen, Fan, Yin, Zhang, Zhang, Han, Wang) Department of Cardiology,
Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
Title
Coronary computed tomographic angiography for patients with
low-to-intermediate risk chest pain: A systematic review and
meta-analysis.
Source
Oncotarget. 8 (2) (pp 2096-2103), 2017. Date of Publication: 2017.
Publisher
Impact Journals LLC (E-mail: editors@impactaging.com)
Abstract
Coronary computed tomographic angiography (CCTA) can image the coronary
vasculature rapidly and detect the presence and severity of luminal
stenosis accurately. However, whether CCTA based care strategy could gain
more benefits than conventional strategy with functional tests for
patients with low-to-intermediate risk chest pain remains unknown. In this
study we performed a meta-analysis to compare the clinical efficacy of
CCTA versus conventional strategy. Eight randomized controlled trials with
14749 patients were finally included in this review after database
searching. Compared with conventional strategy, CCTA significantly
increased the rates of invasive coronary angiography (RR 1.44; 95% CI 1.28
to 1.63) and revascularization (RR 1.94; 95% CI 1.65 to 2.29), but did not
change the rates of major adverse cardiovascular events (RR 1.10; 95% CI
0.92 to 1.30), death (RR 0.95; 95% CI 0.64 to 1.40) and hospital
readmission (RR 0.96; 95% CI 0.66 to 1.40). Consequently, compared with
conventional strategy, CCTA seemed not to improve clinical outcomes for
patients with low-to-intermediate risk chest pain.

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

<78>
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.

<79>
Accession Number
607409926
Author
Li J.; Dreyer R.P.; Li X.; Du X.; Downing N.S.; Li L.; Zhang H.-B.; Feng
F.; Guan W.-C.; Xu X.; Li S.-X.; Lin Z.-Q.; Masoudi F.A.; Spertus J.A.;
Krumholz H.M.; Jiang L.-X.
Institution
(Li, Li, Du, Li, Zhang, Feng, Guan, Jiang) National Clinical Research
Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Diseases
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
(Dreyer, Downing, Xu, Li, Lin, Krumholz) Center for Outcomes Research and
Evaluation, Yale-New Haven Hospital, New Haven, CT, United States
(Dreyer, Krumholz) Section of Cardiovascular Medicine, Department of
Internal Medicine, Yale School of Medicine, New Haven, CT, United States
(Xu) Department of Obstetrics, Gynecology and Reproductive Sciences, Yale
School of Medicine, New Haven, CT, United States
(Masoudi) Division of Cardiology, University of Colorado Anschutz Medical
Campus, Aurora, CO, United States
(Spertus) Department of Biomedical and Health Informatics, University of
Missouri - Kansas City, Kansas City, MO, United States
(Spertus) Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Krumholz) Department of Internal Medicine, Yale School of Medicine, New
Haven, CT, United States
(Krumholz) Department of Health Policy and Management, Yale School of
Public Health, New Haven, CT, United States
Title
China patient-centered evaluative assessment of cardiac events prospective
study of acute myocardial infarction: Study design.
Source
Chinese Medical Journal. 129 (1) (pp 72-80), 2016. Date of Publication: 05
Jan 2016.
Publisher
Chinese Medical Association
Abstract
Background: Despite the rapid growth in the incidence of acute myocardial
infarction (AMI) in China, there is limited information about patients'
experiences after AMI hospitalization, especially on long-term adverse
events and patient-reported outcomes (PROs). Methods: The China
Patient-centered Evaluative Assessment of Cardiac Events
(PEACE)-Prospective AMI Study will enroll 4000 consecutive AMI patients
from 53 diverse hospitals across China and follow them longitudinally for
12 months to document their treatment, recovery, and outcomes. Details of
patients' medical history, treatment, and in-hospital outcomes are
abstracted from medical charts. Comprehensive baseline interviews are
being conducted to characterize patient demographics, risk factors,
presentation, and healthcare utilization. As part of these interviews,
validated instruments are administered to measure PROs, including quality
of life, symptoms, mood, cognition, and sexual activity. Follow-up
interviews, measuring PROs, medication adherence, risk factor control, and
collecting hospitalization events are conducted at 1, 6, and 12 months
after discharge. Supporting documents for potential outcomes are collected
for adjudication by clinicians at the National Coordinating Center. Blood
and urine samples are also obtained at baseline, 1- and 12-month
follow-up. In addition, we are conducting a survey of participating
hospitals to characterize their organizational characteristics.
Conclusion: The China PEACE-Prospective AMI study will be uniquely
positioned to generate new information regarding patient's experiences and
outcomes after AMI in China and serve as a foundation for quality
improvement activities. Copyright &#xa9; 2015 Chinese Medical Journal.

<80>
Accession Number
609104987
Author
Pollesello P.; Parissis J.; Kivikko M.; Harjola V.-P.
Institution
(Pollesello, Kivikko) Critical Care Proprietary Products, Orion Pharma,
Espoo, Finland
(Parissis) Second Department of Cardiology, Heart Failure Unit, University
of Athens Medical School, Attikon University Hospital, Athens, Greece
(Harjola) Emergency Medicine, Helsinki University, Helsinki University
Hospital, Helsinki, Finland
Title
Levosimendan meta-analyses: Is there a pattern in the effect on
mortality?.
Source
International Journal of Cardiology. 209 (pp 77-83), 2016. Date of
Publication: 15 Apr 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Levosimendan is an inodilator developed for treatment of acute
heart failure and other cardiac conditions where the use of an inodilator
is considered appropriate. Levosimendan has been studied in different
therapeutic settings including acutely decompensated chronic heart
failure, advanced heart failure, right ventricular failure, cardiogenic
shock, septic shock, and cardiac and non-cardiac surgery. This variety of
data has been re-analysed in 25 meta-analyses from 15 different
international research groups, based on different rationales to select the
studies included. Methods We here review all previously published
meta-analyses on levosimendan to determine any common denominators for its
effects on patient mortality. In addition, we also perform a comparative
meta-analysis of the six phase II and III randomized double-blind trials
which were taken into consideration by the regulatory authorities for the
purpose of introducing levosimendan into the market. Results Irrespective
of clinical setting or comparator, all meta-analyses consistently show
benefits for levosimendan, with lower relative risk (or odds ratio) for
patient mortality. In 3/25 of the meta-analyses these beneficial trends
did not reach statistical significance, while in 22/25 significance was
reached. The relative risk is consistent overall, and very similar to that
obtained in our own meta-analysis that considered only the 'regulatory'
studies. Conclusion The existing meta-analyses, now based on a population
of over 6000 patients, provide the general message of significant benefits
for levosimendan in terms of patient mortality. The weight of evidence is
now clearly in favour of usefulness/efficacy of levosimendan, with data
from multiple randomized trials and meta-analyses. Copyright &#xa9; 2016
The Authors.

<81>
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.

<82>
Accession Number
610439704
Author
Neupane I.; Arora R.C.; Rudolph J.L.
Institution
(Neupane, Rudolph) Center of Innovation in Long Term Services and Support,
Providence VA Medical Center, Providence, RI, United States
(Arora) University of Manitoba, College of Medicine, Department of
Surgery, Winnipeg, Manitoba, Canada
(Neupane, Rudolph) Warren Alpert School of Medicine at Brown University,
Providence, RI, United States
Title
Cardiac surgery as a stressor and the response of the vulnerable older
adult.
Source
Experimental Gerontology. Part B. 87 (pp 168-174), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
In an aging population, recovery and restoration of function are critical
to maintaining independence. Over the past 50 years, there have been
dramatic improvements made in cardiac surgery processes and outcomes that
allow for procedures to be performed on an increasingly older population
with the goal of improving function. Although improved function is
possible, major surgical procedures are associated with substantial
stress, which can severely impact outcomes. Past literature has identified
that frail patients, who are vulnerable to the stress of surgery, are more
likely to have postoperative major adverse cardiac and cerebrovascular
events (OR 4.9, 95% confidence interval 1.6, 14.6). The objective of this
manuscript is to examine preoperative frailty in biological,
psychological, and social domains using cardiac surgery to induce stress.
We systematically searched PubMed for keywords including "cardiac surgery,
frailty, and aged" in addition to the biological, psychological, and
social keywords. In the biological domain, we examine the association of
physiological and physical vulnerabilities, as well as, the impact of
comorbidities and inflammation on negative surgical outcomes. In the
psychological domain, the impact of cognitive impairment, depression, and
anxiety as vulnerabilities were examined. In the social domain, social
structure, coping, disparities, and addiction as vulnerabilities are
described. Importantly, there is substantial overlap in the domains of
vulnerability. While frailty research has largely focused on discrete
physical vulnerability criteria, a broader definition of frailty
demonstrates that vulnerabilities in biological, psychological, and social
domains can limit recovery after the stress of cardiac surgery.
Identification of vulnerability in these domains can allow better
understanding of the risks of cardiac surgery and tailoring of
interventions to improve outcomes. Copyright &#xa9; 2016

<83>
Accession Number
614248560
Author
Mariathas M.; Olechowski B.; Mahmoudi M.; Curzen N.
Institution
(Mariathas, Olechowski, Mahmoudi, Curzen) Coronary Research Group,
University Hospital Southampton NHS Foundation Trust, Southampton, United
Kingdom
(Mariathas, Olechowski, Mahmoudi, Curzen) Faculty of Medicine, University
of Southampton, Southampton, United Kingdom
Title
Does the evidence really suggest that we should completely revascularise
bystander disease in patients with ST elevation myocardial infarction
undergoing primary angioplasty? Why we still need more definitive trial
data to change routine practice.
Source
Expert Review of Cardiovascular Therapy. 15 (2) (pp 75-81), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: There remains considerable heterogeneity in the management
of significant lesions in non culprit coronary arteries in STEMI patients
undergoing primary percutaneous coronary intervention (PPCI). Three recent
randomised trials have shown clinical outcome benefit in a complete
revascularisation approach when compared to PPCI of the culprit artery
alone. By contrast, observational data suggest that an aggressive complete
revascularisation may not confer clinical benefit and may, in some cases,
be harmful. Areas covered: In this review we discuss the three recent
randomised trials that have advocated a complete revasculariation approach
in addition to data available from registries. Expert commentary: An
adequately powered, randomised controlled trial is required to answer the
question of whether complete revascularisation in STEMI patients is
beneficial and, if so, whether it should be ischaemia directed and whether
it should be at the index procedure or staged. Copyright &#xa9; 2016
Informa UK Limited, trading as Taylor & Francis Group.

<84>
Accession Number
613943790
Author
Koskinas K.C.; Taniwaki M.; Rigamonti F.; Heg D.; Roffi M.; Tuller D.;
Muller O.; Vuillomenet A.; Cook S.; Weilenmann D.; Kaiser C.; Jamshidi P.;
Juni P.; Windecker S.; Pilgrim T.
Institution
(Koskinas, Taniwaki, Windecker, Pilgrim) Department of Cardiology, Swiss
Cardiovascular Center, University Hospital, Bern, Switzerland
(Rigamonti, Roffi) Department of Cardiology, University Hospital, Geneva,
Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, Bern University Hospital, Bern, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Muller) Department of Cardiology, University Hospital, Lausanne,
Switzerland
(Vuillomenet) Department of Cardiology, Kantonsspital, Aarau, Switzerland
(Cook) Department of Cardiology, University Hospital, Fribourg,
Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital, St. Gallen,
Switzerland
(Kaiser) Department of Cardiology, University Hospital, Basel, Switzerland
(Jamshidi) Department of Cardiology, Kantonsspital, Luzern, Switzerland
(Juni) Applied Health Research Centre (AHRC), St. Michael's Hospital,
Toronto, Ontario, Canada
Title
Impact of Patient and Lesion Complexity on Long-Term Outcomes Following
Coronary Revascularization With New-Generation Drug-Eluting Stents.
Source
American Journal of Cardiology. 119 (4) (pp 501-507), 2017. Date of
Publication: 15 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Long-term clinical outcomes of new-generation drug-eluting stents in
complex anatomic and clinical settings are not well defined. This study
assessed the impact of patient and lesion complexity on 2-year outcomes
after coronary revascularization with ultrathin strut
biodegradable-polymer (BP) sirolimus-eluting stents (SES) versus
durable-polymer (DP) everolimus-eluting stents (EES). In a prespecified
analysis of the BIOSCIENCE randomized trial (NCT01443104), complex
patients (911 of 2,119; 43%) were defined by the presence of acute
ST-elevation myocardial infarction (MI); left ventricular ejection
fraction <30%; renal dysfunction; insulin-treated diabetes; treatment of
ostial lesion, bypass graft, unprotected left main lesion; or 3-vessel
intervention. The primary end point was target lesion failure (TLF), a
composite of cardiac death, target vessel MI, and clinically indicated
target lesion revascularization. At 2 years, complex compared with simple
patients had a greater risk of TLF (14.5% vs 7.4%, risk ratio 2.05, 95%
confidence interval 1.56 to 2.69; p <0.001). The difference was sustained
beyond 1 year on landmark analysis. Complex patients had higher rates of
the patient-oriented composite end point of death, any MI, or any
revascularization (23% vs 14.4%; p <0.001) as well as definite stent
thrombosis (1.6% vs 0.4%, p = 0.006). There were no differences in TLF and
patient-oriented composite end point between the BP-SES versus DP-EES,
consistently among simple and complex patients. In conclusion, patient and
lesion complexity had a durable adverse impact on clinical outcomes
throughout 2 years of follow-up in this all-comers randomized trial.
Safety and efficacy of new-generation BP-SES and DP-EES were comparable,
irrespective of complexity status. Copyright &#xa9; 2016 Elsevier Inc.

<85>
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.

<86>
[Use Link to view the full text]
Accession Number
613409672
Author
Gibson C.M.; Pinto D.S.; Chi G.; Arbetter D.; Yee M.; Mehran R.; Bode C.;
Halperin J.; Verheugt F.W.A.; Wildgoose P.; Burton P.; Van Eickels M.;
Korjian S.; Daaboul Y.; Jain P.; Lip G.Y.H.; Cohen M.; Peterson E.D.; Fox
K.A.A.
Institution
(Gibson, Pinto, Chi, Arbetter, Yee, Korjian, Daaboul, Jain) Department of
Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School,
330 Brookline Avenue, Boston, MA 02215, United States
(Mehran, Halperin) Cardiovascular Institute, Mount Sinai Medical Center,
Icahn School of Medicine at Mount Sinai, Mount Sinai, NY, United States
(Bode) Heart Center, Department for Cardiology and Angiology I, University
of Freiburg, Freiburg, Germany
(Verheugt) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Wildgoose, Burton) Janssen Pharmaceuticals Inc., Beerse, Belgium
(Van Eickels) Bayer Pharmaceuticals, Inc., Berlin, Germany
(Lip) University of Birmingham Centre for Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Newark,
NJ, United States
(Peterson) Duke Clinical Research Institute, Durham, NC, United States
(Fox) Centre for Cardiovascular Science, University of Edinburgh, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
Title
Recurrent hospitalization among patients with atrial fibrillation
undergoing intracoronary stenting treated with 2 treatment strategies of
rivaroxaban or a dose-adjusted oral Vitamin K antagonist treatment
strategy.
Source
Circulation. 135 (4) (pp 323-333), 2017. Date of Publication: 24 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Patients with atrial fibrillation who undergo intracoronary
stenting traditionally are treated with a vitamin K antagonist (VKA) plus
dual antiplatelet therapy (DAPT), yet this treatment leads to high risks
of bleeding. We hypothesized that a regimen of rivaroxaban plus a P2Y 12
inhibitor monotherapy or rivaroxaban plus DAPT could reduce bleeding and
thereby have a favorable impact on all-cause mortality and the need for
rehospitalization. Methods: Stented subjects with nonvalvular atrial
fibrillation (n=2124) were randomized 1:1:1 to administration of
reduced-dose rivaroxaban 15 mg daily plus a P2Y 12 inhibitor for 12 months
(group 1); rivaroxaban 2.5 mg twice daily with stratification to a
prespecified duration of DAPT of 1, 6, or 12 months (group 2); or the
reference arm of dose-adjusted VKA daily with a similar DAPT
stratification (group 3). The present post hoc analysis assessed the end
point of all-cause mortality or recurrent hospitalization for an adverse
event, which was further classified as the result of bleeding, a
cardiovascular cause, or another cause blinded to treatment assignment.
Results: The risk of all-cause mortality or recurrent hospitalization was
34.9% in group 1 (hazard ratio=0.79; 95% confidence interval, 0.66-0.94;
P=0.008 versus group 3; number needed to treat=15), 31.9% in group 2
(hazard ratio=0.75; 95% confidence interval, 0.62-0.90; P=0.002 versus
group 3; number needed to treat=10), and 41.9% in group 3 (VKA+DAPT). Both
all-cause death plus hospitalization potentially resulting from bleeding
(group 1=8.6% [P=0.032 versus group 3], group 2=8.0% [P=0.012 versus group
3], and group 3=12.4%) and all-cause death plus rehospitalization
potentially resulting from a cardiovascular cause (group 1=21.4% [P=0.001
versus group 3], group 2=21.7% [P=0.011 versus group 3], and group
3=29.3%) were reduced in the rivaroxaban arms compared with the VKA arm,
but other forms of rehospitalization were not. Conclusions: Among patients
with atrial fibrillation undergoing intracoronary stenting, administration
of either rivaroxaban 15 mg daily plus P2Y 12 inhibitor monotherapy or 2.5
mg rivaroxaban twice daily plus DAPT was associated with a reduced risk of
all-cause mortality or recurrent hospitalization for adverse events
compared with standard-of-care VKA plus DAPT. Copyright &#xa9; 2016 The
Authors.

<87>
Accession Number
614159417
Author
Stanger O.; Gahl B.; Grabherr M.; Krausler R.; Longnus S.; Meinitzer A.;
Cadamuro J.
Institution
(Stanger) Surgical Department, Saint John of God Hospital, Kajetanerplatz
1, Salzburg 5010, Austria
(Gahl, Grabherr, Longnus) Inselspital University Hospital and University
of Berne, Berne, Switzerland
(Krausler) University Department of Cardiac Surgery, Salzburg Paracelsus
Medical University, Salzburg, Austria
(Meinitzer) Department of Laboratory Medicine, Graz Auenbrugger University
Hospital, Austria
(Cadamuro) Department of Laboratory Medicine, Paracelsus Medical
University, Salzburg, Austria
Title
Freedom SOLO-Associated Thrombocytopaenia is Valve-Dependent and Not Due
to In Vitro Pseudothrombocytopaenia.
Source
Heart Lung and Circulation. 26 (3) (pp 268-275), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Use of the Freedom SOLO (FS) stentless aortic bioprosthesis is
limited by a unique and as yet unexplained severe decrease in
postoperative platelet count in the absence of FS-related excess bleeding
or thromboembolism. We investigated whether anticoagulant-associated
pseudothrombocytopaenia could explain this complication. Methods Thirty
consecutive patients (mean age 75.4+/-7.7 years, 11 [36.7%] female)
underwent elective aortic valve replacement (AVR) with either the stented
bovine Mitroflow (MF, n=18) or the stentless bovine FS (n=12) aortic valve
bioprostheses. Serial platelet counts were performed simultaneously with
sampling tubes containing tripotassium (K<inf>3</inf>-)-EDTA, trisodium
(Na<inf>3</inf>)-citrate, or novel alternative magnesium sulfate
(MgSO<inf>4</inf>, ThromboExactTM)-based anticoagulant, respectively.
Results Postoperative platelet counts decreased compared with preoperative
values in all patients (p<0.001), but were significantly lower in patients
receiving FS compared to MF at all measurement time points until the end
of observation (day 9). Lowest platelet counts were seen on the first
postoperative day for MF (mean reduction: -41.5%) and on the second
postoperative day for FS (mean reduction: -59.9%). Postoperative platelet
counts did not correlate with any of the anticoagulants, thereby
indicating no pseudothrombocytopaenia in the study population. There was
no interaction between anticoagulant and type of valve. Only 1% of
variance in platelet counts was caused by the anticoagulant, 46% by the
day of measurement relative to baseline, and 20% was caused by the type of
valve. Conclusions The platelet-lowering effect in patients receiving the
FS is valve-dependent and is not caused by systemic preanalytical
(laboratory) measurement error such as anticoagulant-dependent
pseudothrombocytaemia, particularly with EDTA and citrate. Copyright
&#xa9; 2016 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ)

<88>
Accession Number
613873001
Author
Nairooz R.; Valgimigli M.; Rochlani Y.; Pothineni N.V.; Raina S.; Sardar
P.; Mukherjee D.; Naidu S.S.; Shavelle D.M.
Institution
(Nairooz, Pothineni, Raina) Division of Cardiology, University of Arkansas
for Medical Sciences, Little Rock, AR, United States
(Valgimigli) Division of Cardiology, Thoraxcenter, Erasmus Medical Center,
Rotterdam, Netherlands
(Rochlani) Department of Medicine, University of Arkansas for Medical
Sciences, Little Rock, AR, United States
(Sardar) Division of Cardiovascular Medicine, University of Utah, Salt
Lake City, UT, United States
(Mukherjee) Department of Cardiology, Texas Tech University Health
Sciences Center, El Paso, TX, United States
(Naidu) Division of Cardiology, Winthrop University Hospital, Mineola, NY,
United States
(Shavelle) Division of Cardiovascular Medicine, University of Southern
California, Los Angeles, CA, United States
Title
Meta-analysis of clopidogrel pretreatment in acute coronary syndrome
patients undergoing invasive strategy.
Source
International Journal of Cardiology. 229 (pp 82-89), 2017. Date of
Publication: 15 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background It is unknown whether pretreatment with clopidogrel in acute
coronary syndrome (ACS) managed invasively, is superior to a strategy of
administering clopidogrel in the cardiac catheterization laboratory at the
time of percutaneous coronary intervention (PCI). Current practice
guidelines do not endorse one strategy over the other. Methods A
comprehensive literature search was done to identify all relevant studies
comparing pretreatment with clopidogrel to administration in the cardiac
catheterization laboratory at the time of PCI (no pretreatment). A
meta-analysis using a random effects model was used to calculate outcomes
of interest. Results Our search identified 16 studies including 61,517 ACS
patients undergoing cardiac catheterization. At 30 days, clopidogrel
pretreatment was associated with lower MACE 7.67% vs 9.46% (odds ratio
(OR) 0.77, 95% confidence interval (CI) [0.68, 0.86]; P < 0.0001) and
all-cause mortality 2.8% vs 4.1% (OR 0.70, 95% CI [0.58, 0.85]; P =
0.0003). Mortality according to the longest follow up available was also
significantly lower with pretreatment. No difference in major bleeding
events was observed. These results were not significantly different
between randomized vs observational studies or STEMI vs NSTEACS patients.
Sensitivity analysis showed significantly lower MACE 7.98% vs 9.6% (OR
0.83, 95% CI [0.71, 0.96]; P = 0.01) without increased major bleeding in
NSTEACS patients undergoing PCI within 48 h from pretreatment. Conclusion
In ACS patients undergoing PCI, clopidogrel pretreatment was associated
with significantly lower 30 day all-cause mortality and major adverse
cardiovascular events without increased major bleeding events. Copyright
&#xa9; 2016 Elsevier Ireland Ltd

<89>
Accession Number
609237789
Author
Newhall K.A.; Saunders E.C.; Larson R.J.; Stone D.H.; Goodney P.P.
Institution
(Newhall, Larson, Goodney) Veterans Affairs Outcomes Group, Department of
Veterans Affairs Medical Center, White River Junction, VT, United States
(Newhall) Department of Surgery, Dartmouth Hitchcock Medical Center,
Lebanon, NH, United States
(Saunders, Larson, Goodney) Dartmouth Institute for Health Policy and
Clinical Practice, Lebanon, NH, United States
(Saunders) Dartmouth Psychiatric Research Center, Lebanon, NH, United
States
(Stone, Goodney) Section of Vascular Surgery, Dartmouth Hitchcock Medical
Center, Lebanon, NH, United States
Title
Use of protamine for anticoagulation during carotid endarterectomy a
meta-analysis.
Source
JAMA Surgery. 151 (3) (pp 247-255), 2016. Date of Publication: March 2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance Protamine sulfate can be administered at the conclusion of
carotid endarterectomy (CEA) to reverse the anticoagulant effects of
heparin and to limit the risk for postoperative bleeding. Protamine use
remains controversial owing to concern for increased thrombotic
complications with its use. OBJECTIVE To review the evidence for and
against protamine use, both in its association with increased thrombotic
complications and with decreased bleeding. DATA SOURCES We searched
Medline (1946-2014), EMBASE (1966-2014), Cochrane Library (1972-2014),
clinical trial registries (World Health Organization International
Clinical Trials Registry and clinicaltrials.gov), and abstracts from
conferences of the Society of Vascular Surgery (2002-2014) and American
Heart Association Scientific Sessions (1980-2014) in November 2014. No
language restrictions were applied. STUDY SELECTION We included clinical
trials and observational studies comparing reversal of heparin with
protamine sulfate vs no reversal in patients undergoing carotid
revascularization and reporting stroke during hospitalization. Of 360
records screened, 12 studies (3%) of CEA were eligible for data pooling.
DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data and assessed
quality. Random-effects models were used to summarize relative risks
(RRs). MAIN OUTCOME AND MEASURE Stroke after CEA. RESULTS We included 12
observational studies involving 10 621 patients in the meta-analysis.
Event rates did not differ significantly between patients who received
protamine vs those who did not for the following outcomes: stroke (RR,
0.84; 95%CI, 0.55-1.29; I² = 15%;9 studies),myocardial
infarction (RR, 0.89; 95%CI, 0.53-1.51; I² = 0%; 3 studies), or
mortality (RR, 0.9, 95%CI, 0.62-1.29; I² = 0%; 7 studies). The
use of protamine was associated with a significant decrease in major
bleeding complications requiring reoperation (RR, 0.57; 95%CI, 0.39-0.84;
I² = 32%; 10 studies). CONCLUSIONS AND RELEVANCE Based on
available evidence, the use of protamine following CEA is associated with
a reduction in bleeding complications, without increasing major thrombotic
outcomes, including stroke,myocardial infarction, or death. Copyright
&#xa9; 2016 American Medical Association. All rights reserved.

<90>
Accession Number
614261496
Author
Siegal D.M.; Savage W.J.
Institution
(Siegal, Savage) Division of Hematology and Thromboembolism, McMaster
University, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
(Siegal, Savage) Brigham and Women's Hospital and Harvard Medical School,
Boston, MA, United States
Title
Plasma versus prothrombin complex concentrate for warfarin-associated
major bleeding: A systematic review.
Source
Hematology. 2015 (1) (pp 448-453), 2015. Date of Publication: 05 Dec 2015.
Publisher
American Society of Hematology (E-mail: publishing@hematology.org)

<91>
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.

<92>
Accession Number
614343138
Author
Smith L.E.; Smith D.K.; Blume J.D.; Siew E.D.; Billings F.T.
Institution
(Smith, Billings) Department of Anesthesiology, Vanderbilt University
Medical Center, 1211 21st Avenue South, Nashville, TN 37205, United States
(Smith, Blume) Department of Biostatistics, Vanderbilt University Medical
Center, Nashville, TN, United States
(Siew, Billings) Department of Medicine, Vanderbilt University Medical
Center, Nashville, TN, United States
(Siew) Division of Nephrology and Hypertension, Vanderbilt Center for
Kidney Disease and Integrated Program for AKI Research, Vanderbilt
University Medical Center, Nashville, TN, United States
Title
Latent variable modeling improves AKI risk factor identification and AKI
prediction compared to traditional methods.
Source
BMC Nephrology. 18 (1) (no pagination), 2017. Article Number: 55. Date of
Publication: 08 Feb 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) is diagnosed based on postoperative
serum creatinine change, but AKI models have not consistently performed
well, in part due to the omission of clinically important but practically
unmeasurable variables that affect creatinine. We hypothesized that a
latent variable mixture model of postoperative serum creatinine change
would partially account for these unmeasured factors and therefore
increase power to identify risk factors of AKI and improve predictive
accuracy. Methods: We constructed a two-component latent variable mixture
model and a linear model using data from a prospective, 653-subject
randomized clinical trial of AKI following cardiac surgery (NCT00791648)
and included established AKI risk factors and covariates known to affect
serum creatinine. We compared model fit, discrimination, power to detect
AKI risk factors, and ability to predict AKI between the latent variable
mixture model and the linear model. Results: The latent variable mixture
model demonstrated superior fit (likelihood ratio of 6.68 x 1071) and
enhanced discrimination (permutation test of Spearman's correlation
coefficients, p < 0.001) compared to the linear model. The latent variable
mixture model was 94% (-13 to 1132%) more powerful (median [range]) at
identifying risk factors than the linear model, and demonstrated increased
ability to predict change in serum creatinine (relative mean square error
reduction of 6.8%). Conclusions: A latent variable mixture model better
fit a clinical cohort of cardiac surgery patients than a linear model,
thus providing better assessment of the associations between risk factors
of AKI and serum creatinine change and more accurate prediction of AKI.
Incorporation of latent variable mixture modeling into AKI research will
allow clinicians and investigators to account for clinically meaningful
patient heterogeneity resulting from unmeasured variables, and therefore
provide improved ability to examine risk factors, measure mechanisms and
mediators of kidney injury, and more accurately predict AKI in clinical
cohorts. Copyright &#xa9; 2017 The Author(s).

<93>
Accession Number
614334786
Author
Rogers J.G.; Pagani F.D.; Tatooles A.J.; Bhat G.; Slaughter M.S.; Birks
E.J.; Boyce S.W.; Najjar S.S.; Jeevanandam V.; Anderson A.S.; Gregoric
I.D.; Mallidi H.; Leadley K.; Aaronson K.D.; Frazier O.H.; Milano C.A.
Institution
(Rogers, Milano) Division of Cardiovascular Medicine, Duke Clinical
Research Institute, Duke University Medical Center, Box 3034 DUMC, Durham,
NC 27710, United States
(Pagani, Aaronson) University of Michigan, Ann Arbor, IL, United States
(Tatooles, Bhat) Advocate Christ Medical Center, Oak Lawn, IL, United
States
(Jeevanandam) University of Chicago Medicine, Chicago, IL, United States
(Anderson) Northwestern Memorial Hospital, Chicago, IL, United States
(Slaughter, Birks) University of Louisville, Louisville, KY, United States
(Boyce, Najjar) MedStar Heart Institute, Washington, DC, United States
(Gregoric) University of Texas Health Science Center, Houston, United
States
(Mallidi, Frazier) Texas Heart Institute, Houston, United States
(Leadley) HeartWare, Framingham, MA, United States
Title
Intrapericardial left ventricular assist device for advanced heart
failure.
Source
New England Journal of Medicine. 376 (5) (pp 451-460), 2017. Date of
Publication: 02 Feb 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Mechanical circulatory support with a left ventricular assist
device (LVAD) is an established treatment for patients with advanced heart
failure. We compared a newer LVAD design (a small intrapericardial
centrifugal-flow device) against existing technology (a commercially
available axial-flow device) in patients with advanced heart failure who
were ineligible for heart transplantation. METHODS: We conducted a
multicenter randomized trial involving 446 patients who were assigned, in
a 2:1 ratio, to the study (centrifugal-flow) device or the control
(axial-flow) device. Adults who met contemporary criteria for LVAD
implantation for permanent use were eligible to participate in the trial.
The primary end point was survival at 2 years free from disabling stroke
or device removal for malfunction or failure. The trial was powered to
show noninferiority with a margin of 15 percentage points. RESULTS: The
intention-to treat-population included 297 participants assigned to the
study device and 148 participants assigned to the control device. The
primary end point was achieved in 164 patients in the study group and 85
patients in the control group. The analysis of the primary end point
showed noninferiority of the study device relative to the control device
(estimated success rates, 55.4% and 59.1%, respectively, calculated by the
Weibull model; absolute difference, 3.7 percentage points; 95% upper
confidence limit, 12.56 percentage points; P = 0.01 for noninferiority).
More patients in the control group than in the study group had device
malfunction or device failure requiring replacement (16.2% vs. 8.8%), and
more patients in the study group had strokes (29.7% vs. 12.1%). Quality of
life and functional capacity improved to a similar degree in the two
groups. CONCLUSIONS: In this trial involving patients with advanced heart
failure who were ineligible for heart transplantation, a small,
intrapericardial, centrifugal-flow LVAD was found to be noninferior to an
axial-flow LVAD with respect to survival free from disabling stroke or
device removal for malfunction or failure. Copyright &#xa9; 2017
Massachusetts Medical Society.

<94>
Accession Number
614358759
Author
Cruz-Gonzalez I.; Rama-Merchan J.C.; Rodriguez-Collado J.; Martin-Moreiras
J.; Diego-Nieto A.; Barreiro-Perez M.; Sanchez P.L.
Institution
(Cruz-Gonzalez, Rama-Merchan, Rodriguez-Collado, Martin-Moreiras,
Diego-Nieto, Barreiro-Perez, Sanchez) Cardiology Department, University
Hospital of Salamanca, IBSAL, Salamanca, Spain
(Rama-Merchan) Cardiology Department, Hospital of Merida, Badajoz, Spain
Title
Transcatheter closure of paravalvular leaks: State of the art.
Source
Netherlands Heart Journal. 25 (2) (pp 116-124), 2017. Date of Publication:
February 2017.
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Paravalvular leak (PVL) is a serious complication after surgical valve
replacement or after transcatheter aortic valve replacement. Approximately
1-5% of PVLs can lead to serious clinical consequences, including
congestive heart failure and/or haemolytic anaemia. For years, surgical
reintervention has been considered the treatment of choice for symptomatic
patients with PVLs. However, surgical reintervention is associated with a
high risk of morbidity and mortality. Transcatheter PVL (TPVL) closure is
a less invasive alternative to surgical re-intervention. The safety and
feasibility of TPVL closure has been confirmed in several registries and a
meta-analysis. In this review, we discuss the clinical implications and
diagnosis of PVLs, technical considerations for TPVL, execution of the
procedure and assessment of the results. Copyright &#xa9; The Author(s)
2016.

<95>
Accession Number
614346078
Author
Greenbaum A.B.; Babaliaros V.C.; Chen M.Y.; Stine A.M.; Rogers T.; O'Neill
W.W.; Paone G.; Thourani V.H.; Muhammad K.I.; Leonardi R.A.; Ramee S.;
Troendle J.F.; Lederman R.J.
Institution
(Greenbaum, O'Neill, Paone) Henry Ford Hospital, Detroit, Michigan, United
States
(Babaliaros, Thourani) Emory University, Atlanta, Georgia
(Chen, Stine, Rogers, Troendle, Lederman) National Heart, Lung, and Blood
Institute, National Institutes of Health, Bethesda, Maryland, United
States
(Muhammad) Oklahoma Heart Institute, Tulsa, Oklahoma, United States
(Leonardi) Lexington Medical Center, West Columbia, South Carolina, United
States
(Ramee) Ochsner Medical Center, New Orleans, Louisiana, United States
Title
Transcaval Access and Closure for Transcatheter Aortic Valve Replacement:
A Prospective Investigation.
Source
Journal of the American College of Cardiology. 69 (5) (pp 511-521), 2017.
Date of Publication: 07 Feb 2017.
Publisher
Elsevier USA
Abstract
Background Transcaval access may enable fully percutaneous transcatheter
aortic valve replacement (TAVR) without the hazards and discomfort of
transthoracic (transapical or transaortic) access. Objectives The authors
performed a prospective, independently adjudicated, multicenter,
single-arm trial of transcaval access for TAVR in patients who were
ineligible for femoral artery access and had high or prohibitive risk of
complications from transthoracic access. Methods A total of 100 patients
underwent attempted percutaneous transcaval access to the abdominal aorta
by electrifying a caval guidewire and advancing it into a pre-positioned
aortic snare. After exchanging for a rigid guidewire, conventional TAVR
was performed through transcaval introducer sheaths. Transcaval access
ports were closed with nitinol cardiac occluders. A core laboratory
analyzed pre-discharge and 30-day abdominal computed tomograms. The
Society of Thoracic Surgeons predicted risk of mortality was 9.6 +/- 6.3%.
Results Transcaval access was successful in 99 of 100 patients. Device
success (access and closure with a nitinol cardiac occluder without death
or emergency surgical rescue) occurred 98 of 99 patients; 1 subject had
closure with a covered stent. Inpatient survival was 96%, and 30-day
survival was 92%. Second Valve Academic Research Consortium (VARC-2)
life-threatening bleeding and modified VARC-2 major vascular complications
possibly related to transcaval access were 7% and 13%, respectively.
Median length of stay was 4 days (range 2 to 6 days). There were no
vascular complications after discharge. Conclusions Transcaval access
enabled TAVR in patients who were not good candidates for transthoracic
access. Bleeding and vascular complications, using permeable nitinol
cardiac occluders to close the access ports, were common but acceptable in
this high-risk cohort. Transcaval access should be investigated in
patients who are eligible for transthoracic access. Purpose-built closure
devices are in development that may simplify the procedure and reduce
bleeding. (Transcaval Access for Transcatheter Aortic Valve Replacement in
People With No Good Options for Aortic Access; NCT02280824) Copyright
&#xa9; 2017

<96>
Accession Number
614345987
Author
Upadhaya S.; Baniya R.; Madala S.; Subedi S.K.; Khan J.; Velagapudi R.K.;
Bachuwa G.
Institution
(Upadhaya, Baniya, Madala, Subedi, Khan, Velagapudi, Bachuwa) Department
of Internal Medicine, Hurley Medical Center, Michigan State University,
Flint, MI, United States
Title
Drug-eluting stent placement versus coronary artery bypass surgery for
unprotected left main coronary artery disease: A meta-analysis of
randomized controlled trials.
Source
Journal of Cardiac Surgery. 32 (2) (pp 70-79), 2017. Date of Publication:
01 Feb 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) is the standard of care
for treating left main coronary lesions. However, recently published
randomized controlled trials (RCT) have shown conflicting results. We
sought to compare clinical outcomes of percutaneous coronary intervention
(PCI) with drug-eluting stent placement to CABG using a meta-analysis of
randomized controlled trials. METHODS: A systemic search of Pubmed,
Scopus, Cochrane library, and Clinicaltrials.gov was performed for
randomized controlled trials comparing PCI with CABG in patients with left
main stenosis. Data were analyzed using random effect models and
Mantel-Haenszel methods. The primary outcome was major adverse
cardiovascular and cerebral events (MACCE). The secondary outcomes were
myocardial infarction, stroke, cardiac, and all-cause mortality. A
subgroup analysis based on SYNTAX score was also performed. RESULTS: A
total of 4595 patients (2297 in the PCI group and 2298 in the CABG group)
from five RCTs were included in the analysis. There were significant
differences in MACCE (odds ratio [OR] 1.36, confidence interval [CI] 95%,
1.18-1.58, p-value: < 0.0001) and repeat revascularization (OR 1.85, CI
95%, 1.53-2.23, p-value: < 0.00001) favoring CABG. There were no
significant differences in the incidence of myocardial infarction, stroke,
or cardiac and all-cause mortality. Based on SYNTAX score, CABG was
superior in terms of MACCE only in the subgroup with SYNTAX score of 33 or
more. CONCLUSIONS: CABG results in fewer MACCE and need for repeat
revascularization than PCI in patients with unprotected left main disease.
Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<97>
Accession Number
614278707
Author
Navarese E.P.; Gurbel P.A.; Andreotti F.; Kooodziejczak M.M.; Palmer S.C.;
Dias S.; Buffon A.; Kubica J.; Kowalewski M.; Jadczyk T.; Laskiewicz M.;
Jedrzejek M.; Brockmeyer M.; Airoldi F.; Ruospo M.; Servi S.D.; Wojakowski
W.; O'Connor C.; Strippoli G.F.M.
Institution
(Navarese, Airoldi, Servi) Department of Cardiology, Multimedica IRCCS,
Milan, Italy
(Navarese, Gurbel, Andreotti, Kooodziejczak, Dias, Buffon, Jadczyk,
Laskiewicz, Jedrzejek, Brockmeyer, Wojakowski, O'Connor) Systematic
Investigation and Research on Interventions and Outcomes (SIRIO), MEDICINE
research network, Milan, Italy
(Gurbel, O'Connor) Inova Heart and Vascular Institute, Fairfax, VA, United
States
(Andreotti, Buffon) Institute of Cardiology, Catholic University, Rome,
Italy
(Kooodziejczak) University of Nicolaus Copernicus, Collegium Medicum in
Bydgoszcz, Torun, Poland
(Palmer) Department of Medicine, University of Otago Christchurch,
Christchurch, New Zealand
(Dias) School of Social and Community Medicine, University of Bristol,
Bristol, United States
(Kubica) Department of Cardiology and Internal Medicine, Nicolaus
Copernicus University, Collegium Medicum, Bydgoszcz, Poland
(Kowalewski) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital, Bydgoszcz, Poland
(Jadczyk, Laskiewicz, Jedrzejek, Wojakowski) Department of Cardiology,
Medical University of Silesia in Katowice, Katowice, Poland
(Brockmeyer) Department of Cardiology, University of Duesseldorf,
Duesseldorf, Germany
(Ruospo, Strippoli) Diaverum Medical Scientific Office, Diaverum Sweden
AB, Lund, Sweden
(Strippoli) Sydney School of Public Health, University of Sydney, Sydney,
Australia
(Strippoli) Department of Emergency and Organ Transplantation, University
of Bari, Bari, Italy
Title
Prevention of contrast-induced acute kidney injury in patients undergoing
cardiovascular procedures-A systematic review and network meta-Analysis.
Source
PLoS ONE. 12 (2) (no pagination), 2017. Article Number: e0168726. Date of
Publication: February 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Interventional diagnostic and therapeutic procedures requiring
intravascular iodinated contrast steadily increase patient exposure to the
risks of contrast-induced acute kidney injury (CIAKI), which is associated
with death, nonfatal cardiovascular events, and prolonged hospitalization.
The aim of this study was to investigate the efficacy of pharmacological
and non-pharmacological treatments for CIAKI prevention in patients
undergoing cardiovascular invasive procedures with iodinated contrast.
Methods and findings MEDLINE, Google Scholar, EMBASE and Cochrane
databases as well as abstracts and presentations from major cardiovascular
and nephrology meetings were searched, up to 22 April 2016. Eligible
studies were randomized trials comparing strategies to prevent CIAKI
(alone or in combination) when added to saline versus each other, saline,
placebo, or no treatment in patients undergoing cardiovascular invasive
procedures with administration of iodinated contrast. Two reviewers
independently extracted trial-level data including number of patients,
duration of follow-up, and outcomes. Eighteen strategies aimed at CIAKI
prevention were identified. The primary outcome was the occurrence of
CIAKI. Secondary outcomes were mortality, myocardial infarction, dialysis
and heart failure. The data were pooled using network meta-Analysis.
Treatment estimates were calculated as odds ratios (ORs) with 95% credible
intervals (CrI). 147 RCTs involving 33,463 patients were eligible. Saline
plus N-Acetylcysteine (OR 0.72, 95%CrI 0.57+/-0.88), ascorbic acid (0.59,
0.34+/-0.95), sodium bicarbonate plus N-Acetylcysteine (0.59,
0.36+/-0.89), probucol (0.42, 0.15+/-0.91), methylxanthines (0.39,
0.20+/-0.66), statin (0.36, 0.21+/-0.59), device-guided matched hydration
(0.35, 0.12+/-0.79), prostaglandins (0.26, 0.08+/-0.62) and trimetazidine
(0.26, 0.09+/-0.59) were associated with lower odds of CIAKI compared to
saline. Methylxanthines (0.12, 0.01+/- 0.94) or left ventricular
end-diastolic pressure-guided hydration (0.09, 0.01+/-0.59) were
associated with lower mortality compared to saline. Conclusions Currently
recommended treatment with saline as the only measure to prevent CIAKI
during cardiovascular procedures may not represent the optimal strategy.
Vasodilators, when added to saline, may significantly reduce the odds of
CIAKI following cardiovascular procedures. Copyright &#xa9; 2017 Navarese
et al. This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<98>
Accession Number
614356395
Author
Turky K.; Afify A.M.A.
Institution
(Turky) Faculty of Physical Therapy, October 6 University, 6 of October
City, Geza, Egypt.
Title
Effect of Preoperative Inspiratory Muscle Training on Alveolar-Arterial
Oxygen Gradients After Coronary Artery Bypass Surgery.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. (no pagination),
2017. Date of Publication: 06 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE:: Gas exchange abnormalities and inspiratory muscle dysfunction
are common postoperative pulmonary complications after cardiac surgery.
The aim of this study was to investigate the changes in the alveolar
arterial oxygen gradients and inspiratory muscle power after preoperative
inspiratory muscle training (IMT) followed by postoperative IMT and early
mobilization after coronary artery bypass graft surgery. METHODS::
Patients were randomly assigned to the intervention group (n = 20) or the
usual care group (n = 20). The intervention group received preoperative
IMT by a threshold load inspiratory muscle trainer and education followed
by postoperative IMT and early mobilization. The usual care group received
preoperative education and postoperative routine physical therapy care.
Alveolar-arterial oxygen gradients and oxygen saturation were measured
before induction of anesthesia and postoperatively immediately after
extubation, at 24 hours, 48 hours, and on day 8 postsurgery. Inspiratory
muscle power was measured before surgery, after 48 hours, and on day 8.
RESULTS:: Forty male patients underwent coronary artery bypass graft
surgery. The intervention group showed significant (P< .05) improvement of
alveolar arterial-oxygen gradients and inspiratory muscle power at all
measurement points. The mean of inspiratory muscle power at discharge was
significantly higher than at baseline but not statistically significantly
different from the preoperative measurement. CONCLUSION:: Pre- and
postoperative IMT by the threshold load inspiratory muscle trainer
resulted in improvement of inspiratory muscle power, alveolar-arterial
gradient, and oxygen saturation. Copyright &#xa9; 2017 Wolters Kluwer
Health, Inc. All rights reserved.

<99>
Accession Number
614346906
Author
Soleimani M.; Masoumi N.; Nooraei N.; Lashay A.; Safarinejad M.R.
Institution
(Soleimani, Masoumi, Lashay) Department of Urology Shahid Modarress
Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
(Nooraei) Department of Anesthesiology Shahid Beheshti University of
Medical Sciences Tehran Iran
(Safarinejad) Clinical Center for Urological Disease Diagnosis Private
Clinic Specializing in Urological and Andrological Genetics Tehran Iran
Title
The effect of fibrinogen concentrate on perioperative bleeding in
transurethral resection of the prostate: A double-blind placebo-controlled
and randomized study.
Source
Journal of Thrombosis and Haemostasis. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials: Perioperative bleeding during prostate surgery is still a
common morbidity. Anticoagulant and antiplatelet medications contribute to
the risk of hemorrhage and prolonged hospital stay. Multiple
pharmacological agents have been proposed, but none of them have been
widely accepted. It is crucial to find a safe and effective modality to
reduce hemorrhage. Summary: Background: Hemorrhage during transurethral
resection of the prostate (TUR-P) has always been a concern. Several
studies have shown preoperative administration of fibrinogen concentrate
to have promising results in reducing hemorrhage in cardiac surgery.
Objectives: To investigate the hemostatic effect of fibrinogen concentrate
administration on reducing the amount of bleeding during TUR-P in patients
with benign prostatic hyperplasia. Methods: Sixty men with benign
prostatic hyperplasia, who were chosen to undergo TUR-P, entered this
prospective randomized double-blind placebo-controlled study. The
participants were randomly assigned to two groups: treatment (n = 31) and
placebo (n = 29). They received an infusion of 2 g of fibrinogen
concentrate (treatment group) or normal saline (placebo group) before
surgery. Data regarding the amount of bleeding, the operation and
complications were recorded and analyzed. Results: No difference was
observed in bleeding between the fibrinogen and placebo groups during (521
mL versus 557 mL, respectively) and after (291 mL versus 341 mL,
respectively) surgery. This lack of difference was also seen in operation
time (43 min versus 42 min), irrigating fluid volume used during (17 L
versus 19 L) and after (29 L versus 28 L) surgery, and resected adenoma
volume (19 g versus 19 g). The mean blood pressure was also similar in
both groups as a confounding factor for the amount of bleeding.
Conclusion: Preoperative administration of fibrinogen concentrate had no
significant influence on intraoperative and postoperative bleeding in
TUR-P surgery. Copyright &#xa9; 2017 International Society on Thrombosis
and Haemostasis.

<100>
Accession Number
614341167
Author
Rao M.P.; Al-Khatib S.M.; Pokorney S.D.; She L.; Romanov A.; Nicolau J.C.;
Lee K.L.; Carson P.; Selzman C.H.; Stepinska J.; Cleland J.G.F.;
Tungsubutra W.; Desvigne-Nickens P.M.; Sueta C.A.; Siepe M.; Lang I.;
Feldman A.M.; Yii M.; Rouleau J.L.; Velazquez E.J.
Institution
(Rao) 1Duke Clinical Research Institute and Departments of Biostatistics
and Bioinformatics (KLL) and Medicine(SMA, EJV), Duke University School of
Medicine, Durham, NC; 2State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation; 3Heart Institute, University of Sao Paulo
Medical School, Sao Paulo, Brazil; 4Washington D.C. VA Medical Center,
Washington, DC; 5Division of Cardiothoracic Surgery, University of Utah,
Salt Lake City, UT; 6Institute of Cardiology, Warsaw, Poland; 7National
Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial
College, London, United Kingdom; 8Siriraj Hospital, Mahidol University,
Bangkok, Thailand; 9Division of Cardiovascular Sciences, National Heart
Lung, and Blood Institute, Bethesda, MD; 10University of North Carol
Title
Sudden Cardiac Death in Patients with Ischemic Heart Failure Undergoing
Coronary Artery Bypass Grafting: Results from the Surgical Treatment for
Ischemic Heart Failure (STICH) Randomized Clinical Trial.
Source
Circulation. (no pagination), 2017. Date of Publication: 03 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: The risk of sudden cardiac death (SCD) in patients with heart
failure following CABG has not been examined in a contemporary clinical
trial of surgical revascularization. This analysis describes the
incidence, timing and clinical predictors of SCD after CABG. METHODS-:
Patients enrolled in the Surgical Treatment of Ischemic Heart Failure
(STICH) trial who underwent CABG with or without surgical ventricular
reconstruction (SVR) were included. We excluded patients with prior ICD
and those randomized only to medical therapy. The primary outcome was SCD
as adjudicated by a blinded committee. A Cox model was used to examine and
identify predictors of SCD. The Fine and Gray method was used to estimate
the incidence of SCD accounting for the competing risk of other deaths.
RESULTS-: Over a median follow-up of 46 months, 113 patients of 1411
patients who received CABG without (n = 934) or with SVR (n = 477) had
SCD; 311 died of other causes. The mean LVEF at enrollment was 28+/-9%.
The 5-year cumulative incidence of SCD was 8.5%. Patients who had SCD and
those who did not die were younger and had fewer comorbid conditions than
those who died for reasons other than SCD. In the first 30 days after
CABG, SCD (n=5) accounted for 7% of all deaths. The numerically greatest
monthly rate of SCD was in the 31-90 day time period. In a multivariable
analysis including baseline demographics, risk factors, coronary anatomy
and LV function, ESVI and BNP were most strongly associated with SCD.
CONCLUSIONS-: The monthly risk of SCD shortly after CABG among patients
with a low LVEF is highest between the first and third month, suggesting
that risk stratification for SCD should occur early in the postoperative
period, particularly in patients with increased preoperative ESVI and/or
BNP. CLINICAL TRIAL REGISTRATION-: NCT0002359 (www.stichtrial.org)
Copyright &#xa9; 2017 by the American College of Cardiology Foundation and
the American Heart Association, Inc.

<101>
Accession Number
614326645
Author
Marwali E.M.; Boom C.E.; Budiwardhana N.; Fakhri D.; Roebiono P.S.;
Santoso A.; Sastroasmoro S.; Slee A.; Portman M.A.
Institution
(Marwali, Boom, Budiwardhana) Pediatric Cardiac Intensive Care and
Anesthesiology Division, National Cardiovascular Center Harapan Kita,
Jakarta, Indonesia
(Fakhri) Pediatric Cardiac Surgery Division, National Cardiovascular
Center Harapan Kita, Jakarta, Indonesia
(Roebiono, Santoso) Pediatric Cardiology and Congenital Heart Disease
Division, National Cardiovascular Center Harapan Kita and Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Sastroasmoro) Center for Clinical Epidemiology and Evidence Based
Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Slee) Axio Research, Seattle, Washington
(Portman) Seattle Children's Hospital and Research Institute, and
University of Washington, Seattle, Washington
Title
Oral Triiodothyronine for Infants and Children Undergoing Cardiopulmonary
Bypass.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: This study evaluated the efficacy and safety of oral
triiodothyronine (T3; Tetronine, Dalim BioTech, Korea) for infants and
children undergoing cardiopulmonary bypass in an Indonesian population.
Methods: We performed a single-center, randomized, double-blind, and
placebo-controlled trial in children aged 3 years and younger undergoing
congenital heart disease operations with cardiopulmonary bypass. We
administered oral T3 (1 mug/kg per body weight/dose) or placebo (saccharum
lactis) by nasogastric tube every 6 hours for 60 hours after induction of
anesthesia. The primary end point, time to extubation, was compared with
Cox regression. Results: The modified intention-to-treat group included
101 placebo and 104 treated patients. The stratified log-rank test did not
show a significant treatment difference (p = 0.061) for time to
extubation, but after adjustment for age, the nutritional Z score, and
Aristotle surgical complexity, the hazard ratio was 1.33 (95% confidence
interval, 1.00 to 1.76; p = 0.049). The effect of T3 was stronger in the
strata aged 5 months and younger (hazard ratio, 1.86; 95% confidence
interval 1.02 to 3.39; p = 0.043). Median intubation time was 47.3 hours
for the placebo and 32.1 hours for the T3 group in aged 5 months and
younger. Adverse events rates, including arrhythmia, were similar between
groups, although sepsis was more frequent with placebo. Conclusions: Oral
T3 supplementation may shorten time to extubation in children undergoing
congenital heart disease operations, particularly infants aged 5 months or
younger. Administration is relatively safe, simple and inexpensive.
Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<102>
Accession Number
614326382
Author
Yanagawa B.; Verma S.; Mazine A.; Tam D.Y.; Juni P.; Puskas J.D.;
Murugavel S.; Friedrich J.O.
Institution
(Yanagawa, Verma, Mazine, Tam, Murugavel) Division of Cardiac Surgery, Li
Ka Shing Knowledge Institute, St Michael's Hospital, University of
Toronto, Toronto, Ontario, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute, St
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, USA
(Friedrich) Critical Care and Medicine Departments, Li Ka Shing Knowledge
Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario,
Canada
Title
Impact of total arterial revascularization on long term survival: A
systematic review and meta-analysis of 130,305 patients.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: August 31, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: This meta-analysis compares total arterial revascularization
(TAR) versus conventional coronary artery bypass and additionally to two
arterial grafts. Methods: We searched MEDLINE and EMBASE Databases from
1996-to-2016 for studies comparing TAR versus non-TAR for multi-vessel
surgical revascularization. Data were extracted by 2 independent
investigators. Meta-analysis used random effects, which incorporates
heterogeneity. Results: There were 4 smaller shorter follow-up randomized
controlled trials (RCTs), plus 15 matched/adjusted and 6
unmatched/unadjusted larger longer follow-up observational studies that
met inclusion criteria (N =130.305 patients; mean follow-up range:
1-15years). There were no differences in perioperative stroke, myocardial
infarction or mortality. However, TAR was associated with lower long term
all-cause mortality in observational studies matched/adjusted for
confounders (incident rate ratio 0.85, 95% CI: 0.81-0.89, p <0.0001; I
² =0%) and unmatched/unadjusted (incident rate ratio 0.67, 95%
CI: 0.59-0.76, p <0.0001; I ² =67%) for TAR. Decreases in major
cardiovascular outcomes and revascularization did not achieve statistical
significance. There were greater sternal complications with TAR in the
matched/adjusted studies (pooled risk ratio 1.21, 95% CI: 1.03-1.42, p
=0.02; I ² =0%). When compared to patients with two arterial
grafts, TAR was still associated with reduced long-term all-cause
mortality (incident rate ratio 0.85, 95% CI: 0.73-0.99, p =0.04) with
minimal heterogeneity (I ² =5%). Conclusions: Data from
primarily observational studies suggest that TAR may improve long-term
survival compared with conventional coronary bypass by 15-20% even when
compared with two arterial grafts. Prospective randomized trials of TAR
with long term follow-up are needed. Copyright &#xa9; 2017.

<103>
Accession Number
614318092
Author
Li P.; Qu L.-P.; Qi D.; Shen B.; Wang Y.-M.; Xu J.-R.; Jiang W.-H.; Zhang
H.; Ding X.-Q.; Teng J.
Institution
(Li, Qi) Department of Nephrology, Yantai Yuhuangding Hospital, Yantai,
Shandong, China
(Qu) Department of Obstetrics, Yantai Yuhuangding Hospital, Yantai,
Shandong, China
(Shen, Wang, Xu, Jiang, Zhang, Ding, Teng) Department of Nephrology,
Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai,
China
(Shen, Wang, Xu, Jiang, Zhang, Ding, Teng) Kidney and Dialysis Institute
of Shanghai, Shanghai, China
(Ding, Teng) Shanghai Key Laboratory of Kidney and Blood Purification,
Shanghai, China
Title
Significance of perioperative goal-directed hemodynamic approach in
preventing postoperative complications in patients after cardiac surgery:
a meta-analysis and systematic review.
Source
Annals of Medicine. (pp 1-9), 2017. Date of Publication: 31 Jan 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose: Goal-directed hemodynamic therapy (GDT) is used to prevent
hypoperfusion resulting from surgery. The objective of this study was to
analyze the efficacy and importance of perioperative GDT. Methods: PUBMED,
MEDLINE, CENTRAL, and Google Scholar databases were searched until 17 June
2016 using the search terms: cardiac output, cardiac surgical procedures,
hemodynamics, goal-directed therapy, and intraoperative.
Randomized-controlled trials with pre-emptive hemodynamic intervention for
cardiac surgical population versus standard hemodynamic therapy were
included. Results: Nine studies were included with a total of 1148
patients. The overall analysis revealed no significant difference in the
all-cause mortality (pooled peto OR =0.58, 95%CI =0.27-1.525, p=0.164),
duration of mechanical ventilation (pooled difference in mean=-1.48,
95%CI=-3.24 to 0.28, p=0.099), or length of intensive care unit (ICU) stay
(pooled difference in mean=-9.10, 95%CI=-20.14 to 1.93, p=0.106) between
patients in the GDT and control groups. Patients in the GDP group were
associated with shorter hospital stay than those in the control group
(pooled difference in mean=-1.52, 95%CI=-2.31 to -0.73, p<0.001).
Conclusion: GDT reduces the length of hospital stay compared with the
standard of care. Further studies are necessary to continually assess the
benefit of GDT following major surgery.Key MessagesThe results of this
analysis revealed no significant difference between cardiac surgery
patients receiving goal-directed hemodynamic therapy (GDT) or conventional
fluid therapy in terms of the all-cause mortality, duration of mechanical
intervention, and length of ICU-stay.The length of hospital stay was
significantly reduced in patients treated with GDT compare to conventional
fluid therapy.GDT may have limited benefit in reducing mortality; however,
the association to shorter length of hospital stay may suggest that better
hemodynamic balance can facilitate postoperative recovery. Copyright
&#xa9; 2017 Informa UK Limited, trading as Taylor & Francis Group

<104>
Accession Number
614312762
Author
Arora S.; Strassle P.D.; Ramm C.J.; Rhodes J.A.; Vaidya S.R.; Caranasos
T.G.; Vavalle J.P.
Institution
(Arora, Ramm, Caranasos, Vavalle) Division of Cardiology, University of
North Carolina, Chapel Hill, NC, USA
(Strassle) Division of Epidemiology, University of North Carolina, Chapel
Hill, NC, USA
(Rhodes) Campbell University School of Osteopathic Medicine, Buies Creek,
NC, USA
(Vaidya) Department of Internal Medicine, Cape Fear Valley Medical Center,
Fayetteville, NC, USA
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Lower Surgical Risk Scores: A Systematic Review and Meta-Analysis of Early
Outcomes.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
November 29, 2016.
Publisher
Elsevier Ltd
Abstract
Background: The results from the PARTNER 2 trial showed the feasibility of
transcatheter aortic valve replacement (TAVR) in intermediate surgical
risk patients. Although low risk clinical trials will take time to
conclude, some data has emerged comparing TAVR with surgical aortic valve
replacement (SAVR) in lower risk patients. Methods: A Medline search was
conducted using standard methodology to search for studies reporting
results comparing TAVR and SAVR. Studies were included if the overall mean
Society of Thoracic Surgeons Score was less than 4% (or equivalent
Euroscore). A meta-analysis comparing the 30-day risk of clinical outcomes
between TAVR and SAVR in the lower surgical risk population was conducted.
Results: A total of four studies, including one clinical trial and three
propensity-matched cohort studies met the inclusion criteria. Compared to
SAVR, TAVR had a lower risk of 30-day mortality (RR 0.67, 95% CI 0.41,
1.10), stroke (RR 0.60, 95% CI 0.30, 1.22), bleeding complications (RR
0.51, 95% CI 0.40, 0.67) and acute kidney injury (RR 0.66, 95% CI 0.47,
0.94). However, a higher risk of vascular complications (RR 11.72, 95% CI
3.75, 36.64), moderate or severe paravalvular leak (RR 5.04, 95% CI 3.01,
8.43), and permanent pacemaker implantations (RR 4.62, 95% CI 2.63, 8.12)
was noted for TAVR. Conclusion: Among lower risk patients, TAVR and SAVR
appear to be comparable in short term outcomes. Additional high quality
studies among patients classified as low risk are needed to further
explore the feasibility of TAVR in all surgical risk patients. Copyright
&#xa9; 2017 Australian and New Zealand Society of Cardiac and Thoracic
Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand
(CSANZ).

<105>
Accession Number
614302509
Author
Ando T.; Takagi H.
Institution
(Ando) Detroit Medical Center, Department of Cardiology, Detroit, MI,
United States
(Takagi) Shizuoka Medical Center, Department of Cardiovascular Surgery,
Shizuoka, Japan
Title
Comparison of late mortality after transcatheter aortic valve implantation
versus surgical aortic valve replacement: Insights from a meta-analysis.
Source
European Journal of Internal Medicine. (no pagination), 2017. Date of
Publication: July 11, 2016.
Publisher
Elsevier B.V.
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has shown
non-inferior late mortality in severe aortic stenosis (AS) patients in
intermediate to inoperable risk for surgery compared to surgical aortic
valve replacement (SAVR). Late outcome of TAVI compared to SAVR is crucial
as the number of TAVI continues to increase over the last few years.
Methods: A comprehensive literature search of PUBMED and EMBASE were
conducted. Inclusion criteria were that [1] study design was a randomized
controlled trial (RCT) or a propensity-score matched (PSM) study: [2]
outcomes included >. 2-year all-cause mortality in both TAVI and SAVR. The
random-effects model was utilized to calculate an overall effect size of
TAVI compared to SAVR in all-cause mortality. Publication bias was
assessed quantitatively with Egger's test. Results: A total of 14 studies
with 6503 (3292 TAVI and 3211 SAVR, respectively) were included in the
meta-analysis. There was no difference in late all-cause mortality between
TAVI and SAVR (HR 1.17, 95%CI 0.98-1.41, p=0.08, I² =61%). The
sub-group analysis of all-cause mortality of RCT (HR 0.93 95%CI 0.78-1.10,
p=0.38, I² =40%) and PSM studies (HR 1.44 95%CI 1.15-1.80,
p=0.02, I² =35%) differed significantly (p for subgroup
differences=0.002). Meta-regression implicated that increased age and
co-existing CAD may be associated with more advantageous effects of TAVI
relative to SAVR on reducing late mortality. There was no evidence of
significant publication bias (p=0.19 for Egger's test). Conclusions: TAVI
conferred similar late all-cause mortality compared to SAVR in a
meta-analysis of RCT but had worse outcomes in a meta-analysis of PSM.
Copyright &#xa9; 2017 European Federation of Internal Medicine.