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<1>
Accession Number
612137115
Author
Body R.; Mueller C.; Giannitsis E.; Christ M.; Ordonez-Llanos J.; de
Filippi C.R.; Nowak R.; Panteghini M.; Jernberg T.; Plebani M.; Verschuren
F.; French J.K.; Christenson R.; Weiser S.; Bendig G.; Dilba P.; Lindahl
B.; Nowak R.M.; Horner D.; Dolci A.; Zaninotto M.; Manara A.;
Menassanch-Volker S.; Jarausch J.; Zaugg C.
Institution
(Body) Emergency Department, Central Manchester University Hospitals NHS
Foundation Trust, Manchester Academic Health Sciences Centre, Manchester,
United Kingdom
(Body) Cardiovascular Sciences Research Group, University of Manchester,
Oxford Road, Manchester, United Kingdom
(Mueller) Department of Cardiology, Universitatsspital Basel, Basel,
Switzerland
(Giannitsis) Abteilung Innere Medizin III Kardiologie, Angiologie und
Pneumologie, Medizinische Universitatsklinik (Krehl-Linik), Heidelberg,
Germany
(Christ) Klinik fur Notfallmedizin und Internistische Intensivmedizine,
Klinikum Nurnberg Nord, Nurnberg, Germany
(Ordonez-Llanos) IIB-Hospital de la Santa Creu i Sant Pau and Universitat
Autonoma, Barcelona, Spain
(de Filippi) Division of Cardiology, University of Maryland, Baltimore,
MD, United States
(Nowak) Henry Ford West Bloomfield Hospital, West Bloomfield, MI, United
States
(Panteghini) Azienda Ospedaliera Luigi Sacco Laboratorio Analisi Chimico
Cliniche, Milan, Italy
(Jernberg) Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
(Plebani) Servizio Medicina di Laboratorio Azienda Ospedaliera, Universita
di Padova Via Giustinianeo, Padova, Italy
(Verschuren) Department of Acute Medicine, Cliniques Universitaires
St-Luc, Universite Catholique de Louvain, Brussels, Belgium
(French) Department of Cardiology, Liverpool Hospital, Liverpool, NSW,
Australia
(Christenson) University of Maryland School of Medicine, Baltimore, MD,
United States
(Weiser, Bendig, Dilba) Roche Diagnostics Germany, Penzberg, Germany
(Lindahl) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
Title
The Use of Very Low Concentrations of High-sensitivity Troponin T to Rule
Out Acute Myocardial Infarction Using a Single Blood Test.
Source
Academic Emergency Medicine. 23 (9) (pp 1004-1013), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Recent single-center and retrospective studies suggest that
acute myocardial infarction (AMI) could be immediately excluded without
serial sampling in patients with initial high-sensitivity cardiac troponin
T (hs-cTnT) levels below the limit of detection (LoD) of the assay and no
electrocardiogram (ECG) ischemia. Objective: We aimed to determine the
external validity of those findings in a multicenter study at 12 sites in
nine countries. Methods: TRAPID-AMI was a prospective diagnostic cohort
study including patients with suspected cardiac chest pain within 6 hours
of peak symptoms. Blood drawn on arrival was centrally tested for hs-cTnT
(Roche; 99th percentile = 14 ng/L, LoD = 5 ng/L). All patients underwent
serial troponin sampling over 4-14 hours. The primary outcome, prevalent
AMI, was adjudicated based on sensitive troponin I (Siemens Ultra) levels.
Major adverse cardiac events (MACE) including AMI, death, or
rehospitalization for acute coronary syndrome with coronary
revascularization were determined after 30 days. Results: We included
1,282 patients, of whom 213 (16.6%) had AMI and 231 (18.0%) developed
MACE. Of 560 (43.7%) patients with initial hs-cTnT levels below the LoD,
four (0.7%) had AMI. In total, 471 (36.7%) patients had both initial
hs-cTnT levels below the LoD and no ECG ischemia. These patients had a
0.4% (n = 2) probability of AMI, giving 99.1% (95% confidence interval
[CI] = 96.7% to 99.9%) sensitivity and 99.6% (95% CI = 98.5% to 100.0%)
negative predictive value. The incidence of MACE in this group was 1.3%
(95% CI = 0.5% to 2.8%). Conclusions: In the absence of ECG ischemia, the
detection of very low concentrations of hs-cTnT at admission seems to
allow rapid, safe exclusion of AMI in one-third of patients without serial
sampling. This could be used alongside careful clinical assessment to help
reduce unnecessary hospital admissions. Copyright &#xa9; 2016 by the
Society for Academic Emergency Medicine

<2>
Accession Number
611153187
Author
Siddik-Sayyid S.M.; Aouad M.T.; Ibrahim M.H.; Taha S.K.; Nawfal M.F.;
Tfaili Y.J.; Kaddoum R.N.
Institution
(Siddik-Sayyid, Aouad, Ibrahim, Taha, Nawfal, Tfaili, Kaddoum) Department
of Anesthesiology, American University of Beirut - Medical Center, Beirut,
Lebanon
Title
Femoral arterial cannulation performed by residents: a comparison between
ultrasound-guided and palpation technique in infants and children
undergoing cardiac surgery.
Source
Paediatric Anaesthesia. 26 (8) (pp 823-830), 2016. Date of Publication: 01
Aug 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Percutaneous cannulation of the femoral artery in the
pediatric age group can be technically challenging, especially when
performed by residents in training. Objective: We examined whether the use
of real-time ultrasound guidance is superior to a palpation landmark
technique for femoral artery catheterization in children undergoing heart
surgery. Methods: Patients were prospectively randomized into two groups.
In the palpation group, the femoral artery was cannulated using the
traditional landmark method of palpation of arterial pulse. In the
ultrasound group, cannulation was guided by real-time scanning with an
ultrasound probe. Ten minutes were set as time limit for the resident's
trials during which the time taken for attempted cannulation (primary
outcome), number of attempts, number of successful cannulations on first
attempt, and success rate were compared between the two groups. Adverse
events were monitored on postoperative days 1 and 3. Results: A total of
106 patients were included in the study. The time taken for attempted
femoral artery cannulation was shorter (301 +/- 234 vs 420 +/- 248 s;
difference in mean: 119; 95% confidence interval (CI) of difference:
26-212; P = 0.012) and the number of attempts was lower [1 (1-10) vs 2
(1-5); difference in median: 1, 95% CI of difference: 0.28-1.72; P =
0.003] in the ultrasound group compared with the palpation group. The
number of successful cannulations on first attempt was higher in the
ultrasound group compared with palpation group [24/53 (45%) vs 13/53
(25%); odds ratio (OR): 2.54, 95% CI: 1.11-5.82; P = 0.025]. The number of
patients who had successful cannulation was 31 of 55 (58%) in the
palpation group and 40 of 53 (75%) in the ultrasound group (OR: 2.18, 95%
CI: 0.95-5.01; P = 0.06). None of the patients had adverse events at days
1 and 3. Conclusions: Ultrasound-guided femoral arterial cannulation in
children when performed by anesthesia residents is superior to the
palpation technique based on the reduction of the time taken for attempted
cannulation and the number of attempts, and improvement in first attempt
success. Copyright &#xa9; 2016 John Wiley & Sons Ltd

<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
606776217
Author
Skytte Larsson J.; Bragadottir G.; Krumbholz V.; Redfors B.; Sellgren J.;
Ricksten S.-E.
Institution
(Skytte Larsson, Bragadottir, Krumbholz, Redfors, Sellgren, Ricksten)
Department of Anaesthesiology and Intensive Care Medicine, Institute of
Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
Title
Effects of acute plasma volume expansion on renal perfusion, filtration,
and oxygenation after cardiac surgery: A randomized study on crystalloid
vs colloid.
Source
British Journal of Anaesthesia. 115 (5) (pp 736-742), 2015. Date of
Publication: November 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background In the present randomized study, we evaluated the differential
effects of a colloid and a crystalloid fluid on renal oxygen delivery
(RDO2), glomerular filtration (GFR), renal oxygen consumption (RVO2), and
the renal oxygen supply-demand relationship (i.e. renal oxygenation) after
cardiac surgery with cardiopulmonary bypass. Methods Thirty patients with
normal preoperative renal function, undergoing uncomplicated cardiac
surgery, were studied in the intensive care unit in the early
postoperative period. Patients were randomized to receive a bolus dose of
either a crystalloid (Ringers-acetate 20 ml kg^-1, n=15) or a
colloid solution (Venofundin 10 ml kg^-1, n=15). Systemic
haemodynamics were measured via a pulmonary artery catheter. Renal blood
flow and GFR were measured by the renal vein retrograde thermodilution
technique and by renal extraction of⁵¹Cr-EDTA (=filtration
fraction). Arterial and renal vein blood samples were obtained for
measurements of renal oxygen delivery (RDO2) and RVO2. Renal oxygenation
was estimated from the renal oxygen extraction. Results Despite an
increase in cardiac index and renal blood flow with both fluids, neither
of the fluids improved RDO2, because they both induced haemodilution. The
GFR increased in the crystalloid (28%) but not in the colloid group. The
crystalloid increased the filtration fraction (24%) and renal oxygen
extraction (23%), indicating that the increase in GFR, the major
determinant of RVO2, was not matched by a proportional increase in RDO2.
Conclusions Neither the colloid nor the crystalloid improved RDO2 when
used for postoperative plasma volume expansion. The crystalloid-induced
increase in GFR was associated with impaired renal oxygenation, which was
not seen with the colloid. Copyright &#xa9; The Author 2015. Published by
Oxford University Press on behalf of the British Journal of Anaesthesia.

<5>
Accession Number
613131351
Author
Reichert M.; Hecker M.; Witte B.; Bodner J.; Padberg W.; Weigand M.A.;
Hecker A.
Institution
(Reichert, Witte, Padberg, Hecker) Department of General and Thoracic
Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7,
Giessen 35392, Germany
(Hecker) Department of Pulmonology and Intensive Care Medicine, Medical
Clinic II, University Hospital of Giessen, Giessen 35392, Germany
(Bodner) Department of Thoracic Surgery, Klinikum Bogenhausen,
Englschalkinger Strasse 77, Munich 81925, Germany
(Bodner) Department of Visceral, Transplant and Thoracic Surgery, Center
of Operative Medicine, Innsbruck Medical University, Innsbruck 6020,
Austria
(Weigand) Department of Anesthesiology, University Hospital of Heidelberg,
Heidelberg 69120, Germany
Title
Stage-directed therapy of pleural empyema.
Source
Langenbeck's Archives of Surgery. 402 (1) (pp 15-26), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Intensivists and surgeons are often confronted with critically
ill patients suffering from pleural empyema. Due to it' s multifactorial
pathogenesis and etiology, medicals should be sensitized to recognize the
different stages of the disease. Besides a whole bundle of different
established classification systems, the progress of pleural effusions can
be subdivided into the early exudative, the intermediate fibropurulent and
the late organized phase according to the classification of the American
Thoracic Society. Results: Rapid diagnosis of pleura empyema is essential
for patients' survival. Due to the importance of stage-adapted therapeutic
decisions, different classification systems were established. Depending on
the stage of pleural empyema, both antimicrobial and interventional
approaches are indicated. For organized empyema, minimally invasive and
open thoracic surgery are gold standard. Surgery is based on the three
therapeutic columns: removal of pleural fluid, debridement and
decortication. In general, therapy must be intended stage-directed
following multidisciplinary concepts including surgeons, intensivists,
anesthesiologists, physiotherapists and antibiotic stewards. Despite an
established therapeutic algorithm is presented in this review, there is
still a lack of randomized, prospective studies to evaluate potential
benefits of minimally invasive (versus open) surgery for end-stage empyema
or of catheter-directed intrathoracic fibrinolysis (versus minimally
invasive surgery) for intermediate-stage pleural empyema. Any delay in
adequate therapy results in an increased morbidity and mortality.
Conclusion: The aim of this article is to review current treatment
standards for different phases of adult thoracic empyema from an
interdisciplinary point of view. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<6>
Accession Number
614272322
Author
Tang L.H.; Kikkenborg Berg S.; Christensen J.; Lawaetz J.; Doherty P.;
Taylor R.S.; Langberg H.; Zwisler A.-D.
Institution
(Tang, Kikkenborg Berg, Lawaetz) Department of Cardiology, The Heart
Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Tang, Christensen, Lawaetz, Langberg) CopenRehab, Section of Social
Medicine, Department of Public Health, University of Copenhagen, Denmark
(Tang, Lawaetz) Bachelor's Degree Program in Physiotherapy, Dept. of
Rehabilitation and Nutrition, Faculty of Health and Technology,
Metropolitan University College, Copenhagen, Denmark
(Christensen) Department of Occupational Therapy and Physiotherapy,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Doherty) Department of Health Sciences, University of York, England,
United Kingdom
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, England, United Kingdom
(Taylor) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Taylor, Zwisler) National Centre for Rehabilitation and Palliative Care,
University of Southern Denmark, Denmark
(Taylor, Zwisler) Odense University Hospital, Denmark
Title
Patients' preference for exercise setting and its influence on the health
benefits gained from exercise-based cardiac rehabilitation.
Source
International Journal of Cardiology. 232 (pp 33-39), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To assess patient preference for exercise setting and examine if
choice of setting influences the long-term health benefit of
exercise-based cardiac rehabilitation. Methods Patients participating in a
randomised controlled trial following either heart valve surgery, or
radiofrequency ablation for atrial fibrillation were given the choice to
perform a 12-week exercise programme in either a supervised centre-based,
or a self-management home-based setting. Exercise capacity and physical
and mental health outcomes were assessed for up to 24 months after
hospital discharge. Outcomes between settings were compared using a time x
setting interaction using a mixed effects regression model. Results Across
the 158 included patients, an equivalent proportion preferred to undertake
exercise rehabilitation in a centre-based setting (55%, 95% CI: 45% to
63%) compared to a home-based setting (45%, 95% CI: 37% to 53%, p =
0.233). At baseline, those who preferred a home-based setting reported
better physical health (mean difference in physical component score: 5.0,
95% CI 2.3 to 7.4; p = 0.001) and higher exercise capacity (mean between
group difference 15.9 watts, 95% CI 3.7 to 28.1; p = 0.011). With the
exception of the depression score in the Hospital Anxiety and Depression
Score (F(3.65), p = 0.004), there was no evidence of a significant
difference in outcomes between settings. Conclusion The preference of
patients to participate in home-based and centre-based exercise programmes
appears to be equivalent and provides similar health benefits. Whilst
these findings support that patients should be given the choice between
exercise-settings when initiating cardiac rehabilitation, further
confirmatory evidence is needed. Copyright &#xa9; 2017

<7>
Accession Number
614107348
Author
Hart E.A.; Jansen R.; Meijs T.A.; Bouma B.J.; Riezebos R.K.; Tanis W.; van
Boven W.J.P.; Hindori V.; Wiersma N.; Dessing T.; Westerink J.; Chamuleau
S.A.J.
Institution
(Hart, Jansen, Meijs, Dessing, Westerink, Chamuleau) University Medical
Center Utrecht, Utrecht, Netherlands
(Bouma, van Boven) Academic Medical Center, Amsterdam, Netherlands
(Riezebos, Hindori) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Tanis) Haga Ziekenhuis, The Hague, Netherlands
(Wiersma) Thrombosis Center Saltro, Utrecht, Netherlands
Title
Anticoagulant bridging in left-sided mechanical heart valve patients.
Source
International Journal of Cardiology. 232 (pp 121-126), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background In preparation for an invasive procedure with a high bleeding
risk, patients with a mechanical heart valve temporarily have to
discontinue their anticoagulant therapy and are usually bridged with
either intravenous unfractionated heparin (UFH) or subcutaneous
low-molecular-weight heparin (LMWH). In this study we retrospectively
analyzed the safety of UFH versus LMWH as bridging strategy in left-sided
mechanical heart valve patients. Methods We performed a retrospective
multicenter study in four surgical centers in The Netherlands. Patients
with a mechanical heart valve implantation bridged from January 2010 until
January 2015 were included. The cumulative incidence of adverse events in
the 30 days following the procedure was recorded. Main outcomes were major
bleeding according to International Society on Thrombosis and Haemostasis
(ISTH) criteria, symptomatic thromboembolism, and mortality. Results In
total, 238 (174 aortic, 42 mitral, 22 aortic + mitral) bridging episodes
were included. The incidence of major bleeding was 16 (19%) events in the
UFH group versus 29 (19%) events in the LMWH group (p = 0.97). Incidences
of thromboembolism were 2 (2.4%) versus 1 (0.6%). The incidence of death
was 1 (1.2%) patient in the UFH group versus 3 (1.9%) patients in the LMWH
group. More than 50% of all bleeding complications were categorized as a
major bleeding. Conclusions Bridging anticoagulation in patients with
aortic and mitral mechanical valves is associated with considerable risk,
but no difference was apparent between UFH and LMWH strategy. The rate of
thromboembolism and death was low with either strategy and the vast
majority of adverse events were bleedings. Copyright &#xa9; 2017 Elsevier
B.V.

<8>
Accession Number
614158733
Author
Schafer U.; Deuschl F.; Schofer N.; Frerker C.; Schmidt T.; Kuck K.H.;
Kreidel F.; Schirmer J.; Mizote I.; Reichenspurner H.; Blankenberg S.;
Treede H.; Conradi L.
Institution
(Schafer, Deuschl, Schofer, Mizote, Blankenberg) Department for General
and Interventional Cardiology, University Heart Center, University
Hospital Hamburg-Eppendorf, Germany
(Schirmer, Reichenspurner, Treede, Conradi) Department of Cardiovascular
Surgery, University Heart Center, University Hospital Hamburg-Eppendorf,
Germany
(Frerker, Schmidt, Kuck, Kreidel) Department of Cardiology, Asklepios
Clinic St. Georg, Hamburg, Germany
Title
Safety and efficacy of the percutaneous transaxillary access for
transcatheter aortic valve implantation using various transcatheter heart
valves in 100 consecutive patients.
Source
International Journal of Cardiology. 232 (pp 247-254), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives Transcatheter Aortic Valve Implantation (TAVI) can be performed
via the transaxillary approach, but data about complications and
procedural outcome is limited. Introduction TAVI is an established
treatment option for patients at high risk for conventional aortic valve
replacement. Nowadays, the transfemoral approach is the most commonly used
access for TAVI. Nevertheless, the transfemoral access is not suitable in
many patients necessitating alternative approaches. Methods We analyzed
the outcome of 100 consecutive cases receiving percutaneous transaxillary
TAVI at two different hospitals. Data were retrospectively analyzed by
means of procedural, hemodynamic and clinical outcome. In addition, 1st
versus 2nd generation devices were analyzed. Results Mean age was 78.2 +/-
2.1 years and the logEuroSCORE I was 24.6 +/- 13.9%. Transaxillary TAVI
was performed in 85% via the left and in 15% via the right axillary
artery. Device success was achieved in 95%. In general, there was a clear
learning curve with this approach. No patient experienced a major and 11%
a minor access site complication. There was one procedural death (annular
rupture) and one peri-procedural TIA. 23% of the patients received a new
pacemaker. At discharge, effective orifice area was 1.94 +/- 0.16
cm² and the mean aortic gradient was 6.8 +/- 2.1 mm Hg.
Moderate aortic regurgitation/paravalvular leakage was documented in two
patients. Mortality rates at 30 days and one year were 6% and 14.8%. Last
but not least, 2nd generation devices showed improved procedural outcomes.
Conclusions The percutaneous transaxillary access for TAVI is technically
feasible and safe thereby yielding excellent clinical results. Condensed
abstract We investigated In 100 consecutive patients undergoing
percutaneous transaxillary transcatheter aortic valve implantation thereby
demonstrating that this approach is technically feasible and safe with
acceptable numbers of minor vascular complications. Copyright &#xa9; 2017
Elsevier B.V.

<9>
Accession Number
612864761
Author
Buia A.; Stockhausen F.; Filmann N.; Hanisch E.
Institution
(Buia) Department of General and Visceral Surgery, St.
Elisabethen-Krankenhaus, Academic Teaching Hospital Goethe-University
Frankfurt, Ginnheimer Str. 3, Frankfurt 60487, Germany
(Stockhausen) Department of General and Visceral Surgery, St.
Elisabethen-Krankenhaus, Academic Teaching Hospital Goethe-University
Frankfurt, Frankfurt, Germany
(Filmann) Department of Medicine, Institute of Biostatistics and
Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
(Hanisch) Department of Visceral and Thoracic Surgery, Asklepios Klinik
Langen, Academic Teaching Hospital, Goethe-University Frankfurt, Langen,
Germany
Title
3D vs. 2D imaging in laparoscopic surgery-an advantage? Results of
standardised black box training in laparoscopic surgery.
Source
Langenbeck's Archives of Surgery. 402 (1) (pp 167-171), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: 3D imaging is an upcoming technology in laparoscopic surgery, and
recent studies have shown that the modern 3D technique is superior in an
experimental setting. Methods: All 14 members of the Asklepios Klinik
Langen Department of Visceral and Thoracic Surgery, as well as two
gynaecologists, were asked to undertake 2D vs. 3D laparoscopic black box
skill training. The black box training was adapted to the "fundamentals of
laparoscopic surgery" programme provided by the Society of American
Gastrointestinal and Endoscopic Surgeons (SAGES). First, the participants
categorised themselves as beginner, advanced or expert in laparoscopic
surgery. Then, they were randomised in terms of whether the black box
training commenced with 2D or 3D vision. The exercises included peg
transfer with the dominant hand and the non-dominant hand (with and
without transfer between the graspers), needle capping and cutting a
sutured knot. The time taken to complete these exercises was measured.
After the training, each participant was asked to describe his/her
personal impression of the imaging systems employed. Results: Overall, for
the participants in all groups, the time required for all exercises showed
a significant advantage for 3D imaging (3D vs. 2D; Wilcoxon matched pair
test; mean 68.0 +/- 94.9 s (3D) vs. 90.1 +/- 69.4 s (2D); p = 0.002).
Regarding the subgroups, the experts significantly improved their time in
completing the exercises in 3D vs. 2D by a margin of 25.8 % (mean 30.8 +/-
20.1 s (3D) vs. 41.5 +/- 25.0 s (2D); p = 0.010). In the group of advanced
surgeons, the results were similar, showing an improvement of 23.6 % for
3D, but without significance (mean 61.5 +/- 41.1 s (3D) vs. 80.4 +/- 72.8
s (2D); p = 0.123). The results for the beginner group also showed an
improvement in the 3D exercises of 24.8 %; here, the result also showed a
trend towards 3D but did not reach significance (mean 93.9 +/- 90.7 s (3D)
vs. 124.8 +/- 118.72 (2D); p = 0.062). Conclusion: In our opinion, 3D
imaging could be an advantage in laparoscopic surgery, especially in the
surgical education of upcoming surgical generations. To determine whether
these ex vivo results can be transferred to the clinical situation, our
group has initiated a randomised controlled study. Copyright &#xa9; 2016,
Springer-Verlag Berlin Heidelberg.

<10>
Accession Number
614117344
Author
Schulz E.; Jabs A.; Tamm A.; Herz P.; Schulz A.; Gori T.; von Bardeleben
S.; Kasper-Konig W.; Hink U.; Vahl C.-F.; Munzel T.
Institution
(Schulz, Jabs, Tamm, Herz, Schulz, Gori, von Bardeleben, Hink, Munzel)
Department of Cardiology 1, Universitatsmedizin Mainz, Germany
(Kasper-Konig, Vahl) Department of Cardiovascular and Thoracic Surgery,
Universitatsmedizin Mainz, Germany
(Jabs, Hink) Department of Cardiology, Klinikum Frankfurt Hochst,
Frankfurt am Main, Germany
Title
Comparison of transcatheter aortic valve implantation with the
newest-generation Sapien 3 vs. Direct Flow Medical valve in a single
center cohort.
Source
International Journal of Cardiology. 232 (pp 186-191), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The latest generation transcatheter heart valves including
Edwards Sapien 3 (ES3) and Direct Flow Medical (DFM) were designed to
allow precise implantation at the intended position and to minimize
prosthesis dysfunction as well as procedural complications. Our aim was to
compare short-term functional and clinical outcomes of these 2
transcatheter aortic valve systems. Methods Of 174 patients undergoing
transfemoral transcatheter aortic valve implantation (TAVI) at our
institution between August 2013 and June 2015, 113 were treated with ES3
and 61 with DFM. Device success, residual aortic regurgitation and early
safety endpoints were defined according to the updated VARC-2 criteria and
prespecified as primary endpoints. Results Patients treated with ES3 had a
significantly higher rate of procedural success (ES3 94% vs. DFM 79%, p =
0.005), mainly driven by lower postprocedural gradients (ES3 8.6 +/- 0.5
mm Hg vs. DFM 14.6 +/- 1.4 mm Hg by invasive recordings; p = 0.00012) and
no incidence of more than mild aortic regurgitation. The occurrence of
safety endpoints at 30 days was low and comparable in the DFM vs. ES3
group (ES3 88% vs. DFM 95% of patients without endpoints, p = 0.26). No
significant differences were observed in 30 day mortality, stroke or the
incidence of new permanent pacemaker implantation. Conclusions These
single-center experience data show a higher rate of device success for ES3
treated patients, while 30 day safety outcome was similar in both groups.
Long-term follow-up and larger scale multicenter experience will have to
assess possible effects of these observations on long-term clinical
outcomes. Copyright &#xa9; 2017 Elsevier B.V.

<11>
Accession Number
614029465
Author
Cajita M.I.; Denhaerynck K.; Dobbels F.; Berben L.; Russell C.L.; Davidson
P.M.; De Geest S.
Institution
(Cajita, Davidson) School of Nursing, Johns Hopkins University, Baltimore,
Maryland, United States
(Denhaerynck, Berben, De Geest) Institute of Nursing Science, Department
of Public Health, University of Basel, Basel, Switzerland
(Dobbels, De Geest) Academic Center for Nursing and Midwifery, Department
of Public Health and Primary Care, KU Leuven, Leuven, Belgium
(Russell) School of Nursing and Health Studies, University of
Missouri-Kansas City, Kansas City, Missouri, United States
Title
Health literacy in heart transplantation: Prevalence, correlates and
associations with health behaviors-Findings from the international BRIGHT
study.
Source
Journal of Heart and Lung Transplantation. 36 (3) (pp 272-279), 2017. Date
of Publication: 01 Mar 2017.
Publisher
Elsevier USA
Abstract
Background Health literacy (HL) is a major determinant of health outcomes;
however, there are few studies exploring the role of HL among heart
transplant recipients. The objectives of this study were to: (1) explore
and compare the prevalence of inadequate HL among heart transplant
recipients internationally; (2) determine the correlates of HL; and (3)
assess the relationship between HL and health-related behaviors. Methods A
secondary analysis was conducted using data of the 1,365 adult patients
from the BRIGHT study, an international multicenter, cross-sectional study
that surveyed heart transplant recipients across 11 countries and 4
continents. Using the Subjective Health Literacy Screener, inadequate HL
was operationalized as being confident in filling out medical forms none/a
little/some of the time (HL score of 0 to 2). Correlates of HL were
determined using backward stepwise logistic regression. The relationship
between HL and the health-related behaviors were examined using
hierarchical logistic regression. Results Overall, 33.1% of the heart
transplant recipients had inadequate HL. Lower education level (adjusted
odds ratio [AOR] 0.24, p < 0.001), unemployment (AOR 0.69, p = 0.012) and
country (residing in Brazil, AOR 0.25, p < 0.001) were shown to be
associated with inadequate HL. Heart transplant recipients with adequate
HL had higher odds of engaging in sufficient physical activity (AOR 1.6, p
= 0.016). HL was not significantly associated with the other health
behaviors. Conclusions Clinicians should recognize that almost one third
of heart transplant participants have inadequate health literacy.
Furthermore, they should adopt communication strategies that could
mitigate the potential negative impact of inadequate HL. Copyright &#xa9;
2017 International Society for Heart and Lung Transplantation

<12>
[Use Link to view the full text]
Accession Number
614135324
Author
Santana O.; Singla S.; Mihos C.G.; Pineda A.M.; Stone G.W.; Kurlansky
P.A.; George I.; Kirtane A.J.; Smith C.R.; Beohar N.
Institution
(Santana, Singla, Mihos, Pineda, Beohar) Echocardiography Laboratory,
Columbia University, Division of Cardiology, Mount Sinai Heart Institute,
4300 Alton Rd., Mami Beach, FL 33140, United States
(Stone, Kurlansky, George, Kirtane, Smith) Columbia University Medical
Center, New York, NY, United States
Title
Outcomes of a combined approach of percutaneous coronary revascularization
and cardiac valve surgery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 12 (1) (pp 4-8), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
A subset of patients requiring coronary revascularization and valve
surgery may benefit from a combined approach of percutaneous coronary
intervention (PCI) and valve surgery, as opposed to the standard median
sternotomy approach of combined coronary artery bypass and valve surgery.
To evaluate its potential benefits and limitations, a literature search
was performed using PubMed, EMBASE, Ovid, and the Cochrane library,
through March 2016 to identify all studies involving a combined approach
of PCI and valve surgery in patients with coronary artery and valvular
disease. There were five studies included in the study with a total of 324
patients, of which 75 (23.1%) had a history of previous cardiac surgery.
The interval between PCI and surgery ranged from simultaneous intervention
to a median of 38 days (interquartile range, 18-65 days). The surgical
approach performed consisted of a minimally invasive one or median
sternotomy. There were 275 single valve surgery (84.9%) and 49
double-valve surgery (15.1%) with a 30-day mortality ranging from 0% to
5.5%. The 1-year survival ranged from 78% to 96%, and the follow-up period
ranged from 1.3 to 5 years. Herein, we present a review of the literature
using this technique. &#xa9; Copyright 2017 by the International Society
for Minimally Invasive Cardiothoracic Surgery.

<13>
Accession Number
613210196
Author
Chan J.L.; Kobashigawa J.A.; Reich H.J.; Ramzy D.; Thottam M.M.; Yu Z.;
Aintablian T.L.; Liou F.; Patel J.K.; Kittleson M.M.; Czer L.S.; Trento
A.; Esmailian F.
Institution
(Chan, Kobashigawa, Reich, Ramzy, Thottam, Yu, Aintablian, Liou, Patel,
Kittleson, Czer, Trento, Esmailian) Cedars-Sinai Heart Institute, Los
Angeles, California, United States
(Chan, Reich, Ramzy, Trento, Esmailian) Department of Surgery,
Cedars-Sinai Medical Center, Los Angeles, California, United States
Title
Intermediate outcomes with ex-vivo allograft perfusion for heart
transplantation.
Source
Journal of Heart and Lung Transplantation. 36 (3) (pp 258-263), 2017. Date
of Publication: 01 Mar 2017.
Publisher
Elsevier USA
Abstract
Background The Organ Care System, an ex-vivo heart perfusion platform,
represents an alternative to the current standard of cold organ storage
that sustains the donor heart in a near-physiologic state. It is unknown
whether using the Organ Care System influences 2-year outcomes after heart
transplantation. We reviewed our institutional experience to compare
2-year outcomes for patients randomized to the Organ Care System or
standard cold storage. Methods Between 2011 and 2013, heart transplant
candidates from a single tertiary-care medical center enrolled within the
PROCEED II trial were randomized to either standard cold storage or the
Organ Care System. Outcomes assessed included 2-year survival, freedom
from cardiac allograft vasculopathy (CAV), non-fatal major cardiac events
(NF-MACE), biopsy-proven cellular rejection (CMR) and biopsy-proven
antibody-mediated rejection (AMR). Results Thirty-eight patients were
randomized to the Organ Care System (n = 19) or cold storage group (n =
19). There was no significant difference in 2-year patient survival (Organ
Care System: 72.2%; cold storage: 81.6%; p = 0.38). Similarly, there were
no differences in freedom from CAV, NF-MACE, CMR or AMR. The Organ Care
System group had significantly longer total ischemia time (361 +/- 96
minutes vs 207 +/- 50 minutes; p < 0.001) and shorter cold ischemia time
(134 +/- 45 minutes vs 207 +/- 50 minutes; p < 0.001) compared with the
cold storage group. Conclusion The Organ Care System did not appear to be
associated with significant differences in intermediate results compared
with conventional strategies. These results suggest that this ex-vivo
allograft perfusion system is a promising and valid platform for donor
heart transportation. Copyright &#xa9; 2017 International Society for
Heart and Lung Transplantation

<14>
Accession Number
613137113
Author
Shah A.H.; Horlick E.M.; Eicken A.; Asnes J.D.; Bocks M.L.; Boudjemline
Y.; Cabalka A.K.; Fagan T.E.; Schubert S.; Mahadevan V.S.; Dvir D.; Osten
M.; McElhinney D.B.
Institution
(Shah, Horlick, Osten) Toronto General Hospital, Toronto, Canada
(Eicken) German Heart Centre, Munich, Germany
(Asnes) Yale University, New Haven, CT, United States
(Bocks) University of Michigan, Ann Arbor, MI, United States
(Boudjemline) Necker Enfants Malades Hospital, Paris, France
(Cabalka) Mayo Clinic, Rochester, MN, United States
(Fagan) University of Tennessee Health Science Center and Le Bonheur
Children's Hospital, Memphis, TN, United States
(Schubert) Deutsches Herzzentrum, Berlin, Germany
(Mahadevan) University of California, San Francisco, CA, United States
(Dvir) St. Paul's Hospital, Vancouver, Canada
(McElhinney) Stanford University, Palo Alto, CA, United States
Title
Transcatheter valve implantation for right atrium-to-right ventricle
conduit obstruction or regurgitation after modified Bjork-fontan
procedure.
Source
Catheterization and Cardiovascular Interventions. 89 (2) (pp 298-305),
2017. Date of Publication: 01 Feb 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The most common reason for reintervention after a Bjork
modification of the Fontan procedure, in which the right ventricle (RV) is
incorporated into the pulmonary circulation by connecting the right atrial
(RA) appendage to the RV directly or with an extra-anatomic graft, is
obstruction or regurgitation of the RA-RV connection. Transcatheter
implantation of a valved stent is an appealing option for the treatment of
RA-RV conduit dysfunction in these patients. In the present study, we
assessed early and intermediate results after transcatheter valve
implantation within an obstructed or regurgitant RA-RV modified Fontan
pathway. Methods: Through a retrospective multicenter registry, we
collected data from 16 patients with a modified Fontan circulation who
were treated with percutaneous Melody or Sapien valve implantation for
dysfunction of an extra-anatomic RA-RV conduit or valve. Results: All
patients had successful and uncomplicated implantation of a Melody (n =
15) or Sapien 3 (n = 1) valve with hemodynamic and, in most cases,
clinical improvement. During a median follow-up of 3.3 years, 3 patients
died of cardiovascular causes unrelated to the procedure or the valve, and
no major valve dysfunction was observed. Conclusion: Percutaneous
transcatheter valve deployment to treat a dysfunctional RA-RV connection
after a Bjork modification of the Fontan procedure is a viable alternative
to surgery, with low procedural risk, and appears to offer good early and
intermediate results.&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9;
2016 Wiley Periodicals, Inc.

<15>
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.

<16>
Accession Number
613982038
Author
Chinnaiyan K.M.; Akasaka T.; Amano T.; Bax J.J.; Blanke P.; De Bruyne B.;
Kawasaki T.; Leipsic J.; Matsuo H.; Morino Y.; Nieman K.; Norgaard B.L.;
Patel M.R.; Pontone G.; Rabbat M.; Rogers C.; Sand N.P.; Raff G.
Institution
(Chinnaiyan, Raff) William Beaumont Hospital, Royal Oaks, MI, United
States
(Akasaka) Wakayama Medical University, Wakayama, Japan
(Amano) Aichi Medical University, Aichi, Japan
(Bax) Leiden University Medical Center, Leiden, Netherlands
(Blanke, Leipsic) Department of Radiology, University of British Columbia,
Vancouver, BC, Canada
(De Bruyne) Onze-Lieve-Vrouwziekenhuis Aalst, Aalst, Belgium
(Kawasaki) Shin Koga Hospital, Fukuoka, Japan
(Matsuo) Gifu Heart Center, Gifu, Japan
(Morino) Iwate Medical University, Iwate, Japan
(Nieman) Erasmus Medical Center, Rotterdam, Netherlands
(Norgaard) Aarhus University Hospital, Aarhus Skejby, Denmark
(Patel) Duke University School of Medicine, Durham, NC, United States
(Pontone) Centro Cardiologico Monzino, IRCCS, University of Milan, Milan,
Italy
(Rabbat) Loyola University Medical Center, Maywood, IL, United States
(Rogers) HeartFlow, Redwood City, CA, United States
(Sand) University of Southern Denmark, Odense, Denmark
Title
Rationale, design and goals of the HeartFlow assessing diagnostic value of
non-invasive FFR<inf>CT</inf> in Coronary Care (ADVANCE) registry.
Source
Journal of Cardiovascular Computed Tomography. 11 (1) (pp 62-67), 2017.
Date of Publication: 01 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Coronary CT angiography (CTA) is a reliable tool for the
detection of coronary artery disease (CAD) that conveys significant
prognostic information. It does not provide data on the hemodynamic
significance of a given lesion, particularly in intermediate-grade
stenosis. Fractional flow reserve by CT (FFR<inf>CT</inf>) can accurately
predict the hemodynamic significance of coronary lesions. The primary
objective of this registry is to determine whether the integration of
FFR<inf>CT</inf> as an adjunct to coronary CTA will lead to a significant
change in the management of CAD in patients with stable angina. Methods
The ADVANCE Registry is a multi-center, prospective registry designed to
evaluate utility, clinical outcomes and resource utilization following
FFR<inf>CT</inf>-guided treatment in clinically stable, symptomatic
patients diagnosed with CAD by coronary CTA. Approximately 5000 patients
will be enrolled from up to 50 sites in Europe, USA, Canada and Asia.
Requirement for enrollment is the presence of atherosclerosis on coronary
CTA. For each enrolled patient, a clinical management review committee
will use data from coronary CTA and FFR<inf>CT</inf> to determine the
management plan using the following criteria: (a) optimal medical therapy,
(b) percutaneous coronary intervention, (c) coronary artery bypass graft
surgery, or (d) more information required. The primary endpoint of the
registry is the reclassification rate between the management plan based on
coronary CTA alone versus CTA plus FFR<inf>CT</inf>. The secondary
endpoints of the registry include the evaluation of the rate of invasive
coronary angiography (ICA), revascularization, major adverse coronary
events, resource utilization, cumulative radiation dose exposure and the
rate of ICA without obstructive CAD at 3-year follow-up. Conclusions The
ADVANCE registry is designed to assess the real-world impact of
FFR<inf>CT</inf> on the clinical management of stable CAD when used along
with coronary CTA. Copyright &#xa9; 2016 Society of Cardiovascular
Computed Tomography

<17>
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,
Islamic Republic of
(Nooraei) Department of Anesthesiology, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Safarinejad) Clinical Center for Urological Disease Diagnosis, Private
Clinic Specializing in Urological and Andrological Genetics, Tehran, Iran,
Islamic Republic of
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. 15 (2) (pp 255-262), 2017. Date of
Publication: 01 Feb 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; 2016
International Society on Thrombosis and Haemostasis

<18>
Accession Number
609643361
Author
Mohari N.; Starr J.P.; Gates R.N.; Domico M.B.; Batra A.S.
Institution
(Mohari) Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical
Center, Los Angeles, CA, United States
(Mohari, Domico) Division of Pediatric Critical Care Medicine, Children's
Hospital of Orange County, Orange, CA, United States
(Starr, Gates) Division of Cardiothoracic Surgery, Children's Hospital of
Orange County, Orange, CA, United States
(Batra) Department of Cardiology, University of California, Irvine,
Irvine, CA, United States
Title
Bipolar Versus Unipolar Temporary Epicardial Ventricular Pacing Leads Use
in Congenital Heart Disease: A Prospective Randomized Controlled Study.
Source
PACE - Pacing and Clinical Electrophysiology. 39 (5) (pp 471-477), 2016.
Date of Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: To compare the pacing parameters of unipolar versus bipolar
temporary ventricular epicardial pacing leads. Design: Prospective
Randomized Unblinded Controlled Study. Patients and Methods: Fifty
patients undergoing surgery for congenital heart disease who were
anticipated to require temporary ventricular pacing leads were recruited
preoperatively: 25 patients were randomized to receive unipolar temporary
ventricular epicardial pacing leads; the remaining 25 were randomized to
receive bipolar temporary ventricular epicardial leads. The baseline
characteristics of the groups were similar. The pacing parameters were
measured daily for up to first seven postoperative days (PODs) with the
day of surgery recorded as POD 0. Results: On the day of insertion, the
mean pacing and sensing thresholds were similar for both unipolar and
bipolar leads. Thresholds progressively deteriorated with each subsequent
POD. By POD 4, the mean +/- standard deviation pacing threshold of
ventricular bipolar lead was 2.87 +/- 0.37 mA compared with 5.6 +/- 0.85
mA for the unipolar leads (P = 0.005). The decrease in sensing threshold
of the unipolar ventricular pacing leads was significantly more than that
of bipolar leads (by POD 5, 5.7 +/- 2.64 vs 10.33 +/- 2.8, P = 0.01).
Conclusions: Our study shows that the bipolar leads (Medtronic 6495,
Medtronic Inc., Minneapolis, MN, USA) have superior sensing and pacing
thresholds in the ventricular position in patients undergoing surgery for
congenital heart disease when compared to the unipolar leads (Medical
Concepts Europe VF608ABB, Medical Concepts Europe Inc., Buffalo, NY, USA).
Copyright &#xa9;2016 Wiley Periodicals, Inc.

<19>
[Use Link to view the full text]
Accession Number
613867714
Author
Lazam S.; Vanoverschelde J.-L.; Tribouilloy C.; Grigioni F.; Suri R.M.;
Avierinos J.-F.; Meester C.D.; Barbieri A.; Rusinaru D.; Russo A.; Pasquet
A.; Michelena H.I.; Huebner M.; Maalouf J.; Clavel M.-A.; Szymanski C.;
Enriquez-Sarano M.
Institution
(Lazam, Vanoverschelde, Grigioni, Meester, Rusinaru, Russo, Pasquet,
Huebner, Maalouf, Clavel, Szymanski, Enriquez-Sarano) Division of
Cardiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10-2881,
Brussels B-1200, Belgium
(Michelena) Mayo Clinic College of Medicine, Rochester, United States
(Tribouilloy) Inserm, ERI-12, University Hospital, Amiens, France
(Avierinos) Aix-Marseille Universite, Marseille, France
(Barbieri) University of Modena, Italy
(Suri) Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH,
United States
Title
Twenty-Year Outcome after Mitral Repair Versus Replacement for Severe
Degenerative Mitral Regurgitation: Analysis of a Large, Prospective,
Multicenter, International Registry.
Source
Circulation. 135 (5) (pp 410-422), 2017. Date of Publication: 31 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Mitral valve (MV) repair is preferred over replacement in
clinical guidelines and is an important determinant of the indication for
surgery in degenerative mitral regurgitation. However, the level of
evidence supporting current recommendations is low, and recent data cast
doubts on its validity in the current era. Accordingly, the aim of the
present study was to analyze very long-Term outcome after MV repair and
replacement for degenerative mitral regurgitation with a flail leaflet.
Methods: MIDA (Mitral Regurgitation International Database) is a
multicenter registry enrolling patients with degenerative mitral
regurgitation with a flail leaflet in 6 tertiary European and US centers.
We analyzed the outcome after MV repair (n=1709) and replacement (n=213)
overall, by propensity score matching, and by inverse
probability-of-Treatment weighting. Results: At baseline, patients
undergoing MV repair were younger, had more comorbidities, and were more
likely to present with a posterior leaflet prolapse than those undergoing
MV replacement. After propensity score matching and inverse
probability-of-Treatment weighting, the 2 treatments groups were balanced,
and absolute standardized differences were usually <10%, indicating
adequate match. Operative mortality (defined as a death occurring within
30 days from surgery or during the same hospitalization) was lower after
MV repair than after replacement in both the entire population (1.3%
versus 4.7%; P<0.001) and the propensity-matched population (0.2% versus
4.4%; P<0.001). During a mean follow-up of 9.2 years, 552 deaths were
observed, of which 207 were of cardiovascular origin. Twenty-year survival
was better after MV repair than after MV replacement in both the entire
population (46% versus 23%; P<0.001) and the matched population (41%
versus 24%; P<0.001). Similar superiority of MV repair was obtained in
patient subsets on the basis of age, sex, or any stratification criteria
(all P<0.001). MV repair was also associated with reduced incidence of
reoperations and valve-related complications. Conclusions: Among patients
with degenerative mitral regurgitation with a flail leaflet referred to
mitral surgery, MV repair was associated with lower operative mortality,
better long-Term survival, and fewer valve-related complications compared
with MV replacement. Copyright &#xa9; 2016 American Heart Association,
Inc.

<20>
Accession Number
614107960
Author
Peng F.; Liu S.; Hu Y.; Yu M.; Chen J.; Liu C.
Institution
(Peng, Liu, Hu, Yu, Chen, Liu) Department of Anesthesiology, First
Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
(Peng) Department of Anesthesiology, Northern Jiangsu People's Hospital,
Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
Title
Influence of perioperative nonsteroidal anti-inflammatory drugs on
complications after gastrointestinal surgery: A meta-analysis.
Source
Acta Anaesthesiologica Taiwanica. 54 (4) (pp 121-128), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier Taiwan LLC (96 Chung Shan North Road, Section 2, Taipei, Taiwan
(Republic of China))
Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are a key part of
multimodal perioperative analgesia. This study aimed to evaluate the
influence of perioperative NSAIDs application on complications after
gastrointestinal surgery by using meta-analysis. Methods A systematic
review of published literature was conducted by searching computerized
databases including PubMed, CBM, Springer, Chinese Academic Journals, and
China Info since the databases were published until June 2015. The
articles and retrospective references regarding complications after
gastrointestinal surgery were collected to compare postoperative
complications associated with NSAIDs or other analgesics. After they were
assessed by randomized controlled trials and extracted by the standard of
the Jadad systematic review, the homogeneous studies were pooled using
RevMan 5.3 software. The meta-analysis was performed on five postoperative
complications: postoperative anastomotic leak, cardiovascular events,
surgical site infection, nausea and vomiting, and intestinal obstruction.
Results Twelve randomized controlled trials involving 3829 patients met
the inclusion criteria. The results of meta-analyses showed the following:
(1) postoperative anastomotic leak: NSAIDs (including selective and
nonselective NSAIDs) increased the incidence of anastomotic leak [odds
ratio (OR) = 3.02, 95% confidence interval (CI): 2.16-4.23, p = 0.00001].
Further results showed that nonselective NSAIDs significantly increased
the incidence of anastomotic leak (OR = 2.96, 95% CI: 1.99-4.42, p <
0.00001), and selective NSAIDs had no significant difference as compared
with the control group using other analgesics (OR = 2.27, 95% CI:
0.68-7.56, p = 0.18); (2) postoperative cardiovascular events: NSAIDs
(selective and nonselective NSAIDs) had no difference when compared with
other analgesics (OR = 0.50, 95% CI: 0.23-1.12, p = 0.09); (3)
postoperative surgical site infection: NSAIDs (selective and nonselective
NSAIDs) and other analgesics had no difference in surgical site infection
(OR = 0.77, 95% CI: 0.52-1.15, p = 0.20); (4) postoperative nausea and
vomiting: NSAIDs (selective and nonselective NSAIDs) decreased the
incidence of nausea and vomiting (OR = 0.53, 95% CI: 0.34-0.81, p =
0.003); (5) postoperative intestinal obstruction: NSAIDs (selective and
nonselective NSAIDs) decreased the incidence of intestinal obstruction (OR
= 0.35, 95% CI: 0.13-0.89, p = 0.03). Conclusions The meta-analysis
suggests that postoperative NSAIDs, especially nonselective NSAIDs, could
increase the incidence of anastomotic leak. NSAIDs could decrease
postoperative nausea and vomiting and intestinal obstruction, but showed
no difference in cardiovascular events and surgical site infection as
compared with other analgesics. Copyright &#xa9; 2016

<21>
Accession Number
614496293
Author
Magalhaes E.; Wanono R.; Smonig R.; Lermuzeaux M.; Lebut J.; Olivier A.;
Dupuis C.; Radjou A.; Mourvillier B.; Neuville M.; Pia D'ortho M.; Bouadma
L.; Rouvel-Tallec A.; Timsit J.-F.; Sonneville R.
Institution
(Magalhaes, Smonig, Lermuzeaux, Lebut, Olivier, Dupuis, Radjou,
Mourvillier, Neuville, Bouadma, Timsit, Sonneville) Department of
Intensive Care Medicine and Infectious Diseases, Hopital Bichat-Claude
Bernard-APHP, Paris, France
(Wanono, Pia D'ortho, Rouvel-Tallec) Physiology, Hopital Bichat-Claude
Bernard-AP-HP, Paris, France
Title
Prognostic value of early intermittent electroencephalography in patients
supported by venoarterial ECMO.
Source
Annals of Intensive Care. Conference: French Intensive Care Society,
International Congress - Reanimation 2017. France. Conference Start:
20170111. Conference End: 20170113. 7 (1 Supplement 1) (no pagination),
2017. Date of Publication: January 2017.
Publisher
Springer Verlag
Abstract
Introduction Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is
increasingly used to treat refractory cardiogenic shock or cardiac arrest.
Acute brain injury (i.e. ischemic stroke, haemorrhage and/or failure to
awaken because of diffuse brain injury) may occur in up to 15% of patients
on VA-ECMO and is associated with increased mortality and poor functional
outcome in survivors. However, early indicators of neurological outcome
are lacking in this population. We aimed to assess the prognostic value of
early electroencephalography (EEG) alterations during VA-ECMO. Patients
and methods We conducted a prospective single-center study in the medical
ICU of a university hospital on consecutive patients cannulated to
VA-ECMO. A standardized clinical neurological evaluation including the
RASS score, the GCS score, the Full Outline of UnResponsiveness (FOUR)
score and brainstem reflexes was coupled to an intermittent EEG. EEG was
recorded as soon as possible within the first 72 h after VA-ECMO
cannulation. EEG characteristics were analyzed by a neurophysiologist who
was blinded to the patient's condition. A severely altered EEG pattern was
defined as a predominant delta frequency, discontinuous, unreactive and/or
an isoelectric background. The primary endpoint was poor neurological
outcome, defined as the composite of death or acute brain injury on
neuroimaging within 28 days. Data are presented as median (interquartile
range) or number (percentage). False-positive rates (FPRs, corresponding
to 1-specificity) of poor neurological outcome were calculated for each
significant predictor, using an exact binomial 95% confidence interval
(CI). Results Sixty-nine (age 58 (50-67) years) patients with a SOFA score
of 14 (13-17) were included. Main indications for ECMO were: post cardiac
surgery (n = 25, 36%), terminal dilated cardiomyopathy (n = 12, 17%), and
acute myocardial infarction (n = 11, 16%). Cardiac arrest before ECMO
cannulation was noted in 20 (29%) patients. EEG was recorded 1 (1-2) days
after VA-ECMO cannulation and 62 (90%) patients were sedated at time of
EEG. At day 28, 46 (67%) had a poor outcome (n = 37 deaths and n = 9
patients alive with acute brain injury). In univariate analysis, a lower
RASS score (p = 0.003), a lower FOUR score (p = 0.001), a lower score on
the motor component of the Glasgow coma scale (p = 0.001), and a lack of
cough reflex (p = 0.033) at the time of EEG were significantly associated
with a poor outcome. A severely impaired EEG pattern or presence of a
discontinuous background activity were also associated with a poor outcome
(p = 0.015 and p = 0.002, respectively). Indicators of poor neurologic
outcome are presented in the Table 19. Among all parameters, a
discontinuous background activity was the only variable that constantly
predicted poor outcome (false-positive poor outcome prediction rate of 0%,
95% CI 0-15%). Conclusion Early intermittent EEG has a strong prognostic
value for sedated patients on VA-ECMO. Presence of a discontinuous EEG
background activity seems to be more accurate than clinical alterations to
predict a bad neurologic outcome at 28 days. (Table Presented).

<22>
Accession Number
614479234
Author
Dewaele H.; Foucault L.; Collignon M.; Cirot E.; Raso A.-L.; Pourrat X.
Institution
(Dewaele, Foucault, Collignon, Cirot, Raso, Pourrat) Pharmacy, CHRU
Trousseau Tours, Tours, France
Title
Use of nefopam in epileptic patients: A misuse of contraindication by
clinical pharmacists.
Source
International Journal of Clinical Pharmacy. Conference: 45th ESCP-NSF
International Symposium on Clinical Pharmacy: Clinical Pharmacy Tackling
Inequalities and Access to Health Care. Norway. Conference Start:
20161005. Conference End: 20161007. 39 (1) (pp 280), 2017. Date of
Publication: February 2017.
Publisher
Springer Netherlands
Abstract
Background and objective: Nefopam is a widely used antalgic in hospital.
Its use is contraindicated in the epileptic patient as it results in
lowering the epileptogen threshold and is likely to trigger epileptic
seizures. The clinical pharmacist should systematically warn the
prescriber against this contraindication when analysing prescriptions.
Following the onset in our establishment of an epileptic condition in a
patient treated with nefopam, who had not been subject to any
pharmaceutical intervention (PI), we set about analysing the validation
practices regarding this contraindication and possibly implementing
actions designed to improve those practices. Setting and method:
Retrospective collection over a period of 17 months of prescriptions for
patients hospitalized in 210 hospital beds with clinical pharmacy service
(associating med-reconciliation, checking prescription according to
medical file and participation to medical rounds): orthopaedic surgery,
hepatic-gastro-enterology, general surgery, liver transplant and chest
surgery. Records of patients with nefopam prescription associated to
medication belonging to the therapeutic class of antiepileptics were
consulted with a view to finding cases of epilepsy. The pharmaceutical
alerts were extracted from the pharmaceutical software. Main outcome
measures: Number of epileptic patients treated with nefopam, number of
pharmaceutical interventions issued when prescribing nefopam in epileptic
patients. Results: The study focused on 11,252 patients. 3980 (35.4%) of
them were prescribed nefopam, and 143 (1.3%) of them were prescribed
nefopam associated to medication belonging to the therapeutic class of
antiepileptics. After analysis of the patients' records has shown that 55
of them were really epileptic. Only 29 PI's were effected (52.3% of
problematic prescriptions), and 25 (86%) of them had an immediate
prescription change. 77.8% (14/18) of the patients have a PI in medicine
services compared to 40.5 (15/37) in surgery services (p<0.01).
Conclusion: The results of this study show that 47% of the
contraindications related to the use of nefopam in epileptic patients are
not reported to the prescriber. These results will be presented to our
pharmacists so they can take them into account. Subsequently a new study
will be conducted to measure the relevance and efficiency of this program.

<23>
Accession Number
614411455
Author
Kirmani B.H.; Jones S.G.; Datta S.; McLaughlin E.K.; Hoschtitzky A.J.
Institution
(Kirmani, Datta, McLaughlin, Hoschtitzky) Department of Cardiothoracic
Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
(Kirmani, Jones) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom
Title
A meta-analysis of platelet gel for prevention of sternal wound infections
following cardiac surgery.
Source
Blood Transfusion. 15 (1) (pp 57-65), 2017. Date of Publication: January
2017.
Publisher
SIMTI Servizi Sri (Via Desiderio 21, Milan 20131, Italy)
Abstract
Deep sternal wound infection and bleeding are devastating complications
following cardiac surgery, which may be reduced by topical application of
autologous platelet gel. Systematic review identified seven comparative
studies involving 4,692 patients. Meta-analysis showed significant
reductions in all sternal wound infections (odds ratio 3.48 [1.08-11.23],
p=0.04) and mediastinitis (odds ratio 2.69 [1.20-6.06], p=0.02) but not
bleeding. No adverse events relating to the use of topical platelet-rich
plasma were reported. The use of autologous platelet gel in cardiac
surgery appears to provide significant reductions in serious sternal wound
infections, and its use is unlikely to be associated with significant
risk. Copyright &#xa9; SIMTI Servizi Srl.

<24>
Accession Number
614410326
Author
Yaoguo Y.; Zhong C.; Lei K.; Yaowen X.
Institution
(Yaoguo, Zhong, Lei, Yaowen) Department of Vascular Surgery, The Capital
Medical University Affiliated Beijing Anzhen Hospital, Beijing, China
(Yaoguo, Zhong, Lei, Yaowen) Beijing Institute of Heart Lung and Blood
Vessel Diseases, Beijing, China
Title
Treatment of complex aortic aneurysms with fenestrated endografts and
chimney stent repair: Systematic review and meta-analysis.
Source
Vascular. 25 (1) (pp 92-100), 2017. Date of Publication: 01 Feb 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: We reviewed data pertaining to fenestrated endograft technique
and chimney stent repair of complex aortic aneurysm for comparative
analysis of the outcomes. Methods: A comprehensive search of relevant
databases was conducted to identify articles in English, related to the
treatment of complex aortic aneurysm with fenestrated endovascular
aneurysm repair and chimney stent repair, published until January 2015.
Results: A total of 42 relevant studies and 2264 patients with aortic
aneurysm undergoing fenestrated endovascular aneurysm repair and chimney
stent repair were included in our review. A total of 4413 vessels were
involved in these processes. The cumulative 30-day mortality was 2.4% and
3.2% (p = 0.459). The follow-up aneurysm-related mortality was 1.4% and
3.2% (p = 0.018), and target organ dysfunction was 5.0% and 4.0% in
fenestrated endovascular aneurysm repair and chimney stent repair,
respectively (p = 0.27). A total of 156 vessels showed restenosis or
occlusion after primary intervention (3.6% and 3.4% in fenestrated
endovascular aneurysm repair and chimney stent repair, respectively, p =
0.792). The cumulative type I endoleak was 2.0% (38/1884) after
fenestrated endovascular aneurysm repair compared with 3.4% (13/380) after
chimney stent repair (p = 0.092), and the type II endoleak was 5.4%
(102/1884) and 5.3% (20/380), respectively (p = 0.905). Approximately,
1.1% and 1.6% increase in aneurysm was observed following fenestrated
endovascular aneurysm repair and chimney stent repair, respectively (p =
0.437). The re-intervention frequency was 205 and 19 cases after
fenestrated endovascular aneurysm repair and chimney stent repair,
respectively (11.7%, 5.6%, p = 0.001). Conclusions: Fenestrated
endovascular aneurysm repair and chimney stent repair are safe and
effective in treating patients with complex aortic aneurysm. A higher
aneurysm-related mortality was observed in chimney stent repair while
fenestrated endovascular aneurysm repair was associated with a higher
re-intervention rate. Copyright &#xa9; 2016, &#xa9; The Author(s) 2016.

<25>
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.

<26>
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).

<27>
[Use Link to view the full text]
Accession Number
613939934
Author
Shi Q.; Hong L.; Mu X.; Zhang C.; Chen X.
Institution
(Shi, Hong, Mu, Zhang) Department of Critical Care Medicine, Nanjing First
Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
(Chen) Department of Thoracic and Cardiovascular Surgery, Nanjing First
Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
Title
Meta-analysis for outcomes of acute kidney injury after cardiac surgery.
Source
Medicine (United States). 95 (49) (pp e5558), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
This study aimed to investigate the outcomes of acute kidney injury (AKI)
after cardiac surgery by the meta-analysis. Electronic databases PubMed
and Embase were searched for relative studies from December 2008 to June
2015. For eligible studies, the R software was conducted to meta-analyze
outcomes of AKI patients (AKI group) and none-AKI patients after cardiac
surgery (NO AKI group). The chi-square-based Q test and I2 statistic were
used for heterogeneity analysis. P<0.1 or I2>50% revealed significant
heterogeneity among studies, and then a random effects model was used;
otherwise a fixed effect model was performed. Egger's test was performed
for publication bias assessment. Subgroup analysis was performed by
stratifying AKI definitions and study type. Totally 17 studies with 9656
subjects (2331 in the AKI group and 7325 in the NO AKI group) were
enrolled. Significantly higher renal replacement therapy (RRT) (OR=23.67,
95%CI: 12.58-44.55), mortality (OR=6.27, 95%CI: 3.58-11.00), serum
creatinine (SMD= 1.42, 95%CI: 1.01-1.83), and hospital length of stay
(LOS) (SMD=0.45, 95%CI: 0.02-0.88) were shown in the AKI group compared
with patients in the NO AKI group. Subgroup analysis showed that results
of only 3 subgroups were reversed indicating that the definition of AKI
did not affect its outcomes. Publication bias was only found among studies
involving mortality and serum creatinine, but the 2 outcomes were not
reversed after correction. This meta-analysis confirmed the worse outcomes
of AKI in patients after cardiac surgery, including higher RRT rates,
mortality, and longer hospital LOS than those of NO AKI patients.
Copyright &#xa9; 2016 the Author(s).

<28>
[Use Link to view the full text]
Accession Number
609399024
Author
Sud M.; Naimark D.M.J.
Institution
(Sud) Division of Cardiology, Sunnybrook Health Sciences Centre, 2075
Bayview Ave., Toronto, ON M4N 3M5, Canada
(Naimark) Division of Nephrology, Sunnybrook Health Sciences Centre, 2075
Bayview Ave., Toronto, ON M4N 3M5, Canada
(Naimark) Institute of Health Policy Management and Evaluation, Faculty of
Medicine, University of Toronto, Toronto, ON, Canada
Title
Cardiovascular disease in chronic kidney disease in 2015.
Source
Current Opinion in Nephrology and Hypertension. 25 (3) (pp 203-207), 2016.
Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Purpose of review Chronic kidney disease (CKD) is strongly linked to
premature cardiovascular disease, which is the leading cause of death
before end-stage renal disease in these patients. Herein, we review recent
literature from 2014 to 2015 that has advanced our understanding of
cardiovascular outcomes in patients with advanced and/or progressive CKD.
Recent findings We focus on new data describing the mechanisms of cardiac
death in patients with CKD as well as the novel associations between
cardiac events and the competing risks of end-stage renal disease and
pre-end-stage renal disease death. We review new controversies in
multivessel revascularization of complex coronary artery disease in CKD
and, finally, the treatment of systolic heart failure in advanced CKD,
including the use of implantable defibrillator therapy. Summary Marked
advances in the understanding of cardiovascular disease in CKD have
occurred in the past year, namely from retrospective and registry data.
Although exciting, these recent studies highlight the urgent need for
randomized control trials to guide therapeutic decisions. Copyright &#xa9;
2016 Wolters Kluwer Health, Inc. All rights reserved.

<29>
Accession Number
614414950
Author
Trongtrakul K.; Poopipatpab S.; Pisitsak C.; Chittawatanarat K.; Morakul
S.
Institution
(Trongtrakul) Department of Emergency Medicine, Faculty of Medicine Vajira
Hospital, Navamindradhiraj University, Bangkok, Thailand
(Poopipatpab) Department of Anesthesiology, Faculty of Medicine Vajira
Hospital, Navamindradhiraj University, Bangkok, Thailand
(Pisitsak, Morakul) Department of Anesthesiology, Faculty of Medicine,
Ramithibodi Hospital, Mahidol University, Bangkok, Thailand
(Chittawatanarat) Department of Surgery, Faculty of Medicine, Chiang Mai
University, Chiang Mai, Thailand
Title
Acute kidney injury in elderly patients in thai-surgical intensive care
units (THAI-SICU) study.
Source
Journal of the Medical Association of Thailand. 99 (9 Supplement 6) (pp
S209-S218), 2016. Date of Publication: September 2016.
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: To demonstrate prevalence, characteristics and outcomes of the
elderly patients who were diagnosed with acute kidney injury (AKI) in
surgical intensive care units (ICUs). Material and Method: AKI data were
extracted from multicenter prospective cohort study conducted in 9
university-affiliated surgical ICUs in Thailand (THAI-SICU study) from
April 2011 to January 2013. The elderly group was defined as those over 65
years old. Statistical analysis was done comparing baseline
characteristics and outcomes between the elderly with AKI and those
without. Results: A total of 2,310 elderly patients (49.7%) were
identified in our surgical ICUs from a total 4,652 cases. Of this elderly
group, AKI was diagnosed in 445 cases (19.3%). The differences in the
baseline characteristics of the elderly with AKI group were: older, higher
number of males, greater number of smokers, and greater disease severity
evaluated with APACHE-II and SOFA score than the elderly without AKI. The
ICU mortality and 28-day hospital mortality were higher in the elderly
with AKI than those without (28.1% vs. 5.2%, p<0.001 with RR = 5.401, 95%
CI 4.231-6.895 and 35.7% vs. 9.4%, p<0.001 with RR = 3.786, 95% CI
3.138-4.569, respectively). Using multivariable logistic regression
analysis and after adjustment of covariates, independent potential risk
factors of developing AKI in the SICU included: older age, higher
APACHE-II and SOFA score, smoking history, emergency surgery, concurrent
sepsis, cardiac complications, delirium, and requiring respiratory support
during ICU stay. Conclusion: Geriatric patients made up almost half of our
surgical ICU population and nearly one-fifth of them suffered AKI. Once
they had AKI, ICU mortality and 28-day hospital mortality were higher than
those without AKI. Copyright &#xa9; 2016, Medical Association of Thailand.
All rights reserved.

<30>
Accession Number
614414909
Author
Kitsiripant C.; Chittawatanarat K.; Chatmongkolchart S.; Akaraborworn O.
Institution
(Kitsiripant, Chatmongkolchart) Department of Anesthesiology, Faculty of
Medicine, Prince of Songkla University, Songkhla, Thailand
(Chittawatanarat) Department of Surgery, Faculty of Medicine, Chiang Mai
University, Chiang Mai, Thailand
(Akaraborworn) Department of Surgery, Faculty of Medicine, Prince of
Songkla University, Songkhla, Thailand
Title
Incidence, outcomes and risk factors for mortality of symptomatic upper
gastrointestinal hemorrhage in surgical critical ill patients (THAI SICU
study).
Source
Journal of the Medical Association of Thailand. 99 (9 Supplement 6) (pp
S170-S177), 2016. Date of Publication: September 2016.
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: This multicenter university-based study reports the incidence,
outcomes and defined risk factors for mortality of upper gastrointestinal
hemorrhage (UGIH) patients in the surgical intensive care units (ICU)
patients in Thailand. Material and Method: This is part of a multicenter
prospective observational study in the ICU in Thailand (THAI-SICU study).
Patients who had a clinical presentation of upper gastrointestinal
hemorrhage or an endoscopic diagnosis from April 2011 to January 2013 were
enrolled into this sub-study. Results: A total of 4,652 patients were
analyzed. Fifty-five patients (1.18%) had symptomatic UGIH during ICU
admission. The median age (interquartile range, IQR) was 72 (63-78) years
old and the median APACHE II score (IQR) was 17 (13-22). In a comparison
between the UGIH patients who survived and those who non-survived APACHE
II score were higher in the non-survivors. The ICU mortality rate and
28-day mortality rate in these patients were 30.91% and 40%, respectively.
In multivariable model, UGIH was significantly associated with 28-day
mortality [adjusted odds ratio, OR, (95% confidence interval, CI): 1.99
(1.02 to 3.88); p = 0.043] and ICU length of stay [adjusted coefficient
(95% CI): 9.36 (8.03 to 10.70); p<0.001]. Regarding the exploratory model,
the significant risk factors for non-survived of UGIH patients were
coagulopathy especially platelet count <50,000 [OR (95% CI): 3.96
(1.07-14.67); p = 0.039] and INR >1.5 [5 (1.04-23.98); p = 0.044], renal
failure [6.48 (1.37-30.61); p = 0.018], APACHE II score [1.11 (1.02-1.22);
p = 0.020] and vasopressor use [5.78 (1.6- 37.18); p = 0.013]. Conclusion:
The incidence of symptomatic UGIH in the THAI-SICU study was 1.18% and
UGIH was associated with higher 28-day mortality rate and prolonged ICU
length of stay. The risk factors for mortality were coagulopathy, renal
failure, APACHE II score and vasopressor use. Copyright &#xa9; 2016,
Medical Association of Thailand. All rights reserved.

<31>
Accession Number
614414892
Author
Piriyapatsom A.; Chittawatanarat K.; Kongsayreepong S.; Chaiwat O.
Institution
(Piriyapatsom, Kongsayreepong, Chaiwat) Department of Anesthesiology,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
(Chittawatanarat) Department of Surgery, Faculty of Medicine, Chiang Mai
University, Chiang Mai, Thailand
Title
Incidence and risk factors of unplanned extubation in critically ill
surgical patients: The multi-center thai university-based surgical
intensive care units study (THAI-SICU study).
Source
Journal of the Medical Association of Thailand. 99 (9 Supplement 6) (pp
S153-S162), 2016. Date of Publication: September 2016.
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: Unplanned extubation (UE) is one of the most troubling events
in critically ill patients who require endotracheal intubation and
mechanical ventilation. The aims of this study are to determine the
incidence and to identify the risk factors associated with UE in
critically ill surgical patients. Material and Method: This was a
multi-center prospective observational cohort study, which included
surgical patients admitted to nine university-based surgical intensive
care units (SICUs) in Thailand between April 2011 and January 2013. UE was
defined as deliberate extubation by patients (self-extubation) or
accidental extubation during procedures or transportation. The incidence
of UE was calculated, the adjusted logistic regression model was performed
to determine the independent risk factors for UE and the outcomes were
compared between those with planned extubation and UE. Results: 2,890
patients required endotracheal intubation and mechanical ventilation were
included in the analysis. Of these, 54 patients experienced UE and,
therefore, the incidence of UE was 1.9%. Five independent risk factors for
UE were identified; congestive heart failure (adjusted odds ratio, OR,
3.48; 95% CI, 1.29-9.40), emergency surgery (adjusted OR, 2.18; 95% CI,
1.01-4.74), non-postoperative status (adjusted OR, 2.37; 95% CI,
1.05-5.37), sedation usage (adjusted OR, 3.19; 95% CI, 1.72-5.93) and
delirium (adjusted OR, 3.61; 95% CI, 1.71-7.60). ICU length of stay (LOS)
was significantly longer in patients with UE than those with planned
extubation (adjusted coefficient, 2.76; 95% CI, 1.34-4.19). There was no
significant difference between the two groups in terms of hospital LOS as
well as ICU and 28-day mortality. Conclusion: The incidence of UE in
critically ill surgical patients was 1.9%. Five independent risk factors
for UE were: underlying congestive heart failure, emergency surgery,
non-postoperative status, sedation usage, and delirium. Patients with UE
had significantly longer ICU LOS than those with planned extubation.
Copyright &#xa9; 2016, Medical Association of Thailand. All rights
reserved.

<32>
Accession Number
614414877
Author
Buppha P.; Kusumaphanyo C.; Chittawatanarat K.
Institution
(Buppha, Kusumaphanyo) Department of Anesthesiology, Faculty of Medicine,
Srinakharinwirot University, Nakhon Nayok, Thailand
(Chittawatanarat) Department of Surgery, Faculty of Medicine, Chiang Mai
University, Chiang Mai, Thailand
Title
Outcomes and risk factors of extubation failure: A multicenter study of
the THAI surgical intensive care units (SICUs).
Source
Journal of the Medical Association of Thailand. 99 (9 Supplement 6) (pp
S136-S144), 2016. Date of Publication: September 2016.
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: To identify risk factors associated with extubation failure
(EF) in patients admitted to surgical ICUs (SICUs). Material and Method:
Data were gathered during April 2011-January 2013 by collecting
demographic, admission details, daily summary, nutritional profile, APACHE
II scores, and discharge summary from patients admitted to SICUs among
nine university hospitals. Exclusion criteria include pediatric patients,
non-consent patients, multiple trauma, cardiovascular and thoracic, and
neurosurgical patients. Data were collected to the endpoint of 28 days of
admission. Morbidity and mortality were determined. Complications or
adverse events that occurred during admission were detailed in separate
record forms. Result: Of 4,652 patients, 2,890 were intubated. Among them,
2,749 were successfully extubated leaving 141 with extubation failure.
Overall incidence of EF was 4.88% (with range from 1.41-7.33). Patient
characteristics in EF groups were compared to successful groups. Advanced
age, presence of congestive heart failure, vascular disease, COPD,
emergency surgery, poor APACHE II and SOFA scores, and concurrent use of
vasopressors, inotropes and sedatives were significant differences. The
most common causes of EF were respiratory failure, inability to cough and
laryngeal edema. Outcomes of EF included prolonged length of ICU stay [2
(IQR 1-5) vs. 11 (IQR 6-15) days] and hospital stay [16 (IQR 10-27) vs. 23
(IQR 15-33) days]. Patients with EF were at risk of 6-fold longer ICU stay
than successful extubation. Adjusted odds ratio of age, congestive heart
failure, emergency surgery, and SOFA score were identified with
statistical significance to be risk factors of EF. Conclusion: EF can
affect outcomes of ICU admission. Identifying the risk factors associated
with EF will help reduce its incidence and improve ICU outcomes. Copyright
&#xa9; 2016, Medical Association of Thailand. All rights reserved.

<33>
Accession Number
614414807
Author
Chanthawong S.; Chau-In W.; Pipanmekaporn T.; Chittawatanarat K.;
Kongsayreepong S.; Rojanapithayakorn N.
Institution
(Chanthawong, Chau-In, Rojanapithayakorn) Department of Anesthesiology,
Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
(Pipanmekaporn) Department of Anesthesiology, Faculty of Medicine, Chiang
Mai University, Chiang Mai, Thailand
(Chittawatanarat) Department of Surgery, Faculty of Medicine, Chiang Mai
University, Chiang Mai, Thailand
(Kongsayreepong) Department of Anesthesiology, Faculty of Medicine Siriraj
Hospital, Mahidol University, Bangkok, Thailand
Title
Incidence of cardiac arrest and related factors in a multi-center thai
university-based surgical intensive care units study (THAI-SICU study).
Source
Journal of the Medical Association of Thailand. 99 (9 Supplement 6) (pp
S91-S99), 2016. Date of Publication: September 2016.
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: To describe the incidences, outcomes and determine the risk
factor(s) of cardiac arrest in surgical intensive care unit (SICU).
Material and Method: We collected data between April 2011 and January
2013. The case record form (CRF) included the CRF 1 (admission, daily
screening and discharge data) and the CRF 2 for cardiac arrest events. The
patients were followedup until discharge from SICU or for up to 28 days
after admission in SICU. Results: The incidence of cardiac arrest in SICU
was 226 in 4,652 patients (4.9%). The APACHE II score at the day with
cardiac arrest were 24.1. Initial monitor rhythm during cardiac was
asystole (35.4%), bradycardia (22.6%) and pulseless electrical activity
(14.6%). The main cause was poor patient condition before admission
(51.3%). Most of the cardiac arrest patients (73.9%) had antecedents
within 24 hour and the most common antecedents were hypotension, metabolic
disturbances and sepsis and/or septic shock. The overall return of
spontaneous circulation rate was 23.5%. At hospital discharge, the
mortality rate (91.6%) was statistically different between the cardiac
arrest and non-cardiac arrest group (p<0.001). The Acute Physiologic and
Chronic Health Evaluation II score (APACHE II score) (Odds ratio, (OR
1.15, 95% CI 1.11-1.19, p<0.001), Sequential Organ Failure Assessment
score (SOFA score) (OR 1.12, 95% CI 1.03-1.20, p = 0.005) and American
Society of Anesthesiologists physical status physical status (ASA PS) >3
(OR 2.32, 95% CI 1.33-4.04, p = 0.003) were significantly risk factors for
cardiac arrest. Conclusion: Cardiac arrest in the SICU was uncommon.
Initial non-shockable rhythms were common and mostly had antecedents
before cardiac arrest. The APACHE II score, SOFA score and ASA PS >3 were
independent risk factors for cardiac arrest in SICU. Copyright &#xa9;
2016, Medical Association of Thailand. All rights reserved.

<34>
Accession Number
614169767
Author
Li Z.; Zhou Y.; Xu Q.; Chen X.
Institution
(Li, Chen) Department of Cardiology, Affiliated Hospital Ningbo No. 1
Hospital, Zhejiang University, Ningbo, China
(Zhou) Department of Cardiology, First Affiliated Hospital, School of
Medicine, Zhejiang University, Ningbo, China
(Xu) Department of Nephrology, Affiliated Hospital Ningbo No. 1 Hospital,
Zhejiang University, Ningbo, China
Title
Staged versus one-time complete revascularization with percutaneous
coronary intervention in STEMI patients with multivessel disease: A
systematic review and meta-analysis.
Source
PLoS ONE. 12 (1) (no pagination), 2017. Article Number: e0169406. Date of
Publication: January 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction: In patients with acute ST-elevation myocardial infarction
(STEMI), the preferred intervention is percutaneous coronary intervention
(PCI). Whether staged PCI (S-PCI) or one-time complete PCI (MV-PCI) is
more beneficial and safer in terms of treating the non-culprit vessel
during the primary PCI procedure is unclear. We performed a meta-analysis
of all randomized and non-randomized controlled trials comparing S-PCI
with MV-PCI in patients with acute STEMI and MVD. Methods: Studies of
STEMI with multivessel disease receiving primary PCI were searched in
PUBMED, EMBASE and The Cochrane Register of Controlled Trials from January
2004 to December 2014. The primary end points were long-term rates of
major adverse cardiovascular events and their components - mortality,
reinfarction, and target-vessel revascularization. Data were combined
using a fixed-effects model. Results: Of 507 citations, 10 studies (4
randomized, 6 nonrandomized; 820 patients, 562 staged PCI and 347
one-time, complete multi-vessel PCI) were included. S-PCI compared to
MV-PCI significantly reduced mortality both long-term (OR 0.44, 95% CI
0.29-0.66, P<0.0001,I² = 0%) and short-term (OR 0.23, 95% CI
0.1-0.51, P = 0.0003,I² = 0%). There was a trend toward reduced
risk of MACE with s-PCI compared with MV-PCI (OR 0.83, 0.62-1.12, P =
0.22,I2 = 0%). No difference between S-PCI and MV-PCI was observed in
reinfarction (OR 0.97, 0.61-1.55, P = 0.91, I² = 0%), or target
vessel revascularization (OR1.17, 95% CI 0.81-1.69, P = 0.40,
I² = 8%). Conclusions: The staged strategy for non-culprit
lesions improved short- and long-term survival and should remain the
standard approach to primary PCI in patients with STEMI; one-time complete
multivessel PCI may be associated with greater mortality risk. However,
additional large, randomized trials are required to confirm the optimal
timing of a staged procedure on the non-culprit vessel in STEMI. Copyright
&#xa9; 2017 Li 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.

<35>
Accession Number
614399494
Author
Izzat M.B.; Almohammad F.; Raslan A.F.
Institution
(Izzat, Almohammad, Raslan) Damascus University, Cardiac Surgery Hospital,
PO Box 33831, Damascus, Syrian Arab Republic
Title
Off-pump grafting does not reduce postoperative pulmonary dysfunction.
Source
Asian Cardiovascular and Thoracic Annals. 25 (2) (pp 113-117), 2017. Date
of Publication: 01 Feb 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objectives Pulmonary dysfunction is a recognized postoperative
complication that may be linked to use of cardiopulmonary bypass. The
off-pump technique of coronary artery bypass aims to avoid some of the
complications that may be related to cardiopulmonary bypass. In this
study, we compared the influence of on-pump or off-pump coronary artery
bypass on pulmonary gas exchange following routine surgery. Methods Fifty
patients (mean age 60.4 +/- 8.4 years) with no preexisting lung disease
and good left ventricular function undergoing primary coronary artery
bypass grafting were prospectively randomized to undergo surgery with or
without cardiopulmonary bypass. Alveolar/arterial oxygen pressure
gradients were calculated prior to induction of anesthesia while the
patients were breathing room air, and repeated postoperatively during
mechanical ventilation and after extubation while inspiring 3 specific
fractions of oxygen. Results Baseline preoperative arterial blood gases
and alveolar/arterial oxygen pressure gradients were similar in both
groups. At both postoperative stages, the partial pressure of arterial
oxygen and alveolar/arterial oxygen pressure gradients increased with
increasing fraction of inspired oxygen, but there were no statistically
significant differences between patients who underwent surgery with or
without cardiopulmonary bypass, either during ventilation or after
extubation. Conclusions Off-pump surgery is not associated with superior
pulmonary gas exchange in the early postoperative period following routine
coronary artery bypass grafting in patients with good left ventricular
function and no preexisting lung disease. Copyright &#xa9; SAGE
Publications.

<36>
Accession Number
614399489
Author
Patel J.; Prajapati M.; Patel H.; Gandhi H.; Deodhar S.; Pandya H.
Institution
(Patel, Prajapati, Gandhi, Deodhar) Department of Cardiac Anesthesia, UN
Mehta Institute of Cardiology and Research Center (Affiliated to BJ
Medical College), New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat
380016, India
(Patel) Department of Medical Officer, UN Mehta Institute of Cardiology
and Research Center, Ahmedabad, Gujarat, India
(Pandya) Department of Research, UN Mehta Institute of Cardiology and
Research Center, Ahmedabad, Gujarat, India
Title
Topical and low-dose intravenous tranexamic acid in cyanotic cardiac
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 25 (2) (pp 118-122), 2017. Date
of Publication: 01 Feb 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Coagulopathy is a major problem in surgery for cyanotic
congenital heart disease. Tranexamic acid has been used both topically and
systemically and plays a vital role in pediatric cardiac surgery by
reducing blood loss and blood product requirement. We aimed to determine
the anti-fibrinolytic effectiveness of low-dose systemic or topical
tranexamic acid or a combination of both. Methods Seventy-five patients
were divided in 3 groups of 25. Group A patients were given tranexamic
acid 20 mg kg^-1 intravenously after sternotomy and 20 mg
kg^-1 after heparin reversal. Group B patients were given
tranexamic acid 50 mg kg^-1 in 20 mL of saline
intrapericardially before sternal closure, with the drain clamped for 20
min. Group C patients were given tranexamic acid 20 mg kg^-1
intravenously after sternotomy and 50 mg kg^-1
intrapericardially before sternal closure. A number of clinical variables
were recorded in the first 3 postoperative days. Ventilator time,
intensive care unit stay, and outcome were also recorded. Results Chest
tube drainage and blood product requirements were lowest in group C. Blood
urea and serum creatinine levels were higher in groups A and C (p < 0.05).
Intensive care unit stay and ventilator time were similar in all 3 groups.
No patient died and none had a seizure or other neurological event or
thromboembolic complication postoperatively. Conclusion The combination of
low-dose intravenous and topical tranexamic acid reduces postoperative
blood loss and blood product requirement without incurring neurological,
renal or thromboembolic complications. We recommend the routine use of
topical and low-dose systemic tranexamic acid in cyanotic pediatric
cardiac surgery. Copyright &#xa9; SAGE Publications.

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

<38>
Accession Number
612005502
Author
Wu X.; Kubilay N.Z.; Ren J.; Allegranzi B.; Bischoff P.; Zayed B.; Pittet
D.; Li J.
Institution
(Wu, Ren, Li) Department of Surgery, Jinling Hospital, Medical School of
Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
(Kubilay, Allegranzi, Zayed) Infection Prevention and Control Unit,
Department of Service Delivery & Safety, World Health Organization,
Geneva, Switzerland
(Bischoff) Institute of Hygiene and Environmental Medicine,
Charite-University Medicine Berlin, Berlin, Germany
(Pittet) Infection Control Programme, University of Geneva Hospitals and
Faculty of Medicine, Geneva, Switzerland
Title
Antimicrobial-coated sutures to decrease surgical site infections: a
systematic review and meta-analysis.
Source
European Journal of Clinical Microbiology and Infectious Diseases. 36 (1)
(pp 19-32), 2017. Date of Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
To investigate the effectiveness of antimicrobial-coated sutures compared
with non-coated sutures in reducing surgical site infection (SSI) and
develop recommendations for World Health Organization (WHO) SSI prevention
guidelines. We searched Medline, Embase, Cinahl, Cochrane Central Register
of Controlled Trials, and WHO Global Health from 1990-16/02/2015 with
language restricted to English, Spanish, and French. Meta-analysis was
performed with a random-effects model. Meta-regression analysis assessed
whether the effect of antimicrobial coating changed according to the type
of suture and surgery. Subgroup analyses were based on types of sutures.
Quality of the retrieved evidence was assessed using the Grading of
Recommendations Assessment, Development, and Evaluation. Thirteen
randomized controlled trials (RCTs) and five observational studies (OBSs)
met the inclusion criteria. Antimicrobial sutures significantly reduced
SSI risk (for RCTs: OR 0.72, 95 % CI 0.59-0.88, p = 0.001, I² =
14 %; for OBSs: OR 0.58, 95 % CI 0.40-0.83, p = 0.003, I² = 22
%). Only Vicryl Plus vs Vicryl revealed consistent results in favor of
antimicrobial sutures (for seven RCTs: OR 0.62, 95 % CI 0.44-0.88, p =
0.007, I² = 3 %; for four OBSs: OR 0.58, 95 % CI 0.37-0.92, p =
0.02, I² = 41 %). The effect of antimicrobial coating was
similar between different suture, wound, and procedure types. Quality of
RCT evidence was moderate, and OBS evidence was very low quality.
Triclosan-coated sutures may reduce SSI risk. However, the available
evidence is of moderate/low quality, and many studies had conflicts of
interest. Copyright &#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<39>
Accession Number
614006705
Author
Lee J.M.; Rhee T.-M.; Chang H.; Ahn C.; Park T.K.; Yang J.H.; Song Y.B.;
Choi S.-H.; Gwon H.-C.; Hahn J.-Y.
Institution
(Lee, Chang, Park, Yang, Song, Choi, Gwon, Hahn) Department of Internal
Medicine and Cardiovascular Center, Heart Vascular Stroke Institute,
Samsung Medical Center, Sungkyunkwan University School of Medicine, United
States
(Rhee) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Ahn) Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD, United States
Title
Deferred versus conventional stent implantation in patients with acute
ST-segment elevation myocardial infarction: An updated meta-analysis of 10
studies.
Source
International Journal of Cardiology. 230 (pp 509-517), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background We sought to evaluate safety and efficacy of the deferred
stenting versus immediate stent implantation of infarct-related arteries
in patients with acute ST-segment elevation myocardial infarction (STEMI)
undergoing primary percutaneous coronary intervention (PCI). Methods A
meta-analysis using random-effects models were conducted. The primary
outcome, major adverse cardiac events (MACE), was a composite of all-cause
mortality, myocardial infarction (MI), any unplanned target vessel
revascularization (TVR), and hospitalization due to cardiac cause.
Periprocedural composite events were composed of acute re-occlusion,
no-reflow/slow flow, or distal embolization. Results Seven non-randomized
registries and three randomized trials comparing outcomes of deferred
versus immediate stenting in infarct-related arteries of 2281 STEMI
patients were selected. Risk of MACE between deferred or immediate
stenting did not differ significantly (rates, 12.8% vs 15.0%; pooled RR =
0.68, 95% CI: 0.43-1.06; p = 0.087; I² = 26.8%). Deferred
stenting was associated with significantly reduced risk of periprocedural
composite events (rates, 5.3% vs 10.2%; pooled RR = 0.36, 95% CI:
0.18-0.69; p = 0.002; I² = 68.0%) and flow abnormality in
infarct-related arteries (rates, 3.8% vs 8.4%; pooled RR = 0.29, 95% CI:
0.14-0.61; p = 0.001; I² = 58.1%). However, clinical outcomes
including all-cause mortality, MI, or any unplanned TVR, were unaffected.
Meta-regression indicated a significant relationship between prolonged
total ischemic and reduced risk of MACE after deferred stenting (OR =
0.994, 95% CI: 0.990-0.998; p = 0.027; I² residual 0.0%,
adjusted R² = 100.0%). Conclusions Although deferred stenting
carried significantly lower risk of periprocedural composite events and
abnormal flow in patients undergoing primary PCI for STEMI, such benefits
had no impact on MACE, which did not differ significantly by timing of
stent placement. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<40>
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).

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

<42>
Accession Number
613688511
Author
Papageorgiou N.; Briasoulis A.; Lazaros G.; Imazio M.; Tousoulis D.
Institution
(Papageorgiou) Barts Heart Centre, St Bartholomew's Hospital, London,
United Kingdom
(Papageorgiou, Lazaros, Tousoulis) First Cardiology Department, University
of Athens Medical School, Hippokration General Hospital, Athens, Greece
(Briasoulis) Cardiovascular Institute, Wayne State University, Detroit,
MI, United States
(Imazio) Cardiology Department, Maria Vittoria Hospital, Torino, Italy
(Imazio) Department of Public Health and Pediatrics, University of Torino,
Torino, Italy
Title
Colchicine for prevention and treatment of cardiac diseases: A
meta-analysis.
Source
Cardiovascular Therapeutics. 35 (1) (pp 10-18), 2017. Date of Publication:
01 Feb 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims: Colchicine has been suggested to be beneficial in preventing
recurrent pericarditis. The goal of this study was to review all
randomized controlled trials that assess the use of colchicine for the
prevention and treatment of cardiac diseases. Methods: We performed a
meta-analysis of the effects of colchicine on pericarditis,
postpericardiotomy syndrome and postprocedural atrial fibrillation
recurrence, in-stent restenosis, gastrointestinal adverse effects, and
treatment discontinuation rates. We conducted an EMBASE and MEDLINE search
for prospective controlled trials. Results: We identified 17 prospective
controlled randomized studies with 2082 patients that received colchicine
and 1982 controls with an average follow-up duration of 12 months.
Treatment with colchicine is associated with reduced risk of pericarditis
recurrence/postpericardiotomy syndrome (OR: 0.37; 95% CI: 0.29-0.47;
P<0.001) and lower recurrence of atrial fibrillation rates after cardiac
surgery and ablation procedures. However, gastrointestinal side effects
were more common in patients treated with colchicine (OR: 2.6; 95% CI:
1.82-3.72; P<0.001) in all subgroups except for those treated for
prevention of recurrent pericarditis. The higher rates of side effects
resulted in higher incidence of treatment discontinuation in patients
treated with colchicine. Conclusion: Colchicine appears to be efficacious
and well tolerated for recurrent pericarditis/postpericardiotomy syndrome
and recurrence of postprocedural atrial fibrillation. However, its
efficacy may be limited by its gastrointestinal adverse events and
treatment discontinuation rates particularly in postoperative patients.
Copyright &#xa9; 2016 John Wiley & Sons Ltd

<43>
[Use Link to view the full text]
Accession Number
612933427
Author
Roshanov P.S.; Rochwerg B.; Patel A.; Salehian O.; Duceppe E.; Belley-Cote
E.P.; Guyatt G.H.; Sessler D.I.; Le Manach Y.; Borges F.K.; Tandon V.;
Worster A.; Thompson A.; Koshy M.; Devereaux B.; Spencer F.A.; Sanders
R.D.; Sloan E.N.; Morley E.E.; Paul J.; Raymer K.E.; Punthakee Z.;
Devereaux P.J.
Institution
(Roshanov, Rochwerg, Tandon, Worster, Thompson, Koshy, Devereaux, Spencer,
Sanders, Paul, Raymer, Punthakee, Devereaux) London Kidney Clinical
Research Unit, London Health Sciences Centre, Room ELL-101, 800
Commissioners Road East, London, ON N6A 4G5, Canada
(Belley-Cote, Guyatt, Koshy, Devereaux, Paul, Raymer, Punthakee,
Devereaux) Departments of Medicine, Canada
(Patel, Salehian, Borges, Koshy, Devereaux, Spencer) Clinical Epidemiology
and Biostatistics, Canada
(Patel, Salehian, Tandon, Worster, Koshy, Devereaux) Clinical Epidemiology
and Biostatistics and Anesthesiology, McMaster University, Hamilton, ON,
Canada
(Duceppe, Belley-Cote, Guyatt, Le Manach, Borges) Population Health
Research Institute, Hamilton, ON, Canada
(Sessler) Department of Outcomes Research, Cleveland Clinic, Cleveland,
OH, United States
(Sanders) Department of Anesthesiology, University of Wisconsin, Madison,
WI, United States
(Sloan, Morley) Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
Title
Withholding versus Continuing Angiotensin-converting Enzyme Inhibitors or
Angiotensin II Receptor Blockers before Noncardiac Surgery.
Source
Anesthesiology. 126 (1) (pp 16-27), 2017. Date of Publication: 01 Jan
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The effect on cardiovascular outcomes of withholding
angiotensin-converting enzyme inhibitors or angiotensin II receptor
blockers in chronic users before noncardiac surgery is unknown. Methods:
In this international prospective cohort study, the authors analyzed data
from 14,687 patients (including 4,802 angiotensin-converting enzyme
inhibitor/angiotensin II receptor blocker users) at least 45 yr old who
had in-patient noncardiac surgery from 2007 to 2011. Using multivariable
regression models, the authors studied the relationship between
withholding angiotensin-converting enzyme inhibitors/angiotensin II
receptor blockers and a primary composite outcome of all-cause death,
stroke, or myocardial injury after noncardiac surgery at 30 days, with
intraoperative and postoperative clinically important hypotension as
secondary outcomes. Results: Compared to patients who continued their
angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers,
the 1,245 (26%) angiotensin-converting enzyme inhibitor/angiotensin II
receptor blocker users who withheld their angiotensin-converting enzyme
inhibitors/angiotensin II receptor blockers in the 24 h before surgery
were less likely to suffer the primary composite outcome of all-cause
death, stroke, or myocardial injury (150/1,245 [12.0%] vs. 459/3,557
[12.9%]; adjusted relative risk, 0.82; 95% CI, 0.70 to 0.96; P = 0.01) and
intraoperative hypotension (adjusted relative risk, 0.80; 95% CI, 0.72 to
0.93; P < 0.001). The risk of postoperative hypotension was similar
between the two groups (adjusted relative risk, 0.92; 95% CI, 0.77 to
1.10; P = 0.36). Results were consistent across the range of preoperative
blood pressures. The practice of withholding angiotensin-converting enzyme
inhibitors/angiotensin II receptor blockers was only modestly correlated
with patient characteristics and the type and timing of surgery.
Conclusions: Withholding angiotensin-converting enzyme
inhibitors/angiotensin II receptor blockers before major noncardiac
surgery was associated with a lower risk of death and postoperative
vascular events. A large randomized trial is needed to confirm this
finding. In the interim, clinicians should consider recommending that
patients withhold angiotensin-converting enzyme inhibitors/angiotensin II
receptor blockers 24 h before surgery. Copyright &#xa9; 2016 the American
Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights
Reserved.

<44>
[Use Link to view the full text]
Accession Number
610354392
Author
Conrotto F.; D'Ascenzo F.; Stella P.; Pavani M.; Rossi M.L.; Brambilla N.;
Napodano M.; Covolo E.; Saia F.; Tarantini G.; Agostoni P.; Marzocchi A.;
Presbitero P.; Bedogni F.; Salizzoni S.; D'Amico M.; Moretti C.; Rinaldi
M.; Gaita F.
Institution
(Conrotto, D'Ascenzo, Pavani, D'Amico, Moretti, Gaita) Division of
Cardiology, Citta della Salute e della Scienza Hospital, Corso Bramante
88, Turin 10100, Italy
(Stella, Agostoni) Department of Cardiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Rossi) Division of Cardiology, Istituto Clinico Humanitas, Netherlands
(Brambilla, Presbitero, Bedogni) Department of Cardiology, Clinical
Institute S. Ambrogio, Milan, Italy
(Napodano, Covolo, Tarantini) Department of Cardiac, Thoracic and Vascular
Sciences, Division of Cardiology, University of Padova, Padova, Italy
(Saia, Marzocchi) Division of Cardiology, Policlinico
Sant'Orsola-Malpighi, Bologna, Italy
(Salizzoni, Rinaldi) Division of Cardiac Surgery, Citta della Salute e
della Scienza Hospital, University of Turin, Turin, Italy
Title
Transcatheter aortic valve implantation in low ejection fraction/low
transvalvular gradient patients: The rule of 40.
Source
Journal of Cardiovascular Medicine. 18 (2) (pp 103-108), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Several factors have been identified as predictors of events
after transcatheter aortic valve implantation (TAVI) but the impact of
left ventricular ejection fraction (LVEF) and mean transaortic gradient
(MTG) is controversial. This multicenter study aimed to clarify the
prognostic role of low LVEF and low MTG after TAVI. Methods From 2007 to
2012, 764 consecutive patients with severe symptomatic aortic valve
stenosis underwent TAVI at participating hospitals. Patients were divided
according to LVEF and MTG into four groups. Results Sixty-four patients
had LVEF 40% or less and MTG less than 40 mmHg, 76 had LVEF 40% or less
and MTG at least 40 mmHg, 163 had LVEF more than 40% and MTG less than 40
mmHg, 461 had LVEF more than 40% and MTG at least 40 mmHg. Two-year
mortality was significantly higher in patients with low LVEF and low MTG,
whereas it was similar in patients with low LVEF and high MTG, high LVEF
and low MTG, and high LVEF and high MTG (51.3 vs. 22.4 vs. 23.3. vs.
25.5%, respectively; P = 0.001). These results were confirmed by
multivariate analysis, as the combination of low LVEF and low MTG (both
less than 40) was identified as the stronger mid-term mortality predictor
(hazard ratio 2.4, confidence interval 95% 1.4-3.9; P = 0.001). Conclusion
At least one parameter between LVEF or MTG over 40 predicts a good
prognosis for TAVI patients at midterm follow-up, whereas those with both
left ventricular dysfunction and low mean aortic pressure gradient are at
high risk of all-cause death after TAVI. Copyright &#xa9; 2017 Italian
Federation of Cardiology. All rights reserved.

<45>
Accession Number
614093520
Author
Fink N.; Segev A.; Kornowski R.; Finkelstein A.; Assali A.; Rozenbaum Z.;
Vaknin-Assa H.; Halkin A.; Fefer P.; Ben-Shoshan J.; Regev E.; Konigstein
M.; Orvin K.; Guetta V.; Barbash I.M.
Institution
(Fink, Segev, Fefer, Regev, Guetta, Barbash) Leviev Heart Center,
Interventional Cardiology, Sheba Medical Center, Ramat Gan, Israel
(Finkelstein, Rozenbaum, Halkin, Ben-Shoshan, Konigstein) Department of
Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
(Kornowski, Assali, Vaknin-Assa, Orvin) Department of Cardiology, Rabin
Medical Center, Petach Tikva, Israel
Title
Balloon dilatation and outcome among patients undergoing trans-femoral
aortic valve replacement.
Source
International Journal of Cardiology. 230 (pp 537-541), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Balloon pre-dilatation before transcatheter aortic valve
replacement (TAVR) is performed at the discretion of the treating
physician. Clinical data assessing the implications of this step on
procedural outcomes are limited. Methods We conducted a retrospective
analysis of 1164 consecutive TAVR patients in the Israeli multicenter TAVR
registry (Sheba, Rabin, and Tel Aviv Medical Centers) between the years
2008 and 2014. Patients were divided to those who underwent balloon
pre-dilation (n = 1026) versus those who did not (n = 138). Results Rates
of balloon pre-dilation decreased from 95% in 2008-2011 to 59% in 2014 (p
for trend = 0.002). Baseline characteristics between groups were similar
except for more smoking (22% vs. 8%, p = 0.008), less past CABG (18% vs.
26%, p = 0.016), less diabetes mellitus (35% vs. 45%, p = 0.01), and lower
STS mortality scores (5.2 +/- 3.7 vs. 6.1 +/- 3.5, p = 0.006) in the
pre-dilatation group. The pre-dilation group included less patients with
moderate to severely depressed LVEF (7% vs. 16%, p < 0.001) and higher
aortic peak gradients (76.9 +/- 22.7 mmHg vs. 71.4 +/- 24.3 mmHg, p =
0.01). Stroke rates were comparable in both groups (2.5% vs. 3%, p = 0.8),
but pre-dilation was associated with lower rates of balloon
post-dilatation (9% vs. 26%, p < 0.001). On multivariate analysis, balloon
pre-dilatation was not a predictor of device success or any
post-procedural complications (p = 0.07). Conclusions Balloon
pre-dilatation was not associated with procedural adverse events and may
decrease the need for balloon post-dilatation. The results of the present
study support the current practice to perform liberally balloon
pre-dilatation prior to valve implantation. Copyright &#xa9; 2016 Elsevier
Ireland Ltd

<46>
Accession Number
614188869
Author
Giustino G.; Sorrentino S.; Mehran R.; Faggioni M.; Dangas G.
Title
Cerebral Embolic Protection During TAVR: A Clinical Event Meta-Analysis.
Source
Journal of the American College of Cardiology. 69 (4) (pp 465-466), 2017.
Date of Publication: 31 Jan 2017.
Publisher
Elsevier USA

<47>
Accession Number
614188784
Author
Nakagawa K.; Kim M.-K.; Kaneda H.; Mitsutake Y.; Vlachos H.A.; Waseda K.;
Detre K.M.; Kelsey S.F.; Thomas S.B.; Tyrrell K.S.; Rana J.S.; Averbach
F.; MacGregor J.M.; O'Neal S.M.; Pitluga K.; Sansing V.; Tranchine M.;
Crow S.W.; Bertolet M.M.; Kip K.; Lu J.; Janiszewski S.; Protivnak D.;
Reiser S.; Barton S.; Guo P.; Kushner Y.; Michael O.; Martin J.P.; Kania
C.; Kania M.; O'Donnell J.; Maxwell R.A.; Hueb W.; Ramires J.; Lopes N.;
Wajchenberg B.L.; Martinez E.E.; Oliveira S.A.; Ribeiro E.E.; Perin M.;
Betti R.; Schwartz L.; Steiner G.; Barolet A.; Groenewoud Y.; Mighton L.;
Camelon K.; O'Rourke R.; Blodgett J.; Sako E.; Nicastro J.; Prescott R.;
Rihal C.; Kennedy F.; Barsness G.; Basu A.; Clavell A.; Frye R.; Holmes
D.R.; Lerman A.; Mullaney C.; Reeder G.; Rizza R.; Schaff H.; Smith S.;
Somers V.; Sundt T.; Ting H.; Wright R.S.; Helgemoe P.; Lesmeister D.;
Rolbiecki D.; Lepe-Montoya L.; Escobedo J.; Barraza R.; Baleon R.; Campos
A.; Garcia P.; Lezama C.; Miramontes C.; Ocampo S.; Penafiel J.V.;
Valdespino A.; Verdin R.; Albarran H.; Ayala F.; Chavez E.; Murillo H.;
Buitron L.V.; Rico-Verdin B.; Angulo F.; Adler D.; Halle A.A.;
Ismail-Beigi F.; Paranjape S.; Mazzurco S.; Ridley K.; Solomon S.; Wall
B.; Weinman D.; Touchstone T.; Douglas L.; Bourassa M.; Tardif J.-C.;
Chiasson J.-L.; Lavoie M.A.; Rabasa-Lhoret R.; Langelier H.; Foucher S.;
Trudel J.; Monrad S.; Srinivas V.; Zonszein J.; Crandall J.; Duffy H.;
Vartolomei E.; Jacobs C.; Robertson D.; Porter M.; Eley M.; Nichols E.;
LaCorte J.; Rogers W.; Ovalle F.; Bell D.; Misra V.K.; Hillegass W.B.;
Aqel R.; Pierce P.; Smith M.; Saag L.; Vaughn A.; Smith D.; Grimes T.;
Rolli S.; Hill R.; Barrett B.D.; Morehead C.; Doss K.; Davidson C.J.;
Molitch M.; Beohar N.; Massaro E.; Goodreau L.; Arroyo F.; Neuzil P.;
Pavlickova L.; Stehlikova S.; Benedik J.; Coling L.; Davies R.; Glover C.;
LeMay M.; Mesana T.; Ooi T.C.; Silverman M.; Sorisky A.; Favreau C.;
McClinton S.; Weiss M.; Weiss I.; Saulle L.; Kannam H.; Kurylas J.C.; Vasi
L.; Douglas J.; Ghazzal Z.; Sperling L.; King S.; Dayamani P.; Gebhart S.;
Basu S.; Helmy T.; Tangpricha V.; Hyde P.; Jenkins M.; Grant B.P.; Kent
K.; Suddath W.; Magee M.; Julien-Williams P.; Reed V.; Nassar C.; Dagenais
G.; Garceau C.; Auger D.; Buller C.; Elliott T.; Ramanathan K.; Ricci D.;
Fox R.; Kolesniak D.; Attubato M.; Feit F.; Richardson S.; Sing I.P.;
Amendola A.; Vargas B.; Tsapatsaris N.; Woods B.; Cushing G.; Rutter M.;
Singh P.; DesRochers G.; Woodhead G.; Gannon D.; Campbell N.S.; Ragosta
M.; Sarembock I.; Powers E.; Barrett E.; Jahn L.; Murie K.; Das G.;
Sigurdsson G.; White C.; Bantle J.; Redmon J.B.; Kwong C.; Tamis-Holland
J.; Hochman J.S.; Slater J.; Wilentz J.; Frances S.; Tormey D.; Pepine C.;
Smith K.; Kennedy L.; Brezner K.; Curry T.; Bleyer F.; Albert S.;
Mooradian A.; Plummer S.; Fuentes F.; Robles R.; Lavis V.; Gomez J.;
Iliescu C.; Underwood C.; Fulton M.S.; Ramirez J.G.; Merta J.; Scott G.;
Krishnaswami A.; Dowdell L.; Berkheimer S.; Greenbaum A.; Whitehouse F.;
Pangilinan R.; Mann K.; Jacobs A.K.; Sternthal E.; Ebner S.; Nedeljkovic
Z.; Beardsley P.; Schneider D.; Pratley R.; Cefalu W.; Schnure J.; Tilton
L.; Niederman A.; Mata C.; Kellerman T.; Farmer J.; Garber A.J.; Kleiman
N.; Howard N.; Nichols D.; Pool M.; Granger C.; Feinglos M.; Adams G.;
Green J.; Druken B.; Underwood D.; Stafford J.L.; Donner T.; Laskey W.;
Beach D.; Lopez J.; Davis A.; Faxon D.; Reutrakul S.; Bayer E.; Marroquin
O.; Cohen H.; Korytkowski M.; Koerbel G.; Baxendell L.; Rosenfelder D.;
DeRiso L.; Farrell C.; Vita T.; McGill J.; Krone R.; Bach R.; Recklein C.;
Luepke K.M.; Clifton M.J.; Farkouh M.E.; Kim M.C.; Smith D.A.; Guzman I.;
Travis A.; O'Keefe J.; Forker A.; Isley W.; Moe R.; Kennedy P.; Rosson M.;
Long A.; Bates E.; Herman W.; Pop-Busui R.; Duvernoy C.; Stevens M.;
Luciano A.; Majors C.; Rodriguez A.; Herr M.; Williams D.; Smith R.J.;
Abbott J.D.; Laufgraben M.J.; Grogan M.; Muratori J.; Habib G.; Marcelli
M.; Mikati I.; Cordero E.; Caldwell G.; Schechter D.; Lorber D.; Brown M.;
Depree P.; Huber K.; Hanusch-Enserer U.; Jordanova N.; Cilesiz D.; Vogel
B.; McCallister B.; Kleerekoper M.; Mandagere K.; Urbanic R.; Bengston J.;
Kong B.K.; Pruitt A.; Sanfield J.; Carulli C.; Churley-Strom R.; Magorien
R.; Osei K.; Boyer C.C.; Lee R.; Palumbo P.; Wisbey J.; Alderman E.; Ikeno
F.; Michael Steffes A.S.; Nowicki M.; Bucksa J.; Chaitman B.; Eckstein J.;
Stocke K.; Hlatky M.A.; Boothroyd D.B.; Melsop K.A.; Sobel B.E.; Rowen M.;
Neimane D.; Iskandrian A.E.; Schaaf M.B.; Bongarno T.; August P.; Hultberg
K.; Gottlieb S.H.; Albu J.; Rosenhouse-Romeo H.; Orchard T.J.; Pambianco
G.; Lombardero M.; Mock M.; Frye R.L.; Brooks M.M.; Desvigne-Nickens P.;
Ershow A.; Genuth S.; Goldberg S.; Hardison R.; Jones T.L.Z.; Kelsey S.;
Nesto R.; Orchard T.; Paltoo D.; Rosenberg Y.; Ryan T.; Lebovitz H.; Brown
R.; Friesinger G.; Horton E.; Mason J.; Virmani R.; Wechsler L.;
Bairey-Merz C.N.; Kennedy J.W.; Gordon D.; Antman E.; Colwell J.; Fowler
S.; Furberg C.; Goldman L.; Jennings B.; Rankin S.
Institution
(Ikeno, Nakagawa, Kim, Kaneda, Mitsutake, Waseda, Hlatky) Division of
Cardiovascular Medicine, Stanford University School of Medicine, Stanford,
California, United States
(Brooks, Vlachos, Kelsey) Department of Epidemiology, University of
Pittsburgh, Pittsburgh, Pennsylvania, United States
(Schwartz) Division of Cardiology, University Health Network-Toronto
General Hospital, Toronto, Ontario, Canada
(Frye) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
(Hlatky) Department of Health Research and Policy, Stanford University
School of Medicine, Stanford, California, United States
Title
SYNTAX Score and Long-Term Outcomes: The BARI-2D Trial.
Source
Journal of the American College of Cardiology. 69 (4) (pp 395-403), 2017.
Date of Publication: 31 Jan 2017.
Publisher
Elsevier USA
Abstract
Background The extent of coronary disease affects clinical outcomes and
may predict the effectiveness of coronary revascularization with either
coronary artery bypass graft (CABG) surgery or percutaneous coronary
intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery) score quantifies the extent
of coronary disease. Objectives This study sought to determine whether
SYNTAX scores predicted outcomes and the effectiveness of coronary
revascularization compared with medical therapy in the BARI-2D (Bypass
Angioplasty Revascularization Investigation 2 Diabetes) trial. Methods
Baseline SYNTAX scores were retrospectively calculated for BARI-2D
patients without prior revascularization (N = 1,550) by angiographic
laboratory investigators masked to patient characteristics and outcomes.
The primary outcome was major cardiovascular events (a composite of death,
myocardial infarction, and stroke) over 5 years. Results A mid/high SYNTAX
score (>23) was associated with a higher risk of major cardiovascular
events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01).
Patients in the CABG stratum had significantly higher SYNTAX scores: 36%
had mid/high SYNTAX scores compared with 13% in the PCI stratum (p <
0.001). Among patients with low SYNTAX scores (<22), major cardiovascular
events did not differ significantly between revascularization and medical
therapy, either in the CABG stratum (26.1% vs. 29.9%, p = 0.41) or in the
PCI stratum (17.8% vs. 19.2%, p = 0.84). Among patients with mid/high
SYNTAX scores, however, major cardiovascular events were lower after
revascularization than with medical therapy in the CABG stratum (15.3% vs.
30.3%, p = 0.02), but not in the PCI stratum (35.6% vs. 26.5%, p = 0.12).
Conclusions Among patients with diabetes and stable ischemic heart
disease, higher SYNTAX scores predict higher rates of major cardiovascular
events and were associated with more favorable outcomes of
revascularization compared with medical therapy among patients suitable
for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2
Diabetes; NCT00006305) Copyright &#xa9; 2017 American College of
Cardiology Foundation

<48>
Accession Number
614188736
Author
Kapadia S.R.; Mehran R.; Lazar R.M.; Zivadinov R.; Dwyer M.G.; Jilaihawi
H.; Virmani R.; Thourani V.H.; Chakravarty T.; Nakamura M.; McCabe J.M.;
Szeto W.Y.; Svensson L.; Alu M.C.; White R.M.; Kraemer C.; Parhizgar A.;
Leon M.B.; Makkar R.; Al-Jilaihawi H.; Kapadia S.; Krishnaswamy A.; Tuzcu
E.M.; Mick S.; Kodali S.; Nazif T.; Thourani V.; Babaliaros V.; Devireddy
C.; Mavromatis K.; Waksman R.; Satler L.; Pichard A.; Szeto W.; Anwaruddin
S.; Vallabhajosyula P.; Giri J.; Herrmann H.; Zajarias A.; Lasala J.;
Greenbaum A.; O'Neill W.; Eng M.; Rovin J.; Lin L.; Spriggs D.; Wong
S.-C.; Bergman G.; Salemi A.; Smalling R.; Kar B.; Loyalka P.; Lim D.S.;
Ragosta M.; Reisman M.; McCabe J.; Don C.; Sharma S.; Kini A.; Dangas G.;
Mahoney P.; Morse A.; Stankewicz M.; Rodriguez E.; Linke A.; Mangner N.;
Woitek F.; Frerker C.; Cohen D.
Institution
(Kapadia, Krishnaswamy, Mick, Svensson) Cleveland Clinic, Cleveland, Ohio,
United States
(Kodali, Lazar, Nazif, Alu, Leon) Columbia University Medical Center, New
York, New York, United States
(Makkar, Chakravarty, Nakamura) Cedars-Sinai Medical Center, Los Angeles,
California, United States
(Mehran) Mount Sinai School of Medicine, New York, New York, United States
(Zivadinov, Dwyer) Buffalo Neuroimaging Analysis Center, Buffalo, New
York, United States
(Jilaihawi) NYU Langone Medical Center, New York, New York, United States
(Virmani) CV Path Institute, Gaithersburg, Maryland, United States
(Anwaruddin, Szeto) University of Pennsylvania, Philadelphia,
Pennsylvania, United States
(Thourani) Emory University, Atlanta, Georgia
(Mangner, Woitek, Linke) Herzzentrum Leipzig GmbH-Universitatsklinik,
Leipzig, Germany
(McCabe) University of Washington, Seattle, Washington, United States
(Satler) Medstar Washington Hospital Center, Washington, DC, United States
(Zajarias) Washington University School of Medicine, St. Louis, Missouri,
United States
(White) Duke Clinical Research Institute, Durham, North Carolina, United
States
(Kraemer) NAMSA, Minneapolis, Minnesota, United States
(Parhizgar) Claret Medical, Inc., Santa Rosa, California, United States
(Linke) Leipzig Heart Institute, Leipzig, Germany
Title
Protection Against Cerebral Embolism During Transcatheter Aortic Valve
Replacement.
Source
Journal of the American College of Cardiology. 69 (4) (pp 367-377), 2017.
Date of Publication: 31 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Neurological complications after transcatheter aortic valve
replacement (TAVR) may be reduced with transcatheter cerebral embolic
protection (TCEP). Objectives This study evaluated the safety and efficacy
of TCEP during TAVR. Methods Nineteen centers randomized 363 patients
undergoing TAVR to a safety arm (n = 123), device imaging (n = 121), and
control imaging (n = 119). The primary safety endpoint consisted of major
adverse cardiac and cerebrovascular events (MACCE) at 30 days, and the
primary efficacy endpoint was reduction in new lesion volume in protected
brain territories on magnetic resonance imaging scans at 2 to 7 days.
Patients underwent neurocognitive assessments, and the debris captured was
analyzed. Results The rate of MACCE (7.3%) was noninferior to the
performance goal (18.3%, p<inf>noninferior</inf> < 0.001) and not
statistically different from that of the control group (9.9%; p = 0.41).
New lesion volume was 178.0 mm³ in control subjects and 102.8
mm³ in the device arm (p = 0.33). A post hoc multivariable
analysis identified pre-existing lesion volume and valve type as
predictors of new lesion volume. Strokes at 30 days were 9.1% in control
subjects and 5.6% in patients with devices (p = 0.25) Neurocognitive
function was similar in control subjects and patients with devices, but
there was a correlation between lesion volume and neurocognitive decline
(p = 0.0022). Debris found within filters in 99% of patients included
thrombus, calcification, valve tissue, artery wall, and foreign material.
Conclusions TCEP was safe, captured embolic debris in 99% of patients, and
did not change neurocognitive function. Reduction in new lesion volume on
magnetic resonance scans was not statistically significant. (Cerebral
Protection in Transcatheter Aortic Valve Replacement [SENTINEL];
NCT02214277) Copyright &#xa9; 2017 American College of Cardiology
Foundation

<49>
[Use Link to view the full text]
Accession Number
613247585
Author
Hajjar L.A.; Vincent J.L.; Barbosa Gomes Galas F.R.; Rhodes A.; Landoni
G.; Osawa E.A.; Melo R.R.; Sundin M.R.; Grande S.M.; Gaiotto F.A.;
Pomerantzeff P.M.; Dallan L.O.; Franco R.A.; Nakamura R.E.; Lisboa L.A.;
De Almeida J.P.; Gerent A.M.; Souza D.H.; Gaiane M.A.; Fukushima J.T.;
Park C.L.; Zambolim C.; Rocha Ferreira G.S.; Strabelli T.M.; Fernandes
F.L.; Camara L.; Zeferino S.; Santos V.G.; Piccioni M.A.; Jatene F.B.;
Costa Auler J.O.; Filho R.K.
Institution
(Hajjar, Barbosa Gomes Galas, Osawa, Melo, Sundin, Grande, Franco,
Nakamura, De Almeida, Gerent, Souza, Gaiane, Fukushima, Park, Zambolim,
Rocha Ferreira, Fernandes, Camara, Zeferino, Santos, Piccioni, Costa
Auler) Department of Cardiopneumology, InCor, Faculdade de Medicina da
Universidade de Sao Paulo, Universidade de Sao Paulo, Av Dr Eneas Carvalho
Aguiar 44, Sao Paulo, Brazil
(Gaiotto, Pomerantzeff, Dallan, Lisboa, Jatene) Division of Cardiovascular
Surgery, United States
(Strabelli) Division of Infectious Diseases, United States
(Filho) Division of Cardiology, Heart Institute (InCor), Hospital das
Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo,
Brazil
(Vincent) Department of Intensive Care, Erasme University Hospital,
Universite de Bruxelles, Brussels, Belgium
(Rhodes) Department of Intensive Care Medicine, St George's Healthcare NHS
Trust, St George's University of London, London, United Kingdom
(Landoni) Department of Anesthesia and Intensive Care, San Raffaele
Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after
Cardiac Surgery.
Source
Anesthesiology. 126 (1) (pp 85-93), 2017. Date of Publication: 01 Jan
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Vasoplegic syndrome is a common complication after cardiac
surgery and impacts negatively on patient outcomes. The objective of this
study was to evaluate whether vasopressin is superior to norepinephrine in
reducing postoperative complications in patients with vasoplegic syndrome.
Methods: This prospective, randomized, double-blind trial was conducted at
the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between
January 2012 and March 2014. Patients with vasoplegic shock (defined as
mean arterial pressure less than 65 mmHg resistant to fluid challenge and
cardiac index greater than 2.2 l . min -2 . m -2) after cardiac surgery
were randomized to receive vasopressin (0.01 to 0.06 U/min) or
norepinephrine (10 to 60 mug/min) to maintain arterial pressure. The
primary endpoint was a composite of mortality or severe complications
(stroke, requirement for mechanical ventilation for longer than 48 h, deep
sternal wound infection, reoperation, or acute renal failure) within 30
days. Results: A total of 330 patients were randomized, and 300 were
infused with one of the study drugs (vasopressin, 149; norepinephrine,
151). The primary outcome occurred in 32% of the vasopressin patients and
in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95%
CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found
a lower occurrence of atrial fibrillation in the vasopressin group (63.8%
vs. 82.1%; P = 0.0004) and no difference between groups in the rates of
digital ischemia, mesenteric ischemia, hyponatremia, and myocardial
infarction. Conclusions: The authors' results suggest that vasopressin can
be used as a first-line vasopressor agent in postcardiac surgery
vasoplegic shock and improves clinical outcomes. Copyright &#xa9; 2016 the
American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.
All Rights Reserved.

<50>
Accession Number
614410223
Author
Meyer-Saraei R.; de Waha S.; Eitel I.; Desch S.; Scheller B.; Bohm M.;
Lauer B.; Gawaz M.; Geisler T.; Gunkel O.; Bruch L.; Klein N.; Pfeiffer
D.; Schuler G.; Zeymer U.; Thiele H.
Institution
(Meyer-Saraei, de Waha, Eitel, Desch, Thiele) Department of Cardiology,
Angiology and Intensive Care Medicine, University Heart Centre Luebeck,
University Hospital Schleswig-Holstein, Luebeck, Germany
(Meyer-Saraei, de Waha, Eitel, Desch, Thiele) German Centre for
Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck,
Luebeck, Germany
(Scheller, Bohm) Department of Internal Medicine III, University of
Saarland, Homburg, Germany
(Lauer) Department of Cardiology, Zentralklinik Bad Berka, Germany
(Gawaz, Geisler) Department of Cardiology/Cardiovascular Medicine,
University of Tuebingen, Germany
(Gunkel) Department of Internal Medicine II, Klinikum Frankfurt/Oder,
Germany
(Bruch) Department of Internal Medicine, Unfallkrankenhaus Berlin, Germany
(Klein, Pfeiffer) Department of Internal Medicine I, University of
Leipzig, Germany
(Schuler) Department of Internal Medicine/Cardiology, University of
Leipzig Heart Centre, Germany
(Zeymer) Institut fur Herzinfarktforschung, Klinikum der Stadt
Ludwigshafen, Germany
Title
Thrombus aspiration in non-ST-elevation myocardial infarction - 12-month
clinical outcome of the randomised TATORT-NSTEMI trial.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (1) (pp 10-17), 2017.
Date of Publication: 01 Feb 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: In the randomised TATORT-NSTEMI trial routine thrombus
aspiration in comparison with standard percutaneous coronary intervention
(PCI) did not reduce the primary endpoint of microvascular obstruction
assessed by cardiac magnetic resonance imaging in patients with
non-ST-elevation myocardial infarction (NSTEMI). So far, no data on
long-term outcome of head-to-head comparisons between both treatment
strategies in NSTEMI patients have been reported. Methods: The
prospective, controlled, multicentre, randomised, open-label TATORT-NSTEMI
trial assigned patients with NSTEMI and thrombus-containing lesions to
aspiration thrombectomy plus PCI (n=221) or standard PCI only (n=219). The
primary endpoint of the current analysis was the occurrence of major
adverse cardiac events defined as the composite of death, myocardial
reinfarction, target vessel revascularisation, and new congestive heart
failure at 12-month follow-up. In addition, functional outcome and quality
of life were assessed. Results: At one year, major adverse cardiac events
occurred in 19 patients in the thrombectomy arm and 29 patients in the
standard PCI group (8.7% vs. 13.4%, relative risk 0.63, 95% confidence
interval 0.35-1.12, p=0.11). The individual components of the combined
endpoint such as death (p=0.20), myocardial reinfarction (p=0.73), target
vessel revascularisation (p=0.42), and congestive heart failure (p=0.18)
were similar in both groups. Functional outcome and quality of life did
not differ significantly between both groups (Canadian Cardiovascular
Society class: p=0.68, New York Heart Association class: p=0.70 and
EuroQol5D score: p=0.96). Post-hoc analyses revealed consistent results
with regard to the occurrence of major adverse cardiac events across a
wide range of subgroups (all p>0.05). Conclusions: In this first
randomised trial on thrombectomy in NSTEMI patients, routine thrombus
aspiration before PCI did not improve clinical outcome at 12-month
follow-up. Copyright &#xa9; 2015, &#xa9; The European Society of
Cardiology 2015.

<51>
Accession Number
613674138
Author
Tang M.; Liu X.; Lin C.; He Y.; Cai X.; Xu Q.; Hu P.; Gao F.; Jiang J.;
Lin X.; Zhu Q.; Wang L.; Kong H.; Yu Y.; Wang J.
Institution
(Tang, Liu, Lin, He, Xu, Hu, Gao, Jiang, Lin, Zhu, Wang, Kong, Wang)
Department of Cardiology, Second Affiliated Hospital Zhejiang University
School of Medicine, Hangzhou, China
(Cai) Department of General Surgery, Ningbo Medical Treatment Center
Lihuili Hospital, Ningbo, China
(Yu) Department of Epidemiology and Health Statistics, School of Public
Health, School of Medicine, Zhejiang University, Hangzhou, China
Title
Meta-Analysis of Outcomes and Evolution of Pulmonary Hypertension Before
and After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 119 (1) (pp 91-99), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Pulmonary hypertension (PH) is a common entity in patients with severe
aortic stenosis (AS) who underwent transcatheter aortic valve implantation
(TAVI), but its role on clinical outcomes remains undetermined. We
evaluated the impact of baseline and postprocedural PH on clinical
outcomes and changes in pulmonary artery systolic pressure after TAVI by
performing a meta-analysis of 16 studies enrolling 9,204 patients with AS
who underwent TAVI. In patients with baseline PH, all-cause mortality was
significantly increased, as shown by pooled odds ratio (ORs) for overall
30-day (OR 1.52, 95% confidence interval [CI] 1.28 to 1.80), 1-year (OR
1.39, 95% CI 1.27 to 1.51), and 2-year all-cause mortality (OR 2.00, 95%
CI 1.49 to 2.69), compared with those without PH, independent of different
methods of PH assessment. The presence of post-TAVI PH was associated with
a significant increase in 2-year all-cause mortality (OR 2.32, 95% CI 1.43
to 3.74). Nevertheless, pulmonary artery systolic pressure decreased at
3-month to 1-year follow-up (standardized mean difference -1.12, 95% CI
-1.46 to -0.78). Baseline PH was associated with higher 30-day and 1-year
cardiovascular mortality. Patients with baseline PH had higher risk of
stroke at 1 year and acute kidney injury at 30 days. But the risk of major
vascular complications was significantly lower in patients with baseline
PH. In conclusion, the presence of PH is associated with increased short-
and long-term mortality, also higher risk of stroke and acute kidney
injury after TAVI. A significant decrease in PSAP is detected in patients
with AS in midterm follow-up after TAVI. Copyright &#xa9; 2016 Elsevier
Inc.

<52>
Accession Number
613674129
Author
Jatene T.; Biering-Sorensen T.; Nochioka K.; Mangione F.M.; Hansen K.W.;
Sorensen R.; Jensen J.S.; Jorgensen P.G.; Jeger R.; Kaiser C.; Pfisterer
M.; Galatius S.
Institution
(Jatene, Mangione) Department of Interventional Cardiology, Brigham and
Women's Hospital Heart and Vascular Center and Harvard Medical School,
Boston, Massachusetts, United States
(Biering-Sorensen, Sorensen, Jensen, Jorgensen) Department of Cardiology,
Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen,
Denmark
(Nochioka) Department of Cardiovascular Medicine, Tohoku University
Graduate School of Medicine, Clinical Research, Innovation and Education
Center, Tohoku University Hospital, Sendai, Japan
(Hansen, Galatius) Department of Cardiology, Bispebjerg University
Hospital, Copenhagen, Denmark
(Jeger, Kaiser, Pfisterer) Department of Cardiology, University Hospital,
Basel, Switzerland
Title
Frequency of Cardiac Death and Stent Thrombosis in Patients With Chronic
Obstructive Pulmonary Disease Undergoing Percutaneous Coronary
Intervention (from the BASKET-PROVE I and II Trials).
Source
American Journal of Cardiology. 119 (1) (pp 14-19), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with long-term
all-cause death after percutaneous coronary intervention with bare-metal
stents. Regarding other outcomes, previous studies have shown conflicting
results and the impact of drug-eluting stent (DES) in this population is
not well known. We analyzed 4,605 patients who underwent percutaneous
coronary intervention with bare-metal stents (33.1%) or DES (66.9%) from
the Basel Stent Kosten-Effektivitats Trial-Prospective Validation
Examination trials I and II. COPD patients (n = 283, 6.1%), were older and
had more frequently a smoking or cardiovascular event history. At 2-year
follow-up, cumulative event rates for patients with versus without COPD
were the following: major adverse cardiac events (MACE: composite of
cardiac death, nonfatal myocardial infarction, and target vessel
revascularization): 15.2% versus 8.1% (p <0.001); all-cause death: 11.7%
versus 2.4% (p <0.001); cardiac death: 5.7% versus 1.2% (p <0.001);
myocardial infarction: 3.5% versus 1.9% (p = 0.045);
definite/probable/possible stent thrombosis: 2.5% versus 0.9% (p = 0.01);
and major bleeding: 4.2% versus 2.1% (p = 0.014). After adjusting for
confounders including smoking status, COPD remained an independent
predictor for MACE (hazard ratio [HR] 1.80, 95% confidence interval [CI]
1.31 to 2.49), all-cause death (HR 3.62, 95% CI 2.41 to 5.45), cardiac
death (HR 3.12, 95% CI 1.74 to 5.60), and stent thrombosis (HR 2.39, 95%
CI 1.03 to 5.54). We did not find evidence of an interaction between COPD
and DES implantation (p for interaction = 0.29) for MACE. In conclusion,
COPD is associated with increased 2-year rates of all-cause death, cardiac
death, and stent thrombosis after stent implantation. DES use appears to
be beneficial also in patients with COPD. Copyright &#xa9; 2016 Elsevier
Inc.

<53>
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.

<54>
Accession Number
614041007
Author
Senanayake E.L.; Giri R.; Gopal S.; Nevill A.; Luckraz H.
Institution
(Senanayake, Luckraz) Department of Cardiothoracic Surgery, Heart and Lung
Centre, Wolverhampton, United Kingdom
(Giri) Department of Cardiothoracic Anaesthesia, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Gopal) Department of Intensive Care, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nevill) University of Wolverhampton, Wolverhampton, United Kingdom
Title
Incidence of endotracheal tube colonization with the use of PneuX
endotracheal tubes in patients following cardiac surgery.
Source
Journal of Hospital Infection. 95 (1) (pp 81-86), 2017. Date of
Publication: 01 Jan 2017.
Publisher
W.B. Saunders Ltd
Abstract
Introduction Ventilator-associated pneumonia (VAP) develops in up to 25%
of patients following cardiac surgery. Colonization of the endotracheal
tube (ETT) contributes to VAP. The PneuX ETT has been shown to halve VAP
in high-risk patients undergoing cardiac surgery. This article reports on
the secondary analysis of bacterial colonization in relation to VAP
between the PneuX and standard ETTs. Methods In this randomized controlled
trial, patients were randomized on a 1:1 basis to Group A (PneuX ET,
N=120) or Group B (standard ETT, N=120). Patients aged >70 years with or
without impaired left ventricular function (<50%) undergoing elective and
urgent cardiac surgery were included in this study. Incidence of
postoperative VAP and analysis of bacterial colonization within the ETT
(N=234) were measured for patients requiring <24 h, 24-48 h and >48 h of
intubation. Results Baseline patient demographics were comparable. VAP was
lower in Group A compared with Group B (10.8% vs 21%; P=0.03). The
incidence of VAP was lower at each time point for Group A. There was a
lower incidence of ETT colonization in Group A for patients needing >48 h
of intubation. There was no difference in the type of bacterial
colonization (P=0.5) or the mean number of colony-forming units
[4.35x10⁷ (1.18x10⁸) and 2.16x10⁸
(1.24x10⁹) in Groups A and B, respectively (P=0.8)]. Conclusion
Colonization of the ETT does not seem to play an important role in
early-onset VAP. There is a tendency for reduced colonization in the PneuX
ETT with longer intubation times. This may have an impact on reducing the
incidence of late-onset VAP. Copyright &#xa9; 2016 The Healthcare
Infection Society

<55>
Accession Number
614025709
Author
Constantin J.-M.; Momon A.; Mantz J.; Payen J.-F.; De Jonghe B.; Perbet
S.; Cayot S.; Chanques G.; Perreira B.
Institution
(Constantin, Momon, Perbet, Cayot) Perioperative Department, University
Hospital of Clermont-Ferrand, Clermont-Ferrand 63000, France
(Perreira) Biostatistics Unit, Department of Clinical Research and
Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand
63000, France
(Mantz) Department of Anaesthesiology and Critical Care Medicine, Hopital
Europeen Georges-Pompidou, Universite Paris-Descartes Sorbonne Paris Cite,
Paris 75908, France
(Payen) Department of Anaesthesia and Critical Care, Michallon Hospital,
boulevard de la Chantourne, Grenoble 38000, France
(Payen) Joseph-Fourier University, Grenoble Institute of Neurosciences,
chemin Fortune-Ferrini, Grenoble 38042, France
(De Jonghe) Reanimation Medico-Chirurgicale, Centre Hospitalier de
Poissy-St-Germain, Poissy 78300, France
(Chanques) Intensive Care and Anaesthesiology Department, University of
Montpellier Saint-Eloi Hospital, Montpellier 34000, France
Title
Efficacy and safety of sedation with dexmedetomidine in critical care
patients: A meta-analysis of randomized controlled trials.
Source
Anaesthesia Critical Care and Pain Medicine. 35 (1) (pp 7-15), 2016. Date
of Publication: 01 Feb 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction Dexmedetomidine may help physicians target a low level of
sedation. Unfortunately, the impact of dexmedetomidine on major endpoints
remains unclear in intensive care unit (ICU). Material and methods To
evaluate the association between dexmedetomidine use with efficacy and
safety outcomes, two reviewers independently identified randomized
controlled trials comparing dexmedetomidine with other sedative agents in
non-post-cardiac surgery critically ill patients in the PubMed and
Cochrane databases. Random effects models were considered if heterogeneity
was detected using the DerSimonian and Laird estimation method.
Statistical heterogeneity between results was assessed by examining forest
plots, confidence intervals (CI) and by using the I² statistic.
The risk of bias was assessed using the risk of bias tool. Results This
meta-analysis included 1994 patients from 16 randomized controlled trials.
Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was
associated with a reduction in ICU length of stays (WMD = -0.304; 95% CI
[-0.477, -0.132]; P = 0.001), mechanical ventilation duration (WMD =
-0.313, 95% CI [-0.523, -0.104]; P = 0.003) and delirium incidence (RR =
0.812, 95% CI [0.680, 0.968]; P = 0.020). Dexmedetomidine is also
associated with an increase in the incidence of bradycardia (RR = 1.947,
95% CI [1.387, 2.733]; P = 0.001) and hypotension (RR = 1.264; 95% CI
[1.013, 1.576]; P = 0.038). Conclusions and relevance In this first
meta-analysis including only randomized controlled trials related to ICU
patients, dexmedetomidine was associated with a 48 h reduction in ICU
length of stay, mechanical ventilation duration and delirium occurrence
despite a significant heterogeneity among studies. Dexmedetomidine was
also associated with an increase in bradycardia and hypotension. Copyright
&#xa9; 2015 Societe francaise d'anesthesie et de reanimation (Sfar)

<56>
Accession Number
613571777
Author
Parthiban A.; Levine J.C.; Nathan M.; Marshall J.A.; Shirali G.S.; Simon
S.D.; Colan S.D.; Newburger J.W.; Raghuveer G.
Institution
(Parthiban, Marshall, Shirali, Raghuveer) Children's Mercy Hospital,
University of Missouri Kansas City School of Medicine, Kansas City,
Missouri, United States
(Simon) Department of Biostatistics, University of Missouri Kansas City
School of Medicine, Kansas City, Missouri, United States
(Levine, Colan, Newburger) Department of Cardiology, Boston Children's
Hospital, Boston, Massachusetts, United States
(Nathan) Department of Cardiac Surgery, Boston Children's Hospital,
Boston, Massachusetts, United States
(Levine, Colan, Newburger) Department of Pediatrics, Harvard Medical
School, Boston, Massachusetts, United States
(Nathan) Department of Surgery, Harvard Medical School, Boston,
Massachusetts, United States
Title
Implementation of a Quality Improvement Bundle Improves Echocardiographic
Imaging after Congenital Heart Surgery in Children.
Source
Journal of the American Society of Echocardiography. 29 (12) (pp
1163-1170.e3), 2016. Date of Publication: 01 Dec 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Postoperative echocardiography after congenital heart disease
surgery is of prognostic importance, but variable image quality is
problematic. We implemented a quality improvement bundle comprising of
focused imaging protocols, procedural sedation, and sonographer education
to improve the rate of optimal imaging (OI). Methods Predischarge
echocardiograms were evaluated in 116 children (median age, 0.51 years;
range, 0.01-5.6 years) from two centers after tetralogy of Fallot repair,
arterial switch operation, and bidirectional Glenn and Fontan procedures.
OI rates were compared between the centers before and after the
implementation of a quality improvement bundle at center 1, with center 2
serving as the comparator. Echocardiographic images were independently
scored by a single reader from each center, blinded to center and time
period. For each echocardiographic variable, quality score was assigned as
0 (not imaged or suboptimally imaged) or 1 (optimally imaged); structures
were classified as intra- or extracardiac. The rate of OI was calculated
for each variable as the percentage of patients assigned a score of 1.
Results Intracardiac structures had higher OI than extracardiac structures
(81% vs 57%; adjusted odds ratio [OR], 3.47; P < .01). Center 1 improved
overall OI from 48% to 73% (OR, 4.44; P < .01), intracardiac OI from 69%
to 85% (OR, 3.53; P = .01), and extracardiac OI from 35% to 67% (OR, 5.16;
P < .01). There was no temporal difference for center 2. Conclusions After
congenital heart disease surgery in children, intracardiac structures are
imaged more optimally than extracardiac structures. Focused imaging
protocols, patient sedation, and sonographer education can improve OI
rates. Copyright &#xa9; 2016 American Society of Echocardiography

<57>
[Use Link to view the full text]
Accession Number
614182271
Author
Villablanca P.A.; Massera D.; Mathew V.; Bangalore S.; Christia P.; Perez
I.; Wan N.; Schulz-Schupke S.; Briceno D.F.; Bortnick A.E.; Garcia M.J.;
Lucariello R.; Menegus M.; Pyo R.; Wiley J.; Ramakrishna H.
Institution
(Villablanca, Massera, Briceno, Bortnick, Garcia, Lucariello, Menegus,
Pyo, Wiley) Division of Cardiovascular Diseases, Montefiore Medical
Center, Albert Einstein College of Medicine, New York, NY, United States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(Bangalore) New York University School of Medicine, United States
(Christia, Perez, Wan) Department of Internal Medicine, Jacobi Medical
Center, Albert Einstein College of Medicine, New York, NY, United States
(Schulz-Schupke) Deutsches Herzzentrum Munchen, Technische Universitat,
Klinik Fur Herz-und Kreislauferkrankungen, Munich, Germany
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic College of Medicine, 5777 East Mayo Blvd, Scottsdale, Phoenix, AZ
85054, United States
Title
Outcomes of <6-month versus 12-month dual antiplatelet therapy after
drug-eluting stent implantation: A meta-analysis and meta-regression.
Source
Medicine (United States). 95 (52) (no pagination), 2016. Article Number:
e5819. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The benefit of <6-month compared with 12-month dual
antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI)
with drug-eluting stent (DES) placement remains controversial. We
performed a meta-analysis and meta-regression of <6-month versus 12-month
DAPT in patients undergoing PCI with DES placement. Methods: We conducted
electronic database searches of randomized controlled trials (RCTs)
comparing DAPT durations after DES placement. For studies with longer
follow-up, outcomes at 12 months were identified. Odds ratios and 95%
confidence intervals were computed with the Mantel-Haenszel method.
Fixed-effect models were used; if heterogeneity (I2)>40 was identified,
effects were obtained with random models. Results: Nine RCTs were included
with total n=19,224 patients. No significant differences were observed
between <6-month compared with 12-month DAPT in all-cause mortality (OR
0.87; 95% confidence interval (CI): 0.69-1.11), cardiovascular (CV)
mortality (OR 0.89; 95% CI: 0.66-1.21), non-CV mortality (OR 0.85; 95%
0.58-1.24), myocardial infarction (OR 1.10; 95% CI: 0.89-1.37), stroke (OR
0.97; 95% CI: 0.67-1.42), stent thrombosis (ST) (OR 1.37; 95% CI:
0.89-2.10), and target vessel revascularization (OR 0.95; 95% CI:
0.77-1.18). No significant difference in major bleeding (OR 0.72; 95% CI:
0.49-1.05) was observed, though the all-bleeding event rate was
significantly lower in the <6-month DAPT group (OR 0.76; 95% CI:
0.59-0.96). In the meta-regression analysis, a significant association
between bleeding events and non-CV mortality with 12-month DAPT was found,
as well as between ST and mortality in addition to MI with <6-month DAPT.
Conclusion: DAPT for <6 months is associated with similar mortality and
ischemic outcomes but less bleeding events compared with 12-month DAPT
after PCI with DES. Copyright &#xa9; 2016 the Author(s).

<58>
Accession Number
607445354
Author
McHugh K.E.; Pasquali S.K.; Hall M.A.; Scheurer M.A.
Institution
(McHugh, Scheurer) Medical University of South Carolina, 165 Ashley
Avenue, MSC 915, Charleston, SC 29425, United States
(Pasquali) University of Michigan CS Mott Children's Hospital, Ann Arbor,
MI, United States
(Hall) Children's Hospital Association, Overland Park, KS, United States
Title
Impact of postoperative complications on hospital costs following the
Norwood operation.
Source
Cardiology in the Young. 26 (7) (pp 1303-1309), 2016. Date of Publication:
01 Oct 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Introduction Patients undergoing the Norwood operation consume
considerable healthcare resources; however, detailed information regarding
factors impacting hospitalisation costs is lacking. We evaluated the
association of postoperative complications with hospital costs. Methods In
the present study, we utilised a unique data set consisting of
prospectively collected clinical data from the Pediatric Heart Network
Single Ventricle Reconstruction trial linked at the patient level with
cost data for 10 hospitals participating in the Children's Hospital
Association Case Mix database during the trial period. The relationship
between complications and cost was modelled using linear regression,
accounting for the skewed distribution of cost, adjusting for
within-centre clustering and baseline patient characteristics. Results A
total of 334 eligible Norwood records (97.5%) were matched between data
sets. Overall, 82% suffered from at least one complication (median 2; with
a range from 0 to 33). Those with complications had longer postoperative
length of stay (25 versus 12 days, p<0.001), more total ventilator days (7
versus 5 days, p<0.001), and higher in-hospital mortality (17.6 versus
3.4%, p<0.006). Mean adjusted hospital cost in those with a complication
was $190,689 (95% CI $111,344-$326,577) versus $120,584 (95% CI
$69,246-$209,983) in those without complications (p=0.002). Costs
increased with the number of complications (1-2 complications=$132,800
versus 3-4 complications=$182,353 versus 5 complications=$309,372
[p<0.001]). Conclusions This merged data set of clinical trial and cost
data demonstrated that postoperative complications are common following
the Norwood operation and are associated with worse clinical outcomes and
higher costs. Efforts to reduce complications in this population may lead
to improved outcomes and cost savings. Copyright &#xa9; Cambridge
University Press 2015.

<59>
Accession Number
613134763
Author
Siegel A.J.; Bhatti N.A.; Wasfy J.H.
Institution
(Siegel, Bhatti) Divisions of General Internal Medicine, Massachusetts
General Hospital, Boston, MA, United States
(Siegel, Bhatti, Wasfy) Harvard Medical School, Boston, MA, United States
(Wasfy) Divisions of Cardiology, Massachusetts General Hospital, Boston,
MA, United States
Title
Reprising Ramadan-related angina pectoris: A potential strategy for risk
reduction.
Source
American Journal of Case Reports. 17 (pp 841-844), 2016. Date of
Publication: 10 Nov 2016.
Publisher
Medical Science International (E-mail: office@isl-science.com)
Abstract
Objective: Unusual clinical course Background: A preponderance of evidence
supports short-term aspirin usage to reduce transiently increased
cardiovascular risk in clinical conditions that promote acute myocardial
ischemia. Case Report: We report on the case of a 69-year-old male of
Muslim Indian heritage with multiple cardiovascular risk factors who
experienced the onset of angina pectoris while fasting for Ramadan for
more than 16 hours daily for 30 days in July 2015. While symptom free for
2 months on medical management after ending his fast, he underwent
quadruple coronary artery bypass surgery for severe 4-vessel disease
following an acute anterior myocardial infarction. A percutaneous coronary
intervention with stent placement was subsequently required for persistent
myocardial ischemia on stress-MIBI testing due to occlusion of the graft
to left anterior descending artery. Presently asymptomatic, he decided to
forgo fasting for Ramadan in June 2016. Conclusions: Based on this case,
measures for primary cardiovascular prevention among the 1.2 billion
susceptible males at similar high short-term cardiac risk while fasting
for Ramadan are proposed. The value of aspirin for attenuating high
short-term cardiovascular risk in clinical conditions conferring transient
inflammatory stress is considered. Low-dose aspirin usage at evening meals
while fasting for Ramadan is prudent for primary cardiovascular protection
of males who may have non-obstructive coronary atherosclerosis to mitigate
the risk for rupture of potentially vulnerable plaques. Based in part on
conclusive evidence for protection of middle-aged males from first
myocardial infarction in a randomized prospective primary prevention
trial, this measure is concordant with recommendations from sub-specialty
societies for primary cardiovascular prevention for persons at
above-average risk demonstrated by validated biomarkers and from the
United States Preventive Services Task Force. Copyright &#xa9; Am J Case
Rep.

<60>
Accession Number
611736691
Author
Patel J.; Thosani R.; Kothari J.; Garg P.; Pandya H.
Institution
(Patel, Thosani) Department of Cardiac Anesthesia, UN Mehta Institute of
Cardiology and Research Center (Affiliated to BJ Medical College), New
Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016, India
(Kothari, Garg) Department of Cardiovascular and Thoracic Surgery, UN
Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad,
India
(Pandya) Department of Research, UN Mehta Institute of Cardiology and
Research Center, Asarwa, Ahmedabad, India
Title
Clonidine and ketamine for stable hemodynamics in off-pump coronary artery
bypass.
Source
Asian Cardiovascular and Thoracic Annals. 24 (7) (pp 638-646), 2016. Date
of Publication: 01 Sep 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background The current era of fast-track extubation and faster recovery
after cardiac surgery requires agents that provide perioperative sedation,
suppress sympathetic response, reduce opioid requirement, and maintain
hemodynamic stability. Methods In a prospective randomized double-blind
study, 75 off-pump coronary artery bypass patients were divided into 3
groups of 25 each: group A had clonidine 1 mug.kg^-1, group B
had clonidine 1 mug.kg^-1 and ketamine 1 mg.kg^-1, and
group C had a saline placebo. Perioperative changes in heart rate,
systolic and diastolic blood pressure, sedation score, pain score, and
requirement of analgesics, beta blockers, fentanyl, propofol, and
inotropes were recorded, as well time to extubation, intensive care unit
stay, and 30-day mortality. Results The combination of clonidine and
ketamine led to stable hemodynamics and reduced beta-blocker dosage. The
sedation score was highest in groups A and B up to 24 h postoperatively.
The pain score was lowest in group B in the first 24 h, and the total dose
of analgesics was highest in group C. Clonidine and ketamine or clonidine
alone reduced extubation time, but intensive care unit stay was unchanged
Conclusions Combined low-dose clonidine and ketamine produced
perioperative sedation and effective suppression of sympathetic response
with stable hemodynamics. Intraoperative beta-blocker use was reduced
without increasing inotrope requirement. This combination prolonged the
analgesic effect of opioids, reducing postoperative pain score and
analgesic requirement. Low-dose clonidine alone produced sedation but did
not completely block sympathetic response. Intensive care unit stay and
patient outcome were not affected by clonidine or ketamine. Copyright
&#xa9; SAGE Publications.

<61>
Accession Number
611736660
Author
Srivastava V.; Purohit M.; Bose A.; Bittar M.N.; Rogers S.; Zacharias J.
Institution
(Srivastava, Purohit, Bose, Bittar, Rogers, Zacharias) Department of
Cardiothoracic Surgery, Victoria Hospital, Blackpool FY3 8NR, United
Kingdom
Title
Single crossclamp: Safe training tool for coronary artery bypass grafting.
Source
Asian Cardiovascular and Thoracic Annals. 24 (7) (pp 633-637), 2016. Date
of Publication: 01 Sep 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective The single-crossclamp technique for coronary artery bypass
grafting is recognized to reduce manipulation of the ascending aorta, and
thereby improve neurological outcomes. However, there is a perceived
disadvantage of long cardiopulmonary bypass and crossclamp times. Our
objective was to evaluate outcomes with this technique and determine
whether it is safe for training. Methods Patients undergoing coronary
artery bypass between October 2005 and February 2014 with use of the
single-crossclamp method were divided into 2 groups: a consultant group (n
= 1024), and a trainee group (n = 504), depending on the primary surgeon.
Their outcomes were compared. Results The consultants operated on more
nonelective patients who had a higher risk profile (mean additive
EuroSCORE I 4.05 vs. 3.80, p = 0.085; logistic EuroSCORE I 4.36 vs. 3.64,
p = 0.002). There were 9 (0.9%) deaths in the consultant group and 5 (1%)
in the trainee group. The mean number of grafts in the consultant group
was greater, but the crossclamp time was similar and cardiopulmonary
bypass time was shorter. There were 4 (0.4%) cerebrovascular events in the
consultant group and 3 (0.6%) in the trainee group. Postoperative stay was
shorter in the trainee group (7.19 vs. 7.97 days, p = 0.033). Other
complication rates were similar. Conclusions The technique has excellent
outcomes, especially neurological, and is safe for training junior
surgeons. Copyright &#xa9; SAGE Publications.

<62>
Accession Number
612853533
Author
He F.; Jiang Y.; Li L.
Institution
(He) Department of Anesthesiology and Pain Management, Sir Run Run Shaw
Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang,
China
(Jiang) Department of Anesthesiology, Children's Hospital, Zhejiang
University School of Medicine, Hangzhou, Zhejiang, China
(Li) Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang
University School of Medicine, No. 3, East Qingchun Road, Hangzhou,
Zhejiang 310016, China
Title
The effect of naloxone treatment on opioidinduced side effects A
meta-analysis of randomized and controlled trails.
Source
Medicine (United States). 95 (37) (no pagination), 2016. Article Number:
e4729. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: To evaluate the effects of naloxone on opioid-induced side
effects, the present meta-analysis was constructed. Methods: Electronic
databases including PubMed, EMBASE, and CNKI (China National Knowledge
Internet) were used for literature search. Studies on comparison of
opioid-side effects between naloxone-treated group and placebo or normal
saline-related group were included in the meta-analysis. Heterogeneity
analysis was performed with Chi-square and I2 test. Pooled analysis was
based on fixed-effects model, if heterogeneity between the eligible
studies was negligible (I2>50%, P>0.05), otherwise, randomeffects model
was used. Sensitivity analysis was applied to assess the robustness of the
results and publication bias was evaluated by Begg and Egger test.
Results: Thirteen studies including 1138 patients were included in the
meta-analysis. Pooled analysis indicated that naloxone could significantly
reduce the occurrence of pruritus (RR [risk ratio]=0.252, 95% CI
[confidence interval]=0.137-0.464), nausea (RR= 0.323, 95%
CI=0.245-0.428), and vomiting (RR=0.338, 95% CI=0.192-0.593) which were
induced by opioids. However, naloxone did not relieve pain (standardized
mean difference [SMD]=-0.052, 95% CI=-0.453 to 0.348) and somnolence (RR=
0.561, 95% CI=0.287 to 1.097) in patients received opioid treatment.
Additionally, there were no significant publication bias between the
included studies (Begg test, P=0.602; Egger test, P=0.388). Conclusion:
Addition of naloxone might act as an effective treatment for prophylaxis
of opioid-induced pruritus, nausea, and vomiting in clinical practice.
Copyright &#xa9; 2016 the Author(s). Published by Wolters Kluwer Health,
Inc. All rights reserved.

<63>
[Use Link to view the full text]
Accession Number
612824667
Author
Zhu G.; Huang Y.; Wei D.; Shi Y.
Institution
(Zhu, Huang, Wei, Shi) Department of Respiratory and Critical Care
Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing
Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Title
Efficacy and safety of noninvasive ventilation in patients after
cardiothoracic surgery A PRISMA-compliant systematic review and
meta-analysis.
Source
Medicine (United States). 95 (38) (no pagination), 2016. Article Number:
e4734. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Noninvasive ventilation (NIV) is a promising therapeutic
strategy after cardiothoracic surgery. This study aimed to meta-analyze
the efficacy and safety of NIV as compared to conventional management
after cardiothoracic surgery. Methods: PubMed, EMBASE, and Cochrane
Library databases were searched for randomized controlled trials (RCTs)
comparing NIV with conventional management after cardiothoracic surgery.
Relative risk (RR), standard mean difference (SMD), and 95% confidence
intervals (CIs) were used to measure the efficacy and safety of NIV using
random-effects model. Heterogeneity was evaluated using the Q statistic.
Results: This study included 14 RCTs (1740 patients) for the evaluation of
efficacy and safety of NIV as compared to conventional management after
cardiothoracic surgery. Overall, NIV had minimal effect on the risk of
mortality (RR: 0.64; 95% CI: 0.36-1.14; P= 0.127), endotracheal intubation
(RR: 0.52; 95% CI: 0.24-1.11; P=0.090), respiratory (RR: 0.70; 95% CI:
0.47-1.30; P=0.340), cardiovascular (RR: 0.81; 95% CI: 0.54-1.22;
P=0.306), renal (RR: 0.70; 95% CI: 0.26-1.92; P=0.491), and other
complications (RR: 0.72; 95% CI: 0.38-1.36; P=0.305), respiratory rate
(SMD:-0.10; 95% CI:-1.21-1.01; P=0.862), heart rate (SMD:-0.27; 95%
CI:-0.76-0.22; P=0.288), PaO2/FiO2 ratio (SMD: 0.34; 95% CI:-0.17-0.85;
P=0.194), PaCO2 (SMD: 0.83; 95% CI:-0.12-1.77; P=0.087), systolic pressure
(SMD:-0.04; 95% CI:-0.25-0.17; P=0.700), pH (SMD:-0.01; 95% CI:-0.44-0.43;
P=0.974), length of ICU stay (SMD:-0.19; 95% CI:-0.47-0.08; P=0.171), and
hospital stay (SMD:-0.31; 95% CI:-1.00-0.38; P=0.373). Sensitivity
analysis showed that NIV was associated with higher levels of
PaO<inf>2</inf>/FiO<inf>2</inf> ratio (SMD: 0.52; 95% CI: 0.00-1.05;
P=0.048) and lower risk of endotracheal intubation (RR: 0.38; 95% CI:
0.22-0.66; P=0.001). Conclusion: As compared to conventional management,
the use of NIV after cardiothoracic surgery improved patient's oxygenation
and decreased the need for endotracheal intubation, without significant
complications. Copyright &#xa9; 2016 the Author(s). Published by Wolters
Kluwer Health, Inc. All rights reserved.

<64>
[Use Link to view the full text]
Accession Number
610921974
Author
Cai X.; Zhang P.; Lu S.; Zhang Z.; Yu A.; Liu D.; Wu S.
Institution
(Cai, Zhang, Lu, Zhang, Yu, Liu, Wu) Department of Anesthesiology,
Liaocheng People's Hospital, 67 Dongchang West Road, Liaocheng City,
Shandong 252000, China
(Wu) Xuzhou Medical College, Xuzhou, Jiangsu, China
Title
Effects of intraoperative dexmedetomidine on postoperative pain in highly
nicotine-dependent patients after thoracic surgery.
Source
Medicine (United States). 95 (22) (no pagination), 2016. Article Number:
e3814. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
To investigate the effects of intraoperative dexmedetomidine on pain in
highly nicotine-dependent patients after thoracic surgery. Highly
nicotine-dependent men underwent thoracic surgery and received
postoperative patient-controlled intravenous analgesia with sufentanil. In
dexmedetomidine group (experimental group, n=46), dexmedetomidine was
given at a loading dose of 1mug/kg for 10 minutes, followed by continuous
infusion at 0.5mug/kg/h until 30 minutes before the end of surgery. The
saline group (control group, n=48) received the same volume of saline.
General anesthesia was administered via a combination of inhalation and
intravenous anesthetics. If necessary, patients were administered a
loading dose of sufentanil by an anesthesiologist immediately after
surgery (0hours). Patient-controlled analgesia was started when the
patient's resting numerical rating scale (NRS) score was less than 4.
Resting and coughing NRS scores and sufentanil dosage were recorded 0, 1,
4hours, and every 4hours until 48hours after surgery. Dosages of other
rescue analgesics were converted to the sufentanil dosage. Surgical data,
adverse effects, and degree of satisfaction were obtained. Cumulative
sufentanil dosage, resting NRS, and coughing NRS in the first 24hours
after surgery and heart rate were lower in the experimental compared with
the control group (P<0.05). No patient experienced sedation or respiratory
depression. Frequency of nausea and vomiting and degree of satisfaction
were similar in both groups. Intraoperative dexmedetomidine was associated
with reduced resting and coughing NRS scores and a sufentanil-sparing
effect during the first 24hours after thoracic surgery. Copyright &#xa9;
2016 Wolters Kluwer Health, Inc.

<65>
[Use Link to view the full text]
Accession Number
612272253
Author
De Vries F.E.E.; Wallert E.D.; Solomkin J.S.; Allegranzi B.; Egger M.;
Dellinger E.P.; Boermeester M.A.
Institution
(De Vries, Wallert, Boermeester) Department of Surgery, Academic Medical
Centre Amsterdam, PO Box 22660, Amsterdam 1100, Netherlands
(Solomkin) Department of Surgery, University of Cincinnati College of
Medicine, Cincinnati, OH, United States
(Allegranzi) Infection Prevention and Control Global Unit, Service
Delivery and Safety, World Health Organization, Geneva, Switzerland
(Egger) Institute of Social and Preventive Medicine, University of Bern,
Switzerland
(Dellinger) Department of Surgery, University of Washington, Seattle, WA,
United States
Title
A systematic review and meta-analysis including GRADE qualification of the
risk of surgical site infections after prophylactic negative pressure
wound therapy compared with conventional dressings in clean and
contaminated surgery.
Source
Medicine (United States). 95 (36) (no pagination), 2016. Article Number:
e4673. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Systematically review and Grading of Recommendations
Assessment, Development, and Evaluation (GRADE) studies on prophylactic
negative pressure wound therapy (pNPWT) to prevent surgical site
infections (SSIs). Introduction: pNPWT has been suggested as a new method
to prevent wound complications, specifically SSIs, by its application on
closed incisional wounds. Methods: This review was conducted as part of
the development of the Global Guidelines for prevention of SSIs
commissioned by World Health Organization in Geneva. PubMed, Embase,
CENTRAL, CINAHL, and the World Health Organization database between
January 1, 1990 and October 7, 2015 were searched. Inclusion criteria were
randomized controlled trials and observational studies comparing pNPWT
with conventional wound dressings and reporting on the incidence of SSI.
Meta-analyses were performed with a random effect model. GRADE Pro
software was used to qualify the evidence. Results: Nineteen articles
describing 21 studies (6 randomized controlled trials and 15
observational) were included in the review. Summary estimate showed a
significant benefit of pNPWT over conventional wound dressings in reducing
SSIs in both randomized controlled trials and observational studies, odds
ratio of 0.56 (95% confidence interval, 0.32-0.96; P=0.04) and odds ratio
of 0.30 (95% confidence interval, 0.22-0.42; P<0.00001), respectively.
This translates into lowering the SSI rate from 140 to 83 (49-135) per
1000 patients and from 106 to 34 (25-47) per 1000 patients, respectively.
In stratified analyses, these results were consistent in both clean and
clean-contaminated procedures and in different types of surgery, however
results were no longer significant for orthopaedic/trauma surgery. The
level of evidence as qualified with GRADE was however low. Conclusions:
Low-quality evidence indicates that prophylactic NPWT significantly
reduces the risk of SSIs. Copyright &#xa9; 2016 the Author(s). Published
by Wolters Kluwer Health, Inc. All.

<66>
Accession Number
611100832
Author
Fuernau G.; Fengler K.; Desch S.; Eitel I.; Neumann F.-J.; Olbrich H.-G.;
de Waha A.; de Waha S.; Richardt G.; Hennersdorf M.; Empen K.; Hambrecht
R.; Jung C.; Bohm M.; Poss J.; Strasser R.H.; Schneider S.; Ouarrak T.;
Schuler G.; Werdan K.; Zeymer U.; Thiele H.
Institution
(Fuernau, Desch, Eitel, de Waha, Poss, Thiele) Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), University Heart Center
Lubeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160,
Lubeck 23538, Germany
(Fuernau, Fengler, Schuler) Department of Internal Medicine/Cardiology,
University of Leipzig Heart Center, Leipzig, Germany
(Fuernau, Desch, Eitel, de Waha, Poss, Thiele) German Centre for
Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lubeck, Lubeck,
Germany
(Neumann) Department of Cardiology, Bad Krozingen Heart Center, University
of Freiburg, Bad Krozingen, Germany
(Olbrich) Department of Internal Medicine I, Hospital Langen, Langen,
Germany
(de Waha) Department of Cardiology, German Heart Center Munich, Munich,
Germany
(Richardt) Department of Cardiology/Angiology, Bad Segeberg Heart Center,
Bad Segeberg, Germany
(Hennersdorf) Department of Internal Medicine I, Klinikum am
Gesundbrunnen, Heilbronn, Germany
(Empen) Department of Internal Medicine B, University of Greifswald,
Greifswald, Germany
(Hambrecht) Department of Cardiology/Angiology, Klinikum Links der Weser,
Bremen, Germany
(Jung) Division of Cardiology, Pulmonology and Vascular Medicine,
Department of Internal Medicine, Heinrich-Heine-University, Dusseldorf,
Germany
(Bohm) Department of Internal Medicine III, University of Homburg,
Homburg/Saar, Germany
(Strasser) Clinic for Internal Medicine/Cardiology, University of
Dresden-Heart Center, Dresden, Germany
(Schneider, Ouarrak, Zeymer) Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Werdan) Department of Internal Medicine III, Martin-Luther-University
Halle-Wittenberg, Halle/Saale, Germany
Title
Culprit lesion location and outcome in patients with cardiogenic shock
complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial.
Source
Clinical Research in Cardiology. 105 (12) (pp 1030-1041), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: In myocardial infarction without cardiogenic shock (CS), the
affected coronary vessel has significant influence on the final infarct
size and patient prognosis. CS data on this relation are scarce. The
objective of this study was to determine the prognostic relevance of the
culprit lesion location in patients with CS complicating acute myocardial
infarction. Methods: In the Intraaortic Balloon Pump in Cardiogenic Shock
II (IABP-SHOCK II) trial patients with CS were randomized to therapy with
intraaortic balloon pump or control. Additional CS patients not eligible
for the randomized trial were included in a registry. We compared the
location of the culprit lesions in these patients with regard to the
affected coronary vessel [left main (LM), left anterior descending (LAD),
left circumflex (LCX) and right coronary artery (RCA)] and location within
the vessel (proximal, mid or distal) regarding short- and long-term
outcome. Results: Of 758 patients, the majority had the culprit lesion in
the LAD (44 %) compared to RCA (27 %), LCX (19 %) or LM (10 %). Proximal
lesions were more frequent than mid or distal culprit lesions (60 vs. 27
vs. 13 %, p < 0.001). No differences were observed for mortality with
respect to either culprit vessel (log-rank p value = 0.54). In contrast, a
higher mortality was observed for patients with distal culprit lesions
after 1 year (log-rank p value = 0.04). This difference persisted after
multivariable adjustment (hazard ratio for distal lesions 1.40; 95 %
confidential interval 1.03-1.90; p = 0.03). Conclusion: For patients with
CS complicating myocardial infarction, the culprit vessel seems to be
unrelated with mortality whereas distal culprit lesions may have a worse
outcome Copyright &#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<67>
Accession Number
609136807
Author
Amedro P.; Basquin A.; Gressin V.; Clerson P.; Jais X.; Thambo J.-B.;
Guerin P.; Cohen S.; Bonnet D.
Institution
(Amedro) Pediatric and Congenital Cardiology, Arnaud de Villeneuve
University Hospital, PhyMedexp, INSERM U1046, CNRS UMR 9214, University of
Montpellier, 37, avenue du Doyen Gaston Giraud, Montpellier Cedex 5 34295,
France
(Amedro) Department of Public Health, EA3279 Self-perceived Health
Assessment Research Unit, Aix-Marseille University, Marseille, France
(Basquin) Pediatric and Congenital Cardiology, University Hospital,
Rennes, France
(Gressin) Actelion Pharmaceuticals France, Paris, France
(Clerson) Orgametrie Biostatistics, Roubaix, France
(Jais) Bicetre University Hospital, Le Kremlin-Bicetre, France
(Thambo) Pediatric and Congenital Cardiology, Haut-Leveque University
Hospital, Bordeaux, France
(Guerin) Pediatric and Congenital Cardiology, Guillaume and Rene Laennec
University Hospital, Nantes, France
(Cohen) Adult Congenital Heart Disease Unit, M3C-George Pompidou European
Hospital, AP-HP, Paris Descartes University, France
(Cohen) INSERM-UMRS 1138, Cordelier Research Center, Team 22, France
(Bonnet) Pediatric and Congenital Cardiology, M3C-Necker University
Hospital, AP-HP, Paris Descartes University, Paris, France
Title
Health-related quality of life of patients with pulmonary arterial
hypertension associated with CHD: The multicentre cross-sectional ACHILLE
study.
Source
Cardiology in the Young. 26 (7) (pp 1250-1259), 2016. Date of Publication:
01 Oct 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background The aim of this study was to assess health-related quality of
life in patients with pulmonary arterial hypertension associated with CHD
and correlations with clinical status. Methods This prospective
cross-sectional observational study included CHD patients with pulmonary
arterial hypertension in 14 tertiary-care centres in France. We used two
health-related quality of life questionnaires - SF-36 and Cambridge
Pulmonary Hypertension Outcome Review (CAMPHOR) - and one
anxiety/depression Hospital Anxiety and Depression Scale (HADS)
questionnaire. Results Clinical data were collected for the 208 included
patients (mean age: 42.6 years, range from 15.1 to 85.8 years, 69.7%
female). Most patients were in NYHA functional class II (48.1%) and III
(37.5%). Patients' phenotype was classified as Eisenmenger syndrome
(70.7%), pulmonary arterial hypertension associated with
systemic-to-pulmonary shunts (12.0%), with small defects (3.4%), or after
corrective cardiac surgery (13.9%). In total, 76.4% of the patients were
receiving pulmonary arterial hypertension-specific treatments. SF-36
scores showed impairment compared with normalised data. Health-related
quality of life scores were significantly lower in females than in males
for most dimensions of both questionnaires and were independent of the
patients' phenotype, even after gender adjustment - except for CAMPHOR
functioning - but significantly depended on NYHA functional class. The
Hospital Anxiety and Depression Scale (HADS) scores suggested anxiety and
depression associated with increasing NYHA functional class but
independent of patients' phenotype. NYHA functional class, 6-minute walk
distance, HADS, gender, and recent stressful event significantly affected
quality of life in the multivariate analysis. Conclusions This study
showed impairment of quality of life in a large cohort of patients with
pulmonary arterial hypertension associated with CHD with both generic and
specific questionnaires. NYHA functional class and HADS scores were
predictive of most quality of life scores. Copyright &#xa9; Cambridge
University Press 2016.

<68>
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.

<69>
Accession Number
608059458
Author
Rose A.J.; Phibbs C.S.; Uyeda L.; Su P.; Edson R.; Shih M.-C.; Jacobson
A.; Matchar D.B.
Institution
(Rose) Center for Healthcare Organization and Implementation Research,
Bedford VA Medical Center, 200 Springs Rd, Bedford, MA 01730, United
States
(Rose) Department of Medicine, Section of General Internal Medicine,
Boston University School of Medicine, Boston, MA, United States
(Phibbs, Su) Health Economics Resource Center, VA Palo Alto Health Care
System, Palo Alto, CA, United States
(Uyeda, Edson, Shih) Cooperative Studies Program Coordinating Center, VA
Palo Alto Health Care System, Palo Alto, CA, United States
(Phibbs) Department of Pediatrics and Center for Primary Care and Outcomes
Research, Stanford University School of Medicine, Stanford, CA, United
States
(Shih) Department of Health Research and Policy, Division of
Biostatistics, Stanford University, Stanford, CA, United States
(Jacobson) Research and Development Service, Jerry L. Pettis VA Medical
Center, Loma Linda, CA, United States
(Jacobson) Department of Internal Medicine, School of Medicine, Loma Linda
University, Loma Linda, CA, United States
(Matchar) Durham VA Medical Center, Durham, NC, United States
(Matchar) Department of Medicine and Center for Clinical Health Policy
Research, Division of General Medicine, Duke University Medical Center,
Durham, NC, United States
(Matchar) Health Services and Systems Research Program, Duke-National
University of Singapore Graduate Medical School, Singapore
Title
Does distance modify the effect of self-testing in oral anticoagulation?.
Source
American Journal of Managed Care. 22 (1) (pp 65-71), 2016. Date of
Publication: January 2016.
Publisher
Ascend Media (E-mail: medentcirc@ascendmedia.com)
Abstract
Objectives: Patient self-testing (PST) improves anticoagulation control
and patient satisfaction. It is unknown whether these effects are more
pronounced when the patient lives farther from the anticoagulation clinic
(ACC). If the benefits of PST are limited to a subset of patients (those
living farther from care), selectively providing PST to that subset could
enhance cost-effectiveness. Study Design: This is a secondary analysis of
a randomized trial of PST versus usual ACC care, which involved 2922
patients of the Veterans Health Administration (VHA). Methods: Our 3
outcomes were the primary composite clinical end point (stroke, major
hemorrhage, or death), anticoagulation control (percent time in
therapeutic range), and satisfaction with anticoagulation care. We
measured the driving distance between the patient's residence and the
nearest VHA facility. We divided patients into quartiles by distance and
looked for evidence of an interaction between distance and the effect of
the intervention on the 3 outcomes. Results: The median driving distance
was 12 miles (interquartile range = 6-21). Patients living in the farthest
quartile had higher rates of the primary composite clinical end point in
both groups compared with patients living in the nearest quartile. For
PST, the hazard ratio (HR) was 1.77 (95% CI, 1.18-2.64), and for usual
care, the HR was 1.81 (95% CI, 1.19-2.75). Interaction terms did not
suggest that distance to care modified the effect of the intervention on
any outcome. Conclusions: The benefits of PST were not enhanced among
patients living farther from care. Restricting PST to patients living more
than a certain distance from the ACC is not likely to improve its
cost-effectiveness.

<70>
Accession Number
613354937
Author
Venkata G.K.; Forder J.R.; Clark D.; Shih A.; Udassi S.; Badugu S.; Lamb
M.A.; Porvasnik S.L.; Shih R.S.; Colon-Lopez D.; Zaritsky A.L.; Haque
I.U.; Udassi J.P.
Institution
(Venkata, Lamb) Division of Pediatric Critical Care Medicine, Department
of Pediatrics, University of Florida, College of Medicine, Gainesville,
FL, United States
(Venkata, Porvasnik, Shih, Colon-Lopez, Udassi) Division of Pediatric
Cardiology, Congenital Heart Center, Department of Pediatrics, University
of Florida, College of Medicine, Gainesville, FL, United States
(Forder, Clark) Divisions of Radiology and Biomedical Engineering,
University of Florida, Gainesville, FL, United States
(Shih) Department of Anesthesiology, College of Veterinarian School,
University of Florida, Gainesville, FL, United States
(Udassi) Division of Pediatric Hospitalist Medicine, Department of
Pediatrics, University of Florida, College of Medicine, Gainesville, FL,
United States
(Udassi, Udassi) Department of Pediatrics, Sidra Research and Medical
Center, Doha, Qatar
(Badugu) Division of Pediatric Critical Care, Department of Pediatrics,
Texas Tech University Health Sciences, El Paso Children's Hospital, El
Paso, TX, United States
(Zaritsky) Department of Pediatrics, Children's Hospital of the King's
Daughters, Eastern Virginia Medical School, Norfolk, VA, United States
(Haque) Division of Pediatric Critical Care, Department of Pediatrics,
University of Texas, Health Science Center at Houston, Houston, TX, United
States
Title
Ventricular fibrillation-induced cardiac arrest results in regional
cardiac injury preferentially in left anterior descending coronary artery
territory in piglet model.
Source
BioMed Research International. 2016 (no pagination), 2016. Article Number:
5958196. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Objective. Decreased cardiac function after resuscitation from cardiac
arrest (CA) results from global ischemia of the myocardium. In the
evolution of postarrest myocardial dysfunction, preferential involvement
of any coronary arterial territory is not known. We hypothesized that
there is no preferential involvement of any coronary artery during
electrical induced ventricular fibrillation (VF) in piglet model. Design.
Prospective, randomized controlled study. Methods. 12 piglets were
randomized to baseline and electrical induced VF. After 5 min, the animals
were resuscitated according to AHA PALS guidelines. After return of
spontaneous circulation (ROSC), animals were observed for an additional 4
hours prior to cardiac MRI. Data (mean +/- SD) was analyzed using unpaired
t-test; p value < 0.05 was considered statistically significant. Results.
Segmental wall motion (mm; baseline versus postarrest group) in segment 7
(left anterior descending (LAD)) was 4.68+/-0.54 versus 3.31+/-0.64,
p=0.0026. In segment 13, it was 3.82+/-0.96 versus 2.58+/-0.82, p=0.02. In
segment 14, it was 2.42+/-0.44 versus 1.29+/-0.99, p=0.028. Conclusion.
Postarrest myocardial dysfunction resulted in segmental wall motion
defects in the LAD territory. There were no perfusion defects in the
involved segments. Copyright &#xa9; 2016 Giridhar Kaliki Venkata et al.

<71>
Accession Number
611155490
Author
Spillane N.T.; Kashyap S.; Bateman D.; Weindler M.; Krishnamurthy G.
Institution
(Spillane) Department of Pediatrics, Hackensack UMC, Rutgers University
New Jersey Medical School, Hackensack, NJ, United States
(Kashyap, Bateman, Weindler, Krishnamurthy) Department of Pediatrics,
Columbia University Medical Center, New York, NY, United States
Title
Comparison of Feeding Strategies for Infants With Hypoplastic Left Heart
Syndrome: A Randomized Controlled Trial.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 7 (4) (pp
446-453), 2016. Date of Publication: 01 Jul 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Infants with hypoplastic left heart syndrome are at risk for
growth failure, particularly after stage 1 procedures. The effect of
continuous enteral feedings on weight gain has not been previously
investigated. Methods: A randomized controlled trial was performed in
infants with hypoplastic left heart syndrome and single ventricle variants
after stage 1 procedures. Eligible infants were randomized to a continuous
and intermittent feeding regimen or an exclusive intermittent feeding
regimen after stage 1 procedures and continued until hospital discharge.
Anthropometric measures and markers of nutritional status were assessed
throughout hospitalization. Results: Twenty-six infants completed the
study. There were no significant differences in weight gain, growth, or
nutritional status. Weight gain on full enteral feedings was 24.3 versus
23.6 g/d (P =.88) for the combination (continuous and intermittent) versus
intermittent feeding groups. Weight-for-age Z scores at discharge were
-1.37 versus -1.2 (P =.59) for the combination versus intermittent groups.
Conclusions: No significant differences in weight gain, growth, or
nutritional status were observed at hospital discharge between the two
feeding strategies. Despite both groups achieving target daily weight gain
after attaining full feeds, growth failure continued to be a problem after
stage 1 procedures. Further strategies to improve growth during initial
hospitalization are needed. Copyright &#xa9; The Author(s) 2016.

<72>
Accession Number
614007305
Author
Tsabedze N.; McCutcheon K.; Mkhwanazi L.; Garda R.; Vachiat A.; Ramjee R.;
Moosa J.; Maluleke T.; Mukeshimana G.; Karolia S.; Mpanya D.; Manga P.
Institution
(Tsabedze, McCutcheon, Mkhwanazi, Garda, Vachiat, Ramjee, Moosa, Maluleke,
Mukeshimana, Manga) Division of Cardiology, Department of Medicine,
Faculty of Health Sciences, University of the Witwatersrand, Charlotte
Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
(Karolia) Division of Diagnostic Radiography, Department of Radiation
Sciences, Faculty of Health Sciences, University of the Witwatersrand,
Charlotte Maxeke Johannesburg Academic Hospital, Gauteng, South Africa
(Mpanya) Division of Nuclear Medicine and Molecular Imaging, Department of
Radiation Sciences, Faculty of Health Sciences, University of the
Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Gauteng,
South Africa
Title
Periprocedural myocardial infarction during percutaneous coronary
intervention in an academic tertiary centre in Johannesburg.
Source
International Journal of Cardiology. 230 (pp 175-180), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Percutaneous coronary intervention (PCI) is effective therapy
for significant atherosclerotic coronary artery disease. Despite medical
and technological advances in PCI, periprocedural myocardial infarction
(PMI) remains a common complication. The frequency and factors associated
with PMI have been well investigated in the developed world, yet there is
a paucity of data from the developing world, especially Sub-Saharan
Africa. Methods We prospectively enrolled 153 adult patients undergoing
PCI at the Charlotte Maxeke Johannesburg Academic Hospital from the 1st of
February 2014 to 31st October 2014. Periprocedural Creatinine Kinase-MB
and hs-Troponin I were routinely measured before PCI and at 16-24 h
post-procedure. The third universal definition of myocardial infarction
was used to define a PMI event. Results 152 participants met the inclusion
criteria and were analysed for PMI. 70.4% participants were male. The mean
age was 58.8 (SD 10.9) years old. Sixteen (10.5%) participants fulfilled
the criteria for PMI. Side branch pinching with preserved TIMI III flow
was noted in 62.5% of PMI cases. Duration of procedure (P = 0.007), right
coronary artery intervention (p = 0.042) and total stent length (p =
0.045) were independently associated with PMI. Conclusion PMI occurred in
10.5% of cases undergoing PCI. This is consistent with the prevalence of
PMI internationally. Larger multicentre studies are required in our
demographic region to further define relevant predictors and outcomes
associated with PMI. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<73>
Accession Number
614004741
Author
Bavishi C.; Baber U.; Panwar S.; Pirrotta S.; Dangas G.D.; Moreno P.;
Tamis-Holland J.; Kini A.S.; Sharma S.K.
Institution
(Bavishi, Pirrotta, Moreno, Tamis-Holland) Department of Cardiology, Mount
Sinai St. Luke's and Mount Sinai West Hospitals, New York, United States
(Baber, Panwar, Dangas, Moreno, Kini, Sharma) Zena and Michael A. Wiener
Cardiovascular Institute, Mount Sinai Hospital, New York, United States
Title
Efficacy and safety of everolimus and zotarolimus-eluting stents versus
first-generation drug-eluting stents in patients with diabetes: A
meta-analysis of randomized trials.
Source
International Journal of Cardiology. 230 (pp 310-318), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction Patients with diabetes and coronary artery disease remain at
high risk for adverse cardiovascular events after percutaneous coronary
intervention. The efficacy and safety of the various drug-eluting stents
(DES) in patients with diabetes is unclear. Methods Randomized controlled
trials comparing first-generation DES [paclitaxel-eluting stents (PES) and
sirolimus-eluting stents (SES)] with everolimus-eluting stents (EES) and
zotarolimus-eluting stents (ZES) in diabetic patients were systematically
searched. Efficacy [target vessel revascularization (TVR) and target
lesion revascularization (TLR)] and safety [major adverse cardiac events
(MACE), all-cause and cardiac mortality, myocardial infarction, stent
thrombosis] outcomes were evaluated. Results Eighteen randomized
controlled trials comprising of 8095 patients (17,000 patient-years of
follow-up) were included. Compared to first-generation DES, EES
significantly decreased MACE by 18% (relative risk [RR]: 0.82, 95%
confidence interval [CI]: 0.70-0.96), myocardial infarction by 43% (RR:
0.57, 95% CI: 0.39-0.84) and stent thrombosis by 46% (RR: 0.54, 95% CI:
0.35-0.82) in patients with diabetes. Moreover EES showed a trend towards
reduction in rates of TLR and TVR (p = 0.05). ZES was associated with 89%
increased risk for TLR (RR: 1.89, 95% CI: 1.10-3.22) compared to
first-generation DES. Furthermore, meta-regression analysis showed a
greater magnitude of benefit of EES over first-generation DES for MACE (p
= 0.037) and stent thrombosis (p = 0.036) in diabetic patients requiring
Insulin. Conclusions In patients with diabetes and coronary artery disease
undergoing stenting, EES is the most efficacious and safe DES. The
outcomes data for ZES in diabetes patients were limited and further trials
are needed. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<74>
Accession Number
614093537
Author
Harada M.; Miura T.; Kobayashi T.; Kobayashi H.; Kobayashi M.; Nakajima
H.; Kimura H.; Akanuma H.; Mawatari E.; Sato T.; Hotta S.; Kamiyoshi Y.;
Maruyama T.; Watanabe N.; Eisawa T.; Hashizume N.; Ebisawa S.; Miyashita
Y.; Ikeda U.
Institution
(Harada, Miura, Kobayashi, Ebisawa, Ikeda) Department of Cardiovascular
Medicine, Shinshu University School of Medicine, Nagano, Japan
(Harada) Department of Cardiology, Nagano Prefectural Suzaka Hospital,
Nagano, Japan
(Kobayashi, Ikeda) Department of Cardiology, Nagano Municipal Hospital,
Nagano, Japan
(Kobayashi) Department of Arrhythmology, Takatsuki General Hospital,
Osaka, Japan
(Nakajima) Department of Cardiology, Nagano Matsushiro General Hospital,
Nagano, Japan
(Kimura) Department of Cardiology, Saku Medical Center, Nagano, Japan
(Akanuma) Department of Cardiology, Iida Municipal Hospital, Nagano, Japan
(Mawatari) Department of Cardiology, North Alps Medical Center Azumi
Hospital, Nagano, Japan
(Sato) Department of Cardiology, Okaya City Hospital, Nagano, Japan
(Hotta) Hotta Medical Clinic, Nagano, Japan
(Kamiyoshi) Department of Cardiology, Aizawa Hospital, Nagano, Japan
(Maruyama, Hashizume) Department of Cardiology, Shinonoi General Hospital,
Nagano, Japan
(Watanabe) Department of Cardiology, Hokushin General Hospital, Nagano,
Japan
(Eisawa) Department of Cardiology, Komoro Kosei General Hospital, Japan
(Miyashita) Department of Cardiovascular Medicine, Nagano Red Cross
Hospital, Nagano, Japan
Title
Clinical impact of complete revascularization in elderly patients with
multi-vessel coronary artery disease undergoing percutaneous coronary
intervention: A sub-analysis of the SHINANO registry.
Source
International Journal of Cardiology. 230 (pp 413-419), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Prior reports have revealed that complete revascularization
(CR) by percutaneous coronary intervention (PCI) decreased ischemic
events. However, little is known about the efficacy of CR using PCI in
elderly patients with multi-vessel coronary artery disease (CAD). We
evaluated the 1-year effectiveness of CR-PCI in elderly patients (> 75
years old) with multi-vessel CAD. Methods The SHINANO Registry, a
prospective, observational, multi-center, all-comer cohort study, has
enrolled 1923 patients. From this registry, we recruited 322 elderly
patients with multi-vessel CAD. The primary endpoint was major adverse
cardiovascular events ([MACE]: all-cause mortality, myocardial infarction,
and stroke). Results Of the 322 elderly patients with multi-vessel CAD,
165 (51.2%) received CR and 157 (48.8%) received incomplete
revascularization (ICR). MACE occurred in 44 (13.7%) patients. The
incidence of MACE by survival analysis was significantly lower in the CR
group than in the ICR group (7.4% vs. 21.1%, p < 0.001). On multivariable
Cox proportional hazards analysis of age, sex, and acute coronary syndrome
(ACS), ACS and CR were independent predictors of MACE (hazard ratio [HR],
2.49; 95% confidence interval [CI], 1.29-4.80; p = 0.007, HR, 0.40; 95%
CI, 0.20-0.77; p = 0.007, respectively). In propensity score matching of
age, sex, previous heart failure, previous intracranial bleeding, ACS, and
body mass index, the MACE rate was significantly lower in the CR group
than in the ICR group (7.2% vs. 18.4%, p = 0.015). Conclusions Even in
elderly patients over 75 years old with multi-vessel CAD, CR-PCI appears
to suppress mid-term ischemic events. Copyright &#xa9; 2016 Elsevier
Ireland Ltd

<75>
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.

<76>
Accession Number
614241906
Author
Hemila H.; Suonsyrja T.
Institution
(Hemila) University of Helsinki, Department of Public Health, POB 20,
Tukholmankatu 8 B 2B, Helsinki FI-00014, Finland
(Suonsyrja) Helsinki University Central Hospital, Meilahti Hospital,
Emergency Clinic, Helsinki, Finland
Title
Vitamin C for preventing atrial fibrillation in high risk patients: A
systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 49. Date of Publication: 01 Feb 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial fibrillation (AF), a common arrhythmia contributing
substantially to cardiac morbidity, is associated with oxidative stress
and, being an antioxidant, vitamin C might influence it. Methods: We
searched the Cochrane CENTRAL Register, MEDLINE, and Scopus databases for
randomised trials on vitamin C that measured AF as an outcome in high risk
patients. The two authors independently assessed the trials for inclusion,
assessed the risk of bias, and extracted data. We pooled selected trials
using the Mantel-Haenszel method for the risk ratio (RR) and the inverse
variance weighting for the effects on continuous outcomes. Results: We
identified 15 trials about preventing AF in high-risk patients, with 2050
subjects. Fourteen trials examined post-operative AF (POAF) in cardiac
surgery patients and one examined the recurrence of AF in cardioversion
patients. Five trials were carried out in the USA, five in Iran, three in
Greece, one in Slovenia and one in Russia. There was significant
heterogeneity in the effect of vitamin C in preventing AF. In 5 trials
carried out in the USA, vitamin C did not prevent POAF with RR=1.04 (95%
CI: 0.86-1.27). In nine POAF trials conducted outside of the USA, vitamin
C decreased its incidence with RR=0.56 (95% CI: 0.47-0.67). In the single
cardioversion trial carried out in Greece, vitamin C decreased the risk of
AF recurrence by RR=0.13 (95% CI: 0.02-0.92). In the non-US cardiac
surgery trials, vitamin C decreased the length of hospital stay by 12.6%
(95% CI 8.4-16.8%) and intensive care unit (ICU) stay by 8.0% (95% CI
3.0-13.0%). The US trials found no effect on hospital stay and ICU stay.
No adverse effects from vitamin C were reported in the 15 trials.
Conclusions: Our meta-analysis indicates that vitamin C may prevent
post-operative atrial fibrillation in some countries outside of the USA,
and it may also shorten the duration of hospital stay and ICU stay of
cardiac surgery patients. Vitamin C is an essential nutrient that is safe
and inexpensive. Further research is needed to determine the optimal
dosage protocol and to identify the patient groups that benefit the most.
Copyright &#xa9; 2017 The Author(s).

<77>
Accession Number
614075888
Author
Hongisto M.; Lassus J.; Tarvasmaki T.; Sionis A.; Tolppanen H.; Lindholm
M.G.; Banaszewski M.; Parissis J.; Spinar J.; Silva-Cardoso J.; Carubelli
V.; Di Somma S.; Masip J.; Harjola V.-P.
Institution
(Hongisto, Tarvasmaki, Harjola) Emergency Medicine, University of
Helsinki, Department of Emergency Care, Helsinki University Hospital,
Helsinki, Finland
(Lassus, Tolppanen) Helsinki University Hospital, Heart and Lung Center,
Division of Cardiology, Helsinki, Finland
(Sionis) Intensive Cardiac Care Unit, Cardiology Department, Hospital de
la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant
Pau) Barcelona, Spain
(Lindholm) Rigshospitalet, Copenhagen University Hospital, Intensive
Cardiac Care Unit, Copenhagen, Denmark
(Banaszewski) Institute of Cardiology, Intensive Cardiac Therapy Clinic,
Warsaw, Poland
(Parissis) Attikon University Hospital, Heart Failure Clinic and Secondary
Cardiology Department, Athens, Greece
(Spinar) University Hospital Brno, Department of Internal Medicine and
Cardiology, Brno, Czech Republic
(Silva-Cardoso) University of Porto, CINTESIS, Department of Cardiology,
Porto Medical School, Sao Joao Hospital Center, Porto, Portugal
(Carubelli) Division of Cardiology, Department of Medical and Surgical
Specialties, Radiological Sciences, and Public Health, University and
Civil Hospital of Brescia, Italy
(Di Somma) Department of Medical Sciences and Translational Medicine,
University of Rome Sapienza, Emergency Medicine Sant'Andrea Hospital,
Rome, Italy
(Masip) University of Barcelona, Hospital Sant Joan Despi Moises Broggi,
Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain
Title
Use of noninvasive and invasive mechanical ventilation in cardiogenic
shock: A prospective multicenter study.
Source
International Journal of Cardiology. 230 (pp 191-197), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite scarce data, invasive mechanical ventilation (MV) is
widely recommended over non-invasive ventilation (NIV) for ventilatory
support in cardiogenic shock (CS). We assessed the real-life use of
different ventilation strategies in CS and their influence on outcome
focusing on the use of NIV and MV. Methods 219 CS patients were
categorized by the maximum intensity of ventilatory support they needed
during the first 24 h into MV (n = 137; 63%), NIV (n = 26; 12%), and
supplementary oxygen (n = 56; 26%) groups. We compared the clinical
characteristics and 90-day outcome between the MV and the NIV groups.
Results Mean age was 67 years, 74% were men. The MV and NIV groups did not
differ in age, medical history, etiology of CS,
PaO<inf>2</inf>/FiO<inf>2</inf> ratio, baseline hemodynamics or LVEF. MV
patients predominantly presented with hypoperfusion, with more severe
metabolic acidosis, higher lactate levels and greater need for vasoactive
drugs, whereas NIV patients tended to be more often congestive. 90-day
outcome was significantly worse in the MV group (50% vs. 27%), but after
propensity score adjustment, mortality was equal in both groups.
Confusion, prior CABG, ACS etiology, higher lactate level, and lower
baseline PaO<inf>2</inf> were independent predictors of mortality, whereas
ventilation strategy did not have any influence on outcome. Conclusions
Although MV is generally recommended mode of ventilatory support in CS, a
fair number of patients were successfully treated with NIV. Moreover,
ventilation strategy was not associated with outcome. Thus, NIV seems a
safe option for properly chosen CS patients. Copyright &#xa9; 2016
Elsevier Ireland Ltd

<78>
Accession Number
613543511
Author
Voora D.; Coles A.; Lee K.L.; Hoffmann U.; Wingrove J.A.; Rhees B.; Huang
L.; Daniels S.E.; Monane M.; Rosenberg S.; Shah S.H.; Kraus W.E.; Ginsburg
G.S.; Douglas P.S.
Institution
(Voora, Ginsburg) Duke Center for Applied Genomics & Precision Medicine,
Duke University School of Medicine, Durham, NC, United States
(Voora, Shah, Kraus, Ginsburg, Douglas) Department of Medicine, Duke
University School of Medicine, Durham, NC, United States
(Coles, Lee, Shah, Douglas) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Hoffmann) Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Wingrove, Rhees, Huang, Daniels, Monane, Rosenberg) CardioDx, Inc.,
Redwood City, CA, United States
Title
An age- and sex-specific gene expression score is associated with
revascularization and coronary artery disease: Insights from the
Prospective Multicenter Imaging Study for Evaluation of Chest Pain
(PROMISE) trial.
Source
American Heart Journal. 184 (pp 133-140), 2017. Date of Publication: 01
Feb 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Identifying predictors of coronary artery disease (CAD)-related
procedures and events remains a priority. Methods We measured an age- and
sex-specific gene expression score (ASGES) previously validated to detect
obstructive CAD (oCAD) in symptomatic nondiabetic patients in the PROMISE
trial. The outcomes were oCAD (>70% stenosis in >1 vessel or >50% left
main stenosis on CT angiography [CTA]) and a composite endpoint of death,
myocardial infarction, revascularization, or unstable angina. Results The
ASGES was determined in 2370 nondiabetic participants (47.5% male, median
age 59.5 years, median follow-up 25 months), including 1137 with CTA data.
An ASGES >15 was associated with oCAD (odds ratio 2.5 [95% CI 1.6-3.8], P
< .001) and the composite endpoint (hazard ratio [HR] 2.6 [95% CI
1.8-3.9], P < .001) in unadjusted analyses. After adjustment for
Framingham risk, an ASGES >15 remained associated with the composite
endpoint (P = .02); the only component that was associated was
revascularization (adjusted HR 2.69 [95% CI 1.52-4.79], P < .001).
Compared to noninvasive testing, the ASGES improved prediction for the
composite (increase in c-statistic = 0.036; continuous net
reclassification index = 43.2%). Patients with an ASGES <15 had a
composite endpoint rate no different from those with negative noninvasive
test results (3.2% vs. 2.6%, P = .29). Conclusions A blood-based genomic
test for detecting oCAD significantly predicts near-term revascularization
procedures, but not non-revascularization events. Larger studies will be
needed to clarify the risk with non-revascularization events. Copyright
&#xa9; 2016 The Authors

<79>
Accession Number
614374147
Author
Ha F.J.; Nerlekar N.; Cameron J.D.; Bennett M.R.; Meredith I.T.; West
N.E.J.; Brown A.J.
Title
Midterm Safety and Efficacy of ABSORB Bioresorbable Vascular Scaffold
Versus Everolimus-Eluting Metallic Stent: An Updated Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 10 (3) (pp 308-310), 2017. Date of
Publication: 13 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<80>
Accession Number
614137708
Author
Yeh R.W.; Silber S.; Chen L.; Chen S.; Hiremath S.; Neumann F.-J.; Qiao
S.; Saito S.; Xu B.; Yang Y.; Mauri L.
Institution
(Yeh) Smith Center for Outcomes Research in Cardiology, Beth Israel
Deaconess Medical Center, Boston, Massachusetts, United States
(Silber) Department of Cardiology, Heart Centre at the Isar, Munich,
Germany
(Chen) Union Hospital, Fujian Medical University, Fujian, China
(Chen) Nanjing First Hospital, Jiangshu, China
(Hiremath) Ruby Hall Clinic, Pune, India
(Neumann) University Heart Center Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Qiao, Xu, Yang) Fu Wai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, Beijing, China
(Saito) Shonan Kamakura General Hospital, Kamakura, Japan
(Mauri) Division of Cardiovascular Medicine, Baim Institute for Clinical
Research, Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts, United States
Title
5-Year Safety and Efficacy of Resolute Zotarolimus-Eluting Stent: The
RESOLUTE Global Clinical Trial Program.
Source
JACC: Cardiovascular Interventions. 10 (3) (pp 247-254), 2017. Date of
Publication: 13 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors evaluated the 5-year cumulative incidence of
cardiovascular events following Resolute zotarolimus-eluting stent (R-ZES)
implantation. Background Individual trials are often underpowered to show
differences for low-frequency adverse events. The R-ZES was studied in 10
prospective clinical trials, designed with identical adverse event
definitions, ascertainment, and adjudication. Methods The RESOLUTE Global
Clinical Trial Program includes 7,618 patients treated with R-ZES:
RESOLUTE first-in-human study (N = 139), RESOLUTE All Comers (N = 1,140),
RESOLUTE International (N = 2,349), RESOLUTE US (N = 1,402), RESOLUTE US
38 mm (N = 114), RESOLUTE Japan (N = 100), RESOLUTE Japan Small Vessel
Study (N = 65), RESOLUTE Asia (N = 311), RESOLUTE China Randomized
Controlled Trial (N = 198), and RESOLUTE China Registry (N = 1,800). The
5-year cumulative incidence of events was calculated. Results The 5-year
cumulative incidence of cardiac events was 13.4% for target lesion failure
and included 5.0% cardiac death, 4.4% target vessel myocardial infarction,
and 6.3% clinically driven target lesion revascularization.
Dual-antiplatelet therapy at 1, 3, and 5 years was 91%, 37%, and 32%,
respectively. The 5-year cumulative incidence of definite or probable
stent thrombosis was 1.2%, which comprised 0.7% at 1 year and an
annualized rate of 0.1% thereafter. Five-year use of dual-antiplatelet
therapy varied geographically from 63% in Japan to 11% in Europe.
Conclusions In the largest group of R-ZES patients examined to date, the
majority of stent-related events, including target vessel myocardial
infarction and stent thrombosis, occurred within the first year of
implantation with much lower risks of these events out to 5 years.
Copyright &#xa9; 2017 American College of Cardiology Foundation

<81>
Accession Number
614271770
Author
Xu X.; Hu J.; Song N.; Chen R.; Zhang T.; Ding X.
Institution
(Xu, Hu, Song, Chen, Zhang, Ding) Department of Nephrology, Zhongshan
Hospital, Fudan University, No.180 Fenglin Road, Shanghai 200032, China
(Xu, Hu, Song, Chen, Zhang, Ding) Shanghai Institute of Kidney Disease and
Dialysis, No.180 Fenglin Road, Shanghai 200032, China
(Xu, Hu, Song, Chen, Zhang, Ding) Shanghai Key Laboratory of Kidney
Disease and Blood Purification, No.180 Fenglin Road, Shanghai 200032,
China
Title
Hyperuricemia increases the risk of acute kidney injury: A systematic
review and meta-analysis.
Source
BMC Nephrology. 18 (1) (no pagination), 2017. Article Number: 27. Date of
Publication: 17 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Mounting evidence indicated that the elevated serum uric acid
level was associated with an increased risk of acute kidney injury (AKI).
Our goal was to systematically evaluate the correlation of serum uric acid
(SUA) level and incidence of AKI by longitudinal cohort studies. Methods:
We searched electronic databases and the reference lists of relevant
articles. 18 cohort studies with 75,200 patients were analyzed in this
random-effect meta-analysis. Hyperuricemia was defined as SUA levels
greater than 360-420 mumol/L (6-7 mg/dl), which was various according to
different studies. Data including serum uric acid, serum creatinine, and
incidence of AKI and hospital mortality were summarized using
random-effects meta-analysis. Results: The hyperuricemia group
significantly exerted a higher risk of AKI compared to the controls (odds
ratio OR 2.24, 95% CI 1.76-2.86, p < 0.01). Furthermore, there is less
difference of the pooled rate of AKI after cardiac surgery between
hyperuricemia and control group (34.3% vs 29.7%, OR 1.24, 95% CI
0.96-1.60, p = 0.10), while the rates after PCI were much higher in
hyperuricemia group than that in control group (16.0% vs 5.3%, OR 3.24,
95% CI 1.93-5.45, p < 0.01). In addition, there were significant
differences in baseline renal function at admission between hyperuricemia
and control groups in most of the included studies. The relationship
between hyperuricemia and hospital mortality was not significant. The
pooled pre-operative SUA levels were higher in AKI group than that in the
non-AKI group. Conclusions: Elevated SUA level showed an increased risk
for AKI in patients and measurements of SUA may help identify risks for
AKI in these patients. Copyright &#xa9; 2017 The Author(s).

<82>
Accession Number
614153938
Author
Sharma A.; Agrawal S.; Goel S.; Borer J.S.
Institution
(Sharma, Borer) Division of Cardiovascular Medicine, State University of
New York Downstate Medical Center, Brooklyn, New York, NY 11203, United
States
(Sharma) Institute of Cardiovascular Research and Technology, Brooklyn,
NY, United States
(Agrawal) Division of Cardiology, St. Luke's University Health Network,
Bethlehem, PA, United States
(Goel) Department of Cardiology, Maimonides Medical Center, New York, NY,
United States
(Borer) The Howard Gilman Institute for Heart Valve Diseases and the
Schiavone Institute for Cardiovascular Translational Research, State
University of New York Downstate Medical Center, Brooklyn, New York, NY,
United States
Title
Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus
Replacement.
Source
Current Cardiology Reports. 19 (1) (no pagination), 2017. Article Number:
3. Date of Publication: 01 Jan 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Ischemic mitral regurgitation (MR), which occurs in
about 20-30% patients with a prior myocardial infarction, is associated
with worsening heart failure and an increase in cardiovascular mortality.
It should be treated surgically if certain hemodynamic severity criteria
are met and in patients who continue to experience symptoms of heart
failure despite optimal medical therapy. However, current guidelines do
not suggest which of the available approaches to mitral valve
surgery-mitral valve (MV) repair or replacement (MVR) is superior for this
indication. While MV repair is reported to confer improved survival, MVR
may provide higher rates of freedom from recurrent MR. This article
attempts to provide the reader with a comprehensive review and comparison
of current techniques of mitral valve surgery in patients with severe
ischemic MR. Recent Findings: The first randomized trial to compare MV
repair versus MVR in patients with severe ischemic MR, the Cardiothoracic
Surgical Trials Network (CTSN) trial, was recently concluded and reported
no significant difference in the primary outcome of left ventricular end
systolic volume index between the two approaches at either 1- or 2-year
follow-ups. Summary: Data comparing approaches of MV repair and MVR for
ischemic MR is largely limited to small, non-randomized retrospective
trials. The only randomized trial data to examine this issue suggested no
difference in mortality with either MVR or MV repair; however, MVR was
shown to be consistently associated with higher rates of MR recurrence.
Certain echocardiographic features have been reported to predict poor
outcomes with MVR and may help refine the selection of the surgical
approach in the individual patient. Copyright &#xa9; 2017, Springer
Science+Business Media New York.

<83>
Accession Number
614094607
Author
Muller D.W.M.; Grayburn P.A.; Stoler R.C.; Scalia G.M.; Muller D.; Jansz
P.; Shaw M.; Conellan M.; Spina R.; Pedersen W.; Sorajja P.; Farivar R.S.;
Bae R.; Sun B.; Walters D.; Clarke A.; Scalia G.; Grayburn P.; Stoler R.;
Hebeler R.; Dahle G.; Rein K.A.; Fiane A.; Guerrero M.; Pearson P.;
Feldman T.; Salinger M.; Smart S.; Kapadia S.; Gillinov M.; Mick S.;
Krishnaswamy A.; Pichard A.; Corso P.; Chuang M.; Popma J.; Leipsic J.;
Blanke P.; Carroll J.; George I.; Missov E.; Kiser A.
Institution
(Muller, Jansz, Shaw) Departments of Cardiology and Cardiothoracic
Surgery, St. Vincent's Hospital, Sydney, Australia
(Farivar, Bae, Sorajja) Center for Valve and Structural Heart Disease and
Cardiothoracic Surgery Service, Minneapolis Heart Institute at Abbott
Northwestern Hospital, Minneapolis, Minnesota, United States
(Walters, Clarke, Scalia) Departments of Cardiology and Cardiothoracic
Surgery, Prince Charles Hospital, Brisbane, Australia
(Grayburn, Stoler) Divisions of Cardiology and Cardiothoracic Surgery,
Baylor University Medical Center, Dallas, Texas, United States
(Dahle, Rein) Departments of Cardiology and Cardiothoracic Surgery, Oslo
University Hospital, Oslo, Norway
(Guerrero, Pearson) Divisions of Cardiology and Cardiothoracic Surgery,
Evanston Hospital, Evanston, Illinois, United States
(Kapadia, Gillinov) Departments of Cardiovascular Medicine and
Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio,
United States
(Pichard, Corso) Division of Cardiology and Department of Cardiothoracic
Surgery, Medstar Washington Hospital Center, Washington DC, United States
(Popma, Chuang) Beth Israel Deaconness Medical Center, Boston,
Massachusetts, United States
(Blanke, Leipsic) St. Paul's Hospital, Vancouver, British Columbia, Canada
Title
Transcatheter Mitral Valve Replacement for Patients With Symptomatic
Mitral Regurgitation: A Global Feasibility Trial.
Source
Journal of the American College of Cardiology. 69 (4) (pp 381-391), 2017.
Date of Publication: 31 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Symptomatic mitral regurgitation (MR) is associated with high
morbidity and mortality that can be ameliorated by surgical valve repair
or replacement. Despite this, many patients with MR do not undergo
surgery. Transcatheter mitral valve replacement (TMVR) may be an option
for selected patients with severe MR. Objectives This study aimed to
examine the effectiveness and safety of TMVR in a cohort of patients with
native valve MR who were at high risk for cardiac surgery. Methods
Patients underwent transcatheter, transapical delivery of a self-expanding
mitral valve prosthesis and were examined in a prospective registry for
short-term and 30-day outcomes. Results Thirty patients (age 75.6 +/- 9.2
years; 25 men) with grade 3 or 4 MR underwent TMVR. The MR etiology was
secondary (n = 23), primary (n = 3), or mixed pathology (n = 4). The
Society of Thoracic Surgeons Predicted Risk of Mortality was 7.3 +/- 5.7%.
Successful device implantation was achieved in 28 patients (93.3%). There
were no acute deaths, strokes, or myocardial infarctions. One patient died
13 days after TMVR from hospital-acquired pneumonia. Prosthetic leaflet
thrombosis was detected in 1 patient at follow-up and resolved after
increased oral anticoagulation with warfarin. At 30 days, transthoracic
echocardiography showed mild (1+) central MR in 1 patient, and no residual
MR in the remaining 26 patients with valves in situ. The left ventricular
end-diastolic volume index decreased (90.1 +/- 28.2 ml/m² at
baseline vs. 72.1 +/- 19.3 ml/m² at follow-up; p = 0.0012), as
did the left ventricular end-systolic volume index (48.4 +/- 19.7
ml/m² vs. 43.1 +/- 16.2 ml/m²; p = 0.18).
Seventy-five percent of the patients reported mild or no symptoms at
follow-up (New York Heart Association functional class I or II).
Successful device implantation free of cardiovascular mortality, stroke,
and device malfunction at 30 days was 86.6%. Conclusions TMVR is an
effective and safe therapy for selected patients with symptomatic native
MR. Further evaluation of TMVR using prostheses specifically designed for
the mitral valve is warranted. This intervention may help address an unmet
need in patients at high risk for surgery. (Early Feasibility Study of the
Tendyne Mitral Valve System [Global Feasibility Study]; NCT02321514)
Copyright &#xa9; 2017 American College of Cardiology Foundation

<84>
Accession Number
612362080
Author
Pearson K.L.; Hall N.J.
Institution
(Pearson) Department of General Surgery, Queen Alexandra Hospital,
Portsmouth, United Kingdom
(Pearson, Hall) University Surgery Unit, Faculty of Medicine, University
of Southampton, Southampton, United Kingdom
(Hall) Department of Paediatric Surgery and Urology, Southampton
Children's Hospital, Southampton, United Kingdom
Title
What is the role of enhanced recovery after surgery in children? A scoping
review.
Source
Pediatric Surgery International. 33 (1) (pp 43-51), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Enhanced recovery after surgery (ERAS) pathways are standard
practice in adult specialties resulting in improved outcomes. It is
unclear whether ERAS principles are applicable to Paediatric Surgery. We
performed a scoping review to identify the extent to which ERAS has been
used in Paediatric Surgery, the nature of interventions, and outcomes.
Methods: Pubmed, Cochrane library, Google Scholar, and Embase were
searched using the terms enhanced recovery, post-operative
protocol/pathway, fast track surgery, and paediatric surgery. Studies were
excluded if they did not include abdominal/thoracic/urological procedures
in children. Results: Nine studies were identified (2003-2014; total 1269
patients): three case control studies, one retrospective review and five
prospective implementations, no RCTs. Interventional elements identified
were post-operative feeding, mobilisation protocols, morphine-sparing
analgesia, reduced use of nasogastric tubes and urinary catheters.
Outcomes reported included post-operative length of stay (LOS), time to
oral feeding and stooling, complications, and parent satisfaction.
Fast-track programmes significantly reduced LOS in 6/7 studies, time to
oral feeding in 3/3 studies, and time to stooling in 2/3 studies.
Conclusion: The use of ERAS pathways in Paediatric surgery appears very
limited but such pathways may have benefits in children. Prospective
studies should evaluate interventions used in adult ERAS on appropriate
outcomes in the paediatric setting. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<85>
Accession Number
614342240
Author
Bernier-Jean A.; Albert M.; Shiloh A.L.; Eisen L.A.; Williamson D.;
Beaulieu Y.
Institution
(Bernier-Jean, Beaulieu) Hopital du Sacre-Coeur de Montreal, University of
Montreal, 5400 Gouin Blvd W, Montreal, QC H4 J 1C5, Canada
(Albert) Hopital du Sacre-Coeur de Montreal Research Center, University of
Montreal, Montreal, Canada
(Shiloh, Eisen) Division of Critical Care Medicine, Department of
Medicine, Albert Einstein College of Medicine, J.B. Langner Critical Care
Service, Montefiore Medical Center, New York, NY, United States
(Williamson) Pharmacy Department, Hopital du Sacre-Coeur de Montreal,
Faculty de Pharmacy, University of Montreal, Montreal, Canada
Title
The Diagnostic and Therapeutic Impact of Point-of-Care Ultrasonography in
the Intensive Care Unit.
Source
Journal of Intensive Care Medicine. 32 (3) (pp 197-203), 2017. Date of
Publication: 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Purpose: In light of point-of-care ultrasonography's (POCUS) recent rise
in popularity, assessment of its impact on diagnosis and treatment in the
intensive care unit (ICU) is of key importance. Methods: Ultrasound
examinations were collected through an ultrasound reporting software in 6
multidisciplinary ICU units from 3 university hospitals in Canada and the
United States. This database included a self-reporting questionnaire to
assess the impact of the ultrasound findings on diagnosis and treatment.
We retrieved the results of these questionnaires and analyzed them in
relation to which organs were assessed during the ultrasound examination.
Results: One thousand two hundred and fifteen ultrasound studies were
performed on 968 patients. Intensivists considered the image quality of
cardiac ultrasound to be adequate in 94.7% compared to 99.7% for general
ultrasound (P <.001). The median duration of a cardiac examination was 10
(interquartile range [IQR] 10) minutes compared to 5 (IQR 8) minutes for a
general examination (P <.001). Overall, ultrasound findings led to a
change in diagnosis in 302 studies (24.9%) and to a change in management
in 534 studies (44.0%). A change in diagnosis or management was reported
more frequently for cardiac ultrasound than for general ultrasound (108
[37.1%] vs 127 [16.5%], P <.001) and (170 [58.4%] vs 270 [35.1%], P
<.001). Assessment of the inferior vena cava for fluid status emerged as
the critical care ultrasound application associated with the greatest
impact on management. Conclusion: Point-of-care ultrasonography has the
potential to optimize care of the critically ill patients when added to
the clinical armamentarium of the intensive care physician. Copyright
&#xa9; The Author(s) 2015.

<86>
Accession Number
614449323
Author
Choudhuri P.; Biswas B.K.
Institution
(Choudhuri) Department of Anesthesiology, ESI-Postgraduate Institute of
Medical Sciences & Research, Kolkata, India
(Biswas) Department of Anesthesiology, ESI-Postgraduate Institute of
Medical Sciences & Research, Kolkata, India
Title
Intraoperative Use of Epsilon Amino Caproic Acid and Tranexamic Acid in
Surgeries Performed Under Cardiopulmonary Bypass: a Comparative Study To
Assess Their Impact On Reopening Due To Postoperative Bleeding.
Source
Ethiopian journal of health sciences. 25 (3) (pp 273-278), 2015. Date of
Publication: 01 Jul 2015.
Abstract
BACKGROUND: Open heart surgeries under cardiopulmonary bypass are
associated with excessive perioperative bleeding that often requires
reoperation. Antifibrinolytics like epsilon aminocaproic acid and
tranexamic acid are widely used to control bleeding. There are limited
studies primarily showing the impact of these drugs on the incidence of
reopening following open heart surgical procedures. The goal of this study
was to compare incidence of reopening following open heart surgeries in
patients who were administered either epsilon amino caproic acid or
tranexamic acid for control of perioperative bleeding.
METHODS: A prospective, randomized, controlled trial was performed among
seventy-eight patients of either sex in the age group of 18 to 65 years
scheduled for open heart surgeries under cardiopulmonary bypass. They were
randomly allocated into three groups where group A (n=26) received epsilon
aminocaproic acid, group B (n=26) received tranexamic acid and group C
(control group, n=26) received intravenous 0.9% normal saline. Patients
had similar anaesthetic protocols, and were monitored for twenty-four
hours postoperatively to assess reopening rates because of excessive
bleeding.
RESULTS: Two patients in each group receiving either tranexamic acid or
epsilon aminocaproic acid had excessive bleeding requiring reopening after
surgery whereas three patients in the control group had undergone
reopening for excessive bleeding (p>0.05).
CONCLUSIONS: Epsilon aminocaproic acid and tranexamic acid exhibit similar
and comparable effect to placebo on incidence of reopening for excessive
bleeding following open heart surgeries under cardiopulmonary bypass.

<87>
Accession Number
614474464
Author
Parepa I.-R.; Suceveanu A.-I.; Mazilu L.; Mohamed A.; Nita D.; Tuta L.-A.
Institution
(Parepa, Suceveanu, Mazilu, Tuta) "Ovidius" University, Faculty of
Medicine, Constanta, Romania
(Mohamed, Nita) "Vasile Candea" Army Centre for Cardiovascular Diseases,
Bucharest, Romania
Title
Preventing cardiac complications after non-cardiac non-vascular surgery by
using perioperative statin therapy - a prospective study in Constanta
county, Romania.
Source
Farmacia. 65 (1) (pp 120-124), 2017. Date of Publication: 2017.
Publisher
Romanian Society for Pharmaceutical Sciences (Str. Traian Vuia 6, sector
2, Bucharest 020956, Romania)
Abstract
The aim of the study was to evaluate if statins reduce the risk of cardiac
events when given during perioperative period in patients who undergo
non-cardiac, non-vascular surgery. 1,380 "statin-naive" patients with no
evidence of cardiac disease were randomised for: rosuvastatin 10 mg/day (n
= 691), and placebo (n = 689), given 10 days before and 20 days after
surgery and were followed-up 3 months after surgery. Endpoint was defined
as new-onset angina, silent cardiac ischemia, non-fatal acute coronary
syndrome or fatal coronary heart disease. 82 patients (5.95%) suffered
cardiac events during follow-up: 31 from statin arm and 51 from placebo
arm (p = 0.0029). After adjusting for variables, the statin arm had a
relative-risk reduction of 39% (p = 0.0189) for cardiac events. No
significant decrease in LDL-cholesterol was found in statin patients (p =
0.5664). Perioperative statin therapy was protective against cardiac
complications of non-cardiac non-vascular surgery, irrespective of its
lipid-lowering effect. Copyright &#xa9; 2017, Romanian Society for
Pharmaceutical Sciences. All rights reserved.

<88>
Accession Number
614429183
Author
Sanchez Munoz M.C.; De Kock M.; Forget P.
Institution
(Sanchez Munoz) Anesthesiology Department, Cliniques Universitaires
Saint-Luc, Institute of Neuroscience (Pole CEMO), Universite Catholique de
Louvain, Brussels, Belgium
(De Kock) Anesthesiology department, Centre hospitalier de Wallonie
Picarde (CHWAPI), Tournai, Belgium
(Forget) Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel
(UZ Brussel), department of Anesthesiology and Perioperative Medicine,
Brussels, Belgium
Title
What is the place of clonidine in anesthesia? Systematic review and
meta-analyses of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 38 (pp 140-153), 2017. Date of
Publication: 01 May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective A place for clonidine has been suggested for many
indications in perioperative medicine. The aim of this systematic review
and these meta-analyses is to systematically, and quantitatively, evaluate
these potential indications of clonidine. Design, setting, patients and
interventions We selected and analyzed (qualitatively and, when possible,
quantitatively) the available literature published on PubMed/Medline and
on the Cochrane database. Inclusion criteria included: human randomized
controlled trials involving adults who received perioperative systemic
(oral, intramuscular, transdermal and intravenous) clonidine for every
type of surgery. Measurements and main results We identified 775 trials
and thereafter excluded 718 and analyzed 57 trials concerning, in total,
14,790 patients of whom 7408 received clonidine and 6836 received placebo.
Most important results shows that, in qualitative and quantitative
analyses, clonidine vs placebo reduces analgesics consumption in,
respectively, (159 vs 154 patients: 24%, 95%CI[16%-32%]; p < 0.001),
reduces nausea and vomiting (risk ratio, in 180 vs 181 patients: 0.35,
95%CI[0.25-0.51]; p < 0.001), improves hemodynamic stability (reduction of
HR: 14.9 bpm, 95%CI[10.4-19.5]; p < 0.001; reduction of the MAP: 12.5 mm
Hg, 95%CI[7.14-17.86]; p < 0.001); 1 min after tracheal intubation, in 67
vs 68 patients), prevents postoperative shivering (risk ratio, in 140 vs
140 patients: 0.17, 95%CI[0.10-0.29]; p < 0.001). On the other hand,
clonidine does not have any influence on renal and cardiac outcomes
(adverse events rates, in 5873 vs 5533 patients: 0.00, 95%CI[- 0.10-0.11];
p = 0.96) and does not prolong awakening time. Conclusions In conclusion,
these systematic review and meta-analyses of 57 trials confirm that
clonidine improves pain control, reduces PONV, improves hemodynamic and
sympathetic stability, with no adverse consequences on renal function or
awakening time, but does not influence cardiac outcome in the general
population, after non-cardiac surgery. Nevertheless, given the high
heterogeneity between the studies, this does not exclude different results
in patient subgroups or specific procedures. Copyright &#xa9; 2017

<89>
Accession Number
614474364
Author
Al-Amran F.G.; Hadi N.R.; Mahdi L.A.-S.
Institution
(Al-Amran) Al-Najaf Center for Cardiothoracic Surgery, Iraq
(Hadi) Department of Pharmacology and Therapeutics, Faculty of Medicine,
University of Kufa, Iraq
(Mahdi) Ministry of Health and Environment, Iraq
Title
Effect of montelukast on myocardial ischemia reperfusion injury after
coronary artery bypass graft surgery.
Source
World Heart Journal. 8 (3) (pp 261-270), 2016. Date of Publication: 2016.
Publisher
Nova Science Publishers, Inc. (E-mail: Journals@novapublishers.com)
Abstract
Background. Ischemic heart disease is a major leading cause of death
worldwide. Coronary artery bypass grafting surgery (CABG) is one of the
most effective strategies to revascularize ischemic myocardium. However,
this procedure is usually associated with ischemic reperfusion injury that
can cause long-term myocardial disability and increased mortality rate.
Montelukast, a leukotriene antagonist, had been shown in many experimental
studies to be protective against reperfusion injury in many tissue types,
including the myocardium. In this study, we attempted to investigate the
role of montelukast in protecting patients undergoing bypass surgery from
cardiac injury. Subjects and Methods. Forty patients who were undergoing
elective bypass surgery at the Al-Najaf Cardio-surgery Center were
enrolled in a controlled clinical trial and randomly divided into two
groups: Group 1 (MK group) consists of 20 patients who took a 10 mg
montelukast tablet 2 days before surgery and another one day after
surgery. Group 2 (Non-MK group) consists of 20 patients who did not take
montelukast. Results. In the montelukast treated patients, the
concentrations of cardiac troponin 1 (cTn-I) and interleukin (IL)-1beta
were significantly lower (p < 0.05) and the concentration of
high-sensitive C-reactive protein (hsCRP) was non-significantly lower (p >
0.05) compared to patients not receiving montelukast. Reduced glutathione
(GSH) concentration was significantly higher (p < 0.05) in
montelukast-treated patients than in patients not treated with
montelukast. Conclusions. Montelukast protects against myocardial injury
and inflammation from ischemia reperfusion and enhances antioxidant
potential by increasing GSH. Copyright &#xa9; 2016 Nova Science
Publishers, Inc.

<90>
Accession Number
614406617
Author
Hsu J.C.; Badhwar N.; Gerstenfeld E.P.; Lee R.J.; Mandyam M.C.; Dewland
T.A.; Imburgia K.E.; Hoffmayer K.S.; Vedantham V.; Lee B.K.; Tseng Z.H.;
Scheinman M.M.; Olgin J.E.; Marcus G.M.
Institution
(Hsu, Badhwar, Gerstenfeld, Lee, Mandyam, Dewland, Imburgia, Hoffmayer,
Vedantham, Lee, Tseng, Scheinman, Olgin, Marcus) Section of Cardiac
Electrophysiology, Division of Cardiology, Department of Medicine,
University of California, San Francisco, San Francisco, CA, United States
Title
Randomized trial of conventional transseptal needle versus radiofrequency
energy needle puncture for left atrial access (the TRAVERSE-LA Study).
Source
Journal of the American Heart Association. 2 (5) (no pagination), 2013.
Article Number: e000428. Date of Publication: 2013.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Transseptal puncture is a critical step in achieving left
atrial (LA) access for a variety of cardiac procedures. Although the
mechanical Brockenbrough needle has historically been used for this
procedure, a needle employing radiofrequency (RF) energy has more recently
been approved for clinical use. We sought to investigate the comparative
effectiveness of an RF versus conventional needle for transseptal LA
access. Methods and Results--In this prospective, single-blinded,
controlled trial, 72 patients were randomized in a 1:1 fashion to an RF
versus conventional (BRK-1) transseptal needle. In an intention-to-treat
analysis, the primary outcome was time required for transseptal LA access.
Secondary outcomes included failure of the assigned needle, visible
plastic dilator shavings from needle introduction, and any procedural
complication. The median transseptal puncture time was 68% shorter using
the RF needle compared with the conventional needle (2.3 minutes
[interquartile range (IQR), 1.7 to 3.8 minutes] versus 7.3 minutes [IQR,
2.7 to 14.1 minutes], P = 0.005). Failure to achieve transseptal LA access
with the assigned needle was less common using the RF versus conventional
needle (0/36 [0%] versus 10/36 [27.8%], P < 0.001). Plastic shavings were
grossly visible after needle advancement through the dilator and sheath in
0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P <
0.001). There were no differences in procedural complications (1/36 [2.8%]
versus 1/36 [2.8%]). Conclusions--Use of an RF needle resulted in shorter
time to transseptal LA access, less failure in achieving transseptal LA
access, and fewer visible plastic shavings. Copyright &#xa9; 2013 The
Authors.

<91>
Accession Number
614249298
Author
Iyigun T.; Kaya M.; Gulbeyaz S.O.; Fistikci N.; Uyanik G.; Yilmaz B.; Onan
B.; Erkanli K.
Institution
(Iyigun, Kaya, Yilmaz, Onan, Erkanli) Department of Cardiovascular Surgery
Clinic, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery
Training and Research Hospital, Istanbul, Turkey
(Gulbeyaz) Department of Plastic and Reconstructive Surgery, Istanbul
Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and
Research Hospital, Istanbul, Turkey
(Fistikci) Department of Psychiatry, Bakirkoy Research and Training
Hospital, Istanbul, Turkey
(Uyanik) Departments of Psychology, Istanbul Mehmet Akif Ersoy Thoracic
and Cardiovascular Surgery Training and Research Hospital, Istanbul,
Turkey
Title
Patient body image, self-esteem, and cosmetic results of minimally
invasive robotic cardiac surgery.
Source
International Journal of Surgery. 39 (pp 88-94), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Patient-reported outcome measures reveal the quality of
surgical care from the patient's perspective. We aimed to compare body
image, self-esteem, hospital anxiety and depression, and cosmetic outcomes
by using validated tools between patients undergoing robot-assisted
surgery and those undergoing conventional open surgery. Materials and
methods This single-center, multidisciplinary, randomized, prospective
study of 62 patients who underwent cardiac surgery was conducted at
Hospital from May 2013 to January 2015. The patients were divided into two
groups: the robotic group (n = 33) and the open group (n = 29). The study
employed five different tools to assess body image, self-esteem, and
overall patient-rated scar satisfaction. Results There were statistically
significant differences between the groups in terms of self-esteem scores
(p = 0.038), body image scores (p = 0.026), overall Observer Scar
Assessment Scale (p = 0.013), and overall Patient Scar Assessment Scale (p
= 0.036) scores in favor of the robotic group during the postoperative
period. Robot-assisted surgery protected the patient's body image and
self-esteem, while conventional open surgery decreased these levels but
without causing pathologies. Preoperative depression and anxiety level was
reduced by both robot-assisted surgery and conventional open surgery. The
groups did not significantly differ on Patient Satisfaction Scores and
depression/anxiety scores. Conclusion The results of this study clearly
demonstrated that a minimally invasive approach using robotic-assisted
surgery has advantages in terms of body image, self-esteem, and cosmetic
outcomes over the conventional approach in patients undergoing cardiac
surgery. Copyright &#xa9; 2017 IJS Publishing Group Ltd

<92>
Accession Number
614425474
Author
Singh H.; Ali S.; Luni F.K.; Hashmi F.; Taleb M.
Institution
(Singh, Ali, Luni, Taleb) Department of Cardiovascular Fellowship, Mercy
St Vincent Medical Center and Hospital, 2213 Cherry St, Toledo, OH 43608,
United States
(Hashmi) Department of Cardiothoracic Surgery, Mercy St Vincent Medical
Center and Hospital, Toledo, OH, United States
Title
Isolated rupture of bicuspid aortic valve following blunt chest trauma: A
case report and systematic review of literature.
Source
Cardiovascular Diagnosis and Therapy. 7 (1) (pp 89-91), 2017. Date of
Publication: 2017.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Blunt trauma to chest cause injury to various cardiac structures. Isolated
rupture of aortic valve without aortic dissection is rare complication of
blunt chest trauma and can be caused by a tear or avulsion of the valve.
We report a case of a 35-year-old male who presented with severe aortic
insufficiency due to rupture of a non-infected congenital bicuspid aortic
valve following non-penetrating chest trauma. The diagnosis was suggested
by echocardiography and was confirmed by intra-operative and histological
findings. The patient was successfully treated with surgical valve
replacement with uneventful postoperative course and recovery. We describe
patho-physiology, clinical manifestations, management and the literature
review of traumatic rupture of bicuspid aortic valve.

<93>
Accession Number
614410314
Author
Desborough M.J.R.; Oakland K.A.; Landoni G.; Crivellari M.; Doree C.;
Estcourt L.J.; Stanworth S.J.
Institution
(Desborough, Oakland, Doree, Estcourt, Stanworth) NHS Blood and
Transplant, John Radcliffe Hospital, Oxford, United Kingdom
(Desborough, Estcourt, Stanworth) Oxford Clinical Research in Transfusion
Medicine, Nuffield Division of Clinical Laboratory Sciences, University of
Oxford, Oxford, United Kingdom
(Oakland) Department of Colorectal Surgery, Oxford University Hospitals
NHS Oxford University Hospitals NHS Foundation Trust, Oxford, United
Kingdom
(Landoni, Crivellari) Department of Anesthesia and Intensive Care, IRCCS
San Raffaele Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Desmopressin for treatment of platelet dysfunction and reversal of
antiplatelet agents: a systematic review and meta-analysis of randomized
controlled trials.
Source
Journal of Thrombosis and Haemostasis. 15 (2) (pp 263-272), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials The optimal management of patients with platelet dysfunction
undergoing surgery is unclear. This meta-analysis compared perioperative
administration of desmopressin to placebo. Desmopressin reduced red cell
transfusions, blood loss and risk of re-operation due to bleeding. There
were too few events to determine if there was a change in the risk of
thrombotic events. Summary: Background Platelet dysfunction, including
that caused by antiplatelet agents, increases the risk of perioperative
bleeding. The optimal management of patients with platelet dysfunction
undergoing surgery is unclear. Objectives To assess whether desmopressin
reduces perioperative allogeneic red cell transfusion and bleeding in
patients with platelet dysfunction. Patients/Methods We searched for
randomized controlled trials in The Cochrane Central Register of
Controlled Trials, MEDLINE, PubMed, Embase, the Transfusion Evidence
Library and the ISI Web of Science to 7th July 2016. Data were pooled
using mean difference (MD), relative risks or Peto odds ratios (pOR) using
a random-effects model. Results Ten trials with 596 participants were
identified, all in the setting of cardiac surgery. Platelet dysfunction
was due to antiplatelet agents in six trials and cardiopulmonary bypass in
four trials. Patients treated with desmopressin were transfused with fewer
red cells (MD, -0.65 units; 95% Confidence Interval [CI], -1.16 to -0.13
units), lost less blood (MD, -253.93 mL; 95% CI, -408.01 to -99.85 mL) and
had a lower risk of re-operation due to bleeding (pOR, 0.39; 95% CI,
0.18-0.84). The GRADE quality of evidence was very low to moderate,
suggesting considerable uncertainty over the results. Conclusions
Desmopressin may be a useful agent to reduce bleeding and transfusion
requirements for people with platelet dysfunction or with a history of
recent antiplatelet drug administration undergoing cardiac surgery.
Copyright &#xa9; 2016 International Society on Thrombosis and Haemostasis

<94>
Accession Number
614375325
Author
Rodriguez A.E.; Pavlovsky H.; Del Pozo J.F.
Institution
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina
(Rodriguez) Cardiovascular Research Center (CECI), Buenos Aires, Argentina
(Pavlovsky, Del Pozo) Cardiac Unit, Otamendi Hospital, Buenos Aires,
Argentina
Title
Understanding the outcome of randomized trials with drug-eluting stents
and coronary artery bypass graft in patients with multivessel disease: A
review of a 25-year journey.
Source
Clinical Medicine Insights: Cardiology. 10 (pp 195-199), 2016. Date of
Publication: 03 Nov 2016.
Publisher
Libertas Academica Ltd. (PO Box 300-874, Albany 0751, Mairangi Bay,
Auckland 0751, New Zealand)
Abstract
Randomized clinical trials (RCTs) with first- and second-generation
drug-eluting stents (DESs) confirmed the superiority of coronary artery
bypass surgery (CABG) in patients with multiple vessel disease. In spite
of different DES designs, investigators in these trials used similar
percutaneous coronary intervention (PCI) strategies hoping to achieve
complete revascularization, meaning that all intermediate lesions would be
stented. One of these studies also included small vessels in the
revascularization policy. On this revision, authors searched for a
potential explanation of these intriguing findings and also for solutions
to this problem, not seen years ago when other RCTs compared CABG with PCI
in the previous DES era. After they revised old and new scientific data,
they concluded that improved DES design is not itself enough to narrow the
gap between PCI and CABG and that in the future RCTs we should institute
more conservative strategies avoiding unnecessary multiple DES
implantation. Copyright &#xa9; the authors, publisher and licensee
Libertas Academica Limited.

<95>
Accession Number
614477738
Author
Chang M.; Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Park
D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Park S.-W.; Serruys P.W.; Park
S.-J.
Institution
(Chang) Seoul St. Mary's Hospital Catholic University of Korea Seoul Korea
(Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Heart Institute University of
Ulsan College of Medicine Asan Medical Center Seoul Korea
(Cavalcante, Onuma, Serruys) Erasmus University Medical Center Rotterdam
The Netherlands
(Sotomi) Academic Medical Center University of Amsterdam Amsterdam The
Netherlands
(Serruys) International Center for Circulatory Health Imperial College of
London London UK
Title
Outcomes of Coronary Artery Bypass Graft Surgery Versus Drug-Eluting
Stents in Older Adults.
Source
Journal of the American Geriatrics Society. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Little data are available to compare coronary artery bypass
graft surgery (CABG) vs percutaneous coronary intervention (PCI) with
drug-eluting stents (DES) in older adults. We evaluate the long-term
outcomes of CABG vs PCI with DES in older adults with left main or
multivessel coronary artery disease (CAD). Design: Individual
patient-level meta-analysis. Settings: Databases from the BEST, PRECOMBAT,
and SYNTAX trials were combined. Participants: A total 1,079 adults aged
70 to 89 years were pooled. Measurements: The primary outcome was a
composite of death from any causes, myocardial infarction, stroke, or
repeat revascularization. Results: During a total of 6.3 (median, 4.9)
years of follow-up, the primary composite outcome of all-cause mortality,
myocardial infarction, stroke, or repeat revascularization occurred in 26%
(141/550) and 34% (179/529) of patients in the CABG and PCI groups,
respectively (hazard ratio (HR), 0.75; 95% confidence interval (CI),
0.60-0.94; P = .012). CABG was associated with fewer myocardial infarction
(4% vs 8% for PCI; HR, 0.48; 95% CI, 0.29-0.80; P = .037); and repeat
revascularizations (8% vs 17% for PCI; HR, 044; 95% CI, 0.31-0.64; P <
.001), but had little association with all-cause mortality or stroke.
Conclusion: Older adults age 70 to 89 years with left main or multivessel
CAD who participated in the BEST, PRECOMBAT, and SYNTAX trials; compared
to PCI, CABG was associated with lower risk of primary outcome which was
mostly driven by lower risk of myocardial infarction. Copyright &#xa9;
2017 American Geriatrics Society and Wiley Periodicals, Inc.

<96>
Accession Number
614462584
Author
Tranbaugh R.F.; Schwann T.A.; Swistel D.G.; Dimitrova K.R.; Al-Shaar L.;
Hoffman D.M.; Geller C.M.; Engoren M.; Balaram S.K.; Puskas J.D.; Habib
R.H.
Institution
(Tranbaugh, Dimitrova, Hoffman, Geller, Puskas) Department of
Cardiovascular Surgery, Mount Sinai Beth Israel, New York, New York
(Schwann) Division of Cardiothoracic Surgery, University of Toledo Medical
Center, Toledo, Ohio
(Swistel, Balaram) Division of Cardiothoracic Surgery, Mount Sinai St.
Luke's, New York, New York
(Al-Shaar, Habib) Outcomes Research Unit and Vascular Medicine Program,
American University of Beirut Medical Center, Beirut, Lebanon
(Engoren) Division of Anesthesia, Mercy Saint Vincent Medical Center,
Toledo, Ohio
Title
Coronary Artery Bypass Graft Surgery Using the Radial Artery, Right
Internal Thoracic Artery, or Saphenous Vein as the Second Conduit.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: It is not clear whether radial artery (RA), right internal
thoracic artery (RITA), or saphenous vein (SV) is the preferred second
bypass graft during coronary artery bypass graft surgery using the left
internal thoracic artery (LITA) in patients aged less or greater than 70
years. Methods: Late survival data were collected for 13,324 consecutive,
isolated, primary coronary artery bypass graft surgery patients from three
hospitals. Cox regression analysis was performed on all patients grouped
by age. Results: Adjusted Cox regression showed overall better RA versus
SV survival (hazard ratio [HR] 0.82, p < 0.001) and no difference in RITA
versus SV survival (HR 0.95, p = 0.35). However, the survival benefit of
RA versus SV was seen only in patients aged less than 70 years (HR 0.77, p
< 0.001); and RITA patients aged less than 70 years also had a survival
benefit compared with SV (HR 0.86, p = 0.03). There was no difference in
survival for RA versus RITA across all ages. Conclusions: For patients
aged less than 70 years, the optimal grafting strategy is using either RA
or RITA as the second preferred graft. In patients aged 70 years or more,
RA and RITA grafting should be used selectively. Multiple arterial
grafting using either RA or RITA should be more widely utilized during
coronary artery bypass graft surgery for patients less than 70 years of
age. Copyright &#xa9; 2017 The Society of Thoracic Surgeons.