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<1>
Accession Number
610288838
Author
Van Caenegem O.; Beauloye C.; Bertrand L.; Horman S.; Lepropre S.;
Sparavier G.; Vercruysse J.; Bethuyne N.; Poncelet A.J.; Gianello P.;
Demuylder P.; Legrand E.; Beaurin G.; Bontemps F.; Jacquet L.M.;
Vanoverschelde J.-L.
Institution
(Van Caenegem, Beauloye, Bertrand, Horman, Lepropre, Sparavier, Jacquet,
Vanoverschelde) Pole de recherche cardiovasculaire, Institut de recherche
experimentale et clinique, Universite catholique de Louvain, Brussels,
Belgium
(Van Caenegem, Beauloye, Jacquet) Cardiovascular Intensive Care, Cliniques
universitaires Saint Luc, Brussels, Belgium
(Beauloye, Vanoverschelde) Division of Cardiology, Cliniques
universitaires Saint-Luc, Brussels, Belgium
(Vercruysse, Demuylder) Organ Recovery Systems, Zaventem, Belgium
(Bethuyne, Poncelet) Division of Cardiac Surgery, Cliniques universitaires
Saint Luc, Brussels, Belgium
(Poncelet, Gianello, Legrand, Beaurin) Pole de chirurgie experimentale et
transplantation, Institut de recherche experimentale et clinique,
Universite catholique de Louvain, Brussels, Belgium
(Bontemps) Pole de biochimie et recherche metabolique, Institut de Duve,
Universite catholique de Louvain, Brussels, Belgium
Title
Hypothermic continuous machine perfusion enables preservation of energy
charge and functional recovery of heart grafts in an ex vivo model of
donation following circulatory death.
Source
European Journal of Cardio-thoracic Surgery. 49 (5) (pp 1348-1353), 2016.
Article Number: ezv409. Date of Publication: 01 May 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Cardiac transplantation using hearts from donors after
circulatory death (DCD) is critically limited by the unavoidable warm
ischaemia and its related unpredictable graft function. Inasmuch as
hypothermic machine perfusion (MP) has been shown to improve heart
preservation, we hypothesized that MP could enable the use of DCD hearts
for transplantation. METHODS: We recovered 16 pig hearts following
anoxia-induced cardiac arrest and cardioplegia. Grafts were randomly
assigned to two different groups of 4-h preservation using either static
cold storage (CS) or MP (Modified LifePort&#xa9; System, Organ Recovery
Systems&#xa9;, Itasca, Il). After preservation, the grafts were reperfused
ex vivo using the Langendorff method for 60 min. Energetic charge was
quantified at baseline, post-preservation and post-reperfusion by
measuring lactate and high-energy phosphate levels. Left ventricular
contractility parameters were assessed both in vivo prior to ischaemia and
ex vivo during reperfusion. RESULTS: Following preservation, the hearts
that were preserved using CS exhibited higher lactate levels (57.1 +/-
23.7 vs 21.4 +/- 12.2 mumol/g; P < 0.001), increased adenosine
monophosphate/adenosine triphosphate ratio (0.53 +/- 0.25 vs 0.11 +/-
0.11; P < 0.001) and lower phosphocreatine/ creatine ratio (9.7 +/- 5.3 vs
25.2 +/- 11; P < 0.001) in comparison with the MP hearts. Coronary flow
was similar in both groups during reperfusion (107 +/- 9 vs 125 +/- 9
ml/100 g/min heart; P = ns). Contractility decreased in the CS group, yet
remained well preserved in the MP group. CONCLUSION: MP preservation of
DCD hearts results in improved preservation of the energy and improved
functional recovery of heart grafts compared with CS. Copyright &#xa9; The
Author 2015.

<2>
Accession Number
610288836
Author
Onorati F.; Perrotti A.; Reichart D.; Mariscalco G.; Ratta E.D.;
Santarpino G.; Salsano A.; Rubino A.; Biancari F.; Gatti G.; Beghi C.; Feo
M.D.; Mignosa C.; Pappalardo A.; Fischlein T.; Chocron S.; Detter C.;
Santini F.; Faggian G.
Institution
(Onorati, Faggian) Division of Cardiac Surgery, University of Verona,
Verona, Italy
(Perrotti, Chocron) Department of Cardiac Surgery, University Hospital of
Besancon, Besancon, France
(Reichart, Detter) Division of Cardiac Surgery Univesitat Klinikum
Eppendorf, Hamburg, Germany
(Mariscalco) Department of Cardiovascular Sciences, University of
Leicester, Clinical Sciences Wing, Glenfield Hospital, Leicester, United
Kingdom
(Ratta, Feo) Department of Cardiothoracic and Respiratory Sciences, Second
University of Naples, Caserta, Italy
(Santarpino, Fischlein) Cardiovascular Center, Klinikum
Nurnberg-Paracelsus Medical University, Nuremberg, Germany
(Salsano, Santini) Department of Cardiac Surgery, University of Genoa,
Genoa, Italy
(Rubino, Mignosa) Division of Cardiac Surgery, University of Catania,
Catania, Italy
(Biancari) University of Oulu, Oulu, Finland
(Gatti, Pappalardo) Division of Cardiac Surgery, Cattinara Hospital,
Trieste, Italy
(Beghi) Department of Cardiac Surgery, University of Insubria, Varese,
Italy
Title
Surgical factors and complications affecting hospital outcome in
redomitral surgery: Insights from a multicentre experience.
Source
European Journal of Cardio-thoracic Surgery. 49 (5) (pp e127-e133), 2016.
Article Number: ezw048. Date of Publication: 01 May 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Several single-centre experiences have reported significant
operative mortality and morbidity after mitral valve surgery in redo
scenarios (ReMVS). Several preoperative risk factors outlining 'high-risk'
categories have been reported, but scanty data on the impact of different
operative techniques for these major challenging procedures have been
analysed to date. The aim of the study is to investigate those
intraoperative factors and postoperative events affecting early survival
after redo mitral procedures. METHODS: Operative mortality and major
morbidity events from a large multicentre registry enrolling 832
consecutive redo mitral procedures were analysed. Intraoperative technical
issues and postoperative complications impacting operative mortality were
identified. RESULTS: ReMVS was associated with significant operative
mortality (12.5%), acute myocardial infarction (AMI; 5.9%), stroke (4.9%),
acute respiratory insufficiency (14.8%), pneumonia (7.0%), acute renal
insufficiency (16.1%) and failure (12.6%), reintervention for bleeding
(7.6%), massive transfusion (28.0%), need for permanent pacemaker (10.1%).
Injury of a previous patent left internal mammary artery (LIMA) graft
[odds ratio (OR) 4.2, 95% confidence interval (CI): 1.6-11.5; P = 0.005],
major cardiovascular iatrogenic lesions at re-entry (OR 19.2, 95% CI:
9.2-39.9; P < 0.001), extracellular crystalloid cardioplegia (OR 7.3, 95%
CI: 1.4-37.8; P = 0.018), and incremental cardiopulmonary bypass time (OR
1.1, 95% CI: 1.0-1.2; P = 0.001) independently predicted operative
mortality, whereas combined antegrade + retrograde cardioplegia (OR 0.2,
95% CI: 0.09-0.4; P = 0.001) was the only protective factor against
mortality. Among complications, AMI (OR 4.1, 95% CI: 1.8-9.6; P = 0.001),
need for intra-aortic balloon pumping (IABP; OR 3.1, 95% CI: 1.5-6.1; P =
0.001), prolonged intubation >48 h (OR 5.3, 95% CI: 2.9-9.4; P = 0.001)
and massive (>6 units) transfusions (OR 4.4, 95% CI: 2.4-8.0; P = 0.001)
also predicted operative mortality. CONCLUSIONS: ReMVS still carries the
risk of significant early mortality and major morbidity. Major lesion to
cardiovascular structures is the most dreadful iatrogenic complication,
and injury of a previous LIMA graft identifies patients at higher risk of
operative mortality. Prolonged cross-clamp times, extracellular
crystalloid cardioplegia and massive transfusions have profound impact on
early outcome, as well as the development of perioperative AMI, eventually
requiring IABP and prolonged intubation. The combination of antegrade and
retrograde cardioplegia seems to offer a better myocardial protection in
these high-risk patients. Copyright &#xa9; 2016.

<3>
Accession Number
613437623
Author
Martinez-Parachini J.R.; Karatasakis A.; Karmpaliotis D.; Alaswad K.;
Jaffer F.A.; Yeh R.W.; Patel M.; Bahadorani J.; Doing A.; Nguyen-Trong
P.-K.; Danek B.A.; Karacsonyi J.; Alame A.; Rangan B.V.; Thompson C.A.;
Banerjee S.; Brilakis E.S.
Institution
(Martinez-Parachini, Karatasakis, Nguyen-Trong, Danek, Karacsonyi, Alame,
Rangan, Banerjee, Brilakis) VA North Texas Healthcare System and UT
Southwestern Medical Center, Dallas, TX, United States
(Karmpaliotis) Columbia University, New York, NY, United States
(Alaswad) Henry Ford Hospital, Detroit, MI, United States
(Jaffer) Massachusetts General Hospital and Harvard Medical School,
Boston, MA, United States
(Yeh) Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, MA, United States
(Patel, Bahadorani) VA San Diego Healthcare System and University of
California San Diego, San Diego, CA, United States
(Doing) Medical Center of the Rockies, Loveland, CO, United States
(Thompson) Boston Scientific, Natick, MA, United States
(Brilakis) Minneapolis Heart Institute, Minneapolis, MN, United States
Title
Impact of diabetes mellitus on acute outcomes of percutaneous coronary
intervention in chronic total occlusions: insights from a US multicentre
registry.
Source
Diabetic Medicine. 34 (4) (pp 558-562), 2017. Date of Publication: 01 Apr
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aim: To examine the impact of diabetes mellitus on procedural outcomes of
patients who underwent percutaneous coronary intervention for chronic
total occlusion. Methods: We assessed the impact of diabetes mellitus on
the outcomes of percutaneous coronary intervention for chronic total
occlusion among 1308 people who underwent such procedures at 11 US centres
between 2012 and 2015. Results: The participants' mean +/- sd age was 66
+/- 10 years, 84% of the participants were men and 44.6% had diabetes. As
compared with participants without diabetes, participants with diabetes
were more likely to have undergone coronary artery bypass graft surgery
(38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%;
P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They
also had a higher BMI (31 +/- 6 kg/m² vs 29 +/- 6
kg/m²; P = 0.001), similar Japanese chronic total occlusion
scores (2.6 +/- 1.2 vs 2.5 +/- 1.2; P = 0.82) and similar final successful
crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66),
retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs
25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%;
P = 0.93) success was similar in the two groups, as was the incidence of
major adverse cardiac events (2.2 vs 2.5%; P = 0.61). Conclusions: In a
contemporary cohort of people undergoing percutaneous coronary
intervention for chronic total occlusion, nearly one in two (45%) had
diabetes mellitus. Procedural success and complication rates were similar
in people with and without diabetes. Copyright &#xa9; 2016 Diabetes UK

<4>
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Accession Number
614297940
Author
Gaudino M.; Puskas J.D.; Di Franco A.; Ohmes L.B.; Iannaccone M.; Barbero
U.; Glineur D.; Grau J.B.; Benedetto U.; D'Ascenzo F.; Gaita F.; Girardi
L.N.; Taggart D.P.
Institution
(Gaudino, Di Franco, Ohmes, Girardi) Department of Cardio-Thoracic
Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, United
States
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Iannaccone, Barbero, D'Ascenzo, Gaita) Citta della Scienza e della
Salute, Department of Cardiology, University of Turin, Italy
(Glineur, Grau) Division of Cardiac Surgery, University of Ottawa Heart
Institute, ON, Canada
(Benedetto) Bristol Heart Institute, University of Bristol, United Kingdom
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital,
University of Oxford, United Kingdom
Title
Three Arterial Grafts Improve Late Survival: A Meta-Analysis of
Propensity-Matched Studies.
Source
Circulation. 135 (11) (pp 1036-1044), 2017. Date of Publication: 14 Mar
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Little evidence shows whether a third arterial graft provides
superior outcomes compared with the use of 2 arterial grafts in patients
undergoing coronary artery bypass grafting. A meta-analysis of all the
propensity score-matched observational studies comparing the long-term
outcomes of coronary artery bypass grafting with the use of 2-arterial
versus 3-arterial grafts was performed. Methods: A literature search was
conducted using MEDLINE, EMBASE, and Web of Science to identify relevant
articles. Long-term mortality in the propensity score-matched populations
was the primary end point. Secondary end points were in-hospital/30-day
mortality for the propensity score-matched populations and long-term
mortality for the unmatched populations. In the matched population,
time-to-event outcome for long-term mortality was extracted as hazard
ratios, along with their variance. Statistical pooling of survival
(time-to-event) was performed according to a random effect model,
computing risk estimates with 95% confidence intervals. Results: Eight
propensity score-matched studies reporting on 10 287 matched patients
(2-arterial graft: 5346; 3-arterial graft: 4941) were selected for final
comparison. The mean follow-up time ranged from 37.2 to 196.8 months. The
use of 3 arterial grafts was not statistically associated with early
mortality (hazard ratio, 0.93; 95% confidence interval, 0.71-1.22;
P=0.62). The use of 3 arterial grafts was associated with statistically
significantly lower hazard for late death (hazard ratio, 0.8; 95%
confidence interval, 0.75-0.87; P<0.001), irrespective of sex and diabetic
mellitus status. This result was qualitatively similar in the unmatched
population (hazard ratio, 0.57; 95% confidence interval, 0.33-0.98;
P=0.04). Conclusions: The use of a third arterial conduit in patients with
coronary artery bypass grafting is not associated with higher operative
risk and is associated with superior long-term survival, irrespective of
sex and diabetic mellitus status. Copyright &#xa9; 2017 American Heart
Association, Inc.

<5>
Accession Number
613751708
Author
Ring A.; Morris T.; Wozniak M.; Sullo N.; Dott W.; Verheyden V.; Kumar T.;
Brunskill N.; Vaja R.; Murphy G.J.
Institution
(Ring) University of the Free State, Bloemfontein, South Africa
(Ring) medac GmbH, Wedel, Germany
(Ring, Morris) Leicester Clinical Trials Unit, Leicester General Hospital,
Leicester, United Kingdom
(Wozniak, Sullo, Dott, Verheyden, Kumar, Murphy) University of Leicester,
Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit,
Glenfield Hospital, Leicester, United Kingdom
(Brunskill, Vaja) University Hospitals Leicester NHS Trust, Leicester,
United Kingdom
Title
A Phase I study to determine the pharmacokinetic profile, safety and
tolerability of sildenafil (Revatio) in cardiac surgery: the
REVAKI-1 study.
Source
British Journal of Clinical Pharmacology. 83 (4) (pp 709-720), 2017. Date
of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims: Acute kidney injury (AKI) is a common and severe complication of
cardiac surgery. There is no effective prevention or treatment. Sildenafil
citrate (Revatio, Pfizer Inc.), a phosphodiesterase type 5
inhibitor, prevents post cardiac surgery AKI in pre-clinical studies,
however its use is contraindicated in patients with symptomatic
cardiovascular disease. The aim of this study is to assess the safety and
pharmacokinetics of intravenous sildenafil in cardiac surgery patients.
Methods: We conducted an open label, dose escalation study with six
patients per dose level. The six doses were 2.5 mg, 5 mg or 10 mg as a
bolus, either alone or followed by an additional 2 h infusion of 2.5 mg
sildenafil. Results: Thirty-six patients entered the trial, of which 33
completed it. The mean age was 69.9 years. One patient died during
surgery, two others were removed from the trial before dosing (all at dose
level 5 mg + 2.5 mg). The pharmacokinetic profile of sildenafil was
similar to previously published studies. For a dose of 10 mg administered
as a bolus followed by 2.5 mg administered over 2 h the results were
AUC<inf></inf> 537 ng h ml^-1, C<inf>max</inf> 189.4 ng
ml^-1 and t<inf>1/2</inf> 10.5 h. The drug was well tolerated
with no serious adverse events related to drug administration. Higher
sildenafil doses stabilized post-surgery nitric oxide bioavailability.
Conclusions: Pharmacokinetics of sildenafil during cardiopulmonary bypass
were comparable to those of other patient groups. The drug was well
tolerated at therapeutic plasma levels. These results support the further
evaluation of sildenafil for the prevention of AKI in cardiac surgery.
Copyright &#xa9; 2016 The British Pharmacological Society

<6>
Accession Number
613961578
Author
Wikkelso A.; Wetterslev J.; Moller A.M.; Afshari A.
Institution
(Wikkelso) Department of Anaesthesia and Intensive Care Medicine, Hvidovre
Hospital, Copenhagen University Hospital, Hvidovre, Denmark
(Wetterslev) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, University of Copenhagen, Copenhagen, Denmark
(Moller) Department of Anaesthesia and Intensive Care Medicine, Herlev
Hospital, Herlev, Denmark
(Afshari) Department of Paediatric and Obstetric Anaesthesia, Juliane
Marie Center, Copenhagen University Hospital, Copenhagen, Denmark
Title
Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to
monitor haemostatic treatment in bleeding patients: a systematic review
with meta-analysis and trial sequential analysis.
Source
Anaesthesia. 72 (4) (pp 519-531), 2017. Date of Publication: 01 Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Coagulopathy and severe bleeding are associated with high mortality. We
evaluated haemostatic treatment guided by the functional viscoelastic
haemostatic assays, thromboelastography or rotational thromboelastometry
in bleeding patients. We searched for randomised, controlled trials
irrespective of publication status, publication date, blinding status,
outcomes published or language from date of inception to 5 January 2016 in
six bibliographic databases. We included 17 trials (1493 participants),
most involving cardiac surgery. Thromboelastography or rotational
thromboelastometry seemed to reduce overall mortality compared to any of
our comparisons (3.9% vs. 7.4%, RR (95% CI) 0.52 (0.28-0.95);
I² = 0%, 8 trials, 717 participants). However, the quality of
evidence is graded as low due to the high risk of bias, heterogeneity,
imprecision and low event rate. Thromboelastography or rotational
thromboelastometry significantly reduced the proportion of patients
transfused with red blood cells (RR (95% CI) 0.86 (0.79-0.94);
I² = 0%, 10 trials, 832 participants), fresh frozen plasma (RR
(95% CI) 0.57 (0.33-0.96); I² = 86%, 10 trials, 832
participants) and platelets (RR (95% CI) 0.73 (0.60-0.88); I² =
0%, 10 studies, 832 participants). There was no difference in proportion
needing surgical re-interventions (RR (95% CI) 0.75 (0.50-1.10);
I² = 0%, 9 trials, 887 participants). Trial sequential analysis
of mortality suggests that only 54% of the required information size has
been reached so far. Transfusion strategies guided by thromboelastography
or rotational thromboelastometry may reduce the need for blood products in
patients with bleeding, but the results are mainly based on trials of
elective cardiac surgery involving cardiopulmonary bypass, with
low-quality evidence. Copyright &#xa9; 2017 The Association of
Anaesthetists of Great Britain and Ireland

<7>
Accession Number
612885313
Author
Hill Q.A.; Harrison L.C.; Padmakumar A.D.; Owen R.G.; Prasad K.R.; Lucas
G.F.; Tachtatzis P.
Institution
(Hill) Department of Haematology, St James's University Hospital, Leeds,
United Kingdom
(Harrison, Tachtatzis) Department of Hepatology, St James's University
Hospital, Leeds, United Kingdom
(Padmakumar) Department of Anaesthesia & Intensive Care Medicine, St
James's University Hospital, Leeds, United Kingdom
(Owen) HMDS Laboratory and Department of Haematology, St James's
University Hospital, Leeds, United Kingdom
(Prasad) Department of Transplant and Hepatobiliary Surgery, St James's
University Hospital, Leeds, United Kingdom
(Lucas) Histocompatibility & Immunogenetics Laboratory, NHS Blood and
Transplant, North Bristol Park, Bristol, United Kingdom
Title
A fatal case of transplantation-mediated alloimmune thrombocytopenia
following liver transplantation.
Source
Hematology. 22 (3) (pp 162-167), 2017. Date of Publication: 16 Mar 2017.
Publisher
Taylor and Francis Ltd. (E-mail: maney@maney.co.uk)
Abstract
Objective and importance: Transplantation-mediated alloimmune
thrombocytopenia (TMAT) occurs when leukocytes transferred in a donor
organ from a patient with immune thrombocytopenia (ITP), mount a response
against recipient platelets. We present the first fatal case of TMAT
following liver transplantation and review its aetiology and treatment.
Clinical presentation: The liver donor had ITP and died from an
intracranial haemorrhage. The recipient platelet count fell to 2 x
10⁹/l on post-operative day 2. Treatment refractory
thrombocytopenia resulted in pulmonary haemorrhage and death. TMAT did not
occur in a kidney recipient from the same ITP donor. Intervention:
Extramedullary haematopoiesis was identified in the donor liver biopsy.
Antibodies against platelet GPIb/IX were demonstrated in both donor and
recipient. The thrombocytopenia was refractory to platelet transfusions,
intravenous immunoglobulin, methylprednisolone, rituximab, romiplostim,
plasmapheresis, vincristine and splenic artery embolization. On review of
the literature, severe thrombocytopenia (<10 x 10⁹/l) has
started within 3 days of transplantation in all reported TMAT cases.
Serious non-fatal bleeding was observed in 3/5 previously reported cases.
The optimal treatment is unclear. TMAT should resolve as donor lymphocytes
are eliminated but re-transplantation may be required in severe refractory
cases. TMAT has been reported in recipients of a liver but not kidney or
heart transplant from ITP donors, probably because of the greater burden
of co-transplanted lymphoid tissue. Conclusion: Before using the liver of
an ITP donor, the recipient's fully informed consent is required. However,
the risk of TMAT from an ITP donor is currently unknown and systematic
review of donor registries is needed. Copyright &#xa9; 2016 Informa UK
Limited, trading as Taylor & Francis Group.

<8>
Accession Number
613864823
Author
Maniotis C.; Andreou C.; Karalis I.; Koutouzi G.; Agelaki M.; Koutouzis M.
Institution
(Maniotis, Agelaki, Koutouzis) 2nd Cardiology Department, Hellenic Red
Cross Hospital of Athens, Athens, Greece
(Andreou, Karalis) Interventional Cardiology Department, University
Hospital of Leiden, Leiden, Netherlands
(Koutouzi) Interventional Radiology Department, Sahlgrenska University
Hospital, Gothenburg, Sweden
Title
A systematic review on the safety of Prostar XL versus ProGlide after TAVR
and EVAR.
Source
Cardiovascular Revascularization Medicine. 18 (2) (pp 145-150), 2017. Date
of Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Endovascular aortic aneurysm repair (EVAR) and transfemoral
transcatheter aortic valve replacement (TAVR) are widely spreading
minimally invasive procedures performed mainly through the femoral artery.
Prostar XL and ProGlide vascular closure devices are used in clinical
practice for the hemostasis in these procedures and they have been shown
to be safe and effective. Purpose The aim of our systematic review is to
compare the safety of these two devices for percutaneous closure of large
arteriotomies in patients undergoing TAVR and EVAR. Methods We searched
PubMed, EMBASE, Google Scholar and the Cochrane Central Register of
Controlled Trials for all randomized and observational published studies
that compared Prostar XL vs. ProGlide. Relative risk was calculated by
random-effects model. Review Manager 5.1 was used for statistical
analysis. Results A total number of 2909 patients were included in our
analysis. The rate of overall vascular complications did not differ
between Prostar XL and ProGlide {RR 1.35 (0.80-2.29), p = 0.27}. In
contrary, the risk ratio of all bleeding complications with Prostar XL
compared to ProGlide was 1.82 (1.47-2.24, p < 0.001) and for major and
life-threatening bleeding complications was 2.48 (1.65-3.73, p < 0001,
suggesting a lower bleeding risk with ProGlide). No statistical difference
was found between groups for end-stage acute kidney injury (AKI), with a
risk ratio of 2.14 (0.81-5.66), p = 0.05. Finally, there were no
differences in in-hospital and 30-days mortality rate between the two
groups (1.41, 0.56-3.54, p = 0.46 and 1.43, 0.55-3.73, p = 0.47,
respectively). Conclusions Prostar XL is associated with greater risk of
any bleeding as well as life threatening bleeding compared to the ProGlide
device. However, no significant differences were observed in the rate of
overall vascular complications, end stage AKI and in-hospital and 30-days
mortality. Copyright &#xa9; 2016 Elsevier Inc.

<9>
Accession Number
613877561
Author
Boeder N.F.; Dorr O.; Rixe J.; Weipert K.; Bauer T.; Bayer M.; Hamm C.W.;
Nef H.M.
Institution
(Boeder, Dorr, Rixe, Weipert, Bauer, Bayer, Hamm, Nef) Department of
Cardiology, University Hospital of Giessen, Giessen, Germany
Title
Endocarditis after interventional repair of the mitral valve: Review of a
dilemma.
Source
Cardiovascular Revascularization Medicine. 18 (2) (pp 141-144), 2017. Date
of Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The MitraClip procedure can be an alternative treatment option
for patients with high surgical risk for whom surgical treatment is
contraindicated. Patients with prosthetic material have an increased risk
for infective endocarditis. Hypothesis Incidence, treatment and outcome of
patients with endocarditis after interventional mitral valve repair are
not known. Methods We searched for articles using PubMed using the terms
"interventional mitral valve repair", "mitraclip" and "endocarditis". We
have also searched for case reports in major congresses. Furthermore, we
report two cases. Results Four cases of IE after MitraClip were found in
addition to our cases. The leading cause is a bacterial infection,
typically with staphylococcal bacteria. Approximately two thirds of these
patients underwent surgery. Short-term outcome seems to be reasonable for
these patients. During the early postoperative period and if
Staphylococcus aureus can be cultivated mortality seems to be
significantly elevated. Conclusion IE after MitraClip procedure is a
dilemma. While surgical bail-out seems to be the favorable treatment
option, patients were rejected conventional surgery in first place due to
their high operative risk. Best treatment recommendation must be made on
an individual basis. Predisposing factors should be conscientiously
addressed prior to the procedure. Copyright &#xa9; 2016 Elsevier Inc.

<10>
Accession Number
614780551
Author
Peirce B.; Pulimood T.; Harris C.
Title
Critical review of the current management of pleural infection in a UK
district general hospital. Applying the MIST II (multicentre intrapleural
sepsis trial) evidence to our current practice.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. Conference Start: 20160903.
Conference End: 20160907. 48 (no pagination), 2016. Date of Publication:
01 Sep 2016.
Publisher
European Respiratory Society
Abstract
Introduction: Since the publication of MIST II , there has been a
transition in the management of empyema, with an increase in medical
treatment. Currently there is a wide variation in our treatment approach
to these patients. Aims: To critically appraise our current practice with
regard to management of pleural infection in light of MIST II. To provide
evidence to standardise our future practice. Methods: We retrospectively
identified all patients with empyema from discharge coding in the year
following June 2014. Data was collected from hospital records.
Collaborative working with Papworth Hospital (tertiary referral centre for
thoracic surgery) determined outcomes in those referred for surgery.
Primary outcome was length of inpatient stay. Results: 21 patients were
identified. 3 patients excluded as no evidence of empyema. We were unable
to replicate the reduced length of stay shown in MIST II for those
patients treated with fibrinolysis. The median length of inpatient stay
for those treated with drainage - 14 days, fibrinolysis - 21 days,
surgical management - 8 days. Conclusions: Our patients differed from
those in MIST II with increased age and comorbidity. Current practice was
to start fibrinolysis as a rescue; after failed drainage. MIST II would
suggest benefit in length of stay if fibrinolysis is initiated at
diagnosis. This study has shaped our management of empyema; specifically
initiation of fibrinolysis at diagnosis for those managed medically.

<11>
Accession Number
614780406
Author
Schulz C.K.J.; Himpel A.; Hofmann H.-S.; Koller M.
Title
Updating the EORTC questionnaire for assessing quality of life in lung
cancer patients (EORTC QLQLC13).
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. Conference Start: 20160903.
Conference End: 20160907. 48 (no pagination), 2016. Date of Publication:
01 Sep 2016.
Publisher
European Respiratory Society
Abstract
Abstract Background: The EORTC QLQ-LC13 was the first module developed to
be used in conjunction with the core questionnaire C30. Major advances
have been made with regard to diagnostic and therapeutic options in lung
cancer. Therefore, research objective was to develop a revised lung cancer
module supported by the EORTC. Methods: EORTC employs a four phase
methodology of modules development and Phases I to III have been
completed. Phase I generates quality of life issues using a mix of
sources. Phase II converts issues into questionnaire items. The Phase III
study pre-tests a provisional module to evaluate the importance and
acceptability of the items. Biometrical methods primarily included
descriptive statistics and basic psychometric analyses. The 48 lung cancer
items that emerged from Phases I to III were assessed against a set of
pre-specified criteria comprised of patient ratings and distribution
properties of the items. Results: 12 international centers participated in
the Phase III study. 200 patients were enrolled. Mean age 64 years. 59%
were male, 82% had NSCLC, 56% were treated with a palliative approach.
Patients had to fill in the EORTC QLQ-C30 and a 48-item provisional lung
cancer module and rated the lung cancer items. 29 lung cancer items met
the pre-specified cut-off levels. Psychometric analyses suggested a five
multiitem scale structure. Conclusions: The updated module retained 12 of
the 13 original LC13 items. Further items were identified assessing side
effects of targeted therapy, radiochemotherapy, and thoracic surgery.
Phase IV will be a field study analyzing the proposed scale structure and
assessing the psychometric properties of the module.

<12>
Accession Number
614780312
Author
Da Costa Torres D.; Da Silva P.R.; Lima Reis H.J.; Paisani D.M.;
Chiavegato L.
Title
Effectiveness of an early mobilization program on functional capacity
after coronary artery bypass surgery: Randomized controlled trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. Conference Start: 20160903.
Conference End: 20160907. 48 (no pagination), 2016. Date of Publication:
01 Sep 2016.
Publisher
European Respiratory Society
Abstract
Muscle atrophy and prolonged inactivity are associated with reduced
functional capacity in patients submitted to coronary artery bypass
surgery. Cardiac rehabilitation contributes to improvement in functional
capacity and quality of life; however, the effect of early mobilization in
these patients is poorly known. Objective: To evaluate the effects of an
early mobilization program in the functional capacity, postoperative
complications and length of hospital stay in patients undergoing coronary
artery bypass grafting. Methods: This prospective, randomized, controlled
and blinded trial included 66 consecutive patients randomized into Control
(CG; N=33) and Intervention groups (IG; N=33). CG was submitted to general
orientations while IG performed early mobilization. The intervention was
performed from the 1 to 7 postoperative day, 2xday. The functional
capacity (6MWT) was evaluated before surgery and reevaluated in the 7 day
and the 60 day after discharge. The length of hospital stay and pulmonary
complications was also evaluated. The statistical analysis used linear
mixed models and the level of significance was set at alpha= 5%. Results:
compared with CG, IG patients presented an improvement in the functional
capacity after 7 days (respectively, 355.42+/-42.44 vs. 434.69 +/- 48.38
meters; p<0.05) but no difference was observed at follow-up. Patients from
the IG presented a reduction in hospital staying than CG (4.3 +/- 1.1 vs
7.2 +/- 1.6 days; p<0.05) and less pulmonary complications (24% vs. 48%;
p=0.01). Conclusion: Our results shows that early mobilization improves
functional capacity and reduces pulmonary complications and hospital
staying.

<13>
Accession Number
614780171
Author
Hw ang W.; Jeon J.
Title
The effect of iloprost on arterial oxygenation during one-lung
ventilation.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. Conference Start: 20160903.
Conference End: 20160907. 48 (no pagination), 2016. Date of Publication:
01 Sep 2016.
Publisher
European Respiratory Society
Abstract
Background During one-lung ventilation in patients undergoing thoracic
surgery, the persistent flow in the non-ventilated lung increases
intrapulmonary shunt and decreases systemic arterial oxygenation. Aims and
objectives This study was conducted to evaluate the effects of iloprost on
arterial oxygenation during one-lung ventilation in the lateral decubitus
position during thoracic surgery. Methods 72 patients undergoing
thoracoscopic lobectomy were randomly allocated to three groups: DW
(distilled water), IL2.5 (iloprost 2.5mcg), and IL5 (iloprost 5mcg). Study
drug was inhaled to ventilated lung for 5 minutes after one-lung
ventilation in the lateral decubitus position. Hemodynamic variables,
shunt fraction, and arterial oxygenation were obtained at these points:
after induction of anesthesia with two-lung ventilation (TLV-i), before
treatment with one-lung ventilation in lateral decubitus posisiton (OLV),
10, 20 and 30 min after treatment (OLV+T10, OLV+T20 and OLV+T30), and at
the end of surgery with two-lung ventilation in the supine position
(TLV-e). Results Hemodynamic variables were comparable between three
groups. Shunt fraction was significantly lower in IL5 compared with that
in DW and IL2.5 during one-lung ventilation. PaO2 was significantly higher
in IL5 compared with that in DW and IL2.5 at 10 (198+/-78 vs. 146+/-68,
148+/-70 mmHg, P<0.05), 20 (215+/-92 vs. 154+/-70, 156+/-68 mmHg, P<0.05),
and 30min (214+/-90 vs. 152+/-64, 154+/-70 Conclusions Inhaled iloprost at
5 mcg improves arterial oxygenation during one-lung ventilation in the
lateral decubitus position during thoracic surgery.

<14>
Accession Number
614780067
Author
Garcia R.S.; Paz A.L.; Brage M.I.Y.; Moolhuyzen E.G.; Rioboo M.S.; Mate
J.M.B.
Title
Preliminary efficacy of preoperative exercise training in patients with
lung malignancies undergoing VATS.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. Conference Start: 20160903.
Conference End: 20160907. 48 (no pagination), 2016. Date of Publication:
01 Sep 2016.
Publisher
European Respiratory Society
Abstract
Introduction: Preoperative exercise training can improve the baseline
status of patients undergoing open thoracic surgery and therefore improve
surgical tolerability and enhance postoperative recovery. The aim of this
study was to assess the feasibility and preliminary efficacy of a
preoperative exercise-based programme (PEP) in patients undergoing
Video-assisted thoracic surgery (VATS) for lung cancer. Materials and
Methods: In a randomized, single blinded controlled trial, 20 patients
were allocated to receive a PEP consisted of 3 - 5 sessions per week of
interval endurance training, strength training with elastic bands and
breathing exercises. Exercise capacity (endurance time), muscle strength
(Senior Fitness Test) and health-related quality of life (SF-36) were
assessed at the beginning and at the end of the training. Results: 10
patients completed the intervention attending a median of 16 sessions.
Mean therapeutic delay was 54 days and no adverse events were recorded.
There were statistically significant improvements in endurance time
measured at 80% of the maximal workload (mean difference +396.6+/-197.9
seconds, p<.001), upper and lower body strength (mean difference
+2.9+/-2.1 repetitions, p=.002 and +0.9+/-1.2 repetitions, p=.041) and in
the role physical and physical summary component of the SF-36 (p=.038 and
.008 respectively). Conclusions: preoperative exercise training in
patients with lung malignancies awaiting THANK YOU FOR ACCEPTING COOKIES
VATS is safe and can be achieved without any delay in the surgical
management and results effective to improve exercise capacity, muscle
strength and physical functioning, which could potentially enhance
postoperative recovery.

<15>
Accession Number
614779979
Author
Garcia R.S.; Paz A.L.; Brage M.I.Y.; Moolhuyzen E.G.; Rioboo M.S.; Mate
J.M.B.
Title
Does preoperative exercise training prevent functional decline after
video-assisted thoracic surgery?.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. Conference Start: 20160903.
Conference End: 20160907. 48 (no pagination), 2016. Date of Publication:
01 Sep 2016.
Publisher
European Respiratory Society
Abstract
Introduction: Prehabilitation of surgical patients is gaining popularity
specially among those who exhibit poor baseline status. In this study, we
aimed to evaluate whether prehabilitation of patients undergoing lung
resection surgery by Video-assisted thoracic surgery (VATS) prevents the
functional decline observed after surgery and enhances postoperative
recovery. Material and Methods: 40 patients scheduled for lung resection
surgery were initially randomized in two groups. Patients in the
Rehabilitation Group (RG) received a preoperative exercise-based
intervention consisted of 3 - 5 sessions per week of interval endurance
training, resistance training with elastic bands and breathing exercises.
Patients in the Control Group (CG) received standard care (no
prehabilitation). Exercise capacity (endurance time), functional capacity
(6-minute walk test), muscle strength (Senior Fitness Test) and
health-related quality of life (SF-36) were measured at baseline (T0) and
three weeks (T1) and three months (T2) post-surgery. Results: 22 patients
completed the study and were analysed. There were no statistically
significant differences between groups at T1 in any of the main outcomes.
However, at T2, patients in the RG had improved their endurance time and
lower muscle strength comparing to baseline which led to statistically
significant differences with the CG in the endurance time and both upper
and lower muscle strength (p<.05). There were also significant differences
in the physical component summary and bodily pain of the SF-36 (p<.01).
Conclusions: Preoperative exercise training seems to prevent the
functional decline observed after VATS and hastens postoperative recovery.

<16>
Accession Number
614778489
Author
Zaric B.; Stojanovic G.; Budisin E.; Potic M.; Kovacevic T.; Perin B.
Title
Safety, feasibility and efficacy of 2% polidocanol in endobronchial
sealing of bronchopleural fistulae-phase 2 interventional clinical trial.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. Conference Start: 20160903.
Conference End: 20160907. 48 (no pagination), 2016. Date of Publication:
01 Sep 2016.
Publisher
European Respiratory Society
Abstract
Introduction: Broncho-pleural fistula (BPF) is rare but serious
complication following thoracic surgery. Primary goal of this trial was
determination of safety and feasibility of endobronchial sealing of the
BPF with 2% polidocanol. Secondary objective was determination of the
procedural efficacy. Methods: This was a phase II interventional trial
that recruited 15 patients with BPF. Endobronchial sealing was performed
by submucosal application of 1-2 mL of 2% polidocanol through TBNA needle.
Number of punctures and procedures were determined on case by case basis.
Selected patient, procedure and technique related factors were evaluated
for multivariate analysis regarding efficacy. Results: Incidence of BPF in
investigated study population was 1.12%. Endobronchial sealing was
successful in 80% (12/15) patients. Mean age of the patients was 54+/-16
years, mean size of fistulae 7+/-5.5 mm, duration of intervention 20+/-3
minutes, number of punctures 9+/-6, number of interventions 1.5, time from
surgery 42+/-34 days, time to closure 10+/-9 days. In majority of patients
age under 50 years, male gender, non-smoking status, absence of
respiratory comorbidity and lobectomy led to bronchoscopic sealing.
Neoadjuvant therapy, shorter time from surgery and positive margins led to
failure of bronchoscopic sealing. Size of fistula (p=0.018) and time to
closure (p=0.004) were significantly correlated to success of
bronchoscopic sealing. We did not observe any procedure-related adverse
effects. Conclusion: Endobronchial sealing with 2% polidocanol is safe,
feasible and possibly very efficient technique for treatment of BPF.

<17>
Accession Number
614777137
Author
Petak F.; Balogh A.L.; Fodor G.H.; Vigh E.; Sudy R.; Babik B.
Title
Strategies to reverse lung function deterioration to cardiopulmonary
bypass: Comparison of ventilation management and/or bronchodilator
therapies.
Source
European Respiratory Journal. Conference: European Respiratory Society
Annual Congress 2016. United Kingdom. Conference Start: 20160903.
Conference End: 20160907. 48 (no pagination), 2016. Date of Publication:
01 Sep 2016.
Publisher
European Respiratory Society
Abstract
The lung function deterioration to cardiopulmonary bypass (CPB) can be
alleviated by recruitment manoeuvres (RM), elevating the positive
end-expiratory pressure (PEEP), and/or bronchodilator therapies. We aimed
at comparing the efficiency of these treatment strategies. Airway
resistance (Raw), respiratory compliance (C), capnogram phase III slope
(SIII), and Horowitz coefficient (HQ) were measured in anaesthetized,
mechanically ventilated patients undergoing cardiac surgeries. Five
different therapeutic interventions were compared to the standard post-CPB
lung management with 4 cmH<inf>2</inf>O PEEP: i) application of elevated
PEEP (8 cmH<inf>2</inf>O), ii) administration of 1 MAC sevoflurane (SEV)
during either PEEP4 or iii) PEEP8, iv) a RM followed by PEEP8, and v)
concomitant use of a RM, PEEP8, and SEV. The Raw decreased significantly
in all groups, with the greatest drop after the combined application of
RM, PEEP and SEV (-60+/-21[SD]%, p<0.001). C decreased similarly in all
groups (43+/-33%, p<0.001) with the exception of SEV alone. SIII decreased
in all patients; elevated PEEP and SEV induced the greatest changes
(-32+/-16%, p<0.001). Significant increases in HQ were only observed in
the patients receiving RM (iv: 32+/-27%, v: 47+/-28%, p<0.001). We
conclude that elevated PEEP combined with RM recruit alveoli, thereby
decreasing ventilation heterogeneities, increasing C and improving gas
exchange. SEV contributes to the homogenization of the lungs via its
bronchodilation potential. The adverse respiratory effects of CPB are
complex; combination of lung recruitment and bronchodilator therapies is
the most efficient as a reversal.

<18>
Accession Number
614878869
Author
Hajek R.; Fluger I.; Zezula R.; Maderova K.; Prikrylova K.; Zuscich O.;
Lonsky V.; Ruzickova J.
Institution
(Hajek, Fluger, Zezula, Maderova, Prikrylova, Zuscich, Lonsky) Cardiac
Surgery, University Hospital Olomouc, Olomouc, Czech Republic
(Ruzickova) Management, Central Moravian Hospital Group, Prostejov, Czech
Republic
Title
Coagulation patterns during and after cardiopulmonary bypass detected with
thrombelastography.
Source
International Journal of Artificial Organs. Conference: 43rd Annual
European Society for Artificial Organs, ESAO Congress. Poland. Conference
Start: 20160914. Conference End: 20160917. 39 (7) (pp 367), 2016. Date of
Publication: July 2016.
Publisher
Wichtig Publishing Srl
Abstract
Introduction: Cardiopulmonary bypass (CPB) is associated with complex
activation of hemostatic system: enzymatic, platelet and fibrinolytic. The
complexity of this patterns cannot be described by standard laboratory
tests especially during full heparinization. Thrombelastography (TEG) is
reliable method for detection of hemostatic abnormalities during cardiac
surgery. Material and methods: Prospective randomized study in university
hospital setting was conducted. Two groups of elective cardiac surgery
patients were evaluated. Standard normotermic or mild hypothermic CPB with
Capiox oxygenator without heparin coating and crystaloid-colloid priming
volume 1700 ml was provided. TEG device Haemoscope 5000 was used. Group
TEG (n = 499) was monitored both with TEG and laboratory tests, Group
Control (n = 475) was monitored only with laboratory tests. The following
TEG measurements were performed: 1st after induction of anesthesia
(native), 2nd during CPB after aortic X-clamp releasing (heparinase), 3rd
and 4th 10 min after protamine administration (native and heparinase).
Hemostatic profile with using TEG algorithm, changes of TEG parameters and
laboratory tests before and after CPB, blood loss, number of transfusion
and reexploration because of bleeding were evaluated. Standard dosing of
heparin (3 mg/kg iv bolus + 1 mg/kg into CPB) and no prophylactic
antifibrinolytics were used. Chronic antiplatelet and anticoagulation
drugs were withdrawn according to ESC/ESA guidelines. Results: Both groups
were comparable by demographics. No significant difference in peroperative
blood loss, number of transfusion, therapeutic antifibrinolytics
administration and reexploration because of bleeding were recorded. The
only significant difference in postoperative blood loss (819 +/- 519 vs
861 +/- 422 ml, p<0.05) was assessed. Values of PT, aPTT, TT significantly
increased, fibrinogen and platelets significantly decreased during CPB.
Changes of PT, aPTT and platelets correlated with CPB duration. The main
hemostatic patterns according to TEG algorithm: T1: 18.0% platelet
hyperfunction, 12.4% enzymatic hypercoagulability. T2: 22.8% platelet
hypofunction, 19% primary fibrinolysis. T3: 9.4% platelet hypofunction, 7%
primary fibrinolysis. T4: 15.0% platelet hypofunction, 8% enzymatic
hypercoagulation. Discussion: Very different coagulation patterns during
standard CPB were recorded. No impact of TEG guided algorithm on
transfusion therapy was assessed. Platelet hypofunction and primary
fibrinolysis were the most common patterns during CPB. Hypercoagulation
before surgery is common. Patients with hypercoagulation after surgery can
represent a challenge due to the possibility of early thrombotic
complications.

<19>
Accession Number
614878854
Author
Abbasciano R.; Onorati F.; San Biagio L.; Lucarelli C.; Fanti D.; Dobson
G.; Menon T.; Gottin L.; Biancari F.; Tessari M.; Mazzucco A.; Faggian G.
Institution
(Abbasciano, Onorati, San Biagio, Lucarelli, Fanti, Menon, Tessari,
Mazzucco, Faggian) Department of Cardiac Surgery, University of Verona,
Verona, Italy
(Dobson) College of Medicine and Dentistry, Australian Institute of
Tropical Health and Medicine (AITHM), James Cook University, Townsville,
Australia
(Gottin) Division of Cardiac Surgery, Postoperative Intensive Care Unit,
University of Verona, Verona, Italy
(Biancari) Division of Cardiac Surgery, University of Oulu, Oulu, Finland
Title
High-dose adenosine-lidocaine-magnesium polarized arrest in elective
caridac surgery: Results of the first human randomized controlled trial.
Source
International Journal of Artificial Organs. Conference: 43rd Annual
European Society for Artificial Organs, ESAO Congress. Poland. Conference
Start: 20160914. Conference End: 20160917. 39 (7) (pp 338), 2016. Date of
Publication: July 2016.
Publisher
Wichtig Publishing Srl
Abstract
Introduction: Potassium depolarization has been linked to myocardial and
endothelial injury, left ventricular dysfunction and reperfusion
arrhythmias. Our aim was to examine the potential benefits of normokalemic
'polarizing' cardioplegia comprising adenosine, lidocaine and Mg2+ (ALM)
compared to 'depolarizing' Buckberg-cardioplegia a prospective, randomized
trial. Material and methods: Two-hundred-eight patients undergoing
low-risk elective CABG or AVR were randomized to traditional 4:1 cold
blood Buckberg- cardioplegia (High-K+-Group) or "polarizing" high-dose ALM
normokalemic cold blood cardioplegia (ALM-Group). Perioperative troponin
I, peripheral lactate, and hemodynamic status (thermodilution method) were
compared. Time-to-cardiac arrest (TtCA), spontaneous recovery of sinus
rhythm at declamping (sSRr) and clinical outcome were recorded. Troponin
I, lactate, SvO²%, and Base Excess (B.E.) were measured in
coronary sinus blood before aortic cross-clamping and at reperfusion.
Results: Longer TtCA (p = .03) but higher sSRr (p<.001) were found after
ALM cardioplegia. The ALM-Group at 10 min reperfusion had significantly
lower coronary sinus troponin (p = .002), lower lactate (p<.001), higher
SVO2 (p<.001) and higher base-excess (p = .001). Improved ALM
cardioprotection was reflected in significantly lower peripheral troponin
I (betweengroup p = .003), higher cardiac index (between-group p<.001) and
lower PCWP (between-group p<.001) and one day less in the ICU (p<.01),
suggesting improved flows and less whole body ischemia (peripheral lactate
release between-group p = .01). Other clinical outcome variables were
comparable. Discussion: We show for the first time that full-polarized ALM
arrest is safe and potentially efficacious in elective cardiac surgery,
leading to significantly improved myocardial protection, perioperative
hemodynamics, less whole body ischemia and lower ICU stays.

<20>
Accession Number
614835553
Author
Vierling W.
Institution
(Vierling) Institute of Pharmacology and Toxicology TUM, Munich, Germany
Title
Position of magnesium regarding the prevention of atrial fibrillation
during thoracic surgery.
Source
Trace Elements and Electrolytes. Conference: 35th Symposium of the German
Society for Magnesium Research. Germany. Conference Start: 20151023.
Conference End: 20151024. 33 (3) (pp 130), 2016. Date of Publication:
2016.
Publisher
Dustri-Verlag Dr. Karl Feistle
Abstract
An increased risk for supraventricular cardiac arrhythmias and particular
atrial fibrillation after thoracic surgery. These arrhythmias can be the
basis for ventricular arrhythmias, embolism and stroke. In the present
meta-analysis, it was investigated whether there are studies which show
that certain drugs can prevent the appearance of atrial fibrillation (AF),
especially in patients undergoing lung resection [1]. In the analysis, 10
randomized, controlled investigations were selected from 161 studies.
Taken together, by using several agents, a significant reduction in the
risk of postoperative atrial fibrillation was found with a relative risk
(RR) of 0.53 and a number needed-to-treat (NNT) of 8.5. The most effective
drug was amiodarone (RR: 0.32; NNT: 4.8) followed by magnesium (RR: 0.40;
NNT: 6.3). Also beta-blockers were efficient (RR: 0.43; NNT: 3.8) while
calcium channel blockers were less effective (RR: 0.55; NNT: 10.4).
Digoxin clearly increased the risk for AF and therefore should be avoided.
Amiodarone, magnesium, beta-blockers, and calcium channel blockers did not
show severe adverse effects during the observation period. However, one
trial with amiodarone was terminated earlier because of the danger to
develop lung dysfunction. Calcium channel blockers induced hypotension and
bradycardia, which however, could be managed. The results show that
amiodarone, magnesium, beta-blockers, and calcium channel blockers are
suited to prevent the development of AF in patients with lung resection
surgery. Therefore, the authors recommend the administration of one of
these compounds to prevent AF after lung surgery and here preferentially
amiodarone or magnesium. In view of the fact that amiodarone principally
can exert severe damage of the remaining lung tissue, it seems reasonable
to prefer magnesium or beta-blockers. However, further studies are
necessary to define the optimal drug and dosage for the prevention of AF.

<21>
Accession Number
614838027
Author
Bhangu N.; Pappachan J.; Forrest K.; Kirkham F.J.
Institution
(Bhangu, Pappachan, Forrest, Kirkham) University Hospital Southampton,
London, United Kingdom
(Kirkham) UCL, Institute of Child Health, London, United Kingdom
Title
Incidence of and risk factors for neurological complications of cardiac
bypass surgery in children with congenital heart disease.
Source
Developmental Medicine and Child Neurology. Conference: 42nd Annual
Conference of the British Paediatric Neurology Association, BPNA 2016.
United Kingdom. Conference Start: 20160127. Conference End: 20160129. 58
(pp 10), 2016. Date of Publication: January 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Decline in mortality is leading to a shift in emphasis towards
reducing morbidity in children requiring surgery with cardio-pulmonary
bypass (CPB) for congenital heart disease (CHD). Children with CHD often
have preoperative risk factors for cognitive problems, including
genetically determined syndromes, but whether there are potentially
modifiable risk factors, such as anaemia or iron deficiency, for acute
neurological complications has received little attention. Although one
study in children found that intraoperative haemoglobin was not associated
with developmental outcome at 1 year post CPB, in adults post-operative
anaemia and low intra-operative haematocrit are risk factors for stroke.
Methods: This service evaluation of all children (<16 years) with CHD
undergoing CPB (including circulatory arrest) between
01/04/2003-31/03/2015 in 1 of the 9 UK centres undertaking paediatric CPB,
examined, in a nested case control design, whether lower intra and post
operative haematocrit predicted neurological complications. Patients were
identified from the electronic procedural database, and discharge
summaries were reviewed independently by 2 consultant paediatric
neurologists, with case note review if information required clarification,
and for all with neurological complications. Results: There were 1934 CPB
operations in 1576 children. Forty-four children (2.2%) died and there
were neurological complications in 94 (4.9%), involving the central
nervous system (CNS) in 32/94 (1.7%). Longer bypass time was a risk factor
for death (odds ratio, OR 1.006, 95% confidence intervals, CI 1.002,
1.009) and neurological complications (OR 1.004, 95%CI 1.002, 1.007).
Matched for date of birth, gender and diagnosis, intra-operative
(0.315+/-0.1 vs 0.35+/-0.02; p=0.035) and post-operative (0.357+/-0.07 vs
0.389+/-0.08; p=0.049) haematocrit were lower in those with neurological
complications. Conclusion: The range of observed neurological
complications following CPB may be changing with less CNS complications.
Low intra- & post-operative haematocrit may be associated with acute
neurological complications and may be modifiable. Future studies should
include pre-operative haematocrit.

<22>
Accession Number
614798045
Author
Pittiruti M.; La Greca A.; Biasucci D.
Title
Intracavitary ECG for tip location in atrial fibrillation patients.
Source
JAVA - Journal of the Association for Vascular Access. Conference: Annual
Scientific Meeting of the Association for Vascular Access, AVA 2016.
United States. Conference Start: 20160916. Conference End: 20160919. 21
(4) (pp 252-253), 2016. Date of Publication: December 2016.
Publisher
Elsevier B.V.
Abstract
Purpose/Design: Prospective observational cohort pilot study to assess if
intracavitary electrocardiography (IC-ECG) may be used for placing the tip
of a central venous access device at the caval-atrial junction (CAJ) in
patients with atrial fibrillation (AF). Primary end-point: to verify if a
difference in IC-ECG at different tip positions can be detected and used
to locate the CAJ. Secondary end-point: safety of the method, in terms of
incidence of rhythm disturbances and other undesired effects. Methods: Ten
adult patients with AF undergoing cardiac surgery and needing
trans-esophageal echocardiography (TEE) for intraoperative monitoring were
prospectively enrolled. Exclusion criteria were the presence of a
pacemaker and contraindications to TEE. A 7.5 Fr chlorhexidine-coated
triple lumen CVAD was inserted by ultrasound-guided puncture of a central
vein. Under TEE and IC-ECG control, the CVAD was advanced and its tip
position recorded as follows: right atrium, 2 cm below the CT (CAJ+2);
superior vena cava, 2 cm above the CT (CAJ-2); at the CT (final position,
CAJ). The IC-ECG at each tip position was recorded and analyzed. Results:
CVAD insertion was successful and uneventful in all patients. An increase
in the mean IC-ECG amplitude of the f waves in the T-Q segment was
recorded with the J-tip placed at the CT; a clear reduction in amplitude
was evident in the two alternative positions in all patients. ECG traces
have been renamed according to a random sequence and post-procedural
qualitative (width of the f waves) and quantitative (energy of the
electrical signal recorded in the TQ tract) analysis performed by a
blinded expert cardiologist confirmed the results. Conclusion: IC-ECG is
feasible, safe and accurate in verifying correct tip location at the CAJ
in patients with AF.

<23>
Accession Number
614781550
Author
Zhao B.; Lu Q.; Cheng Y.; Belcher J.M.; Siew E.D.; Leaf D.E.; Body S.C.;
Fox A.A.; Waikar S.S.; Collard C.D.; Thiessen-Philbrook H.; Ikizler T.A.;
Ware L.B.; Edelstein C.L.; Garg A.X.; Choi M.; Schaub J.A.; Zhao H.;
Lifton R.P.; Parikh C.R.
Institution
(Zhao, Choi, Zhao, Lifton) Department of Genetics, Yale University, School
of Medicine, New Haven, CT, United States
(Lu, Zhao) Department of Biostatistics, Yale School of Public Health, New
Haven, CT, United States
(Cheng) Program of Computational Biology and Bioinformatics, Yale
University, New Haven, CT, United States
(Belcher, Thiessen-Philbrook, Schaub, Parikh) Program of Applied
Translational Research, Yale University, School of Medicine, New Haven,
CT, United States
(Belcher, Thiessen-Philbrook, Parikh) Section of Nephrology, Yale
University, School of Medicine, New Haven, CT, United States
(Belcher, Parikh) Clinical Epidemiology Research Center, Veterans Affairs
Medical Center, West Haven, CT, United States
(Siew, Ikizler) Division of Nephrology and Hypertension, Department of
Medicine, Nashville, TN, United States
(Siew, Ikizler) Vanderbilt Center for Kidney Disease, Vanderbilt
University Medical Center, Nashville, TN, United States
(Siew, Ikizler) Vanderbilt Integrated Program for Acute Kidney Injury
Research, Vanderbilt University Medical Center, Nashville, TN, United
States
(Leaf, Waikar) Division of Renal Medicine, Perioperative and Pain
Medicine, Brigham and Women's Hospital, Boston, MA, United States
(Body) Department of Anesthesiology, Perioperative and Pain Medicine,
Brigham and Women's Hospital, Boston, MA, United States
(Fox) Department of Anesthesiology and Pain Management, University of
Texas Southwestern Medical Center, Dallas, TX, United States
(Fox) McDermott Center for Human Growth and Development, University of
Texas Southwestern Medical Center, Dallas, TX, United States
(Collard) Department of Anesthesiology, Baylor St. Luke's Medical Center,
Texas Heart Institute, Houston, TX, United States
(Thiessen-Philbrook, Garg) Lilibeth Caberto Kidney Clinical Research Unit,
London Health Sciences Centre, London, ON, Canada
(Ware) Division of Allergy, Pulmonary, and Critical Care Medicine,
Department of Medicine, Nashville, TN, United States
(Edelstein) Division of Renal Diseases, University of Colorado, Denver,
CO, United States
(Garg) Division of Nephrology, Department of Medicine, Western University,
London, ON, Canada
(Garg) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
(Lifton) Howard Hughes Medical Institute, Yale University, School of
Medicine, New Haven, CT, United States
Title
A Genome-wide association study to identify single-nucleotide
polymorphisms for acute kidney injury.
Source
American Journal of Respiratory and Critical Care Medicine. 195 (4) (pp
482-490), 2017. Date of Publication: 15 Feb 2017.
Publisher
American Thoracic Society (E-mail: malexander@thoracic.org)
Abstract
Rationale: Acute kidney injury is a common and severe complication of
critical illness and cardiac surgery. Despite significant attempts at
developing treatments, therapeutic advances to attenuate acute kidney
injury and expedite recovery have largely failed. Objectives: Identifying
genetic loci associated with increased risk of acute kidney injury may
reveal novel pathways for therapeutic development. Methods: We conducted
an exploratory genome-wide association study to identify single-nucleotide
polymorphisms associated with genetic susceptibility to in-hospital acute
kidney injury. Measurements and Main Results: We genotyped 609,508
single-nucleotide polymorphisms and performed genotype imputation in 760
acute kidney injury cases and 669 controls. We then evaluated
polymorphisms that showed the strongest association with acute kidney
injury in a replication patient population containing 206 cases with 1,406
controls. We observed an association between acute kidney injury and four
single-nucleotide polymorphisms at two independent loci on metaanalysis of
discovery and replication populations. These include rs62341639
(metaanalysis P = 2.48 x 10^-7; odds ratio [OR], 0.64; 95%
confidence interval [CI], 0.55-0.76) and rs62341657 (P = 3.26 x
10^-7; OR, 0.65; 95% CI, 0.55-0.76) on chromosome 4 near APOL1
-regulator IRF2, and rs9617814 (metaanalysis P = 3.81 x 10^-6;
OR, 0.70; 95% CI, 0.60-0.81) and rs10854554 (P = 6.53 x 10^-7;
OR, 0.67; 95% CI, 0.57-0.79) on chromosome 22 near acute kidney
injury-related gene TBX1. Conclusions: Our findings reveal two genetic
loci that are associated with acute kidney injury. Additional studies
should be conducted to functionally evaluate these loci and to identify
other common genetic variants contributing to acute kidney injury. &#xa9;
Copyright 2017 by the American Thoracic Society.

<24>
Accession Number
613709953
Author
Khashram M.; Williman J.A.; Hider P.N.; Jones G.T.; Roake J.A.
Institution
(Khashram, Roake) Department of Surgery, University of Otago,
Christchurch, New Zealand
(Khashram, Roake) Department of Vascular, Endovascular & Transplant
Surgery, Christchurch Hospital, Christchurch, New Zealand
(Williman, Hider) Department of Population Health, University of Otago,
Christchurch, New Zealand
(Jones) Department of Surgical Sciences, Dunedin School of Medicine,
University of Otago, Christchurch, New Zealand
Title
Management of Modifiable Vascular Risk Factors Improves Late Survival
following Abdominal Aortic Aneurysm Repair: A Systematic Review and
Meta-Analysis.
Source
Annals of Vascular Surgery. 39 (pp 301-311), 2017. Date of Publication: 01
Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The main determinants of survival following abdominal aortic
aneurysm (AAA) repair are preexisting risk factors rather than the method
of repair chosen. The main aim of this meta-analysis was to assess the
effect of modifiable risk factors on late survival following AAA repair.
Methods Electronic databases were searched to identify all relevant
articles reporting the influence of modifiable risk factors on long-term
survival (>1 year) following elective open aneurysm repair and
endovascular aneurysm repair. Results Twenty-four studies which comprised
53,118 patients, published between 1989 and 2015, were included in the
analysis. The use of statin, aspirin, beta-blockers, and a higher
hemoglobin level was all significant predictors of improved survival
following repair with a hazard ratio (HR) and 95% confidence interval (CI)
of 0.75 (0.70-0.80), 0.81 (0.73-0.89), 0.75 (0.61-0.93), and 0.84
(0.74-0.96), respectively. Smoking history and uncorrected coronary
disease were associated with a worse long-term survival of HR 1.27 (95% CI
1.07-1.51) and HR 2.59 (95% CI 1.14-5.88), respectively. Conclusions
Addressing cardiovascular risk factors in patients preoperatively improves
long-term survival following AAA repair. Global strategies to improve risk
factor modifications in these patients are warranted to optimize long-term
outcomes. Copyright &#xa9; 2016 Elsevier Inc.

<25>
Accession Number
613939231
Author
Wang Y.; Shi X.; Du R.; Chen Y.; Zhang Q.
Institution
(Wang, Shi, Du, Chen, Zhang) Department of Cardiology, West China
Hospital, Sichuan University, 37 Guoxue Street, Chengdu, Sichuan 610041,
China
Title
Off-pump versus on-pump coronary artery bypass grafting in patients with
diabetes: a meta-analysis.
Source
Acta Diabetologica. 54 (3) (pp 283-292), 2017. Date of Publication: 01 Mar
2017.
Publisher
Springer-Verlag Italia s.r.l. (E-mail: springer@springer.it)
Abstract
Aims: The effects of off-pump CABG (OFF-CABG) versus on-pump CABG
(ON-CABG) in diabetic patients remain controversial. The aim of our study
was to compare mortality and postoperative morbidity between OFF-CABG and
ON-CABG for diabetic patients. Methods: Electronic databases including
PubMed, EMBASE and Cochrane Library for studies investigating clinical
outcomes of OFF-CABG versus ON-CABG in diabetic patients were searched,
collecting data from inception until June 2016. We pooled the odds ratios
from individual studies and performed heterogeneity, quality assessment
and publication bias analysis. Results: A total of 543,220 diabetic
patients in 10 studies were included. The overall mortality (OR, 0.87; 95%
CI, 0.58-1.31; p = 0.50) was comparable between the OFF-CABG and ON-CABG.
OFF-CABG was associated with significantly fewer cerebrovascular accidents
(OR, 0.45; 95% CI, 0.31-0.65; p < 0.0001), bleeding complications (OR,
0.59; 95% CI, 0.43-0.80; p < 0.001) and pulmonary complications. However,
no differences in myocardial infarction (OR, 0.76; 95% CI, 0.52-1.12; p =
0.16), renal failure (OR, 0.74; 95% CI, 0.50-1.11; p = 0.14) and other
postoperative morbidity outcomes were found. Conclusions: OFF-CABG
significantly reduces the incidence of postoperative cerebrovascular
accidents and bleeding complications compared with ON-CABG in diabetic
patients. No differences were found regarding mortality, myocardial
infarction and renal failure between these two techniques. Our study
suggests that OFF-CABG may be an optimal strategy for diabetic patients
although adequately powered randomized trials are needed to further verify
the finding. Copyright &#xa9; 2016, Springer-Verlag Italia.

<26>
Accession Number
613194453
Author
Katz M.; Carlos Bacelar Nunes Filho A.; Caixeta A.; Antonio Carvalho L.;
Sarmento-Leite R.; Alves Lemos Neto P.; Eduardo Koenig Sao Thiago L.; Dias
Dourado Oliveira A.; Antonio Marino M.; Tadeu Tumelero R.; Antonio Perin
M.; Abizaid A.; Tarasoutchi F.; Sandoli de Brito F.
Institution
(Katz, Carlos Bacelar Nunes Filho, Caixeta, Antonio Perin, Abizaid,
Tarasoutchi, Sandoli de Brito) Hospital Israelita Albert Einstein, Sao
Paulo, SP, Brazil
(Antonio Carvalho) Hospital Pro-Cardiaco, Rio de Janeiro, RJ, Brazil
(Sarmento-Leite) Instituto de Cardiologia do Rio Grande do
Sul/Universidade Federal de Ciencias da Saude de Porto Alegre, Porto
Alegre, RS, Brazil
(Alves Lemos Neto, Tarasoutchi) Heart Institute (InCor), University of Sao
Paulo Medical School, Sao Paulo, SP, Brazil
(Eduardo Koenig Sao Thiago) Hospital S.O.S Cardio, Florianopolis, SC,
Brazil
(Eduardo Koenig Sao Thiago) Instituto de Cardiologia de Santa Catarina,
Sao Jose, SC, Brazil
(Dias Dourado Oliveira) Hospital Santa Izabel da Santa Casa de
Misericordia da Bahia, Salvador, BA, Brazil
(Antonio Marino) Hospital Madre Teresa, Belo Horizonte, MG, Brazil
(Tadeu Tumelero) Associacao Hospitalar Beneficente Sao Vicente de Paulo,
Passo Fundo, RS, Brazil
(Abizaid) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil
Title
Gender-related differences on short- and long-term outcomes of patients
undergoing transcatheter aortic valve implantation.
Source
Catheterization and Cardiovascular Interventions. 89 (3) (pp 429-436),
2017. Date of Publication: 15 Feb 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study aimed to compare gender-related differences in
outcomes of patients undergoing TAVI over a long-term follow-up period.
Background: Transcatheter aortic valve implantation (TAVI) has been
considered the standard therapy for patients with inoperable or high-risk
symptomatic aortic stenosis. The influence of gender-related differences
in outcomes of patients undergoing TAVI is currently on debate. Methods:
From January 2008 to January 2015, 819 patients (49% men) underwent TAVI
and were included in a multicenter Brazilian registry. Patients were
followed-up and clinical outcomes were evaluated according to the updated
Valve Academic Research Consortium-2 criteria. Results: Mean follow-up was
497 +/- 478 days. Compared with women, men had a lower rate of major or
life-threatening bleeding (12.0% vs. 20.6%; HR = 0.57 [95CI% 0.40-0.81]; P
= 0.001), and major vascular complications (6% vs. 11.7%; HR = 0.50 [95CI%
0.31-0.82]; P = 0.004). At 30 days, all-cause mortality was lower in men
than in women (6.5% vs. 11.5%; P = 0.013), however, cumulative all-cause
mortality was similar between groups (25.9% vs. 29.7%, men and women,
respectively, HR = 0.92 [95CI% 0.71-1.19]; P = 0.52) over the entire
follow-up period. By adjusted Cox regression model, renal function,
diabetes, peripheral artery disease, and chronic obstructive pulmonary
disease (COPD) remained independently predictors of all-cause mortality.
Conclusions: In this large-scale study evaluating patients undergoing
TAVI, 30-day mortality was higher among women than men driven by
significant higher rates of major or life-threatening bleeding and major
vascular complications. However, all-cause mortality on long-term
follow-up was similar between groups. &#xa9; 2016 Wiley Periodicals, Inc.
Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<27>
Accession Number
614326382
Author
Yanagawa B.; Verma S.; Mazine A.; Tam D.Y.; Juni P.; Puskas J.D.;
Murugavel S.; Friedrich J.O.
Institution
(Yanagawa, Verma, Mazine, Tam, Murugavel) Division of Cardiac Surgery, Li
Ka Shing Knowledge Institute, St Michael's Hospital, University of
Toronto, Toronto, Ontario, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute, St
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Friedrich) Critical Care and Medicine Departments, Li Ka Shing Knowledge
Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario,
Canada
Title
Impact of total arterial revascularization on long term survival: A
systematic review and meta-analysis of 130,305 patients.
Source
International Journal of Cardiology. 233 (pp 29-36), 2017. Date of
Publication: 15 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives This meta-analysis compares total arterial revascularization
(TAR) versus conventional coronary artery bypass and additionally to two
arterial grafts. Methods We searched MEDLINE and EMBASE Databases from
1996-to-2016 for studies comparing TAR versus non-TAR for multi-vessel
surgical revascularization. Data were extracted by 2 independent
investigators. Meta-analysis used random effects, which incorporates
heterogeneity. Results There were 4 smaller shorter follow-up randomized
controlled trials (RCTs), plus 15 matched/adjusted and 6
unmatched/unadjusted larger longer follow-up observational studies that
met inclusion criteria (N = 130.305 patients; mean follow-up range: 1-15
years). There were no differences in perioperative stroke, myocardial
infarction or mortality. However, TAR was associated with lower long term
all-cause mortality in observational studies matched/adjusted for
confounders (incident rate ratio 0.85, 95% CI: 0.81-0.89, p < 0.0001;
I² = 0%) and unmatched/unadjusted (incident rate ratio 0.67,
95% CI: 0.59-0.76, p < 0.0001; I² = 67%) for TAR. Decreases in
major cardiovascular outcomes and revascularization did not achieve
statistical significance. There were greater sternal complications with
TAR in the matched/adjusted studies (pooled risk ratio 1.21, 95% CI:
1.03-1.42, p = 0.02; I² = 0%). When compared to patients with
two arterial grafts, TAR was still associated with reduced long-term
all-cause mortality (incident rate ratio 0.85, 95% CI: 0.73-0.99, p =
0.04) with minimal heterogeneity (I² = 5%). Conclusions Data
from primarily observational studies suggest that TAR may improve
long-term survival compared with conventional coronary bypass by 15-20%
even when compared with two arterial grafts. Prospective randomized trials
of TAR with long term follow-up are needed. Copyright &#xa9; 2017 Elsevier
B.V.

<28>
Accession Number
614700724
Author
Fan Z.-G.; Gao X.-F.; Li X.-B.; Mao W.-X.; Chen L.-W.; Tian N.-L.
Institution
(Fan, Gao, Li, Mao, Chen, Tian) Department of Cardiology, Nanjing First
Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu
210006, China
(Gao, Li, Mao, Tian) Department of Cardiology, Nanjing Heart Center,
Nanjing, China
Title
The optimal strategy of percutaneous coronary intervention for
ST-elevation myocardial infarction patients with multivessel disease: An
updated meta-analysis of 9 randomized controlled trials.
Source
Minerva Cardioangiologica. 65 (2) (pp 148-156), 2017. Date of Publication:
April 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Introduction: The optimal strategy of percutaneous coronary intervention
(PCI) for patients with ST-elevation myocardial infarction (STEMI) and
multivessel disease (MVD) still remains controversial. This study sought
to explore the optimal PCIstrategy for those patients.
Evidenceacquisition: Medline, EMBASEand the Cochrane Controlled Trials
Registry were searched for relevant studies. We analyzed the comparison of
major adverse cardiac events (MACEs) as the primary end point between the
preventive PCIstrategy and the culprit only PCIstrategy (CV-PCI). The
further analysis of two subgroups described as the complete multivessel
PCIstrategy during primary procedure (CMV-PCI) and the staged PCIstrategy
(S-PCI) was also performed. Evidencesynthesis: Nine randomized trials were
identified. The risk of MACEs was reduced significantly regarding to
preventive PCIstrategy (OR=0.41, 95% CI: 0.31-0.53, P<0.001) compared to
CV-PCIstrategy. There were lower risks of long-term mortality,
reinfarction and repeat revascularization in the preventive PCI group
compared to the CV-PCIgroup (OR=0.41, 95% CI: 0.27-0.62, P<0.001; OR=0.54,
95% CI: 0.32-0.91, P=0.021; OR=0.37, 95% CI: 0.26-0.51, P<0.001). Subgroup
analysis showed that staged PCIstrategy reduced the incidence of long-term
mortality versus CMV-PCIstrategy. Conclusions: The preventive PCI is
associated with the lower risk of MACEs in STEMI patients with MVD
compared to the CV-PCIstrategy, and the S-PCIstrategy seems to be an
optimal choice for these patients rather than the CMV-PCI. Copyright
&#xa9; 2016 Edizioni Minerva Medica.

<29>
Accession Number
613945139
Author
Ramos dos Santos P.M.; Aquaroni Ricci N.; Aparecida Bordignon Suster E.;
de Moraes Paisani D.; Dias Chiavegato L.
Institution
(Ramos dos Santos, Aquaroni Ricci, Aparecida Bordignon Suster, Dias
Chiavegato) Masters and Doctoral Programmes in Physical Therapy,
Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
(de Moraes Paisani) Research Institute, Hospital do Coracao, Sao Paulo,
Brazil
(Dias Chiavegato) Pulmonary Division, Universidade Federal de Sao Paulo,
Sao Paulo, Brazil
Title
Effects of early mobilisation in patients after cardiac surgery: a
systematic review.
Source
Physiotherapy (United Kingdom). 103 (1) (pp 1-12), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Early mobilisation is prescribed after cardiac surgery to
prevent postoperative complications, decrease length of hospital stay, and
augment return to daily activities. Objective To evaluate the evidence for
the effects of early mobilisation in patients after cardiac surgery on
length of hospital stay, functional capacity and postoperative
complications. Data sources The data sources used were Medline, Embase,
CINAHL, PEDro, Web of Science and Cochrane Central Register of Controlled
Trials. Study selection Randomised controlled trials of early mobilisation
after cardiac surgery. Study selection was not restricted by language or
publication time. Study appraisal and synthesis methods The methodological
quality of each article was appraised with the PEDro scale. All review
phases (selection, data extraction and appraisal) were conducted by two
investigators, and a third investigator provided consensus. Results Nine
trials were selected. The PEDro scale showed that the studies had a low
risk of bias (range 5 to 9 points). The trials revealed diversity in
techniques used for mobilisation, as well as periods considered early for
the start of the intervention. Early mobilisation groups had improved
outcomes compared with control groups without treatment. Generally, these
advantages did not differ when groups of interventions were compared.
Limitations It was not possible to perform a meta-analysis due to the
variability of the interventions proposed as early mobilisation.
Conclusions Regardless of the techniques used as mobilisation, the
essential point is to avoid bed rest. Early mobilisation seems to be
important to prevent postoperative complications, improve functional
capacity and reduce length of hospital stay in patients after cardiac
surgery. Copyright &#xa9; 2016 Chartered Society of Physiotherapy

<30>
[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.

<31>
[Use Link to view the full text]
Accession Number
613915057
Author
Fan Y.; Chen Y.; Wan Z.; Zhou D.; Ma A.
Institution
(Fan, Chen, Wan, Zhou, Ma) Department of Cardiovascular Medicine, First
Affiliated Hospital of Medical College, Xi'an Jiaotong University,
Institute of Cardiovascular Channelopathy, Key Laboratory of Environment
and Genes Related to Diseases of Ministry of Education, Key Laboratory of
Molecular Cardiology of Shaanxi Province, 277 Yanta West Road, Xi'an,
Shaanxi 710061, China
Title
The prognostic value of autoantibodies against beta1-adrenoceptor and
cardiac troponin-I for clinical outcomes in STEMI.
Source
Journal of Cardiovascular Medicine. 18 (1) (pp 34-41), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims: The prevalence and potential role of autoantibodies against the
beta1-adrenoceptor autoantibody (beta1-aab) and cardiac troponin-I
(anti-cTnI) in patients with ST-elevation myocardial infarction (STEMI)
are unknown. The aim of this study is to test whether beta1-aab and
anti-cTnI are prevalent in STEMI patients and to investigate their
prognostic value for left ventricular remodeling and clinical outcomes in
STEMI patients. Methods: This study included 491 patients with first STEMI
at two centers. Serum samples were obtained. beta1-aab and anti-cTnI were
detected by enzyme-linked immunoabsorbent assay. Echocardiographic
assessments were performed at admission and following 1 year. The major
adverse cardiovascular events (MACEs) were evaluated during a median
follow-up period of 37 months. Results: The positive rates of beta1-aab
and anti-cTnI in STEMI patients were 39.1 and 19.1%, respectively. The
extent of left ventricular remodeling correlated with the presence of
beta1-aab and/or anti-cTnI (double positive > single positive > double
negative). Logistic regression revealed that both beta1-aab [odds ratio
(OR) 2.298, 95% confidence interval (CI) 1.561-3.384, P<0.001] and
anti-cTnI (OR 2.389, 95% CI 1.460-3.909, PU0.001) were predictive of left
ventricular remodeling. Cox proportional-hazard regression revealed that
beta1-aab, but not anti-cTnI, was strongly predictive of MACEs (hazard
ratio 1.802, 95% CI 1.301-2.496, P<0.001). Conclusion: beta1-aab and
anti-cTnI were prevalent in STEMI patients. Both beta1-aab and anti-cTnI
were independent predictors of left ventricular remodeling, whereas only
beta1-aab was an independent predictor of MACEs. Our findings suggest that
beta1-aab and anti-cTnI may actively participate in the process of left
ventricular remodeling after STEMI. Copyright &#xa9; 2017 Italian
Federation of Cardiology. All rights reserved.

<32>
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.

<33>
Accession Number
614782928
Author
Koh J.-S.; Park Y.; Tantry U.S.; Ahn J.-H.; Kang M.G.; Kim K.; Jang J.Y.;
Park H.W.; Park J.R.; Hwang S.-J.; Kwak C.H.; Hwang J.-Y.; Gurbel P.A.;
Jeong Y.-H.
Institution
(Koh, Kang, Kim, Park, Park, Hwang, Hwang) Department of Internal
Medicine, Gyeongsang National University School of Medicine and Gyeongsang
National University Hospital, Jinju, South Korea
(Park, Ahn, Jang, Kwak, Jeong) Department of Internal Medicine, Gyeongsang
National University School of Medicine and Cardiovascular Center,
Gyeongsang National University Changwon Hospital, Changwon, South Korea
(Tantry, Gurbel) Inova Center for Thrombosis Research and Drug
Development, Inova Heart and Vascular Institute, Fairfax, VA, United
States
(Jeong) Institute of the Health Sciences, Gyeongsang National University,
Jinju, South Korea
Title
Pharmacodynamic effects of a new fixed-dose clopidogrel-aspirin
combination compared with separate administration of clopidogrel and
aspirin in patients treated with coronary stents: The ACCEL-COMBO trial.
Source
Platelets. 28 (2) (pp 187-193), 2017. Date of Publication: 17 Feb 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely
prescribed regimen to prevent ischemic events in patients undergoing
percutaneous coronary intervention (PCI). A fixed-dose combination (FDC)
capsule (HCP0911) has been developed to provide dosing convenience and
improve adherence. We compared the antiplatelet effects of single daily
dose HCP0911 with separate treatment with daily 75 mg clopidogrel plus 100
mg aspirin. This was a randomized, open-label, two-period, crossover,
non-inferiority study conducted in stented patients who had been treated
for at least 6 months with clopidogrel and aspirin. Thirty patients were
randomly assigned to receive either daily 75 mg clopidogrel plus 100 mg
aspirin treatment or HCP0911 for 2 weeks and then were crossed over to the
other treatment for 2 weeks. Pharmacodynamic effects were measured with
VerifyNow, light transmittance aggregometry (LTA), and thromboelastography
(TEG). The primary endpoint was P2Y12 Reaction Units (PRU)
measured by VerifyNow. PRUs during treatment with HCP0911 were not
inferior to those during separate treatment (202 +/- 52 vs. 207 +/- 60
PRU; mean difference, -5 PRU; 90% confidence interval of difference, -23
to 13 PRU; P for non-inferiority = 0.015 for predetermined limit). "BASE"
and Aspirin Reaction Units by VerifyNow did not differ between the two
treatments. During each treatment, there were no differences in maximal
and final platelet aggregations by LTA (all P values >0.822) and
TEG measurements. In conclusion, in stented patients, the
antiplatelet effect of a fixed-dose clopidogrel-aspirin combination,
HCP0911, was not inferior to separate administration of clopidogrel and
aspirin. Copyright &#xa9; 2016 Taylor & Francis.

<34>
Accession Number
612666966
Author
Linde J.J.; Sorgaard M.; Kuhl J.T.; Hove J.D.; Kelbaek H.; Nielsen W.B.;
Kofoed K.F.
Institution
(Linde, Hove, Nielsen) Department of Cardiology, Hvidovre University
Hospital, University of Copenhagen, Kettegaard alle 30, Hvidovre 2650,
Denmark
(Linde, Sorgaard, Kuhl, Kofoed) Department of Cardiology, The Heart
Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Kofoed) Department of Radiology, The Diagnostic Centre, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
(Kelbaek) Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark
(Hove) Center for Functional and Diagnostic Imaging and Research, Hvidovre
Hospital, University of Copenhagen, Hvidovre, Denmark
Title
Prediction of clinical outcome by myocardial CT perfusion in patients with
low-risk unstable angina pectoris.
Source
International Journal of Cardiovascular Imaging. 33 (2) (pp 261-270),
2017. Date of Publication: 01 Feb 2017.
Publisher
Springer Netherlands
Abstract
The prognostic implications of myocardial computed tomography perfusion
(CTP) analyses are unknown. In this sub-study to the CATCH-trial we
evaluate the ability of adenosine stress CTP findings to predict mid-term
major adverse cardiac events (MACE). In 240 patients with acute-onset
chest pain, yet normal electrocardiograms and troponins, a clinically
blinded adenosine stress CTP scan was performed in addition to
conventional diagnostic evaluation. A reversible perfusion defect (PD) was
found in 38 patients (16 %) and during a median follow-up of 19 months
(range 12-22 months) 25 patients (10 %) suffered a MACE (cardiac death,
non-fatal myocardial infarction and revascularizations). Accuracy for the
prediction of MACE expressed as the area under curve (AUC) on
receiver-operating characteristic curves was 0.88 (0.83-0.92) for visual
assessment of a PD and 0.80 (0.73-0.85) for stress TPR (transmural
perfusion ratio). After adjustment for the pretest probability of
obstructive coronary artery disease, both detection of a PD and stress TPR
were significantly associated with MACE with an adjusted hazard ratio of
39 (95 % confidence interval 11-134), p < 0.0001, for visual
interpretation and 0.99 (0.98-0.99) for stress TPR, p < 0.0001. Patients
with a PD volume covering >10 % of the LV myocardium had a worse prognosis
compared to patients with a PD covering <10 % of the LV myocardium, p =
0.0002. The optimal cut-off value of the myocardial PD extent to predict
MACE was 5.3 % of the left ventricle [sensitivity 84 % (64-96),
specificity 95 % (91-97)]. Myocardial CT perfusion parameters predict
mid-term clinical outcome in patients with recent acute-onset chest pain.
Copyright &#xa9; 2016, Springer Science+Business Media Dordrecht.

<35>
Accession Number
613247537
Author
Basaran O.; Dogan V.; Beton O.; Tekinalp M.; Aykan A.C.; Kalaycioglu E.;
Bolat I.; Tasar O.; Safak O.; Kalcik M.; Yaman M.; Inci S.; Altintas B.;
Kalkan S.; Kirma C.; Biteker M.; and Collaborators; Karadeniz F.O.;
Tekkesin A.I.; Cakilli Y.; Turkkan C.; Hamidi M.; Demir V.; Gursoy M.O.;
Ozturk M.T.; Aksan G.; Seyis S.; Balli M.; Alici M.H.; Bozyel S.; Altun
I.; Calik F.; Karaca O.; Helvaci F.; Akay K.; Canga Y.; Celebi S.;
Altuntas E.; Ayturk M.; Gunes H.M.; Bezgin T.; Aksakal A.; Cakal B.; Colak
A.; Kaplan O.; Tatlisu A.; Gozubuyuk G.; Demirelli S.; Kaya A.;
Rencuzogullari I.; Bayram Z.; Simsek Z.; Civan M.; Batgharel U.; Ata A.E.;
Gol G.; Mert G.O.; Mert K.U.; Degirmencioglu A.; Candan O.; Celebi O.O.;
Dogan C.; Yavuz F.; Ulucan S.; Arisoy A.; Sahin B.D.; Ermis E.; Gokaslan
S.; Pektas I.; Tanindi A.; Tekin K.; Sancar K.M.; Cekic E.G.; Basaran N.F.
Institution
(Basaran, Dogan, Biteker) Department of Cardiology, Faculty of Medicine,
Mugla Sitki Kocman Universitesi Tip Fakultesi, Orhaniye Mah. Haluk Ozsoy
Cad., Mugla 48000, Turkey
(Beton) Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet
University, Sivas, Turkey
(Tekinalp) Department of Cardiology, Kahramanmaras Necip Fazil State
Hospital, Kahramanmaras, Turkey
(Aykan, Kalaycioglu) Department of Cardiology, Trabzon Ahi Evren Chest
Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
(Bolat) Department of Cardiology, Fethiye State Hospital, Mugla, Turkey
(Tasar) Department of Cardiology, Elazig Education and Research Hospital,
Elazig, Turkey
(Safak) Department of Cardiology, Burdur State Hospital, Burdur, Turkey
(Kalcik) Department of Cardiology, Iskilip Atif Hoca State Hospital,
Iskilip, Turkey
(Yaman) Department of Cardiology, Samsun Education and Research Hospital,
Samsun, Turkey
(Inci) Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
(Altintas) Department of Cardiology, Diyarbakir Gazi Yasargil Education
and Research Hospital, Diyarbakir, Turkey
(Kalkan) Department of Cardiology, Gonen State Hospital, Gonen, Turkey
(Kirma) Kartal Kosuyolu Heart Education and Research Hospital, Istanbul,
Turkey
Title
Impact of valvular heart disease on oral anticoagulant therapy in
non-valvular atrial fibrillation: results from the RAMSES study.
Source
Journal of Thrombosis and Thrombolysis. 43 (2) (pp 157-165), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The definition of non-valvular atrial fibrillation (NVAF) is
controversial. We aimed to assess the impact of valvular heart disease on
stroke prevention strategies in NVAF patients. The RAMSES study was a
multicenter and cross-sectional study conducted on NVAF patients
(ClinicalTrials.gov identifier NCT02344901). The study population was
divided into patients with significant valvular disease (SVD) and
non-significant valvular disease (NSVD), whether they had at least one
moderate valvular disease or not. Patients with a mechanical prosthetic
valve and mitral stenosis were excluded. Baseline characteristics and oral
anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF,
there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant
valvular disease was mitral regurgitation (58.1%), followed by aortic
regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had
higher CHA<inf>2</inf>DS<inf>2</inf>VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0;
5.0), p < 0.001] and HAS-BLED [2.0 (1.0; 2.0) vs. 2.0 (1.0; 2.0), p =
0.004] scores compared to patients with NSVD. Overall, 2763 (71.2%) of
NSVD and 1515 (73.8%) of SVD patients were on OAC therapy (p = 0.035).
When the patients with SVD were analyzed separately, the mean
CHA<inf>2</inf>DS<inf>2</inf>VASc and HAS-BLED scores were higher in
patients with mitral regurgitation compared to patients with aortic
regurgitation and aortic stenosis [4.0 (3.0; 5.0), 3.0 (2.0; 4.0), 3.0
(2.0; 4.0) p < 0.001 and 2.0 (1.0; 3.0), 1.0 (1.0; 2.0), 1.0 (0.0; 2.0) p
< 0.001, respectively]. In patients with SVD, 65.7% of mitral
regurgitation, 82.6% of aortic regurgitation and 88.0% of aortic stenosis
patients were on OAC therapy. One out of three NVAF patients had at least
one moderate valvular heart disease with the predominance of mitral
regurgitation. Patients with SVD were at greater risk of stroke and
bleeding compared to patients with NSVD. Although patients with mitral
regurgitation should be given more aggressive anticoagulant therapy due to
their higher risk of stroke, they are undertreated compared to patients
with aortic valve diseases. Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<36>
[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.

<37>
Accession Number
613145841
Author
Meneguz-Moreno R.A.; Ramos A.I.O.; Siqueira D.; de Castro-Filho A.; Jatene
T.; Dias Jeronimo A.; Le Bihan D.; Moreira A.; Arrais M.; Abizaid A.;
Sousa A.; Eduardo Sousa J.
Institution
(Meneguz-Moreno, Ramos, Siqueira, de Castro-Filho, Jatene, Dias Jeronimo,
Le Bihan, Arrais, Abizaid, Sousa, Eduardo Sousa) Instituto Dante Pazzanese
de Cardiologia, Sao Paulo, Brazil
(Siqueira, Moreira, Arrais, Abizaid, Sousa, Eduardo Sousa) Hospital do
Coracao, Sao Paulo, Brazil
Title
Prognostic value of renal function in patients with aortic stenosis
treated with transcatheter aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. 89 (3) (pp 452-459),
2017. Date of Publication: 15 Feb 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The objectives of the present study were to analyze the
variation of renal function after transcatheter aortic valve replacement
(TAVR) focused on acute kidney injury (AKI) and its impact on short- and
mid-term mortality. Background: Changes on renal function after TAVR and
their impact on clinical outcomes are incompletely understood until now.
Methods: At two tertiary centers 221 consecutive patients were submitted
to TAVR. Kidney injury was defined according to VARC-2 criteria. Patients
were classified according to the presence (group 1) or absence (group 2)
of AKI. Creatinine values were collected daily until seventh day after
procedure, 1 month, 6 months, and then 1 year after TAVR. Results: At
baseline, groups were similar, except for EuroSCORE II (8.66% vs. 7.34%, P
= 0.02) and glomerular filtration rate (GFR) (39.59 vs. 48.49 mL/min.1.73
m², P = 0.002). Overall 30 day-mortality and 1-year mortality
were 6.3% and 14.0%, respectively. Both 30-day mortality (23.1% vs. 1.2%,
P < 0.001) and 1-year mortality (44.2% vs. 4.7%, P < 0.001) were higher in
group 1. After multivariable-adjusted models, the only independent
predictor for AKI after TAVR was baseline GFR (HR: 1.37, 95% CI:
1.08-1.77, P = 0.01). The independent risk factors for 1-year mortality
were AKI (HR: 15.66, 95% CI: 6.07-44.63, P < 0.001), COPD (HR: 3.14, 95%
CI: 1.05-9.40, P = 0.04) and aortic regurgitation grade postprocedure > 2
(P = 0.05) also after multivariate analysis. Conclusions: In this TAVR
cohort, baseline GFR was the only independent predictor of AKI, which
negatively impacted on 30-day and 1-year mortality. &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<38>
Accession Number
614694101
Author
Lewis S.R.; Alderson P.; Smith A.F.
Institution
(Lewis) Royal Lancaster Infirmary, Patient Safety Research Department,
Pointer Court 1, Ashton Road, Lancaster LA1 4RP, United Kingdom
(Alderson) National Institute for Health and Care Excellence, Level 1A,
City Tower,Piccadilly Plaza, Manchester M1 4BD, United Kingdom
(Smith) Royal Lancaster Infirmary, Department of Anaesthesia, Ashton Road,
Lancaster, Lancashire LA1 4RP, United Kingdom
Title
Continuation versus discontinuation of antiplatelet therapy for bleeding
and ischaemic events in adults undergoing non-cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD012584. Date of Publication: 08 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives
are as follows: To compare the effects of continuation versus
discontinuation of antiplatelet therapy on the occurrence of bleeding and
ischaemic events in non-cardiac surgical patients. Copyright &#xa9; 2017
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<39>
Accession Number
614517553
Author
Stanska A.; Jagielak D.; Brzezinski M.; Wojakowski W.; Kochman J.; Huczek
Z.; Witkowski A.; Zembala M.
Institution
(Stanska, Jagielak, Brzezinski) Department of Cardiac and Vascular
Surgery, Medical University of Gdansk, ul. Debinki 7, Gdansk 80-211,
Poland
(Zembala) Department of Cardiothoracic Surgery and Transplantology,
Silesian Centre for Heart Diseases, Zabrze, Poland
(Wojakowski) 3rd Department of Cardiology, Silesian Centre for Heart
Diseases, Zabrze, Poland
(Kochman, Huczek) 1st Department of Cardiology, Medical University of
Warsaw, Warsaw, Poland
(Witkowski) Department of Interventional Cardiology and Angiology,
Institute of Cardiology, Warsaw, Poland
(Zembala) Department of Cardiac, Vascular and Endovascular Surgery and
Transplantology, School of Medicine, Silesian Centre for Heart Diseases,
Zabrze, Poland
Title
Improvement of quality of life following transcatheter aortic valve
implantation in the elderly: A multi-centre study based on the Polish
national TAVI registry.
Source
Kardiologia Polska. 75 (1) (pp 13-20), 2017. Date of Publication: 24 Jan
2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an effective
therapeutic method for elderly high-risk patients with symptomatic severe
aortic stenosis, not eligible for surgical treatment. Aim: The aim of the
study was to evaluate short-term changes in elderly people's quality of
life following TAVI, based on the POL-TAVI registry. Methods: One hundred
and eighty-four octogenarians' and nonagenarians' samples from the
POL-TAVI database were included in the study. The quality of life status
was assessed with EQ-5D-3L questionnaire at baseline and after one-month
follow-up. Results: The mean of patients' age was 84 (80-93) years.
Logistic EuroSCORE mean was 19.83% (3.48-83.94%), and transaortic mean
gradient was 54.99 (19.0-149.0) mm Hg. At baseline, up to 24.50% of
patients declared severe problems in performing usual activities. 13.60%
felt extreme pain or discomfort; 9.80% were unable to wash and dress by
themselves; 8.20% were extremely anxious or depressed; and 7.10% of the
patients in the study were confined to bed. After 30 days the percentage
of patients declaring severe problems in each dimension did not exceed
4.00%. The comparison between quality of life data at baseline and after
one-month follow-up showed a significant improvement in each of five
dimensions: mobility, self-care, usual activities, pain/discomfort, and
anxiety/depression (p < 0.001). Patients' quality of life was increasing
regardless of gender (female vs. male), the type of anaesthesia (general
vs. local), and the type of procedure (TA vs. TF). Conclusions: Short-term
quality of life in the elderly subjects was significantly improved after
one-month follow-up following TAVI. Copyright &#xa9; 2017 Polskie
Towarzystwo Kardiologiczne.

<40>
Accession Number
614517308
Author
Zhao D.F.; Edelman J.J.; Seco M.; Bannon P.G.; Wilson M.K.; Byrom M.J.;
Thourani V.; Lamy A.; Taggart D.P.; Puskas J.D.; Vallely M.P.
Institution
(Zhao, Edelman, Seco, Bannon, Byrom, Vallely) Sydney Medical School, The
University of Sydney, Sydney, New South Wales, Australia
(Zhao, Edelman, Seco, Bannon, Wilson, Byrom, Vallely) Baird Institute of
Applied Heart and Lung Surgical Research, Sydney, New South Wales,
Australia
(Edelman, Seco, Bannon, Wilson, Byrom, Vallely) Cardiothoracic Surgical
Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
(Bannon, Byrom, Vallely) Institute of Academic Surgery, Royal Prince
Alfred Hospital, Sydney, New South Wales, Australia
(Bannon, Wilson, Byrom, Vallely) Sydney Heart and Lung Surgeons, Sydney,
New South Wales, Australia
(Thourani) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, Georgia
(Lamy) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Taggart) Department of Cardiovascular Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Puskas) Department of Cardiac Surgery, Mt. Sinai Hospital, New York, New
York, United States
Title
Coronary Artery Bypass Grafting With and Without Manipulation of the
Ascending Aorta: A Network Meta-Analysis.
Source
Journal of the American College of Cardiology. 69 (8) (pp 924-936), 2017.
Date of Publication: 28 Feb 2017.
Publisher
Elsevier USA
Abstract
Background Coronary artery bypass grafting (CABG) remains the standard of
treatment for 3-vessel and left main coronary disease, but is associated
with an increased risk of post-operative stroke compared to percutaneous
coronary intervention. It has been suggested that CABG techniques that
eliminate cardiopulmonary bypass and reduce aortic manipulation may reduce
the incidence of post-operative stroke. Objectives A network meta-analysis
was performed to compare post-operative outcomes between all CABG
techniques, including anaortic off-pump CABG (anOPCABG), off-pump with the
clampless Heartstring device (OPCABG-HS), off-pump with a partial clamp
(OPCABG-PC), and traditional on-pump CABG with aortic cross-clamping.
Methods A systematic search of 6 electronic databases was performed to
identify all publications reporting the outcomes of the included
operations. Studies reporting the primary endpoint, 30-day post-operative
stroke rate, were included in a Bayesian network meta-analysis. Results
There were 13 included studies with 37,720 patients. At baseline, anOPCABG
patients had higher previous stroke than did the OPCABG-PC (7.4% vs. 6.5%;
p = 0.02) and CABG (7.4% vs. 3.2%; p = 0.001) patients. AnOPCABG was the
most effective treatment for decreasing the risk of post-operative stroke
(-78% vs. CABG, 95% confidence interval [CI]: 0.14 to 0.33; -66% vs.
OPCABG-PC, 95% CI: 0.22 to 0.52; -52% vs. OPCABG-HS, 95% CI: 0.27 to
0.86), mortality (-50% vs. CABG, 95% CI: 0.35 to 0.70; -40% vs. OPCABG-HS,
95% CI: 0.38 to 0.94), renal failure (-53% vs. CABG, 95% CI: 0.31 to
0.68), bleeding complications (-48% vs. OPCABG-HS, 95% CI: 0.31 to 0.87;
-36% vs. CABG, 95% CI: 0.42 to 0.95), atrial fibrillation (-34% vs.
OPCABG-HS, 95% CI: 0.49 to 0.89; -29% vs. CABG, 95% CI: 0.55 to 0.87; -20%
vs. OPCABG-PC, 95% CI: 0.68 to 0.97), and shortening the length of
intensive care unit stay (-13.3 h; 95% CI: -19.32 to -7.26; p < 0.0001).
Conclusions Avoidance of aortic manipulation in anOPCABG may decrease the
risk of post-operative stroke, especially in patients with higher stroke
risk. In addition, the elimination of cardiopulmonary bypass may reduce
the risk of short-term mortality, renal failure, atrial fibrillation,
bleeding, and length of intensive care unit stay. Copyright &#xa9; 2017
American College of Cardiology Foundation

<41>
Accession Number
614517238
Author
Perrotti A.; Gatti G.; Dorigo E.; Sinagra G.; Pappalardo A.; Chocron S.
Institution
(Perrotti, Dorigo, Chocron) Department of Thoracic and Cardio-Vascular
Surgery, University Hospital Jean Minjoz, Besancon, France
(Gatti, Sinagra, Pappalardo) Cardio-Vascular Department, Ospedali Riuniti
and University of Trieste, via P. Valdoni, Trieste 7-34148, Italy
Title
Validation of a predictive scoring system for deep sternal wound infection
after bilateral internal thoracic artery grafting in a cohort of French
patients.
Source
Surgical Infections. 18 (2) (pp 181-188), 2017. Date of Publication:
February-March 2017.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: The Gatti score is a weighted scoring system based on risk
factors for deep sternal wound infection (DSWI) that was created in an
Italian center to predict DSWI risk after bilateral internal thoracic
artery (BITA) grafting. No external evaluation based on validation samples
derived from other surgical centers has been performed. The aim of this
study is to perform this validation. Patients and Methods: During 2015,
BITA grafts were used as skeletonized conduits in all 255 consecutive
patients with multi-vessel coronary disease who underwent isolated
coronary bypass surgery at the Department of Thoracic and Cardio-Vascular
Surgery, University Hospital Jean Minjoz, Besancon, France. Baseline
characteristics, operative data, and immediate outcomes of every patient
were collected prospectively. A DSWI risk score was assigned to each
patient pre-operatively. The discrimination power of both models,
pre-operative and combined, of the Gatti score was assessed with the
calculation of the area under the receiver operating characteristic curve.
Results: Fourteen (5.5%) patients had DSWI. Major differences both as the
baseline characteristics of patients and surgical techniques were found
between this series and the original series from which the Gatti score was
derived. The area under the receiver operating characteristic curve was
0.78 (95% confidence interval: 0.64-0.92) for the pre-operative model and
0.84 (95% confidence interval: 0.69-0.98) for the combined model.
Conclusions: The Gatti score has proven to be effective even in a cohort
of French patients despite major differences from the original Italian
series. Multi-center validation studies must be performed before
introducing the score into clinical practice. &#xa9; Copyright 2017, Mary
Ann Liebert, Inc. 2017.

<42>
Accession Number
613108601
Author
Colleran R.; Kufner S.; Harada Y.; Giacoppo D.; Cassese S.; Repp J.; Wiebe
J.; Lohaus R.; Lahmann A.; Schneider S.; Ibrahim T.; Laugwitz K.-L.;
Kastrati A.; Byrne R.A.
Institution
(Colleran, Kufner, Harada, Giacoppo, Cassese, Repp, Wiebe, Lohaus,
Lahmann, Kastrati, Byrne) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Schneider, Ibrahim, Laugwitz) I. Medizinische Klinik, Klinikum Rechts der
Isar, Technische Universitat Munchen, Munich, Germany
(Laugwitz, Kastrati) DZHK (German Centre for Cardiovascular Research),
Partner Site Munich Heart Alliance, Munich, Germany
Title
Five-year follow-up of polymer-free sirolimus- and probucol-eluting stents
versus new generation zotarolimus-eluting stents in patients presenting
with st-elevation myocardial infarction.
Source
Catheterization and Cardiovascular Interventions. 89 (3) (pp 367-374),
2017. Date of Publication: 15 Feb 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Patients with ST-segment elevation myocardial infarction
(STEMI) undergoing drug-eluting stent (DES) implantation are at increased
risk of late adverse events, partly explained by an exaggerated
inflammatory reaction to durable-polymer stent coatings. Objectives: We
sought to investigate whether implantation of polymer-free DES would
reduce this risk. Methods: In the ISAR-TEST 5 (the Intracoronary Stenting
and Angiographic Results: Test Efficacy of Sirolimus- and Probucol- and
Zotarolimus-Eluting Stents) trial, patients were randomly allocated to
receive a polymer-free sirolimus- and probucol-eluting stent or a new
generation durable-polymer zotarolimus-eluting stent. We analyzed late
clinical outcomes in the subgroup of patients presenting with STEMI. The
primary endpoint was the combined incidence of cardiac death, target
vessel-related myocardial infarction or target lesion revascularization at
5 years. Results: 311 patients with STEMI were randomized to receive
sirolimus- and probucol-eluting stents (n = 215) or zotarolimus-eluting
stents (n = 96). At 5 years, there was no difference in the incidence of
the primary endpoint in patients treated with sirolimus- and
probucol-eluting stents versus zotarolimus-eluting stents (18.3% versus
20.1% respectively, hazard ratio = 0.87, 95% CI, 0.50-1.51; P = 0.62).
Rates of the individual components of the primary endpoint were also
comparable in both groups. The incidence of definite/probable stent
thrombosis was 1.4% versus 1.0% respectively (hazard ratio = 1.35, 95% CI,
0.14-12.94, P = 0.80). Conclusions: Long-term outcomes of patients with
STEMI treated with polymer-free sirolimus- and probucol-eluting stents
versus durable-polymer zotarolimus-eluting stents were similar. Stent
thrombosis rates were low and comparable in both treatment groups, with no
events beyond 12 months. Clinical Trial Registration: Registered at
ClinicalTrials.gov (Identifier NCT 00598533) &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<43>
Accession Number
614374849
Author
Ondrus T.; Penicka M.; Kotrc M.; Vanderheyden M.; Bartunek J.
Institution
(Ondrus) Department of Internal Medicine and Cardiology, Medical Faculty
of Masaryk University and University Hospital Brno, Jihlavska 20, Brno 625
00, Czech Republic
(Ondrus, Penicka, Vanderheyden, Bartunek) Cardiovascular Center Aalst, OLV
Clinic, Moorselbaan 164, Aalst 9300, Belgium
(Kotrc) Department of Cardiology, Institute for Clinical and Experimental
Medicine (IKEM), Videnska 1958/9, Prague 140 21, Czech Republic
Title
MitraClip: Catheter-based treatment of mitral regurgitation.
Source
Cor et Vasa. 59 (1) (pp e85-e91), 2017. Date of Publication: 01 Feb 2017.
Publisher
Elsevier Science B.V.
Abstract
Mitral regurgitation (MR) is the second most prevalent heart valve disease
requiring surgery. Despite the evidence of unfavourable prognosis, around
half of patients with severe MR are not referred for surgery due to high
per-operative risk. MitraClip (Abbott Vascular-Structural Heart, Menlo
Park, California, United States) implantation is an emerging percutaneous
technique with edge-to-edge MV repair inspired by the Alfieri surgery.
Favourable safety profile together with improvement of functional status
and decrease of MR severity in high-surgical-risk patients have been
demonstrated in randomized clinical trials and "real-world" registries for
both primary and secondary MR. Our own data confirmed its safety and
efficacy comparing to minimally invasive MV surgery in treatment of
functional MR in population with severe systolic heart failure. Copyright
&#xa9; 2017 The Czech Society of Cardiology

<44>
Accession Number
614514320
Author
Shadvar K.; Sanaie S.; Mahmoodpoor A.; Safarpoor M.; Nagipour B.
Institution
(Shadvar) Fellowship of Critical Care Medicine, Cardiovascular Research
Center, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Sanaie) Lung Disease and Tuberculosis Research Center, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Mahmoodpoor) Fellowship of Critical Care Medicine, Department of
Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
(Safarpoor) Student Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Nagipour) Fellowship of Cardiac Anesthesia, Department of Anesthesiology,
Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of
Title
The effect of bilateral intrapleural infusion of lidocaine with fentanyl
versus only lidocaine in relieving pain after coronary artery bypasses
surgery.
Source
Pakistan Journal of Medical Sciences. 33 (1) (pp 177-181), 2017. Date of
Publication: January-February 2017.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Background and Objective: Pain control during surgery in order to cause
analgesia and reduce the somatic and autonomic response may decrease the
morbidity. Intrapleural catheter embedding during surgery under direct
vision of surgeon is safe and easy and without potential risk of thoracic
epidural block. The aim of this study was to investigate the effect of
bilateral intrapleural infusion of lidocaine with fentanyl versus only
lidocaine in relieving pain after coronary artery bypass surgery. Methods:
In this prospective randomized double blind clinical trial,130 adult
patients undergoing elective CABG with age range of 20 to 60 years were
divided into two groups receiving either lidocaine and fentanyl (group A)
or lidocaine (group B). The analgesia was evaluated every two hours in all
intubated and non-intubated patients using Visual analog scale (VAS) and
data were analyzed using SPSS software package. Results: Of all patients,
67 (51.5%) were males and 63 (48.5%) were females. The average age of
subjects was 53.49 +/- 5.099 years. Mean pain score six hours after the
surgery was statistically different between the groups at all times.
Conclusion: The pain in patients receiving combination of lidocaine and
fentanyl is less than patients receiving only lidocaine. Copyright &#xa9;
2017, Professional Medical Publications. All rights reserved.

<45>
Accession Number
613453923
Author
Novobilsky K.; Kryza R.; Cerny P.; Horak I.; Kaucak V.; Mrozek J.; Stipal
R.
Institution
(Novobilsky, Kryza, Cerny, Horak, Kaucak, Mrozek, Stipal) Department of
Cardiology, Municipal Hospital Ostrava, Czech Republic
Title
Early discharge (48-72 hours) after acute st-segment elevation myocardial
infarction: Interim results of the open, randomized, monocentric study.
Source
Lekar a Technika. 46 (2) (pp 55-60), 2016. Date of Publication: 2016.
Publisher
Czech Medical Association J.E. Purkyne (E-mail:
andrea.opletalova@meditorial.cz)
Abstract
Authors present the interim analysis of open, prospective, randomized
study, comparing the strategy of early (48-72 hours) and standard (after
72 hours) discharge in low risk patients after myocardial infarction with
ST-segment elevation (STEMI), treated with successful primary percutaneous
coronary intervention (PCI). 91 patients (22.5% of all STEMI patients
admitted within the period between October 15, 2013 and October 6, 2015),
who fulfilled given inclusion criteria of low risk, were randomly assigned
to two groups in a 1: 1 ratio. The primary end point was the composite of
death, myocardial infarction (MI), unstable angina, stroke, unplanned
rehospitalization, repeated target vessel revascularization, stent
thrombosis within 90-day follow-up. The length of stay was significantly
shorter in the intervention group (63.0 +/- 7.8 h vs. 91.1 +/- 11.9 h, p <
0.0001). The primary end point at 3 months occurred in 3 patients assigned
to intervention group as compared to 2 patients assigned to control group
(6.4% vs. 4.5%, p = 1.0 for non-inferiority). There were no significant
differences in the incidence rates of individual components of the primary
end point at 90 days. Presented interim data of the study support the
claim that early discharge (48-72 hours) in selected patients after STEMI,
treated with successful primary PCI, is possible and safe, with the
results comparable to the later discharge, realized in compliance with
current guidelines and present everyday clinical practice. Copyright
&#xa9; 2016, Czech Medical Association J.E. Purkyne. All rights reserved.

<46>
Accession Number
613626628
Author
Hatemi A.C.; Ceviker K.; Tongut A.; Ozgol I.; Mert M.; Kaya A.
Institution
(Hatemi, Mert) Department of Cardiovascular Surgery, Institute of
Cardiology, Istanbul University, Istanbul, Turkey
(Ceviker, Ozgol) Department of Cardiovascular Surgery, Faculty of
Medicine, Suleyman Demirel University, Isparta, Turkey
(Tongut) Pediatric Cardiac Surgery Clinic, Kartal Kosuyolu YIEAH,
Istanbul, Turkey
(Kaya) Division of Biochemistry, Institute of Cardiology, Istanbul
University, Istanbul, Turkey
Title
Oxidant Status following Cardiac Surgery with Phosphorylcholine-Coated
Extracorporeal Circulation Systems.
Source
Oxidative Medicine and Cellular Longevity. 2016 (no pagination), 2016.
Article Number: 3932092. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Introduction. Extracorporeal circulation (ECC) related systemic oxidative
stress is a well-known entity but the underlying mechanisms are not
clearly described. Our aim was to investigate the relation between the
oxidative stress indices, inflammatory markers, and
phosphorylcholine-coated (PCC) ECC systems. Patients and Methods.
Thirty-two consecutive coronary artery bypass grafting (CABG) cases were
randomly assigned to Group I (PCC, n=18) and Group II (noncoated, n=14)
ECC circuits. Total Antioxidant Status (TAS), Total Oxidant Status (TOS),
Tumor Necrosis Factor-alpha (TNF-alpha), Interleukin-1beta (IL-beta),
Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10), and
Procalcitonin (PCT) levels were measured at 5 different time points. The
association between the oxidative indices levels and PCC system used was
analyzed. Results. In Group I TOS and TAS statuses were increased at T1,
T2, T3, and T4, while IL-10 and TNF-alpha levels accompanied those raises
only at T2 (Group I-Group II, 4.73+/-2.04 versus 2.79+/-0.63, p=0.002, and
30.56+/-8.11 versus 23.97+/-7.8, p=0.031, resp.). In contrast, mean TAS
and TOS levels were similar to baseline at all time points in Group II but
IL-6 and IL-8 levels were increased at T2 (Group I-Group II, 16.84+/-5.63
versus 44.81+/-17.0, p=0.001, and 38.88+/-9.8 versus 46.14+/-9.25,
p=0.038, resp.). Conclusion. Even coated ECC systems are still incapable
of attenuating the inflammatory response to cardiopulmonary bypass (CPB).
Copyright &#xa9; 2016 Ali Can Hatemi et al.

<47>
[Use Link to view the full text]
Accession Number
53231907
Author
Lu C.; Qin F.; Yan Y.; Liu T.; Li J.; Chen H.
Institution
(Lu, Qin, Yan, Liu, Chen) Division of Cardiology, Chengdu First People's
Hospital, 18 North Wan Xiang Road, High-Tech District, Chengdu 610016,
China
(Li) Department of Evidence-Based Medicine, West China Hospital, Sichuan
University, Chengdu, China
Title
Immunosuppressive treatment for myocarditis: A meta-analysis of randomized
controlled trials.
Source
Journal of Cardiovascular Medicine. 17 (8) (pp 631-637), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Immunosuppressive treatment for myocarditis is controversial. Several
small-scale randomized controlled trials (RCTs) reported inconsistent
outcomes for patients with myocarditis. Methods We searched on the
Medline, Embase, and Cochrane databases for articles in English language
between January 1966 and May 2013, as well as on the China National
Knowledge Internet (CNKI, 1979 to May 2012) and the Chinese Biomedical
Literature Database (CBM, 1978 to May 2013) for articles in Chinese
language. Statistical analysis was performed using Review Manager 5.0.
Results Nine articles were finally selected, in which 342 patients were in
immunosuppressive treatment group and 267 patients in conventional
treatment group. The immunosuppressive treatment group showed a
significant improvement in left ventricular ejection fraction at both
short-term (<3 months) [difference: 0.08, 95% confidence interval (CI):
0.05-0.10) and long-term (difference: 0.10, 95% CI: 0.00-0.21)] follow-up.
Moreover, left ventricular end-diastolic dimension decreased significantly
in the immunosuppressive treatment group after short-term follow-up
(difference:-1.85 mm, 95% CI:-3.18 to-0.52 mm), but a long-term beneficial
effect was not sustained (difference:-5.79 mm, 95% CI:-15.30 to 3.72 mm).
There was no difference, however, between the two groups in the rate of
death or heart transplantation (odds ratio: 1.33, 95% CI: 0.77, 2.31).
Conclusion Immunosuppressive treatment might be beneficial for improving
left ventricular systolic function and remodeling in patients with
myocarditis, which could be considered as a therapeutic alternative when
optimal conventional therapy is not effective. More large RCTs, however,
are required. Copyright &#xa9; 2016 Italian Federation of Cardiology.

<48>
[Use Link to view the full text]
Accession Number
607997926
Author
D'Ascenzo F.; Abu-Assi E.; Raposeiras-Roubin S.; Henriques J.P.S.; Saucedo
J.; Gonzalez-Juanatey J.R.G.; Wilton S.B.; Kikkert W.J.; Nunez-Gil I.;
Ariza-Sole A.; Song X.; Alexopoulos D.; Liebetrau C.; Kawaji T.; Moretti
C.; Huczek Z.; Nie S.-P.; Fujii T.; Correia L.C.; Kawashiri M.-A.;
Garcia-Acuna J.M.; Southern D.; Alfonso E.; Terol B.; Garay A.; Zhang D.;
Chen Y.; Xanthopoulou I.; Osman N.; Mollmann H.; Shiomi H.; Giordana F.;
Scarano S.; Gaita F.; Kowara M.; Filipiak K.J.; Wang X.; Yan Y.; Fan
J.-Y.; Ikari Y.; Nakahayshi T.; Sakata K.; Yamagishi M.; Kalpak O.; Kedev
S.
Institution
(D'Ascenzo, Moretti, Giordana, Scarano, Gaita) Dipartimento di Scienze
Mediche, Divisione di Cardiologia, University of Turin, Citta della Salute
e della Scienza, Corso Bramante 88/90, Torino 10126, Italy
(Abu-Assi, Raposeiras-Roubin, Gonzalez-Juanatey, Garcia-Acuna) University
Clinical Hospital, Santiago de Compostela, Spain
(Henriques, Kikkert) University Academic Medical Center, Amsterdam,
Netherlands
(Saucedo) NorthShore University Hospital, Chicago, IL, United States
(Wilton, Southern) Libin Cardiovascular Institute of Alberta, Calgary, AB,
Canada
(Nunez-Gil, Alfonso) San Carlos Hospital, Madrid, Spain
(Ariza-Sole, Garay) Bellvitge Hospital, Barcelona, Spain
(Song, Zhang, Chen) Anzhen Hospital, Beijing, China
(Alexopoulos, Xanthopoulou) University Patras Hospital, Athens, Greece
(Liebetrau, Osman, Mollmann) Kerckhoff Heart and Thorax Center, Frankfurt,
Germany
(Kawaji, Shiomi) University Clinical Hospital, Kyoto, Japan
(Huczek, Kowara, Filipiak) University Clinical Hospital, Warsaw, Poland
(Nie, Wang, Yan, Fan) Institute of Heart, Lung and Blood Vessel Disease,
Beijing, China
(Fujii, Ikari) Tokai University School of Medicine, Tokyo, Japan
(Correia) University Bahian Medical School, Salvador, Brazil
(Kawashiri, Nakahayshi, Sakata, Yamagishi) Division of Cardiovascular
Medicine, Kanazawa University Graduate, School of Medicine, Kanazawa,
Japan
(Kalpak, Kedev) University Clinic of Cardiology, Skopje, Macedonia
Title
BleeMACS: Rationale and design of the study.
Source
Journal of Cardiovascular Medicine. 17 (10) (pp 744-749), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Bleeding events after an acute coronary syndrome have a
negative impact on prognosis. Available risk scores are limited by
suboptimal accuracy, prediction of only in-hospital events and absence of
patients treated with new antiplatelet agents in the current era of
widespread use of percutaneous coronary intervention. Design The BleeMACS
(Bleeding complications in a Multicenter registry of patients discharged
after an Acute Coronary Syndrome) project is a multicenter
investigatorinitiated international retrospective registry that enrolled
more than 15 000 patients discharged with a definitive diagnosis of acute
coronary syndrome and treated with percutaneous revascularization. The
primary end point is the incidence of major bleeding events requiring
hospitalization and/or red cell transfusion concentrates within 1 year. An
integer risk score for bleeding within the first year after hospital
discharge will be developed from a multivariate competing-risks
regression. Conclusion The BleeMACS registry collaborative will allow
development and validation of a risk score for prediction of major
bleeding during follow-up for patients receiving contemporary therapies
for acute coronary syndrome. Copyright &#xa9; 2016 Italian Federation of
Cardiology.

<49>
Accession Number
613544518
Author
Stone G.W.; Sabik J.F.; Serruys P.W.; Simonton C.A.; Genereux P.; Puskas
J.; Kandzari D.E.; Morice M.-C.; Lembo N.; Brown W.M.; Taggart D.P.;
Banning A.; Merkely B.; Horkay F.; Boonstra P.W.; Van Boven A.J.; Ungi I.;
Bogats G.; Mansour S.; Noiseux N.; Sabate M.; Pomar J.; Hickey M.;
Gershlick A.; Buszman P.; Bochenek A.; Schampaert E.; Page P.; Dressler
O.; Kosmidou I.; Mehran R.; Pocock S.J.; Kappetein A.P.
Institution
(Stone) New York Presbyterian Hospital, Columbia University Medical
Center, New York, United States
(Stone, Genereux, Dressler, Kosmidou, Mehran) Cardiovascular Research
Foundation, New York, United States
(Puskas, Mehran) Mount Sinai Medical Center, New York, United States
(Sabik) Cleveland Clinic Foundation, Cleveland, United States
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Taggart, Banning) Oxford University Hospitals, Oxford, United Kingdom
(Hickey, Gershlick) University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Genereux, Schampaert, Page) Hopital du Sacre-Coeur de Montreal, Montreal,
Canada
(Mansour, Noiseux) Centre Hospitalier de L'Universite de Montreal, Hopital
Hotel-Dieu de Montreal, Montreal, Canada
(Kandzari, Lembo, Brown) Piedmont Hospital, Atlanta, United States
(Morice) Ramsay Generale de Sante, Hopital Prive Jacques Cartier, Massy,
France
(Merkely, Horkay) Semmelweis University, Budapest, Hungary
(Ungi, Bogats) University of Szeged, Szeged, Hungary
(Boonstra, Van Boven) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Sabate, Pomar) Hospital Clinic, Barcelona, Spain
(Buszman, Bochenek) Medical University of Silesia, Katowice, Poland
(Buszman, Bochenek) American Heart of Poland, Ustron, Poland
Title
Everolimus-eluting Stents or bypass surgery for left main coronary artery
disease.
Source
New England Journal of Medicine. 375 (23) (pp 2223-2235), 2016. Date of
Publication: 08 Dec 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Patients with obstructive left main coronary artery disease are
usually treated with coronary-artery bypass grafting (CABG). Randomized
trials have suggested that drug-eluting stents may be an acceptable
alternative to CABG in selected patients with left main coronary disease.
METHODS We randomly assigned 1905 eligible patients with left main
coronary artery disease of low or intermediate anatomical complexity to
undergo either percutaneous coronary intervention (PCI) with
fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group,
948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was
assessed at the sites and defined by a Synergy between Percutaneous
Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32
or lower (the SYNTAX score reflects a comprehensive angiographic
assessment of the coronary vasculature, with 0 as the lowest score and
higher scores [no upper limit] indicating more complex coronary anatomy).
The primary end point was the rate of a composite of death from any cause,
stroke, or myocardial infarction at 3 years, and the trial was powered for
noninferiority testing of the primary end point (noninferiority margin,
4.2 percentage points). Major secondary end points included the rate of a
composite of death from any cause, stroke, or myocardial infarction at 30
days and the rate of a composite of death, stroke, myocardial infarction,
or ischemia-driven revascularization at 3 years. Event rates were based on
Kaplan-Meier estimates in time-to-first-event analyses. RESULTS At 3
years, a primary end-point event had occurred in 15.4% of the patients in
the PCI group and in 14.7% of the patients in the CABG group (difference,
0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage
points; P = 0.02 for noninferiority; hazard ratio, 1.00; 95% confidence
interval, 0.79 to 1.26; P = 0.98 for superiority). The secondary end-point
event of death, stroke, or myocardial infarction at 30 days occurred in
4.9% of the patients in the PCI group and in 7.9% in the CABG group
(P<0.001 for noninferiority, P = 0.008 for superiority). The secondary
end-point event of death, stroke, myocardial infarction, or
ischemia-driven revascularization at 3 years occurred in 23.1% of the
patients in the PCI group and in 19.1% in the CABG group (P = 0.01 for
noninferiority, P = 0.10 for superiority). CONCLUSIONS In patients with
left main coronary artery disease and low or intermediate SYNTAX scores by
site assessment, PCI with everolimus-eluting stents was noninferior to
CABG with respect to the rate of the composite end point of death, stroke,
or myocardial infarction at 3 years. Copyright &#xa9; 2016 Massachusetts
Medical Society.

<50>
[Use Link to view the full text]
Accession Number
607382573
Author
Usmiani T.; Andreis A.; Budano C.; Sbarra P.; Andriani M.; Garrone P.;
Fanelli A.L.; Calcagnile C.; Bergamasco L.; Biancone L.; Marra S.
Institution
(Usmiani, Andreis, Budano, Sbarra, Andriani, Garrone, Fanelli, Calcagnile,
Marra) Cardiovascular and Thoracic Department, A.O.U. Citta della Salute e
della Scienza di Torino-Molinette, Corso Bramante 88, Turin 10126, Italy
(Bergamasco) Department of Surgical Sciences, University of Torino, Turin,
Italy
(Biancone) Nephrology Department, A.O.U. Citta della Salute e della
Scienza di Torino-Molinette, Turin, Italy
Title
AKIGUARD (Acute Kidney Injury GUARding Device) trial: In-hospital and
one-year outcomes.
Source
Journal of Cardiovascular Medicine. 17 (7) (pp 530-537), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims: Contrast-induced acute kidney injury (CIAKI) in patients with
chronic kidney disease undergoing coronary angiography or percutaneous
coronary intervention is a common iatrogenic complication associated with
increased morbidity and mortality. This study compares sodium
bicarbonate/isotonic saline/N-acetylcysteine/vitamin C prophylaxis
(BS-NAC) against high-volume forced diuresis with matched hydration in
CIAKI prevention. Methods: One-hundred and thirty-three consecutive
patients undergoing coronary angiography or percutaneous coronary
intervention with estimated glomerular filtration rate less than 60
mL/min/1.73m² were randomized to the study group receiving
matched hydration (MHG) or to the control group receiving BS-NAC. MHG
received in vein (i.v.) 250 mL isotonic saline bolus, followed by a 0.5
mg/kg furosemide i.v. bolus to forced diuresis. A dedicated device
automatically matched the isotonic saline i.v. infusion rate to the
urinary output for 1 h before, during and 4 h after the procedure.
Results: MHG had the lowest incidence of CIAKI (7 vs. 25%, P = 0.01),
major adverse cardiac and cerebrovascular events at 1 year (7 vs. 32%, P <
0.01) and readmissions to cardiology/nephrology departments (8 vs. 25%, P
= 0.03; hospitalization days 1.0 +/- 3.8 vs. 4.9 +/- 12.5, P = 0.01).
Three months after the procedure the decrease in the estimated glomerular
filtration rate was 0.02% for MHG versus 15% for the control group.
Conclusion: Matched hydration was more effective than BS-NAC in CIAKI
prevention. One-year follow-up showed that matched hydration was
associated also with limited chronic kidney disease progression, major
adverse cardiac and cerebrovascular events and hospitalizations. Copyright
&#xa9; 2016 Italian Federation of Cardiology. All rights reserved.

<51>
Accession Number
614595135
Author
Phrommintikul A.; Krittayaphong R.; Wongcharoen W.; Boonyaratavej S.;
Wongvipaporn C.; Tiyanon W.; Dinchuthai P.; Kunjara-Na-Ayudhya R.;
Tatsanavivat P.; Sritara P.
Institution
(Phrommintikul, Wongcharoen) Department of Internal Medicine, Faculty of
Medicine, Chiang Mai University, Chiang Mai, Thailand
(Krittayaphong) Department of Medicine, Faculty of Medicine, Siriraj
Hospital, Mahidol University, Bangkok 10700, Thailand
(Boonyaratavej) Department of Medicine, Faculty of Medicine, Chulalongkorn
University, Bangkok, Thailand
(Wongvipaporn, Tatsanavivat) Department of Medicine, Faculty of Medicine,
Khon Kaen University, Khon Kaen, Thailand
(Tiyanon) Department of Medicine, Phramongkutklao College of Medicine,
Bangkok, Thailand
(Dinchuthai) Faculty of Medicine, Burapha University, Chonburi, Thailand
(Kunjara-Na-Ayudhya) Vichaiyut Hospital and Medical Center, Bangkok,
Thailand
(Sritara) Department of Medicine, Faculty of Medicine, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
Title
Management and risk factor control of coronary artery disease in elderly
versus nonelderly: A multicenter registry.
Source
Journal of Geriatric Cardiology. 13 (12) (pp 954-959), 2016. Date of
Publication: 2016.
Publisher
Science Press (E-mail: shengtaixuebao@mail.rcees.ac.cn)
Abstract
Background Coronary artery disease (CAD) is a leading cause of death in
elderly because aging is the important non-modifiable risk factors of
atherosclerosis and also a predictor of poor outcomes. Underuse of
guideline directed therapy may contribute to suboptimal risk factor
control and worse outcomes in the elderly. We aimed to explore the
management of CAD, risk factors control as well as goal attainment in
elderly compared to nonelderly CAD patients. Methods The CORE-Thailand is
an ongoing multicenter, prospective, observational registry of patients
with high atherosclerotic risk in Thailand. The data of 4120 CAD patients
enrolled in this cohort was analyzed comparing between the elderly (age >
65 years) vs. nonelderly (age < 65 years). Results There were 2172 elderly
and 1948 nonelderly patients. The elderly CAD patients had higher
prevalence of hypertension, dyslipidemia, atrial fibrillation and chronic
kidney disease. The proportion of patients who received coronary
revascularization was not different between the elderly and nonelderly CAD
patients. Antiplatelets were prescribed less in the elderly while statin
was prescribed in the similar proportion. Goal attainments of risk factor
control of glycemic control, low density lipoprotein cholesterol, and
smoking cessation except the blood pressure goal were higher in the
elderly CAD patients. Conclusions The CORE-Thailand registry showed the
equity in the treatment of CAD between elderly and non-elderly. Elderly
CAD patients had higher rate of goal attainment in risk factor control
except blood pressure goal. The effects of goal attainment on
cardiovascular outcomes will be demonstrated from ongoing cohort.
Copyright &#xa9; 2016 JGC All rights reserved.

<52>
Accession Number
613337945
Author
Mishra B.; Gupta A.; Sagar S.; Singhal M.; Kumar S.
Institution
(Mishra, Gupta, Sagar, Singhal, Kumar) Division of Trauma Surgery &
Critical Care, JPN Apex Trauma Centre, All India Institute of Medical
Sciences, New Delhi, India
Title
Traumatic cardiac injury: Experience from a level-1 trauma centre.
Source
Chinese Journal of Traumatology - English Edition. 19 (6) (pp 333-336),
2016. Date of Publication: 01 Dec 2016.
Publisher
Elsevier B.V.
Abstract
Purpose Traumatic cardiac injury (TCI) is a challenge for trauma surgeons
as it provides a short therapeutic window and the management is often
dictated by the underlying mechanism and hemodynamic status. The current
study is to evaluate the factors influencing the outcome of TCI. Methods
Prospectively maintained database of TCI cases admitted at a Level-1
trauma center from July 2008 to June 2013 was retrospectively analyzed.
Hospital records were reviewed and statistical analysis was performed
using the SPSS version 15. Results Out of 21 cases of TCI, 6 (28.6%) had
isolated and 15 (71.4%) had associated injuries. Ratio between blunt and
penetrating injuries was 2:1 with male preponderance. Mean ISS was 31.95.
Thirteen patients (62%) presented with features suggestive of shock.
Cardiac tamponade was present in 12 (57%) cases and pericardiocentesis was
done in only 6 cases of them. Overall 19 patients underwent surgery.
Perioperatively 8 (38.1%) patients developed cardiac arrest and 7
developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality
was related to cardiac arrest (p = 0.014), arrhythmia (p = 0.014), and
hemorrhagic shock (p = 0.04). The diagnostic accuracy of focused
assessment by sonography in trauma (FAST) was 95.24%. Conclusion High
index of clinical suspicion based on the mechanism of injury, meticulous
examination by FAST and early intervention could improve the overall
outcome. Copyright &#xa9; 2016 Daping Hospital and the Research Institute
of Surgery of the Third Military Medical University

<53>
Accession Number
612636007
Author
Ando T.; Briasoulis A.; Holmes A.A.; Takagi H.; Slovut D.P.
Institution
(Ando) Department of Internal Medicine, Mount Sinai Beth Israel, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Briasoulis) Division of Cardiology, Wayne State University/Detroit
Medical Center, Detroit, MI, United States
(Holmes) Leon H. Charney Division of Cardiology, NYU Langone Medical
Center, New York, NY, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Slovut) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, Bronx, NY, United
States
(Slovut) Division of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
Title
Percutaneous versus surgical cut-down access in transfemoral transcatheter
aortic valve replacement: A meta-analysis.
Source
Journal of Cardiac Surgery. 31 (12) (pp 710-717), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The transfemoral (TF) approach has become the preferred
approach for transcatheter aortic valve replacement (TAVR) because of its
low risk profile. However, the relative safety of the percutaneous
approach (PC) compared to surgical cut-down (SC) remains unclear. Our aim
was to compare the outcomes between PC versus SC access in patients
undergoing TF-TAVR using a meta-analysis. Methods: We conducted a
systematic electronic database search for studies reporting major and
minor vascular complications (VC), major and minor bleeding, and
perioperative all-cause mortality, in PC versus SC TF-TAVR cases.
Complications were reported based on the Valve Academic Research
Consortium criteria. A random-effects model was used to calculate odds
ratios and 95% confidence intervals. Results: Eight observational cohort
studies and one randomized control trial (2513 patients in PC and 1767
patients in SC) were included in the analysis. Major and minor VC, as well
as bleeding complications, were comparable between the two approaches. The
need for surgical intervention for VC was comparable between PC and SC.
There was no difference in perioperative all-cause mortality. Conclusions:
PC and SC have similar safety profiles and outcomes when used
appropriately in selected patients. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<54>
Accession Number
613811082
Author
Gibson C.M.; Mehran R.; Bode C.; Halperin J.; Verheugt F.W.; Wildgoose P.;
Birmingham M.; Ianus P.J.; Burton P.; Van Eickels M.; Korjian S.; Daaboul
Y.; Lip G.Y.H.; Cohen M.; Husted S.; Peterson E.D.; Fox A.K.
Institution
(Gibson, Korjian, Daaboul) Cardiovascular Division, Department of
Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, United States
(Mehran, Halperin) Cardiovascular Institute, Mount Sinai Medical Center,
Icahn School of Medicine, Mount Sinai, NY, United States
(Bode) Heart Center, Department for Cardiology and Angiology I, University
of Freiburg, Freiburg, Germany
(Verheugt) Bayer Pharmaceuticals, Leverkusen (M.E.), Germany
(Wildgoose, Birmingham, Ianus, Burton) Onze Lieve Vrouwe Gasthuis
Amsterdam, Janssen Pharmaceuticals, Titusville, United States
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Newark,
NJ, United States
(Lip) University of Birmingham Institute of Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom
(Husted) Aarhus University Hospital, Medical Department, Hospital Unit
West, Herning, Denmark
(Peterson) Duke Clinical Research Institute, Durham, NC, United States
(Van Eickels, Fox) Centre for Cardiovascular Science, University of
Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
(Gibson) Harvard Medical School, Beth Israel Deaconess Medical Center, 330
Brookline Ave., Overland 540, MA 02215, United States
Title
Prevention of bleeding in patients with atrial fibrillation undergoing
PCI.
Source
New England Journal of Medicine. 375 (25) (pp 2423-2434), 2016. Date of
Publication: 22 Dec 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In patients with atrial fibrillation undergoing percutaneous
coronary intervention (PCI) with placement of stents, standard
anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy
(DAPT) with a P2Y12 inhibitor and aspirin reduces the risk of thrombosis
and stroke but increases the risk of bleeding. The effectiveness and
safety of anticoagulation with rivaroxaban plus either one or two
antiplatelet agents are uncertain. METHODS We randomly assigned 2124
participants with nonvalvular atrial fibrillation who had undergone PCI
with stenting to receive, in a 1:1:1 ratio, low-dose rivaroxaban (15 mg
once daily) plus a P2Y12 inhibitor for 12 months (group 1), very-low-dose
rivaroxaban (2.5 mg twice daily) plus DAPT for 1, 6, or 12 months (group
2), or standard therapy with a doseadjusted vitamin K antagonist (once
daily) plus DAPT for 1, 6, or 12 months (group 3).The primary safety
outcome was clinically significant bleeding (a composite of major bleeding
or minor bleeding according to Thrombolysis in Myocardial Infarction
[TIMI] criteria or bleeding requiring medical attention). RESULTS The
rates of clinically significant bleeding were lower in the two groups
receiving rivaroxaban than in the group receiving standard therapy (16.8%
in group 1, 18.0% in group 2, and 26.7% in group 3; hazard ratio for group
1 vs. group 3, 0.59; 95% confidence interval [CI], 0.47 to 0.76; P<0.001;
hazard ratio for group 2 vs. group 3, 0.63; 95% CI, 0.50 to 0.80;
P<0.001). The rates of death from cardiovascular causes, myocardial
infarction, or stroke were similar in the three groups (Kaplan-Meier
estimates, 6.5% in group 1, 5.6% in group 2, and 6.0% in group 3; P values
for all comparisons were nonsignificant). CONCLUSIONS In participants with
atrial fibrillation undergoing PCI with placement of stents, the
administration of either low-dose rivaroxaban plus a P2Y12 inhibitor for
12 months or very-lowdose rivaroxaban plus DAPT for 1, 6, or 12 months was
associated with a lower rate of clinically significant bleeding than was
standard therapy with a vitamin K antagonist plus DAPT for 1, 6, or 12
months. The three groups had similar efficacy rates, although the observed
broad confidence intervals diminish the surety of any conclusions
regarding efficacy. (Funded by Janssen Scientific Affairs and Bayer
Pharmaceuticals; PIONEER AF-PCI ClinicalTrials.gov number, NCT01830543.)
Copyright &#xa9; 2016 Massachusetts Medical Society. All rights reserved.

<55>
Accession Number
614667158
Author
Crucitti P.; Mangiameli G.; Petitti T.; Condoluci A.; Rocco R.; Gallo
I.F.; Longo F.; Rocco G.
Institution
(Crucitti, Mangiameli, Condoluci, Rocco, Gallo, Longo) Section of Thoracic
Surgery, Department of Vascular Surgery, Campus Bio-Medico University of
Rome, Rome, Italy
(Petitti) Department of Public Health, Hygiene and Statistics, Campus
Bio-Medico University of Rome, Rome, Italy
(Rocco) Department of Thoracic Surgery and Oncology, Division of Thoracic
Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Napoli,
Italy
Title
Does prophylactic ligation of the thoracic duct reduce chylothorax rates
in patients undergoing oesophagectomy? A systematic review and
meta-Analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (6) (pp 1-6), 2016. Date
of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
A systematic review of English and non-English articles using OVID MEDLINE
(1980-2014) was performed to evaluate the potential value of prophylactic
ligation of the thoracic duct in preventing chylous leakage after
oesophagectomy for cancer. Search terms included [Oesophagectomy OR
esophagectomy] AND [chylothorax] AND [thoracic duct ligation]. Only those
papers that directly compared the incidence of chylothorax in patients who
underwent prophylactic ligation [ligation group (LG)] with that in those
who had conservative treatment were selected [preservation group (PG)];
all the articles presenting original data and supplying sufficient
information on the chylothorax rate after oesophagectomy were included.
Independent extraction of articles was performed by two authors using
predefined data fields, including study quality indicators. The PRISMA
guidelines were carefully adhered to. A total of 5254 subjects were
included in the 7 clinical studies examined into the current
meta-analysis. Of these, 2179 patients underwent prophylactic ligature of
the thoracic duct (LG group) and 3075 had preservation of the thoracic
duct (PG group). A significant difference in terms of chylothorax rate
[odd ratios (ORs) 0.47 in favour of LG, 95% confidence interval (CI)
0.27-0.80] was noted between the LG group and the PG group. According to
our meta-analysis and taking into account-specific caveats, prophylactic
ligation of the thoracic duct could be considered as an effective
preventative measure to reduce the incidence of postoperative chylothorax.
Copyright &#xa9; The Author 2016.

<56>
Accession Number
610080794
Author
Rasmussen L.A.; Ryhammer P.K.; Greisen J.; Bhavsar R.R.; Lorentzen A.-G.;
Jakobsen C.-J.
Institution
(Rasmussen, Ryhammer, Greisen, Bhavsar, Lorentzen, Jakobsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle
Juel-Jensens Boulevard 99, Aarhus, N 8200, Denmark
Title
Ultrashort acting remifentanil is not superior to long-acting sufentanil
in preserving cognitive function - A randomized study.
Source
Journal of Clinical Anesthesia. 33 (pp 127-134), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Postoperative cognitive dysfunction (POCD) is a well-known
complication after cardiac surgery and may cause permanent disabilities
with severe consequences for quality of life. The objectives of this study
were, first, to estimate the frequency of POCD after on-pump cardiac
surgery in patients randomized to remifentanil- or sufentanil-based
anesthesia and, second, to evaluate the association between POCD and
quality of recovery and perioperative hemodynamics, respectively. Design
Randomized study. Setting Postoperative cardiac recovery unit, University
Hospital. Patients Sixty patients with ischemic heart disease scheduled
for elective coronary artery bypass grafting +/- aortic valve replacement.
Interventions and handling Randomized to either remifentanil or sufentanil
anesthesia as basis opioid. Postoperative pain management consisted of
morphine in both groups. Measurements Cognitive functioning evaluated
preoperatively and on the 1st, 4th, and 30th postoperative day using the
cognitive test from the Palo Alto Veterans Affairs Hospital. Perioperative
invasive hemodynamics and the quality of recovery was evaluated by means
of invasive measurements and an intensive care unit discharge score. Main
results No difference between opioids in POCD at any time. A negative
correlation was found between preoperative cognitive function and POCD on
the first postoperative day (r = - 0.47; P =.0002). The fraction of
patients with POCD on the first postoperative day was statistically
greater in patients with more than 15 minutes of Svo<inf>2</inf> < 60 (P
=.037; chi² test). Among patients with postoperative
ventilation time exceeding 300 minutes, more patients had POCD on
postoperative day 4 (P =.002). Conclusions We could not demonstrate
differences in POCD between remifentanil and sufentanil based anaesthesia,
but in general, the fraction of patients with POCD seemed smaller than
previously reported. We found an association between POCD and both
perioperative low Svo<inf>2</inf> and postoperative ventilation time,
underlining the importance of perioperative stable hemodynamics and
possible fast-track protocols with short ventilation times to attenuate
POCD. Copyright &#xa9; 2016 Elsevier Inc. All rights reserved.

<57>
Accession Number
609833350
Author
Amann M.; Ferenc M.; Valina C.M.; Bomicke T.; Stratz C.; Leggewie S.;
Trenk D.; Neumann F.-J.; Hochholzer W.
Institution
(Amann, Ferenc, Valina, Bomicke, Stratz, Leggewie, Trenk, Neumann,
Hochholzer) Department of Cardiology and Angiology II, University Heart
Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
Title
Validation of a P2Y<inf>12</inf>-receptor specific whole blood platelet
aggregation assay.
Source
Platelets. 27 (7) (pp 668-672), 2016. Date of Publication: 02 Oct 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Testing of P2Y<inf>12</inf>-receptor antagonist effects can support
clinical decision-making. However, most platelet function assays use only
ADP as agonist which is not P2Y<inf>12</inf>-receptor specific. For this
reason P2Y<inf>12</inf>-receptor specific assays have been developed by
adding prostaglandin E1 (PGE1) to reduce ADP-induced platelet activation
via the P2Y<inf>1</inf>-receptor. The present study sought to evaluate a
P2Y<inf>12</inf>-receptor specific assay for determination of
pharmacodynamic and clinical outcomes. This study enrolled 400 patients
undergoing coronary stenting after loading with clopidogrel or prasugrel.
ADP-induced platelet reactivity was assessed by whole blood aggregometry
at multiple time points with a standard ADP assay (ADPtest) and a
P2Y<inf>12</inf>-receptor specific assay (ADPtest HS, both run on
Multiplate Analyzer, Roche Diagnostics). Patients were clinically followed
for 1 month and all events adjudicated by an independent committee. In
total, 2084 pairs of test results of ADPtest and ADPtest HS were available
showing a strong correlation between results of both assays (r = 0.96, p <
0.001). These findings prevailed in multiple prespecified subgroups (e.g.,
age; body mass index; diabetes). Calculated cutoffs for ADPtest HS and the
established cutoffs of ADPtest showed a substantial agreement for
prediction of ischemic and hemorrhagic events with a Cohen's kappa of 0.66
and 0.66, respectively. The P2Y<inf>12</inf>-receptor specific ADPtest HS
assay appears similarly predictive for pharmacodynamic and clinical
outcomes as compared to the established ADPtest assay indicating its
applicability for clinical use. Further evaluation in large cohorts is
needed to determine if P2Y<inf>12</inf>-receptor specific testing offers
any advantage for prediction of clinical outcome. Copyright &#xa9; 2016
Taylor & Francis.

<58>
Accession Number
609833255
Author
Gurbel P.A.; Bliden K.P.; Tantry U.S.; Monroe A.L.; Muresan A.A.; Brunner
N.E.; Lopez-Espina C.G.; Delmenico P.R.; Cohen E.; Raviv G.; Haugen D.L.;
Ereth M.H.
Institution
(Gurbel, Bliden, Tantry) Inova Heart and Vascular Institute, Falls Church,
VA, United States
(Monroe) Magee Women's Hospital of UPMC, Pittsburgh, PA, United States
(Haugen, Ereth) Mayo Clinic, Rochester, MN, United States
(Muresan, Brunner, Cohen, Raviv) Coramed Technologies, Niles, IL, United
States
(Lopez-Espina, Delmenico) Haemonetics Corporation, Braintree, MA, United
States
Title
First report of the point-of-care TEG: A technical validation study of the
TEG-6S system.
Source
Platelets. 27 (7) (pp 642-649), 2016. Date of Publication: 02 Oct 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Thrombelastography (TEG) measured by the TEG5000 Hemostasis Analyzer is an
established but the labor-intensive method for assessing global
hemostasis. The first true point-of-care TEG, the TEG6s system, uses
resonance-frequency viscoelasticity measurements and a disposable
multi-channel microfluidic cartridge to assess hemostasis and response to
antiplatelet therapy. TEG assays (n = 5,100) were performed on the blood
of healthy volunteers (n = 157) and patients undergoing coronary
revascularization at three hospitals (n = 300). The results from the TEG6s
were compared with the conventional TEG5000 in accordance with Clinical
and Laboratory Standards Institute (CLSI) and FDA recommendations.
Precision testing was conducted using blood from healthy donors, all
assays were run for 5 consecutive days in duplicate using multiple
operators, lots, and instruments. Reference ranges were comparable between
the TEG systems. Deming regression analysis demonstrated a strong
correlation between the two systems for the standard hemostasis tests (R r
= 0.932, MA r = 0.972, LY30 r = 0.938). Method comparison analysis showed
an acceptable agreement between PlateletMapping (PM) assays for measuring
arachidonic acid (indicator of aspirin response)- and adenosine
diphosphate (indicator of P2Y<inf>12</inf> inhibitor response)-induced
platelet aggregation (total agreement = 90%, and 72%, respectively). TEG6s
precision testing yielded low variability (CV 0-13%) in all measures. The
new point-of-care TEG6s is associated with greater ease of use than the
TEG5000 and provides precise results. The results correlated between
methods for all variables. TEG6s is a promising device for near-patient
hemostasis monitoring and future trials of personalized therapy designed
to reduce bleeding and thrombosis. Copyright &#xa9; Taylor & Francis.

<59>
Accession Number
610738814
Author
Michler R.E.; Smith P.K.; Parides M.K.; Ailawadi G.; Thourani V.;
Moskowitz A.J.; Acker M.A.; Hung J.W.; Chang H.L.; Perrault L.P.; Gillinov
A.M.; Argenziano M.; Bagiella E.; Overbey J.R.; Moquete E.G.; Gupta L.N.;
Miller M.A.; Taddei-Peters W.C.; Jeffries N.; Weisel R.D.; Rose E.A.;
Gammie J.S.; DeRose J.J.; Puskas J.D.; Dagenais F.; Burks S.G.; El-Hamamsy
I.; Milano C.A.; Atluri P.; Voisine P.; O'Gara P.T.; Gelijns A.C.
Institution
(Michler, DeRose) Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York,
United States
(Parides, Moskowitz, Chang, Bagiella, Overbey, Moquete, Gupta, Gelijns)
International Center for Health Outcomes and Innovation Research
(InCHOIR), Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., Box 1077, New
York, NY 10029, United States
(Argenziano) Division of Cardiothoracic Surgery, Department of Surgery,
College of Physicians and Surgeons, Columbia University, New York, United
States
(Rose, Puskas) Department of Cardiac Surgery, Mount Sinai Health System,
New York, United States
(Smith, Milano) Division of Cardiovascular and Thoracic Surgery,
Department of Surgery, Duke University Medical Center, Durham, NC, United
States
(Ailawadi, Burks) Division of Thoracic and Cardiovascular Surgery,
University of Virginia, School of Medicine, Charlottesville, United States
(Thourani) Clinical Research Unit, Division of Cardiothoracic Surgery,
Emory University, School of Medicine, Atlanta, United States
(Acker, Atluri) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania, School of Medicine, Philadelphia, United
States
(Hung) Division of Cardiology, Massachusetts General Hospital, Boston,
United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
United States
(Perrault, El-Hamamsy) Montreal Heart Institute, University of Montreal,
Montreal, Canada
(Weisel) Peter Munk Cardiac Centre, Division of Cardiovascular Surgery,
Toronto General Hospital, University Health Network, Division of Cardiac
Surgery, University of Toronto, Toronto, Canada
(Dagenais, Voisine) Institut Universitaire de Cardiologie de Quebec,
Hopital Laval, Quebec, QC, Canada
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, United States
(Miller, Taddei-Peters) Division of Cardiovascular Sciences, United States
(Jeffries) Office of Biostatistics Research, United States
(Gammie) National Heart, Lung, and Blood Institute, Bethesda, MD, United
States
(Gammie) Department of Surgery, University of Maryland Medical Center,
Baltimore, MD, United States
Title
Two-year outcomes of surgical treatment of moderate ischemic mitral
regurgitation.
Source
New England Journal of Medicine. 374 (20) (pp 1932-1941), 2016. Date of
Publication: 19 May 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: In a trial comparing coronary-artery bypass grafting (CABG)
alone with CABG plus mitral-valve repair in patients with moderate
ischemic mitral regurgitation, we found no significant difference in the
left ventricular end-systolic volume index (LVESVI) or survival after 1
year. Concomitant mitral-valve repair was associated with a reduced
prevalence of moderate or severe mitral regurgitation, but patients had
more adverse events. We now report 2-year outcomes. METHODS: We randomly
assigned 301 patients to undergo either CABG alone or the combined
procedure. Patients were followed for 2 years for clinical and
echocardiographic outcomes. RESULTS: At 2 years, the mean (+/-SD) LVESVI
was 41.2+/-20.0 ml per square meter of bodysurface area in the CABG-alone
group and 43.2+/-20.6 ml per square meter in the combined-procedure group
(mean improvement over baseline, -14.1 ml per square meter and -14.6 ml
per square meter, respectively). The rate of death was 10.6% in the
CABG-alone group and 10.0% in the combined-procedure group (hazard ratio
in the combined-procedure group, 0.90; 95% confidence interval, 0.45 to
1.83; P = 0.78). There was no significant between-group difference in the
rank-based assessment of the LVESVI (including death) at 2 years (z score,
0.38; P = 0.71). The 2-year rate of moderate or severe residual mitral
regurgitation was higher in the CABG-alone group than in the
combined-procedure group (32.3% vs. 11.2%, P<0.001). Overall rates of
hospital readmission and serious adverse events were similar in the two
groups, but neurologic events and supraventricular arrhythmias remained
more frequent in the combined-procedure group. CONCLUSIONS: In patients
with moderate ischemic mitral regurgitation undergoing CABG, the addition
of mitral-valve repair did not lead to significant differences in left
ventricular reverse remodeling at 2 years. Mitral-valve repair provided a
more durable correction of mitral regurgitation but did not significantly
improve survival or reduce overall adverse events or readmissions and was
associated with an early hazard of increased neurologic events and
supraventricular arrhythmias. Copyright &#xa9; 2016 Massachusetts Medical
Society.

<60>
Accession Number
610738813
Author
Gillinov A.M.; Bagiella E.; Moskowitz A.J.; Raiten J.M.; Groh M.A.;
Bowdish M.E.; Ailawadi G.; Kirkwood K.A.; Perrault L.P.; Parides M.K.;
Smith R.L.; Kern J.A.; Dussault G.; Hackmann A.E.; Jeffries N.O.; Miller
M.A.; Taddei-Peters W.C.; Rose E.A.; Weisel R.D.; Williams D.L.; Mangusan
R.F.; Argenziano M.; Moquete E.G.; O'Sullivan K.L.; Pellerin M.; Shah
K.J.; Gammie J.S.; Mayer M.L.; Voisine P.; Gelijns A.C.; O'Gara P.T.; Mack
M.J.
Institution
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, NY, United States
(Bagiella, Moskowitz, Kirkwood, Parides, Williams, Moquete, O'Sullivan,
Shah, Gelijns) International Center for Health Outcomes and Innovation
Research, Department of Population Health Science and Policy, Icahn School
of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., Box 1077, New York, NY
10029, United States
(Rose) Department of Cardiac Surgery, Mount Sinai Health System, New York,
United States
(Argenziano) Division of Cardiothoracic Surgery, Department of Surgery,
College of Physicians and Surgeons, New York, United States
(Raiten) Department of Anesthesiology and Critical Care, University of
Pennsylvania, Philadelphia, United States
(Mayer) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania, School of Medicine, Philadelphia, United
States
(Groh, Mangusan) Cardiovascular and Thoracic Surgery, Mission Health and
Hospitals, Asheville, NC, United States
(Bowdish, Hackmann) Department of Surgery, Keck School of Medicine of USC,
University of Southern California, Los Angeles, United States
(Ailawadi, Kern) Division of Thoracic and Cardiovascular Surgery,
University of Virginia, School of Medicine, Charlottesville, United States
(Perrault, Pellerin) Montreal Heart Institute, Universite de Montreal,
Montreal, Canada
(Dussault, Voisine) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Hopital Laval, Quebec, QC, Canada
(Weisel) Peter Munk Cardiac Centre, Division of Cardiovascular Surgery,
Toronto General Hospital, University Health Network, Division of Cardiac
Surgery, University of Toronto, Toronto, Canada
(Smith, Mack) Department of Cardiovascular Surgery, Heart Hospital Baylor
Plano, Baylor Health Care System, Plano, TX, United States
(Jeffries) Office of Biostatistics Research, National Heart, Lung, and
Blood Institute, Bethesda, MD, United States
(Miller, Taddei-Peters) Division of Cardiovascular Sciences, National
Heart, Lung, and Blood Institute, Bethesda, MD, United States
(Gammie) Department of Surgery, University of Maryland Medical Center,
Baltimore, MD, United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
United States
Title
Rate control versus rhythm control for atrial fibrillation after cardiac
surgery.
Source
New England Journal of Medicine. 374 (20) (pp 1911-1921), 2016. Date of
Publication: 19 May 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Atrial fibrillation after cardiac surgery is associated with
increased rates of death, complications, and hospitalizations. In patients
with postoperative atrial fibrillation who are in stable condition, the
best initial treatment strategy - heart-rate control or rhythm control -
remains controversial. METHODS: Patients with new-onset postoperative
atrial fibrillation were randomly assigned to undergo either rate control
or rhythm control. The primary end point was the total number of days of
hospitalization within 60 days after randomization, as assessed by the
Wilcoxon ranksum test. RESULTS: Postoperative atrial fibrillation occurred
in 695 of the 2109 patients (33.0%) who were enrolled preoperatively; of
these patients, 523 underwent randomization. The total numbers of hospital
days in the rate-control group and the rhythm-control group were similar
(median, 5.1 days and 5.0 days, respectively; P = 0.76). There were no
significant between-group differences in the rates of death (P = 0.64) or
overall serious adverse events (24.8 per 100 patient-months in the
rate-control group and 26.4 per 100 patient-months in the rhythm-control
group, P = 0.61), including thromboembolic and bleeding events. About 25%
of the patients in each group deviated from the assigned therapy, mainly
because of drug ineffectiveness (in the rate-control group) or amiodarone
side effects or adverse drug reactions (in the rhythm-control group). At
60 days, 93.8% of the patients in the rate-control group and 97.9% of
those in the rhythm-control group had had a stable heart rhythm without
atrial fibrillation for the previous 30 days (P = 0.02), and 84.2% and
86.9%, respectively, had been free from atrial fibrillation from discharge
to 60 days (P = 0.41). CONCLUSIONS: Strategies for rate control and rhythm
control to treat postoperative atrial fibrillation were associated with
equal numbers of days of hospitalization, similar complication rates, and
similarly low rates of persistent atrial fibrillation 60 days after onset.
Neither treatment strategy showed a net clinical advantage over the other.
Copyright &#xa9; 2016 Massachusetts Medical Society.

<61>
Accession Number
613296985
Author
Heddle N.M.; Cook R.J.; Arnold D.M.; Liu Y.; Barty R.; Crowther M.A.;
Devereaux P.J.; Hirsh J.; Warkentin T.E.; Webert K.E.; Roxby D.;
Sobieraj-Teague M.; Kurz A.; Sessler D.I.; Figueroa P.; Ellis M.;
Eikelboom J.W.
Institution
(Heddle, Arnold, Liu, Barty, Crowther, Devereaux, Hirsh, Warkentin,
Eikelboom) Department of Medicine, Hamilton, ON, Canada
(Heddle, Crowther, Warkentin, Webert) Department of Pathology and
Molecular Medicine, Hamilton, ON, Canada
(Heddle, Devereaux) Department of Clinical Epidemiology and Biostatistics,
Hamilton, ON, Canada
(Heddle, Cook, Arnold, Liu, Barty, Warkentin, Webert) McMaster Centre for
Transfusion Research, Hamilton, ON, Canada
(Heddle, Arnold, Webert) McMaster University, Canadian Blood Services, HSC
3H51, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada
(Devereaux, Eikelboom) Population Health Research Institute, Hamilton, ON,
Canada
(Eikelboom) Thrombosis and Atherosclerosis Research Institute, Hamilton,
ON, Canada
(Cook) Department of Statistics and Actuarial Science, University of
Waterloo, Waterloo, ON, Canada
(Roxby, Sobieraj-Teague) SA Pathology Transfusion Service, Flinders
Medical Centre, Flinders University, Adelaide, SA, Australia
(Kurz) Department of General Anesthesiology, United States
(Kurz, Sessler) Department of Outcomes Research, Anesthesiology Institute,
United States
(Figueroa) Robert J. Tomsich Pathology and Laboratory Medicine Institute,
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, United
States
(Ellis) Meir Medical Center Kfar Saba and Sackler School of Medicine, Tel
Aviv University, Tel Aviv, Israel
Title
Effect of short-term vs. Long-term blood storage on mortality after
transfusion.
Source
New England Journal of Medicine. 375 (20) (pp 1937-1945), 2016. Date of
Publication: 17 Nov 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Randomized, controlled trials have suggested that the
transfusion of blood after prolonged storage does not increase the risk of
adverse outcomes among patients, although most of these trials were
restricted to high-risk populations and were not powered to detect small
but clinically important differences in mortality. We sought to find out
whether the duration of blood storage would have an effect on mortality
after transfusion in a general population of hospitalized patients.
METHODS In this pragmatic, randomized, controlled trial conducted at six
hospitals in four countries, we randomly assigned patients who required a
red-cell transfusion to receive blood that had been stored for the
shortest duration (short-term storage group) or the longest duration
(long-term storage group) in a 1:2 ratio. Only patients with type A or O
blood were included in the primary analysis, since pilot data suggested
that our goal of achieving a difference in the mean duration of blood
storage of at least 10 days would not be possible with other blood types.
Written informed consent was waived because all the patients received
treatment consistent with the current standard of care. The primary
outcome was in-hospital mortality, which was estimated by means of a
logistic-regression model after adjustment for study center and patient
blood type. RESULTS From April 2012 through October 2015, a total of
31,497 patients underwent randomization. Of these patients, 6761 who did
not meet all the enrollment criteria were excluded after randomization.
The primary analysis included 20,858 patients with type A or O blood. Of
these patients, 6936 were assigned to the short-term storage group and
13,922 to the long-term storage group. The mean storage duration was 13.0
days in the short-term storage group and 23.6 days in the long-term
storage group. There were 634 deaths (9.1%) in the short-term storage
group and 1213 (8.7%) in the long-term storage group (odds ratio, 1.05;
95% confidence interval [CI], 0.95 to 1.16; P = 0.34). When the analysis
was expanded to include the 24,736 patients with any blood type, the
results were similar, with rates of death of 9.1% and 8.8%, respectively
(odds ratio, 1.04; 95% CI, 0.95 to 1.14; P = 0.38). Additional results
were consistent in three prespecified high-risk subgroups (patients
undergoing cardiovascular surgery, those admitted to intensive care, and
those with cancer). CONCLUSIONS Among patients in a general hospital
population, there was no significant difference in the rate of death among
those who underwent transfusion with the freshest available blood and
those who underwent transfusion according to the standard practice of
transfusing the oldest available blood. Copyright &#xa9; 2016
Massachusetts Medical Society.

<62>
Accession Number
608484196
Author
Jacob K.A.; Leaf D.E.; Dieleman J.M.; Van Dijk D.; Nierich A.P.; Rosseel
P.M.; Van Der Maaten J.M.; Hofland J.; Diephuis J.C.; De Lange F.; Boer
C.; Kluin J.; Waikar S.S.
Institution
(Jacob, Dieleman, Van Dijk) Department of Anesthesiology and Intensive
Care Medicine, University Medical Center Utrecht, Intensive Care and
Emergency Medicine, Mail Stop F.06.149, PO Box 85500, Utrecht 3508 GA,
Netherlands
(Jacob, Kluin) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Leaf, Waikar) Division of Renal Medicine, Harvard Medical School, Brigham
and Women's Hospital, Boston, MA, United States
(Nierich) Department of Anesthesiology, Isala Klinieken, Zwolle,
Netherlands
(Rosseel) Department of Anesthesiology, Amphia Ziekenhuis, Breda,
Netherlands
(Van Der Maaten) Department of Anesthesiology, University Medical Center,
Groningen, Netherlands
(Hofland) Department of Anesthesiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Diephuis) Department of Anesthesiology, Medisch Spectrum Twente,
Enschede, Netherlands
(De Lange) Department of Cardiac Anesthesiology, Medical Center
Leeuwarden, Leeuwarden, Netherlands
(Boer) Department of Anesthesiology, Vrije Universiteit University Medical
Center, Amsterdam, Netherlands
Title
Intraoperative high-dose dexamethasone and severe AKI after cardiac
surgery.
Source
Journal of the American Society of Nephrology. 26 (12) (pp 2947-2951),
2015. Date of Publication: December 2015.
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Administration of prophylactic glucocorticoids has been suggested as a
strategy to reduce postoperative AKI and other adverse events after
cardiac surgery requiring cardiopulmonary bypass. In this post hoc
analysis of a large placebo-controlled randomized trial of dexamethasone
in 4465 adult patients undergoing cardiac surgery, we examined severe AKI,
defined as use of RRT, as a primary outcome. Secondary outcomes were
doubling of serum creatinine level or AKI-RRT, as well as AKI-RRT or
in-hospital mortality (RRT/death). The primary outcome occurred in ten
patients (0.4%) in the dexamethasone group and in 23 patients (1.0%) in
the placebo group (relative risk, 0.44; 95% confidence interval, 0.19 to
0.96). In stratified analyses, the strongest signal for potential benefit
of dexamethasone was in patients with an eGFR,15 ml/min per 1.73 m2. In
conclusion, comparedwith placebo, intraoperative dexamethasone appeared to
reduce the incidence of severe AKI after cardiac surgery in those with
advanced CKD. Copyright &#xa9; 2015 by the American Society of Nephrology.

<63>
Accession Number
614522168
Author
Agus M.S.D.; Wypij D.; Hirshberg E.L.; Srinivasan V.; Faustino E.V.;
Luckett P.M.; Alexander J.L.; Asaro L.A.; Curley M.A.Q.; Steil G.M.;
Nadkarni V.M.
Institution
(Agus, Alexander, Steil) Division of Medicine Critical Care, Boston
Children's Hospital, Harvard Medical School, Boston, MA 02115, United
States
(Wypij, Asaro) Department of Cardiology, Boston Children's Hospital,
Harvard Medical School, Boston, UT, United States
(Hirshberg) Division of Pediatric Critical Care, University of Utah
Medical School, Primary Children's Hospital, Salt Lake City, UT, United
States
(Srinivasan, Nadkarni) Children's Hospital of Philadelphia, University of
Pennsylvania, PA, United States
(Srinivasan, Curley, Nadkarni) Perelman School of Medicine, University of
Pennsylvania, PA, United States
(Curley) School of Nursing, University of Pennsylvania, PA, United States
(Faustino) Yale School of Medicine, New Haven, CT, United States
(Luckett) Children's Medical Center Dallas, University of Texas
Southwestern Medical School, Dallas, United States
Title
Tight glycemic control in critically Ill children.
Source
New England Journal of Medicine. 376 (8) (pp 729-741), 2017. Date of
Publication: 23 Feb 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In multicenter studies, tight glycemic control targeting a
normal blood glucose level has not been shown to improve outcomes in
critically ill adults or children after cardiac surgery. Studies involving
critically ill children who have not undergone cardiac surgery are
lacking. METHODS In a 35-center trial, we randomly assigned critically ill
children with confirmed hyperglycemia (excluding patients who had
undergone cardiac surgery) to one of two ranges of glycemic control: 80 to
110 mg per deciliter (4.4 to 6.1 mmol per liter; lower-Target group) or
150 to 180 mg per deciliter (8.3 to 10.0 mmol per liter; higher-Target
group). Clinicians were guided by continuous glucose monitoring and
explicit methods for insulin adjustment. The primary outcome was the
number of intensive care unit (ICU)-free days to day 28. RESULTS The trial
was stopped early, on the recommendation of the data and safety monitoring
board, owing to a low likelihood of benefit and evidence of the
possibility of harm. Of 713 patients, 360 were randomly assigned to the
lower-Target group and 353 to the higher-Target group. In the
intention-To-Treat analysis, the median number of ICU-free days did not
differ significantly between the lower-Target group and the higher-Target
group (19.4 days [interquartile range {IQR}, 0 to 24.2] and 19.4 days
[IQR, 6.7 to 23.9], respectively; P = 0.58). In per-protocol analyses, the
median time-weighted average glucose level was significantly lower in the
lower-Target group (109 mg per deciliter [IQR, 102 to 118]; 6.1 mmol per
liter [IQR, 5.7 to 6.6]) than in the higher-Target group (123 mg per
deciliter [IQR, 108 to 142]; 6.8 mmol per liter [IQR, 6.0 to 7.9];
P<0.001). Patients in the lower-Target group also had higher rates of
health care-Associated infections than those in the highertarget group (12
of 349 patients [3.4%] vs. 4 of 349 [1.1%], P = 0.04), as well as higher
rates of severe hypoglycemia, defined as a blood glucose level below 40 mg
per deciliter (2.2 mmol per liter) (18 patients [5.2%] vs. 7 [2.0%], P =
0.03). No significant differences were observed in mortality, severity of
organ dysfunction, or the number of ventilator-free days. CONCLUSIONS
Critically ill children with hyperglycemia did not benefit from tight
glycemic control targeted to a blood glucose level of 80 to 110 mg per
deciliter, as compared with a level of 150 to 180 mg per deciliter.
Copyright &#xa9; 2017 Massachusetts Medical Society.

<64>
[Use Link to view the full text]
Accession Number
614472918
Author
Chaudhary R.; Garg J.; Krishnamoorthy P.; Shah N.; Feldman B.A.; Martinez
M.W.; Freudenberger R.
Institution
(Chaudhary, Garg) Department of Medicine, Sinai Hospital of Baltimore,
Johns Hopkins University, Baltimore, MD, United States
(Garg, Shah, Feldman, Martinez, Freudenberger) Division of Cardiology,
Lehigh Valley Health Network, 1250 S Cedar Crest Blvd, Allentown, PA
18103, United States
(Krishnamoorthy) Department of Medicine, Einstein Healthcare Network,
Philadelphia, PA, United States
Title
On-X Valve: The Next Generation Aortic Valve.
Source
Cardiology in Review. 25 (2) (pp 77-83), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The On-X valve is a newer generation mechanical bileaflet valve. Its key
features include the use of pure pyrolytic carbon (devoid of silicon), a
length-to-diameter ratio similar to a native valve, an inlet flared
orifice, a leaflet opening up to 90 degrees, a shorter leaflet closing
angle, a 2-point leaflet contact, and an actuated pivot. These features
have translated into increased strength, improved valve hemodynamics,
reduced hemolysis, and thrombogenicity. The 2014 American Heart
Association/American College of Cardiology guidelines for the management
of patients with valvular heart disease recommend an international
normalized ratio (INR) of 2.5 (range, 2-3) in patients with a mechanical
valve at the aortic position. However, based on the results of the
Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT), the
Food and Drug Administration approved this valve in April 2015 in the
aortic position with a lower INR goal of 1.5-2.0. This reduction in INR
goals led to a statistically significant reduction in the combined
endpoint of clots, bleeding events, and stroke rates with 9/patient-years
for the lower INR group compared with 12/patient-years in the standard INR
group. This review compares the currently available literature on the On-X
valve with that of other contemporary valves. Copyright &#xa9; 2017
Wolters Kluwer Health, Inc. All rights reserved.

<65>
[Use Link to view the full text]
Accession Number
606808347
Author
Al-Qadheeb N.S.; Skrobik Y.; Schumaker G.; Pacheco M.N.; Roberts R.J.;
Ruthazer R.R.; Devlin J.W.
Institution
(Al-Qadheeb, Devlin) School of Pharmacy, Northeastern University, Boston,
MA, United States
(Skrobik) Department of Medicine, McGill University, Montreal, QC, Canada
(Schumaker, Devlin) Division of Pulmonary, Critical Care and Sleep
Medicine, Tufts Medical Center, Boston, MA, United States
(Pacheco) Department of Psychiatry, Tufts Medical Center, Boston, MA,
United States
(Roberts) Department of Pharmacy, Tufts Medical Center, Boston, MA, United
States
(Ruthazer) Biostatistics Research Center, Tufts Clinical and Translational
Science Institute, Tufts Medical Center, Boston, MA, United States
Title
Preventing ICU Subsyndromal Delirium Conversion to Delirium with Low-Dose
IV Haloperidol: A Double-Blind, Placebo-Controlled Pilot Study.
Source
Critical Care Medicine. 44 (3) (pp 583-591), 2016. Date of Publication: 01
Mar 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
To compare the efficacy and safety of scheduled low-dose haloperidol
versus placebo for the prevention of delirium (Intensive Care Delirium
Screening Checklist > 4) administered to critically ill adults with
subsyndromal delirium (Intensive Care Delirium Screening Checklist = 1-3).
Design: Randomized, double-blind, placebo-controlled trial. Setting: Three
10-bed ICUs (two medical and one surgical) at an academic medical center
in the United States. Patients: Sixty-eight mechanically ventilated
patients with subsyndromal delirium without complicating neurologic
conditions, cardiac surgery, or requiring deep sedation. Interventions:
Patients were randomly assigned to receive IV haloperidol 1 mg or placebo
every 6 hours until delirium occurred (Intensive Care Delirium Screening
Checklist > 4 with psychiatric confirmation), 10 days of therapy had
elapsed, or ICU discharge. Measurements and Main Results: Baseline
characteristics were similar between the haloperidol (n = 34) and placebo
(n = 34) groups. A similar number of patients given haloperidol (12/34
[35%]) and placebo (8/34 [23%]) developed delirium (p = 0.29). Haloperidol
use reduced the hours per study day spent agitated (Sedation Agitation
Scale > 5) (p = 0.008), but it did not influence the proportion of 12-hour
ICU shifts patients spent alive without coma (Sedation Agitation Scale <
2) or delirium (p = 0.36), the time to first delirium occurrence (p =
0.22), nor delirium duration (p = 0.26). Days of mechanical ventilation (p
= 0.80), ICU mortality (p = 0.55), and ICU patient disposition (p = 0.22)
were similar in the two groups. The proportion of patients who developed
corrected QT-interval prolongation (p = 0.16), extrapyramidal symptoms (p
= 0.31), excessive sedation (p = 0.31), or new-onset hypotension (p = 1.0)
that resulted in study drug discontinuation was comparable between the two
groups. Conclusions: Low-dose scheduled haloperidol, initiated early in
the ICU stay, does not prevent delirium and has little therapeutic
advantage in mechanically ventilated, critically ill adults with
subsyndromal delirium. Copyright &#xa9; 2016 by the Society of Critical
Care Medicine and Wolters Kluwer Health, Inc.

<66>
Accession Number
610061249
Author
Leung A.A.; Nerenberg K.; Daskalopoulou S.S.; McBrien K.; Zarnke K.B.;
Dasgupta K.; Cloutier L.; Gelfer M.; Lamarre-Cliche M.; Milot A.; Bolli
P.; Tremblay G.; McLean D.; Tobe S.W.; Ruzicka M.; Burns K.D.; Vallee M.;
Prasad G.V.R.; Lebel M.; Feldman R.D.; Selby P.; Pipe A.; Schiffrin E.L.;
McFarlane P.A.; Oh P.; Hegele R.A.; Khara M.; Wilson T.W.; Penner S.B.;
Burgess E.; Herman R.J.; Bacon S.L.; Rabkin S.W.; Gilbert R.E.; Campbell
T.S.; Grover S.; Honos G.; Lindsay P.; Hill M.D.; Coutts S.B.; Gubitz G.;
Campbell N.R.C.; Moe G.W.; Howlett J.G.; Boulanger J.-M.; Prebtani A.;
Larochelle P.; Leiter L.A.; Jones C.; Ogilvie R.I.; Woo V.; Kaczorowski
J.; Trudeau L.; Petrella R.J.; Hiremath S.; Drouin D.; Lavoie K.L.; Hamet
P.; Fodor G.; Gregoire J.C.; Lewanczuk R.; Dresser G.K.; Sharma M.; Reid
D.; Lear S.A.; Moullec G.; Gupta M.; Magee L.A.; Logan A.G.; Harris K.C.;
Dionne J.; Fournier A.; Benoit G.; Feber J.; Poirier L.; Padwal R.S.; Rabi
D.M.
Institution
(Leung) Division of Endocrinology and Metabolism, Department of Medicine,
University of Calgary, Calgary, AB, Canada
(Nerenberg) Department of Medicine and Department of Obstetrics and
Gynecology, University of Calgary, Calgary, AB, Canada
(Daskalopoulou, Dasgupta) Divisions of General Internal Medicine, Clinical
Epidemiology and Endocrinology, Department of Medicine, McGill University,
McGill University Health Centre, Montreal, QC, Canada
(McBrien) Departments of Family Medicine and Community Health Sciences,
Institute for Public Health, Cumming School of Medicine, University of
Calgary, Calgary, AB, Canada
(Zarnke, Herman) Division of General Internal Medicine, University of
Calgary, Calgary, AB, Canada
(Cloutier) Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec,
Canada
(Gelfer) Department of Family Medicine, University of British Columbia,
Copeman Healthcare Centre, Vancouver, BC, Canada
(Lamarre-Cliche, Larochelle) Institut de Recherches Cliniques de Montreal,
Universite de Montreal, Montreal, QC, Canada
(Milot, Lebel) Department of Medicine, Universite Laval, Quebec, QC,
Canada
(Bolli) Ambulatory Internal Medicine Teaching Clinic, St Catharines, ON,
Canada
(Tremblay) CHU-Quebec-Hopital St Sacrement, Quebec, QC, Canada
(McLean, Lewanczuk) University of Alberta, Edmonton, AB, Canada
(Tobe, Prasad, Gupta, Logan) University of Toronto, Toronto, ON, Canada
(Ruzicka, Burns) Division of Nephrology, Department of Medicine, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
(Vallee) Hopital Maisonneuve-Rosemont, Universite de Montreal, Montreal,
QC, Canada
(Feldman) Discipline of Medicine, Memorial University of Newfoundland, St
John's, NL, Canada
(Selby) Centre for Addiction and Mental Health, University of Toronto,
Toronto, ON, Canada
(Pipe) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Schiffrin) Department of Medicine and Lady Davis Institute for Medical
Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
(McFarlane) Division of Nephrology, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Oh) University Health Network, University of Toronto, Toronto, ON, Canada
(Hegele) Departments of Medicine (Division of Endocrinology) and
Biochemistry, Western University, London, ON, Canada
(Khara) Vancouver Coastal Health Addiction Services, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
(Wilson) Department of Medicine, University of Saskatchewan, Saskatoon,
SK, Canada
(Penner) Department of Internal Medicine, University of Manitoba,
Winnipeg, MB, Canada
(Burgess) Department of Medicine, University of Calgary, Calgary, AB,
Canada
(Bacon) Department of Exercise Science, Concordia University, and Montreal
Behavioural Medicine Centre, Hopital du Sacre-Coeur de Montreal, Montreal,
QC, Canada
(Rabkin) Vancouver Hospital, University of British Columbia, Vancouver,
BC, Canada
(Gilbert) Division of Endocrinology, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Campbell) Department of Psychology, University of Calgary, Calgary, AB,
Canada
(Grover) Division of Clinical Epidemiology, Montreal General Hospital,
Montreal, QC, Canada
(Honos) University of Montreal, Montreal, QC, Canada
(Lindsay) Best Practices and Performance, Heart and Stroke Foundation,
Toronto, ON, Canada
(Hill) Department of Clinical Neurosciences, Hotchkiss Brain Institute,
University of Calgary, Calgary, AB, Canada
(Coutts) Departments of Clinical Neurosciences and Radiology, Hotchkiss
Brain Institute, University of Calgary, Calgary, AB, Canada
(Gubitz) Division of Neurology, Halifax Infirmary, Dalhousie University,
Halifax, NS, Canada
(Campbell) Medicine, Community Health Sciences, Physiology and
Pharmacology, Libin Cardiovascular Institute of Alberta, University of
Calgary, Calgary, AB, Canada
(Moe) St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Howlett) Departments of Medicine and Cardiac Sciences, University of
Calgary, Calgary, AB, Canada
(Boulanger) Charles LeMoyne Hospital Research Centre, Sherbrooke
University, Sherbrooke, QC, Canada
(Prebtani, Gupta) McMaster University, Hamilton, ON, Canada
(Leiter) Keenan Research Centre in the Li Ka Shing Knowledge Institute of
St Michael's Hospital, And University of Toronto, Toronto, ON, Canada
(Jones) University of British Columbia, Vancouver, BC, Canada
(Ogilvie) University Health Network, Departments of Medicine and
Pharmacology, University of Toronto, Toronto, ON, Canada
(Woo) University of Manitoba, Winnipeg, MB, Canada
(Kaczorowski) Universite de Montreal and CHUM, Montreal, QC, Canada
(Trudeau) Division of Internal Medicine, McGill University, Montreal, QC,
Canada
(Petrella) Department of Family Medicine, Western University, London, ON,
Canada
(Hiremath) Faculty of Medicine, University of Ottawa, Ottawa Hospital
Research Institute, Ottawa, ON, Canada
(Drouin) Faculty of Medicine, Universite Laval, Quebec, QC, Canada
(Lavoie) Department of Psychology, University of Quebec at Montreal
(UQAM), Montreal, QC, Canada
(Hamet) Faculte de Medicine, Universite de Montreal, Montreal, QC, Canada
(Fodor) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Gregoire) Universite de Montreal, Institut de cardiologie de Montreal,
Montreal, QC, Canada
(Dresser) Schulich School of Medicine and Dentistry, Western University,
London, ON, Canada
(Sharma) The Canadian Stroke Network, Ottawa, ON, Canada
(Reid) Canadian Forces Health Services, Department of National Defence and
Dietitians of Canada, Ottawa, ON, Canada
(Lear) Faculty of Health Sciences, Simon Fraser University, Vancouver, BC,
Canada
(Moullec) Research Center, Hopital du Sacre-Coeur de Montreal, Public
Health School, University of Montreal, Montreal, QC, Canada
(Magee) St George's, University of London, London, United Kingdom
(Harris, Dionne) Department of Pediatrics, University of British Columbia,
Vancouver, BC, Canada
(Fournier) Service de cardiologie, Centre Hospitalier Universitaire
Sainte-Justine, Universite de Montreal, Montreal, QC, Canada
(Benoit) Service de nephrologie, Centre Hospitalier Universitaire
Sainte-Justine, Universite de Montreal, Montreal, QC, Canada
(Feber) Division of Neurology, Department of Pediatrics, Children's
Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
(Poirier) Centre Hospitalier Universitaire de Quebec et Faculte de
Pharmacie, Universite Laval, Quebec, QC, Canada
(Padwal) Department of Medicine, University of Alberta, Edmonton, AB,
Canada
(Rabi) Departments of Medicine, Community Health and Cardiac Sciences,
University of Calgary, Calgary, AB, Canada
Title
Hypertension Canada's 2016 Canadian Hypertension Education Program
Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk,
Prevention, and Treatment of Hypertension.
Source
Canadian Journal of Cardiology. 32 (5) (pp 569-588), 2016. Date of
Publication: 01 May 2016.
Publisher
Pulsus Group Inc.
Abstract
Hypertension Canada's Canadian Hypertension Education Program Guidelines
Task Force provides annually updated, evidence-based recommendations to
guide the diagnosis, assessment, prevention, and treatment of
hypertension. This year, we present 4 new recommendations, as well as
revisions to 2 previous recommendations. In the diagnosis and assessment
of hypertension, automated office blood pressure, taken without
patient-health provider interaction, is now recommended as the preferred
method of measuring in-office blood pressure. Also, although a serum lipid
panel remains part of the routine laboratory testing for patients with
hypertension, fasting and nonfasting collections are now considered
acceptable. For individuals with secondary hypertension arising from
primary hyperaldosteronism, adrenal vein sampling is recommended for those
who are candidates for potential adrenalectomy. With respect to the
treatment of hypertension, a new recommendation that has been added is for
increasing dietary potassium to reduce blood pressure in those who are not
at high risk for hyperkalemia. Furthermore, in selected high-risk
patients, intensive blood pressure reduction to a target systolic blood
pressure < 120 mm Hg should be considered to decrease the risk of
cardiovascular events. Finally, in hypertensive individuals with
uncomplicated, stable angina pectoris, either a beta-blocker or calcium
channel blocker may be considered for initial therapy. The specific
evidence and rationale underlying each of these recommendations are
discussed. Hypertension Canada's Canadian Hypertension Education Program
Guidelines Task Force will continue to provide annual updates. Copyright
&#xa9; 2016 Canadian Cardiovascular Society.

<67>
Accession Number
610661030
Author
Nguyen-Trong P.-K.J.; Alaswad K.; Karmpaliotis D.; Lombardi W.; Grantham
J.A.; Lembo N.; Kandzari D.; Karatasakis A.; Karacsonyi J.; Danek B.A.;
Rangan B.V.; Roesle M.; Ayers C.R.; Thompson C.A.; Banerjee S.; Brilakis
E.S.
Institution
(Nguyen-Trong, Karatasakis, Karacsonyi, Danek, Rangan, Roesle, Ayers,
Banerjee, Brilakis) Dallas VA Medical Center (111A), 4500 South Lancaster
Road, Dallas, TX 75216, United States
(Alaswad) Henry Ford Hospital, Detroit, MI, United States
(Karmpaliotis) Columbia University, New York, NY, United States
(Lombardi) University of Washington, Seattle, WA, United States
(Grantham) Mid America Heart Institute, Kansas City, MI, United States
(Lembo, Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Thompson) Boston Scientific, Natick, MA, United States
Title
Use of Saphenous Vein Bypass Grafts for Retrograde Recanalization of
Coronary Chronic Total Occlusions: Insights from a Multicenter Registry.
Source
Journal of Invasive Cardiology. 28 (6) (pp 218-224), 2016. Date of
Publication: June 2016.
Publisher
HMP Communications
Abstract
BACKGROUND: The use of saphenous vein grafts (SVGs) for retrograde
native-vessel chronic total occlusion (CTO) percutaneous coronary
intervention (PCI) has received limited study. METHODS: We retrospectively
reviewed the medical records and coronary angiograms of retrograde CTO-PCI
performed through an SVG at four United States institutions between 2012
and 2013. RESULTS: During the study period, retrograde CTO-PCI was
performed in 144 of 572 cases (25.2%) and retrograde CTO-PCI via SVG in 21
patients (14.6% of all retrograde cases). Mean age was 71 +/- 7 years and
95.2% of the patients were men. The CTO target vessel was the right
coronary (38%), circumflex (38%), and left anterior descending (24%)
artery. Mean J-CTO score was 3.5 +/- 1.0. The most common reentry
technique was reverse controlled antegrade dissection and reentry.
Technical and procedural success rates were 86% and 81%, respectively,
with retrograde SVG-PCI attempts being successful in 67%. A major adverse
cardiac event occurred in 2 patients (1 periprocedural myocardial
infarction and 1 tamponade resulting in death). Median contrast volume,
fluoroscopy time, and procedure time were 250 mL, 91.6 minutes, and 214
minutes, respectively. Two SVGs were coiled due to competitive flow after
CTO recanalization. CONCLUSION: Retrograde native-vessel CTO-PCI via SVG
represents a small proportion of retrograde CTO-PCIs and was associated
with high technical success rates, but may carry increased risk for
complications.

<68>
[Use Link to view the full text]
Accession Number
606847494
Author
Alamir M.A.; Ellenberg S.S.; Swerdloff R.S.; Wenger N.K.; Mohler E.R.;
Lewis C.E.; Barrett-Conner E.; Nakanishi R.; Darabian S.; Alani A.;
Matsumoto S.; Nezarat N.; Snyder P.J.; Budoff M.J.
Institution
(Alamir, Swerdloff, Darabian, Alani, Matsumoto, Nezarat, Budoff) Los
Angeles Biomedical Research Institute at Harbor-UCLA, 1124WCarson Street,
Torrance, CA 90502, United States
(Ellenberg) Center for Clinical Epidemiology and Biostatistics, United
States
(Mohler) Division of Cardiovascular Disease, Section of Vascular Medicine,
United States
(Snyder) Division of Endocrinology, Diabetes, and Metabolism, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Wenger) Department of Medicine, Division of Cardiology, Emory University
School of Medicine, Emory Heart and Vascular Center, Atlanta, GA, United
States
(Lewis) Division of Preventive Medicine, University of Alabama at
Birmingham, Birmingham, AL, United States
(Barrett-Conner) Department of Family and Preventive Medicine, Division of
Epidemiology, University of California San Diego, San Diego, CA, United
States
(Nakanishi) Cardiology Department, University of Florida, Gainesville, FL,
United States
Title
The Cardiovascular Trial of the Testosterone Trials: Rationale, design,
and baseline data of a clinical trial using computed tomographic imaging
to assess the progression of coronary atherosclerosis.
Source
Coronary Artery Disease. 27 (2) (pp 95-103), 2016. Date of Publication: 28
Jan 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Data from prior studies have yielded inconsistent results on
the association of serum testosterone levels with the risk for
cardiovascular disease. There are no clinical trial data on the effects of
testosterone replacement therapy on plaque progression. Objective We
designed a study to investigate the effect of testosterone therapy on
coronary artery plaque progression using serial coronary computed
tomographic angiography (CCTA). In this paper, we describe the study
design, methods, and characteristics of the study population. Methods The
Cardiovascular Trial of the Testosterone Trials (TTrials; NCT00799617) is
a double-blind, placebocontrolled trial of 1 year of testosterone therapy
in men 65 years or older with clinical manifestations of androgen
deficiency and unequivocally low serum testosterone concentrations (<275
ng/dl). CCTA performed at baseline and after 12 months of therapy will
determine the effects of testosterone on the progression of the total
volume of noncalcified plaques. All scans are evaluated at a central
reading center by an investigator blinded to treatment assignment. Results
A total of 165 men were enrolled. The average age is 71.1 years, and the
average BMI is 30.7. About 9% of men had a history of myocardial
infarction, 6% angina, and 10% coronary artery revascularization. A
majority reported hypertension and/or high cholesterol; 31.8% reported
diabetes. Total noncalcified plaque at baseline showed a slight but
nonsignificant trend toward lower plaque volume with higher serum
testosterone concentrations (P=0.12). Conclusion The Cardiovascular Trial
will test the hypothesis that testosterone therapy inhibits coronary
plaque progression, as assessed by serial CCTA. Copyright &#xa9; 2016
Wolters Kluwer Health, Inc. All rights reserved.

<69>
Accession Number
612933208
Author
Abe S.; Ishida K.; Masuda M.; Ueda H.; Kohno H.; Matsuura K.; Tamura Y.;
Watanabe M.; Matsumiya G.
Institution
(Abe, Ishida, Ueda, Kohno, Matsuura, Tamura, Watanabe, Matsumiya)
Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba
University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
(Masuda) Department of Cardiovascular Surgery, Chiba Medical Center, 4-1-2
Tsubakimori, Chuo-ku, Chiba 260-0042, Japan
Title
A prospective, randomized study of inhaled prostacyclin versus nitric
oxide in patients with residual pulmonary hypertension after pulmonary
endarterectomy.
Source
General Thoracic and Cardiovascular Surgery. 65 (3) (pp 153-159), 2017.
Date of Publication: 01 Mar 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objectives: Pulmonary endarterectomy (PEA) is an effective treatment for
chronic thromboembolic pulmonary hypertension (CTEPH), but postoperative
residual hypertension leads to in-hospital mortality. Inhaled epoprostenol
sodium (PGI<inf>2</inf>) and NO are administered for pulmonary
hypertension after cardiothoracic surgery. This prospective study provides
the first comparative evaluation of the effects of inhaled PGI<inf>2</inf>
and NO on pulmonary hemodynamics, systemic hemodynamics, and gas exchange
in patients developing residual pulmonary hypertension after PEA. Methods:
Thirteen patients were randomized to receive either NO (n = 6) or PGI2 (n
= 7) inhalation when pulmonary hypertension persisted after weaning from
cardiopulmonary bypass. Hemodynamic and respiratory variables were
measured before inhalation of the agent (T0); 30 min (T1), 3 h (T2), and 6
h after inhalation (T3); and the next morning (T4). The NO dose was
started at 20 ppm and gradually tapered until extubation, and
PGI<inf>2</inf> was administered at a dose of 10 ng kg^-1
min^-1. Results: In both groups, mean pulmonary artery pressure
(PAP) and pulmonary vascular resistance (PVR) significantly decreased over
time until T4 (mean PAP: p < 0.0001; PVR: p = 0.003), while mean systemic
arterial blood pressure significantly increased (p = 0.028). There were no
significant between-group differences in patient characteristics, cardiac
index, left atrial pressure, or ratio of arterial oxygen tension to
fraction of inspired oxygen. There were no in-hospital deaths.
Conclusions: Both inhaled PGI<inf>2</inf> and NO significantly reduced PAP
and PVR without adverse effects on systemic hemodynamics in patients who
developed residual pulmonary hypertension after PEA. Inhaled
PGI<inf>2</inf> can be offered as alternative treatment option for
residual pulmonary hypertension. Copyright &#xa9; 2016, The Author(s).

<70>
Accession Number
611171627
Author
Ardhanari S.; Yarlagadda B.; Parikh V.; Dellsperger K.C.; Chockalingam A.;
Balla S.; Kumar S.
Institution
(Ardhanari, Yarlagadda, Chockalingam, Balla, Kumar) Department of
Medicine, Division of Cardiology, University of Missouri School of
Medicine, Columbia, MO, United States
(Parikh) Department of Cardiology, University of South Florida, Tampa, FL,
United States
(Dellsperger) Department of Medicine, Augusta University Health, Augusta,
GA, United States
Title
Systematic review of non-invasive cardiovascular imaging in the diagnosis
of constrictive pericarditis.
Source
Indian Heart Journal. 69 (1) (pp 57-67), 2017. Date of Publication: 01 Jan
2017.
Publisher
Elsevier B.V.
Abstract
Background Diagnosis of constrictive pericarditis (CP) can be challenging.
It can be nearly impossible to distinguish CP from other causes of right
heart failure. Although various imaging modalities help in the diagnosis,
no test is definitive. Several reviews have addressed the role of various
imaging techniques in the diagnosis of CP but a systematic review has not
yet been published. Objective Our intention was to study the ability of
various non-invasive imaging modalities to diagnose CP in patients with
surgically confirmed disease and to apply our findings to develop a
clinically useful diagnostic algorithm. Methods A PubMed (NLM) search was
performed with MeSH term "constrictive pericarditis". Original articles
that investigated the ability of various cardiovascular imaging modalities
to noninvasively diagnose surgically confirmed CP were included in our
review. Investigations that included any cases without surgical
confirmation were excluded. Results The PubMed search yielded 3001 results
with MeSH term "constrictive pericarditis" (January 8, 2016). We
identified (40) studies on CP that matched our inclusion criteria. We
summarized our results sorted by individual non-invasive CV imaging
modalities - echocardiography, cardiac computed tomography (CT), and
magnetic resonance imaging (MRI). Under each imaging modality, we grouped
our discussion based on different parameters useful in CP diagnosis.
Conclusions In conclusion, contemporary diagnosis of CP is based on
clinical features and echocardiography. Cardiac MRI is recommended in
patients where echocardiography is not diagnostic. Both cardiac MRI and CT
can guide surgical planning but we prefer MRI as it provides both
structural and functional information. Copyright &#xa9; 2016

<71>
Accession Number
614254252
Author
Alfonso F.; Perez-Vizcayno M.J.; Garcia del Blanco B.; Garcia-Touchard A.;
Lopez-Minguez J.-R.; Sabate M.; Zueco J.; Melgares R.; Hernandez R.;
Moreno R.; Dominguez A.; Sanchis J.; Moris C.; Moreu J.; Cequier A.;
Romaguera R.; Rivero F.; Cuesta J.; Gonzalo N.; Jimenez-Quevedo P.;
Cardenas A.; Fernandez C.
Institution
(Alfonso, Rivero, Cuesta) Hospital Universitario de La Princesa, Madrid,
Spain
(Perez-Vizcayno, Gonzalo, Jimenez-Quevedo, Cardenas, Fernandez) Hospital
Universitario Clinico San Carlos, Madrid, Spain
(Perez-Vizcayno) Funacion Interhospitalaria Investigacion Cardiovascular,
Madrid, Spain
(Garcia del Blanco) Hospital Universitario Vall d'Hebron, Barcelona, Spain
(Garcia-Touchard) Hospital Universitario Puerta de Hierro-Majadahonda,
Madrid, Spain
(Lopez-Minguez) Hospital Universitario Infanta Cristina, Badajoz, Spain
(Sabate) Hospital Universitario Clinic de Barcelona, Barcelona, Spain
(Zueco) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Melgares) Hospital Universitario Virgen de las Nieves, Granada, Spain
(Hernandez) Hospital Universitario Ramon y Cajal, Madrid, Spain
(Moreno) Hospital Universitario La Paz, Madrid, Spain
(Dominguez) Hospital Universitario Virgen de la Victoria, Malaga, Spain
(Sanchis) Hospital Universitario Clinico de Valencia, Valencia, Spain
(Moris) Hospital Universitario Central de Asturias, Oviedo, Spain
(Moreu) Hospital Universitario Virgen de la Salud Toledo, Toledo, Spain
(Cequier, Romaguera) Hospital Universitario de Bellvitge, Barcelona, Spain
Title
Usefulness of Drug-Eluting Balloons for Bare-Metal and Drug-Eluting
In-Stent Restenosis (from the RIBS IV and V Randomized Trials).
Source
American Journal of Cardiology. 119 (7) (pp 983-990), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Treatment of patients with drug-eluting stent (DES) in-stent restenosis
(ISR) is particularly challenging. We sought to compare results of
drug-eluting balloons in patients with DES-ISR with those in patients with
bare-metal stent (BMS) ISR. A pooled analysis of the Restenosis
Intra-Stent: Drug-Eluting Balloon versus Everolimus-Eluting Stent IV and V
randomized trials was performed. Both trials had identical inclusion and
exclusion criteria. Results of drug-eluting balloons in 95 patients with
BMS-ISR and 154 patients with DES-ISR were compared. Patients with DES-ISR
were more frequently diabetics, presented more often as an acute coronary
syndrome and had more severe lesions and more frequently a focal pattern,
including edge-ISR. Late angiographic findings (92% of eligible patients),
including minimal lumen diameter (1.80 +/- 0.6 vs 2.01 +/- 0.6 mm, p =
0.001; absolute mean difference 0.21 mm; 95% confidence interval 0.04 to
0.38; p = 0.014) and restenosis rate (19% vs 9.5%, p <0.05) were poorer in
DES-ISR. Results were consistent across 10 prespecified subgroups.
Moreover, on multiple linear regression analysis, minimal lumen diameter
at follow-up remained significantly smaller in patients with DES-ISR after
adjusting for potential confounders (adjusted absolute mean difference
0.17 mm; 95% confidence interval 0.04 to 0.41; p = 0.019). Finally, at
1-year clinical follow-up (100% of patients), rates of target vessel
revascularization (16% vs 6%, p = 0.02) and of the main combined clinical
end point (18% vs 8%, p = 0.03) were significantly higher in patients
treated for DES-ISR. In conclusion, this study confirms the efficacy of
DEB for patients with ISR. However, the long-term clinical and
angiographic results of DEB are poorer in patients with DES-ISR than in
those with BMS-ISR. (ClinicalTrials.gov Identifier: NCT01239953 &
NCT01239940). Copyright &#xa9; 2017 Elsevier Inc.

<72>
Accession Number
614525461
Author
Dervan L.A.; Yaghmai B.; Watson R.S.; Wolf F.M.
Institution
(Dervan, Watson) Division of Pediatric Critical Care Medicine, Department
of Pediatrics, University of Washington School of Medicine, Seattle, WA,
United States
(Yaghmai) Department of Pediatrics, University of Kansas School of
Medicine-Wichita, Wichita, KS, United States
(Watson) Center for Child Health, Behavior, and Development, Seattle
Children's Research Institute, Seattle, WA, United States
(Wolf) Department of Biomedical Informatics and Medical Education,
University of Washington School of Medicine, Seattle, WA, United States
Title
The use of methadone to facilitate opioid weaning in pediatric critical
care patients: a systematic review of the literature and meta-analysis.
Source
Paediatric Anaesthesia. 27 (3) (pp 228-239), 2017. Date of Publication: 01
Mar 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Continuous opioid infusion therapy is commonly utilized in the
pediatric intensive care setting to treat pain and facilitate tolerance of
invasive therapies. Transitioning to methadone is one common strategy for
weaning from continuous opioid infusions, but in practice this transition
can be challenging, and many children still experience iatrogenic
withdrawal. Aim: We reviewed the literature to evaluate the best available
evidence to guide methadone therapy in this setting, and to summarize
associated adverse events. Methods: We included all studies of methadone
used to facilitate weaning from continuous opioid infusions in pediatric
critical care patients, including medical, cardiac, and surgical patients,
excluding case reports and studies treating neonatal abstinence syndrome,
or acute or chronic pain. Medline, Embase, and CINAHL databases from
inception to May 2015 were queried; references of included works and
conference proceedings were also reviewed. Two authors independently
extracted data from each study. Meta-analysis with fixed- and
random-effects models was used to pool results of studies when applicable.
Results: Twelve studies involving 459 patients met criteria for inclusion.
A wide variety of methadone dosing and taper strategies were reported.
Mean inpatient methadone taper times varied widely, from 4.3 to 26.2 days.
Excessive sedation was the most frequently reported adverse event,
occurring in up to 16% of patients. Withdrawal occurred in 27% of patients
among studies reporting this outcome. In three of three studies in which a
new methadone protocol was introduced, a decreased proportion of patients
experienced withdrawal (standardized mean difference, SMD = -0.60, 95% CI
= -0.998 to -0.195, P = 0.004). Conclusion: We did not identify sufficient
evidence to recommend any particular methadone weaning strategy, or to
recommend methadone over other medications or prescribed infusion weaning,
for successful weaning of continuous opioid infusions in the pediatric
intensive care setting. Copyright &#xa9; 2017 John Wiley & Sons Ltd

<73>
Accession Number
614239062
Author
Moser J.M.; Willems S.; Andresen D.; Brachmann J.; Eckardt L.; Hoffmann
E.; Kuck K.-H.; Lewalter T.; Schumacher B.; Spitzer S.G.; Hochadel M.;
Senges J.; Hoffmann B.A.
Institution
(Moser, Willems) Department of Cardiology-Electrophysiology, University
Hospital Hamburg, University Heart Center, Hamburg, Germany
(Kuck) Department of Cardiology, Asklepios Klinik St. Georg, Hamburg,
Germany
(Andresen) Department of Cardiology and Internal Medicine, Evangelisches
Krankenhaus Hubertus, Charite Berlin, Berlin, Germany
(Brachmann) Hospital Klinikum Coburg, Teaching Hospital of the University
of Wurzburg, Coburg, Germany
(Eckardt) Division of Electrophysiology, Department of Cardiology and
Angiology, University of Munster, Munster, Germany
(Hoffmann) Department of Cardiology and Internal Intensive Care Medicine,
Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich,
Germany
(Lewalter) Department of Cardiology and Intensive Care, Peter Osypka Heart
Center Munich, Hospital Munich-Thalkirchen, Munich, Germany
(Schumacher) 2nd Department of Medicine, Westpfalz-Klinikum,
Kaiserslautern, Germany
(Spitzer) Praxisklinik Herz und Gefase-Teaching Hospital of the Technical
University of Dresden, Germany
(Hochadel, Senges) Institute for Myocardial Infarction Research (IHF),
Ludwigshafen, Germany
(Hoffmann) Department of Cardiology II/Electrophysiology; Center of
Cardiology, University Medical Center, Johannes Gutenberg-University,
Mainz, Germany
Title
Complication Rates of Catheter Ablation of Atrial Fibrillation in Patients
Aged >75 Years versus <75 Years-Results from the German Ablation Registry.
Source
Journal of Cardiovascular Electrophysiology. 28 (3) (pp 258-265), 2017.
Date of Publication: 01 Mar 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Despite a rising demand for catheter ablation (CA) of atrial
fibrillation (AF) in an elderly population, complication and success rates
are not fully elucidated. We sought to compare complication rates of CA of
AF in patients >75 versus <75 years of age. Methods and Results: Patients
with symptomatic, drug-refractory AF were prospectively enrolled from
January 2007 to 2010 in this multicenter study. A total of 4,449 patients,
group 1 >75 years and group 2 <75 years (n = 227, age 77.3 +/- 2.2 vs.
59.7 +/- 9.8 years, 52.0% vs. n = 4,222, 68.9% male,
CHA<inf>2</inf>DS<inf>2</inf>-VASc-Score 3.7 +/- 1.0 vs. 1.7 +/- 1.2; P <
0.001, respectively), with paroxysmal AF (59.9% in group 1 vs. 63.3% in
group 2, P = 0.30), and persistent AF (34.8% in group 1 vs. 29.4% in group
2, P = 0.082) underwent CA of AF. A centralized follow-up was obtained in
4,347 patients by the Institute for Myocardial Infarction Research (IHF,
Ludwigshafen). There was a significant difference between periprocedural
stroke rates in the elderly versus the younger cohort (1.3% vs. 0.1%, P <
0.01). In-hospital severe nonfatal complications did not differ
significantly between the groups (4.4% vs. 2.7%, P = 0.14). Other
procedure-related, in-hospital complications were not significantly
different. After a mean follow-up of 472 +/- 99 days (group 1) and 477 +/-
94 days (group 2), no differences were found in complication rates.
Conclusion: CA of AF in patients >75 years is associated with higher
in-hospital stroke rates. In a 1-year follow-up, complication rates do not
differ between the groups. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<74>
Accession Number
614668195
Author
Bahiru E.; de Cates A.N.; Farr M.R.B.; Jarvis M.C.; Palla M.; Rees K.;
Ebrahim S.; Huffman M.D.
Institution
(Bahiru) Northwestern University, Internal Medicine; Division of
Cardiology, 201 E. Huron St. Galter 19-100, Chicago, IL 60611, United
States
(de Cates, Farr, Jarvis, Rees) Warwick Medical School, University of
Warwick, Division of Health Sciences, Coventry CV4 7AL, United Kingdom
(Palla) Wayne State University, Department of Medicine, 540 E Canfield St,
Detroit, MI 48201, United States
(Ebrahim) London School of Hygiene and Tropical Medicine, Department of
Non-communicable Disease Epidemiology, Keppel Street, London WC1E 7HT,
United Kingdom
(Huffman) Northwestern University Feinberg School of Medicine, Departments
of Preventive Medicine and Medicine (Cardiology), 680 N. Lake Shore Drive,
Suite 1400, Chicago, IL 60611, United States
Title
Fixed-dose combination therapy for the prevention of atherosclerotic
cardiovascular diseases.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD009868. Date of Publication: 06 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading
cause of death and disability worldwide, yet ASCVD risk factor control and
secondary prevention rates remain low. A fixed-dose combination of blood
pressure- and cholesterol-lowering and antiplatelet treatments into a
single pill, or polypill, has been proposed as one strategy to reduce the
global burden of ASCVD. Objectives: To determine the effect of fixed-dose
combination therapy on all-cause mortality, fatal and non-fatal ASCVD
events, and adverse events. We also sought to determine the effect of
fixed-dose combination therapy on blood pressure, lipids, adherence,
discontinuation rates, health-related quality of life, and costs. Search
methods: We updated our previous searches in September 2016 of CENTRAL,
MEDLINE, Embase, ISI Web of Science, and DARE, HTA, and HEED. We also
searched two clinical trials registers in September 2016. We used no
language restrictions. Selection criteria: We included randomised
controlled trials of a fixed-dose combination therapy including at least
one blood pressure-lowering and one lipid-lowering component versus usual
care, placebo, or an active drug comparator for any treatment duration in
adults 18 years old or older, with no restrictions on presence or absence
of pre-existing ASCVD. Data collection and analysis: Three review authors
independently selected studies for inclusion and extracted the data for
this update. We evaluated risk of bias using the Cochrane 'Risk of bias'
assessment tool. We calculated risk ratios (RR) for dichotomous data and
mean differences (MD) for continuous data with 95% confidence intervals
(CI) using fixed-effect models when heterogeneity was low (I² <
50%) and random-effects models when heterogeneity was high (I²
> 50%). We used the GRADE approach to evaluate the quality of evidence.
Main results: In the initial review, we identified nine randomised
controlled trials with a total of 7047 participants and four additional
trials (n = 2012 participants; mean age range 62 to 63 years; 30% to 37%
women) were included in this update. Eight of the 13 trials evaluated the
effects of fixed-dose combination (FDC) therapy in populations without
prevalent ASCVD, and the median follow-up ranged from six weeks to 23
months. More recent trials were generally larger with longer follow-up and
lower risk of bias. The main risk of bias was related to lack of blinding
of participants and personnel, which was inherent to the intervention.
Compared with the comparator groups (placebo, usual care, or active drug
comparator), the effects of the fixed-dose combination treatment on
mortality (FDC = 1.0% versus control = 1.0%, RR 1.10, 95% CI 0.64 to 1.89,
I² = 0%, 5 studies, N = 5300) and fatal and non-fatal ASCVD
events (FDC = 4.7% versus control = 3.7%, RR 1.26, 95% CI 0.95 to 1.66,
I² = 0%, 6 studies, N = 4517) were uncertain (low-quality
evidence). The low event rates for these outcomes and indirectness of
evidence for comparing fixed-dose combination to usual care versus
individual drugs suggest that these results should be viewed with caution.
Adverse events were common in both the intervention (32%) and comparator
(27%) groups, with participants randomised to fixed-dose combination
therapy being 16% (RR 1.16, 95% CI 1.09 to 1.25, 11 studies, 6906
participants, moderate-quality evidence) more likely to report an adverse
event . The mean differences in systolic blood pressure between the
intervention and control arms was -6.34 mmHg (95% CI -9.03 to -3.64, 13
trials, 7638 participants, moderate-quality evidence). The mean
differences (95% CI) in total and LDL cholesterol between the intervention
and control arms were -0.61 mmol/L (95% CI -0.88 to -0.35, 11 trials, 6565
participants, low-quality evidence) and -0.70 mmol/L (95% CI -0.98 to
-0.41, 12 trials, 7153 participants, moderate-quality evidence),
respectively. There was a high degree of statistical heterogeneity in
comparisons of blood pressure and lipids (I² > 80% for all)
that could not be explained, so these results should be viewed with
caution. Fixed-dose combination therapy improved adherence to a multidrug
strategy by 44% (26% to 65%) compared with usual care (4 trials, 3835
participants, moderate-quality evidence). Authors' conclusions: The
effects of fixed-dose combination therapy on all-cause mortality or ASCVD
events are uncertain. A limited number of trials reported these outcomes,
and the included trials were primarily designed to observe changes in
ASCVD risk factor levels rather than clinical events, which may partially
explain the observed differences in risk factors that were not translated
into differences in clinical outcomes among the included trials.
Fixed-dose combination therapy is associated with modest increases in
adverse events compared with placebo, active comparator, or usual care but
may be associated with improved adherence to a multidrug regimen. Ongoing,
longer-term trials of fixed-dose combination therapy will help demonstrate
whether short-term changes in risk factors might be maintained and lead to
expected differences in clinical events based on these changes. Copyright
&#xa9; 2017 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<75>
Accession Number
614668124
Author
Hummel J.; Rucker G.; Stiller B.
Institution
(Hummel, Stiller) Heart Center, University of Freiburg, Department of
Congenital Heart Defects and Pediatric Cardiology, Mathildenstr. 1,
Freiburg 79106, Germany
(Rucker) Faculty of Medicine and Medical Center - University of Freiburg,
Institute for Medical Biometry and Statistics, Stefan-Meier-Str. 26,
Freiburg 79104, Germany
Title
Prophylactic levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD011312. Date of Publication: 06 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Low cardiac output syndrome remains a serious complication,
and accounts for substantial morbidity and mortality in the postoperative
course of paediatric patients undergoing surgery for congenital heart
disease. Standard prophylactic and therapeutic strategies for low cardiac
output syndrome are based mainly on catecholamines, which are effective
drugs, but have considerable side effects. Levosimendan, a calcium
sensitiser, enhances the myocardial function by generating more
energy-efficient myocardial contractility than achieved via adrenergic
stimulation with catecholamines. Thus potentially, levosimendan is a
beneficial alternative to standard medication for the prevention of low
cardiac output syndrome in paediatric patients after open heart surgery.
Objectives: To review the efficacy and safety of the postoperative
prophylactic use of levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease. Search methods: We identified trials via
systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as
well as clinical trial registries, in June 2016. Reference lists from
primary studies and review articles were checked for additional
references. Selection criteria: We only included randomised controlled
trials (RCT) in our analysis that compared prophylactic levosimendan with
standard medication or placebo, in infants and children up to 18 years of
age, who were undergoing surgery for congenital heart disease. Data
collection and analysis: Two review authors independently extracted data
and assessed risk of bias according to a pre-defined protocol. We obtained
additional information from all but one of the study authors of the
included studies. We used the five GRADE considerations (study
limitations, consistency of effect, imprecision, indirectness, and
publication bias) to assess the quality of evidence from the studies that
contributed data to the meta-analyses for the prespecified outcomes. We
created a 'Summary of findings' table to summarise the results and the
quality of evidence for each outcome. Main results: We included five
randomised controlled trials with a total of 212 participants in the
analyses. All included participants were under five years of age. Using
GRADE, we assessed there was low-quality evidence for all analysed
outcomes. We assessed high risk of performance and detection bias for two
studies due to their unblinded setting. Levosimendan showed no clear
effect on risk of mortality (risk ratio (RR) 0.47, 95% confidence interval
(CI) 0.12 to 1.82; participants = 123; studies = 3) and no clear effect on
low cardiac output syndrome (RR 0.64, 95% CI 0.39 to 1.04; participants =
83; studies = 2) compared to standard treatments. Data on time-to-death
were not available from any of the included studies. There was no
conclusive evidence on the effect of levosimendan on the secondary
outcomes. The levosimendan groups had shorter length of intensive care
unit stays (mean difference (MD) 0.33 days, 95% CI -1.16 to 1.82;
participants = 188; studies = 4; I2 = 35%), length of hospital stays (0.26
days, 95% CI -3.50 to 4.03; participants = 75; studies = 2), and duration
of mechanical ventilation (MD -0.04 days, 95% CI -0.08 to 0.00;
participants = 208; studies = 5; I2 = 0%). The risk of mechanical
circulatory support or cardiac transplantation favoured the levosimendan
groups (RR 1.49, 95% CI 0.19 to 11.37; participants = 60; studies = 2).
Published data about adverse effects of levosimendan were limited. A
meta-analysis of hypotension, one of the most feared side effects of
levosimendan, was not feasible because of the heterogeneous expression of
blood pressure values. Authors' conclusions: The current level of evidence
is insufficient to judge whether prophylactic levosimendan prevents low
cardiac output syndrome and mortality in paediatric patients undergoing
surgery for congenital heart disease. So far, no significant differences
have been detected between levosimendan and standard inotrope treatments
in this setting. The authors evaluated the quality of evidence as low,
using the GRADE approach. Reasons for downgrading were serious risk of
bias (performance and detection bias due to unblinded setting of two
RCTs), serious risk of inconsistency, and serious to very serious risk of
imprecision (small number of included patients, low event rates).
Copyright &#xa9; 2017 The Cochrane Collaboration. Published by John Wiley
& Sons, Ltd.

<76>
[Use Link to view the full text]
Accession Number
612361864
Author
Phan K.; Haswell J.M.; Xu J.; Assem Y.; Mick S.L.; Kapadia S.R.; Cheung
A.; Ling F.S.; Yan T.D.; Tchantchaleishvili V.
Institution
(Phan, Yan, Tchantchaleishvili) Collaborative Research (CORE) Group,
Macquarie University, Sydney, NSW, Australia
(Phan, Xu) Faculty of Medicine, University of Sydney, Sydney, NSW,
Australia
(Phan, Assem) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Haswell, Ling) Division of Cardiovascular Diseases, University of
Rochester Medical Center, Rochester, NY, United States
(Mick) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Cheung) Division of Cardiothoracic Surgery, St. Paul's Hospital,
University of British Columbia, Vancouver, BC, Canada
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, NSW, Australia
(Tchantchaleishvili) Division of Cardiac Surgery, University of Rochester
Medical Center, Rochester, NY, United States
(Tchantchaleishvili) Division of Cardiac Surgery, Mayo Clinic, 200 First
Street, Rochester, MN, United States
Title
Percutaneous Transcatheter Interventions for Aortic Insufficiency in
Continuous-Flow Left Ventricular Assist Device Patients: A Systematic
Review and Meta-Analysis.
Source
ASAIO Journal. 63 (2) (pp 117-122), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
De novo progressive aortic insufficiency (AI) is a side effect frequently
related to prolonged support with continuous-flow left ventricular assist
devices (CF-LVAD). Its progression can result in recurrent clinical heart
failure symptoms and significantly increased mortality. Recently,
percutaneous intervention methods, such as transcatheter aortic valve
replacement (TAVR) and percutaneous occluder devices, have emerged.
However, given the very scarce global experience with these approaches,
evidence in the literature is lacking. We sought to assess the outcomes of
CF-LVAD patients who had undergone percutaneous intervention for AI. A
systematic search of six databases from inception to April 2016 was
performed by two independent reviewers. Eligible studies were those that
included series or cases where patients had percutaneous transcatheter
interventions for AI in CF-LVAD patients. Data were extracted and
meta-analyzed from the identified studies. A total of 29 patients from 15
published studies and 3 unpublished records were included in the analysis.
Mean patient age was 56.6 +/- 13.7 years, and 72.4% were male. The
etiology of heart failure resulting in LVAD placement was ischemic
cardiomyopathy in 17.2%. The two intervention groups were TAVR (27.6%) and
occluder devices (72.4%). A transfemoral approach (69%), apical approach
(10%), brachial approach (7%), subclavian approach (3%), and
mini-sternotomy (3%) were used. The preintervention AI grade was severe
with a median grade of 4 (interquartile range, 4-4). Postoperatively, the
AI grade improved significantly to a median grade of 0 (0-2). At long-term
follow-up AI grade was still trivial with a median AI grade of 1 (0-1).
Subgrouping the treatments into the occluder device and TAVR, it was found
that both interventional techniques were similarly effective in reducing
the AI grade from severe to trivial. In terms of complications, from the
occluder group, two patients were complicated with device migration and
another two with transient hemolysis. In the TAVR cohort, two patients
experienced device migration and another had significant postimplant
perivalvular leakage. Our results indicate that percutaneous interventions
for AI in CF-LVAD patients with TAVR, and closure devices demonstrate
similar efficacy in significantly reducing severe AI. Current results are
encouraging, potentiating viability as a treatment option, particularly in
nonsurgical candidates. Future research with larger patient cohorts and
comparative controls is required to sufficiently evaluate the efficacy of
this technique and promote its widespread acceptance as a mainstay
treatment. Copyright &#xa9; 2016 by the ASAIO.

<77>
Accession Number
614721435
Author
Korteland N.M.; Ahmed Y.; Koolbergen D.R.; Brouwer M.; De Heer F.; Kluin
J.; Bruggemans E.F.; Klautz R.J.M.; Stiggelbout A.M.; Bucx J.J.J.;
Roos-Hesselink J.W.; Polak P.; Markou T.; Van Den Broek I.; Ligthart R.;
Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Korteland, Bogers, Takkenberg) Department of Cardio-Thoracic Surgery,
Erasmus MC, PO Box 2040, Rotterdam 3000 CA, Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus MC, Rotterdam,
Netherlands
(Ahmed, Koolbergen, De Heer, Kluin) Department of Cardio-Thoracic Surgery,
Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Brouwer) Department of Cardio-Thoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Bruggemans, Klautz) Department of Cardio-Thoracic Surgery, Leiden
University Medical Center, Netherlands
(Stiggelbout) Department of Medical Decision Making, Leiden University
Medical Center, Netherlands
(Bucx) Department of Cardiology, Diakonessenhuis, Utrecht, Netherlands
(Polak) Department of Cardiology, St. Anna Hospital, Geldrop, Netherlands
(Markou) Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle,
Netherlands
(Van Den Broek, Ligthart) Patient Organisation De HartandVaatgroep, The
Hague, Netherlands
Title
Does the use of a decision aid improve decision making in prosthetic heart
valve selection?.
Source
Circulation: Cardiovascular Quality and Outcomes. 10 (2) (no pagination),
2017. Article Number: e003178. Date of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - A Dutch online patient decision aid to support prosthetic
heart valve selection was recently developed. A multicenter randomized
controlled trial was conducted to assess whether use of the patient
decision aid results in optimization of shared decision making in
prosthetic heart valve selection. Methods and Results - In a 5-center
randomized controlled trial, patients were allocated to receive either
standard preoperative care (control group) or additional access to the
patient decision aid (intervention group). Legally capable adult patients
accepted for elective isolated or combined aortic and mitral valve
replacement were included. Primary outcome was preoperative decisional
conflict (Decisional Conflict Scale); secondary outcomes included patient
knowledge, involvement in valve selection, anxiety and depression,
(valve-specific) quality of life, and regret. Out of 306 eligible
patients, 155 were randomized (78 control and 77 intervention).
Preoperative decisional conflict did not differ between the groups (34%
versus 33%; P=0.834). Intervention patients felt better informed (median
Decisional Conflict Scale informed subscore: 8 versus 17; P=0.046) and had
a better knowledge of prosthetic valves (85% versus 68%; P=0.004).
Intervention patients experienced less anxiety and depression (median
Hospital Anxiety and Depression Scale score: 6 versus 9; P=0.015) and
better mental well-being (mean Short Form Health Survey score: 54 versus
50; P=0.032). Three months postoperatively, valve-specific quality of life
and regret did not differ between the groups. Conclusions - A patient
decision aid to support shared decision making in prosthetic heart valve
selection does not lower decisional conflict. It does result in more
knowledgeable, better informed, and less anxious and depressed patients,
with a better mental well-being. Copyright &#xa9; 2017 American Heart
Association, Inc.

<78>
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

<79>
Accession Number
614200662
Author
D'Ascenzo F.; Chieffo A.; Cerrato E.; Ugo F.; Pavani M.; Kawamoto H.; di
Summa R.; Varbella F.; Boccuzzi G.; Omede P.; Rettegno S.; Garbo R.;
Conrotto F.; Montefusco A.; Biondi-Zoccai G.; D'Amico M.; Moretti C.;
Escaned J.; Gaita F.; Colombo A.
Institution
(D'Ascenzo, Pavani, di Summa, Omede, Rettegno, Conrotto, Montefusco,
D'Amico, Moretti, Gaita) Dipartimento di Scienze Mediche, Divisione di
Cardiologia, Citta della Salute e della Scienza, Turin, Italy
(Chieffo, Kawamoto, Colombo) Ospedale San Raffaele, Milano, Italy
(Cerrato, Varbella) Dipartimento di Cardiologia, Ospedale degli Infermi,
Rivoli, Italy
(Ugo, Boccuzzi, Garbo) Dipartimento di Cardiologia, Ospedale San Giovanni
Bosco, Torino, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Escaned) Hospital San Carlos, Madrid, Spain
Title
Incidence and Management of Restenosis After Treatment of Unprotected Left
Main Disease With Second-Generation Drug-Eluting Stents (from Failure in
Left Main Study With 2nd Generation Stents-Cardiogroup III Study).
Source
American Journal of Cardiology. 119 (7) (pp 978-982), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Incidence, predictors, and impact on prognosis of target lesion
revascularization (TLR) for patients treated with second-generation
drug-eluting stents (DESs) on unprotected left main (ULM) remain to be
defined. The present study is a multicenter study including patients
treated with a second-generation DES on ULM from June 2007 to January
2015. Rate of TLR was the primary end point. All cause death, myocardial
infarction, target vessel revascularization, and stent thrombosis were the
secondary end points. A total of 1,270 patients were enrolled: after a
follow-up of 650 days (230 to 1,170), 47 (3.7%) of them underwent a
re-percutaneous coronary intervention TLR on the left main, 22 during a
planned angiographic follow-up. Extent of coronary artery disease was
similar among groups (median value of Syntax of 27 +/- 10 vs 26 +/- 9, p =
0.45), as localization of the lesion in the ULM. Of patients reporting
with TLR on ULM, 56% presented with a focal restenosis, 33% diffuse and
10% proliferative. At multivariate analysis, insulin-dependent diabetes
mellitus increased risk of TLR (hazard ratio [HR] 2.0: 1.1 to 3.6, p =
0.04), whereas use of intravascular ultrasound resulted protective (HR
0.5: 0.3 to 0.9, p = 0.02). At follow-up, rates of cardiovascular death
did not differ among the 2 groups (4% vs 4%, p = 0.95). At multivariate
analysis, TLR on LM did not increase risk of all cause death (HR 0.4: 0.1
to 1.6, p = 0.22), whereas cardiogenic shock and III tertile of Syntax
portended a worse prognosis (HR 4.5: 2.1 to 10.2, p = 0.01 and HR 1.4: 1.1
to 1.6, p = 0.03, respectively). In conclusion, repeated revascularization
after implantation of second-generation DES on ULM represents an
unfrequent event, being increased in insulin-dependent patients and
reduced by intravascular ultrasound. Impact on prognosis remains neutral,
being related to clinical presentation and extent of coronary artery
disease. Copyright &#xa9; 2017 Elsevier Inc.

<80>
Accession Number
614687994
Author
De Loor J.; Herck I.; Francois K.; Van Wesemael A.; Nuytinck L.; Meyer E.;
Hoste E.A.J.
Institution
(De Loor, Meyer) Laboratory of Biochemistry, Department of Pharmacology,
Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent
University, Salisburylaan 133, Merelbeke 9820, Belgium
(Herck, Hoste) Division of Intensive Care, Department of Internal
Medicine, Ghent University Hospital, Faculty of Medicine and Health
Sciences, Ghent University, De Pintelaan 185, Ghent 9000, Belgium
(Francois) Division of Cardiac Surgery, Department of Surgery, Ghent
University Hospital, Faculty of Medicine and Health Sciences, Ghent
University, De Pintelaan 185, Ghent 9000, Belgium
(Van Wesemael) Department of Anaesthesiology, General Hospital Sint-Lucas
Ghent, Groenebriel 1, Ghent 9000, Belgium
(Nuytinck) Bimetra - Clinical Research Centre Ghent, Ghent University
Hospital, Ghent University, De Pintelaan 185, Ghent 9000, Belgium
(Hoste) Research Foundation - Flanders, Egmontstraat 5, Brussels 1000,
Belgium
Title
Diagnosis of cardiac surgery-associated acute kidney injury: differential
roles of creatinine, chitinase 3-like protein 1 and neutrophil
gelatinase-associated lipocalin: a prospective cohort study.
Source
Annals of Intensive Care. 7 (1) (no pagination), 2017. Article Number: 24.
Date of Publication: 01 Dec 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Background: A common and serious complication of cardiac surgery prompting
early detection and intervention is cardiac surgery-associated acute
kidney injury (CSA-AKI). Urinary chitinase 3-like protein 1 (UCHI3L1) was
found to predict AKI associated with critical illness in adults. Our aims
were therefore to evaluate whether UCHI3L1 can also be used to predict AKI
associated with elective cardiac surgery in adults, and to compare this
predictive ability with that of urinary neutrophil gelatinase-associated
lipocalin (UNGAL), more frequently assessed early serum creatinine (SCr)
measurements, and various two-biomarker panels. Methods: This was a
single-centre prospective cohort study at the eight-bed cardiac surgery
ICU of Ghent University Hospital. AKI was diagnosed and classified
according to the Kidney Disease
Improving Global Outcomes definitions for the diagnosis and staging of
AKI, which are based on SCr and urine output (UO). Of the 211 enrolled
elective cardiac surgery patients, we included 203 patients who had no AKI
pre-operatively and at time of post-operative ICU admission (t1) in the
primary endpoint analysis (i.e. AKI stage >1 within 48 h after t1), while
210 patients without AKI stage >2 pre-operatively and at t1 were included
in the secondary endpoint analysis (i.e. AKI stage >2 within 12 h after
t1). Systemic and/or urine concentrations of Cr, CHI3L1 and NGAL were
measured more frequently than SCr in routine early post-operative ICU
practice. UO was monitored hourly in the ICU. Results: Within 48 h after
t1, 46.8% of the patients had developed AKI (70.5% stage 1, 20.0% stage 2
and 9.5% stage 3). In the early post-operative period, only SCr was a good
predictor of AKI within 48 h after t1 (primary endpoint). SCHI3L1 combined
with either UCHI3L1 or UNGAL was a good predictor of AKI stage >2 within
12 h after t1 (secondary endpoint). However, SCr and its absolute
difference from pre-operative to early measures after surgery outperformed
these combinations. Conclusions: We found that more frequent assessment of
the functional biomarker SCr in the early post-operative ICU period (first
4 h) after elective cardiac surgery in adult patients had good to
excellent predictive value for CSA-AKI, indicating that routine SCr
assessment must become more frequent in order to detect AKI more early.
This performance was in contrast with the inadequate predictive value of
the urinary renal stress or damage biomarkers UCHI3L1 and UNGAL. Copyright
&#xa9; 2017, The Author(s).

<81>
Accession Number
614470540
Author
Elbadawi A.; Saad M.; Nairooz R.
Institution
(Elbadawi) Department of Medicine, Rochester General Hospital, Rochester,
NY, United States
(Saad, Nairooz) Division of Cardiovascular Medicine, University of
Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205,
United States
(Elbadawi) Department of Cardiovascular Medicine, Ain Shams University,
Cairo, Egypt
Title
Aspirin Use Prior to Coronary Artery Bypass Grafting Surgery: a Systematic
Review.
Source
Current Cardiology Reports. 19 (2) (no pagination), 2017. Article Number:
18. Date of Publication: 01 Feb 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Aspirin use before coronary artery bypass graft (CABG)
surgery has been a puzzling question for years. Controversy existed
regarding the overall benefits vs. risk of pre-operative aspirin use and
was translated to conflicting guidelines from major societies. Recent
Findings: Observational studies have suggested a reduced mortality with
pre-operative aspirin use. A meta-analysis of randomized controlled trials
showed increased risk of post-operative bleeding with aspirin, with no
associated increased mortality risk. A recent large randomized controlled
trial did not find a significant difference in bleeding risk or
post-operative mortality with pre-CABG aspirin use. Summary: The results
of available studies showed a beneficial effect with pre-CABG aspirin use
by decreasing thrombotic complications and perioperative myocardial
infarction, with an associated adverse risk of bleeding that did not
affect mortality rates. Given overall benefit-risk assessment, we are in
favor of pre-operative aspirin use in CABG patients. Copyright &#xa9;
2017, Springer Science+Business Media New York.

<82>
Accession Number
614470535
Author
Ujueta F.; Weiss E.N.; Shah B.; Sedlis S.P.
Institution
(Ujueta, Weiss, Shah, Sedlis) Department of Medicine Division of
Cardiology New York VA Healthcare Network and New York University School
of Medicine, 423 East 23rd Street, New York, NY 10010, United States
Title
Effect of Percutaneous Coronary Intervention on Survival in Patients with
Stable Ischemic Heart Disease.
Source
Current Cardiology Reports. 19 (2) (no pagination), 2017. Article Number:
17. Date of Publication: 01 Feb 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: This study aims to determine if percutaneous coronary
intervention (PCI) does improve survival in stable ischemic heart disease
(SIHD). Recent Findings: The International Study of Comparative Health
Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial will
evaluate patients with moderate to severe ischemia and will be the largest
randomized trial of an initial management strategy of coronary
revascularization (percutaneous or surgical) versus optimal medical
therapy alone for SIHD. Although the ISCHEMIA trial may show a benefit
with upfront coronary revascularization in this high-risk population,
cardiac events after PCI are largely caused by plaque rupture in segments
outside of the original stented segment. Furthermore, given the robust
data from prior randomized trials, which showed no survival benefit with
PCI, and the likelihood that the highest risk patients in ISCHEMIA will be
treated with surgery, it is unlikely that the ISCHEMIA trial will show a
survival benefit particular to PCI. Recent Findings: Although PCI relieves
symptoms, the evidence base indicates that it does not prolong survival in
SIHD. Copyright &#xa9; 2017, Springer Science+Business Media New York
(outside the USA).

<83>
Accession Number
611268002
Author
Pouwels S.; Hageman D.; Gommans L.N.M.; Willigendael E.M.; Nienhuijs S.W.;
Scheltinga M.R.; Teijink J.A.W.
Institution
(Pouwels, Hageman, Gommans, Nienhuijs, Teijink) Department of Surgery,
Catharina Hospital, Eindhoven, Netherlands
(Pouwels, Hageman, Gommans, Teijink) Department of Epidemiology, CAPHRI
Research School, Maastricht University, Maastricht, Netherlands
(Willigendael) Department of Surgery, Medisch Spectrum Twente, Enschede,
Netherlands
(Scheltinga) CARIM Research School, Maastricht University, Maastricht,
Netherlands
(Scheltinga) Department of Vascular Surgery, Maxima Medical Centre,
Veldhoven, Netherlands
Title
Preoperative exercise therapy in surgical care: a scoping review.
Source
Journal of Clinical Anesthesia. 33 (pp 476-490), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives Several systematic reviews have focused on the role of
preoperative exercise therapy (PET) in various fields of surgical care.
Aims of the present scoping review are to summarize research findings and
to identify gaps in existing literature. Methods Two authors independently
conducted a comprehensive literature search on systematic reviews
regarding PET. The risk of bias was assessed using "the methodology
checklist for systematic reviews and meta-analyses of the Scottish
Intercollegiate Guidelines Network (SIGN)." Findings of the included
systematic reviews were summarized according to type of surgery and type
of PET. Results Twenty-one reviews on PET with a low risk of bias were
included. Seven reviews investigated PET in multiple surgical fields and
14 in just a single surgical field. PET was studied before cardiac surgery
(n = 9), orthopedic surgery (n = 8), abdominal surgery (n = 8), thoracic
surgery (n = 8), vascular surgery (n = 3), and urologic surgery (n = 1).
Conclusion Overall, it seems that PET exerts beneficial effects on
physical fitness and postoperative outcome measures. Gaps in current
literature are the heterogeneity in selected patient populations and
outcome measures as well as lack of guidelines on the specific PET
regimes. Therefore, there is increasing need for multicenter randomized
trials with specifically designed PET programs and a carefully selected
patient population to strengthen current evidence. Copyright &#xa9; 2016
Elsevier Inc.

<84>
Accession Number
610945672
Author
Saracoglu A.; Saracoglu K.T.
Institution
(Saracoglu, Saracoglu) Department of Anesthesiology and Reanimation,
Istanbul Bilim University Medical School, Florence Nightingale Hospital,
Abide-i Hurriyet Cad. No. 164 Sisli Caglayan, Istanbul, Turkey
Title
VivaSight: A new era in the evolution of tracheal tubes.
Source
Journal of Clinical Anesthesia. 33 (pp 442-449), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective To evaluate the available data describing the use of
single and double lumen VivaSight tubes. Design Systematic review. Setting
The use of VivaSight tubes for elective surgeries including advantages,
disadvantages, and possible complications. Patients Systematic review of
randomized controlled trials from databases including Medline, Web of
Knowledge, Google Scholar, and Cochrane Central Register of Controlled
Trials. Interventions Comparison of VivaSight single and double-lumen
tubes with conventional tubes during normal airway and expected difficult
airway management. The effectiveness of the devices was also evaluated
during 1-lung ventilation for patients undergoing thoracic surgery.
Measurements Intubation time, success rate, the requirement for fiberoptic
bronchoscope, and the rate of complications. Main Results Following a
VivaSight double-lumen tube, a flexible bronchoscope is still needed. It
is difficult to agree that VivaSight tube reduces the need or use of a
bronchoscope. According to the current literature, it is unclear if there
is any advantage of the VivaSight compared with using flexible
bronchoscopy to direct a blocker into the correct lung. The cost may be
another issue. Studies comparing VivaSight tubes with standard double
lumen tubes reported faster tracheal intubation rate and higher success
rate at first attempt for VivaSight. However, VivaSight tubes may cause
soft tissue trauma such as bleeding, hematoma, edema, and erythema. Sore
throat and dysphonia are other reported complications. Due to the outer
thickness, smaller-sized double-lumen tube may be necessary. It has been
reported to have the disadvantages, such as melting due to the heat of
light source before insertion and sudden shutdown without warning.
Conclusions Problems such as overheating and melting on the distal end of
the tube due to the light source and potential breakdowns of the cable
should be solved by the manufacturer. This will probably require a
redesign and necessitate further studies. Copyright &#xa9; 2016 Elsevier
Inc.

<85>
Accession Number
612001821
Author
Tempe D.K.; Kiro K.L.; Satyarthy S.; Virmani S.; Kumar P.; Betigiri V.M.;
Minhas H.S.
Institution
(Tempe, Kiro, Virmani, Kumar) Departments of Anaesthesiology and Intensive
Care, G B Pant Hospital, New Delhi 110002, India
(Satyarthy, Betigiri, Minhas) Cardiothoracic and Vascular Surgery, G B
Pant Hospital, New Delhi, India
Title
Evaluation of different types of inferior vena cava cannulae placement by
transesophageal echocardiography and its impact on hepatic dysfunction.
Source
Perfusion (United Kingdom). 31 (6) (pp 482-488), 2016. Date of
Publication: 01 Sep 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Postoperative hepatic dysfunction may occur in an otherwise
uncomplicated open heart surgery. One of the reasons is malpositioning of
the inferior vena cava (IVC) cannula in the hepatic vein (HV) or beyond. A
straight cannula is considered more likely to be malpositioned compared to
the angled cannula and a malpositioned cannula can lead to hepatic
dysfunction. Methods: In this prospective study, forty adult patients
undergoing atrial septal defect repair were randomized into two groups as:
straight cannula group (n=20) and angled cannula group (n=20). The cannula
position was assessed by transesophageal echocardiography (TEE) (hepatic
vein view). Alanine aminotransferase levels (ALT) and bilirubin levels
were measured immediately, at 6 hours and on day 1, day 2 and day 7 after
surgery as a marker of hepatic injury. Results: TEE localization of the
IVC cannula was achieved in all patients except one. Visualization was
good in 85% of patients. A cannula in the HV or beyond the HV in the IVC
was considered malpositioned. The number of cases of cannula malposition
was 10 (50%) and 4 (20%) in the straight and angled cannula groups,
respectively. The pattern of change in serum bilirubin and liver enzymes
levels in the postoperative period was similar in both the groups
(p>0.05). The mean distance between the right atrium (RA) - inferior vena
cava (IVC) junction to the hepatic vein was 1.94+/-0.56 cm and the mean
diameters of the IVC and HV were 1.95+/-0.5 and 1.31+/-0.33 cm,
respectively. Conclusion: TEE can be used to monitor IVC cannula position.
A higher frequency of cannula malposition was observed with the straight
cannula compared to the angled cannula, but was not found to be associated
with hepatic dysfunction. Copyright &#xa9; The Author(s) 2016.

<86>
Accession Number
607236533
Author
Goel S.S.; Dilip Gajulapalli R.; Athappan G.; Philip F.; Gupta S.; Murat
Tuzcu E.; Ellis S.G.; Mishkel G.; Kapadia S.R.
Institution
(Goel, Mishkel) Prairie Cardiovascular Consultants, St John's Hospital,
Springfield, IL, United States
(Dilip Gajulapalli, Gupta, Murat Tuzcu, Ellis, Kapadia) Department of
Cardiovascular Medicine, Cleveland Clinic Foundation, J2-3, 9500 Euclid
Ave, Cleveland, OH 44195, United States
(Athappan) Mount Sinai Medical Center, New York, NY, United States
(Philip) Division of Cardiovascular Medicine, University of California
(Davis) Medical Center, Sacramento, CA, United States
Title
Management of drug eluting stent in-stent restenosis: A systematic review
and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 87 (6) (pp 1080-1091),
2016. Date of Publication: 01 May 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background The optimal management for coronary drug eluting stent in-stent
restenosis (DES ISR) is unclear. We performed a meta-analysis of
observational and randomized studies to compare the outcomes of management
of DES ISR using DES, drug eluting balloon (DEB), or balloon angioplasty
(BA). Methods Eligible studies (25 single arm and 13 comparative,
including 4 randomized studies with a total of 7,474 patients with DES
ISR) were identified using MEDLINE search and proceedings of international
meetings. Outcomes studied include major adverse cardiac events (MACE),
target lesion revascularization (TLR), target vessel revascularization
(TVR), myocardial infarction (MI), stent thrombosis (ST), and mortality.
Follow-up ranged from 0.5 to 3.5 years (mean 1.4 years). Results The rate
of TLR was significantly lower in the DES (odds ratio [OR] 0.50, 95%
confidence interval [CI] 0.36-0.69) and DEB (OR 0.31, 95% CI 0.18-0.55)
groups compared to BA. Similarly, TVR rate was significantly lower in the
DES (OR 0.55, 95% CI 0.39-0.77) and DEB (OR 0.32, 95% CI 0.18-0.58) groups
compared to BA. All other outcomes were similar between the DES/BA and
DEB/BA comparisons. TLR was significantly lower in the DES group compared
to BA for vessels < or > 2.75 mm. Conclusion Treatment of coronary DES ISR
with DES or DEB is associated with a reduction in the risk of TLR and TVR
compared to BA alone. The relative risk reduction for TLR with DES is
similar to DEB. DEBs have a potential role in the treatment of DES ISR by
avoiding placement of another layer of stent. Copyright &#xa9; 2015 Wiley
Periodicals, Inc.

<87>
Accession Number
607236332
Author
Wolff R.; Fefer P.; Knudtson M.L.; Cheema A.N.; Galbraith P.D.; Sparkes
J.D.; Wright G.A.; Wijeysundera H.C.; Strauss B.H.
Institution
(Wolff, Fefer, Sparkes, Wright, Wijeysundera, Strauss) Division of
Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre,
2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
(Fefer) Department of Cardiology, Sheba Medical Center, Tel Aviv
University, Tel Aviv, Israel
(Knudtson, Galbraith) Division of Cardiology, Libin Cardiovascular
Institute of Alberta, Calgary, AB, Canada
(Cheema) Division of Cardiology, St. Michael's Hospital, Toronto, ON,
Canada
(Cheema, Wijeysundera, Strauss) Department of Medicine, University of
Toronto, Division of Cardiology, Toronto, ON, Canada
(Wijeysundera) Management and Evaluation (IHPME), University of Toronto,
Institute of Health Policy, Toronto, ON, Canada
(Wijeysundera) Institute for Clinical Evaluative Sciences (ICES), Toronto,
ON, Canada
Title
Gender differences in the prevalence and treatment of coronary chronic
total occlusions.
Source
Catheterization and Cardiovascular Interventions. 87 (6) (pp 1063-1071),
2016. Date of Publication: 01 May 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Gender differences exist in the presentation and outcomes of
patients with coronary artery disease (CAD). Our study objective was to
compare gender differences in prevalence, co-morbidities, and
revascularization treatment in CAD patients with chronic total occlusions
(CTOs). Methods A retrospective analysis using the Canadian Multicenter
CTO Registry, which included 1,690 consecutive CTO patients identified at
coronary angiography and a control group of 7,682 non-CTO patients.
Results The prevalence of women in the CTO group was significantly lower
compared to the control group (19% vs. 30%, P < 0.001). Within the overall
CTO group, women were significantly older than men (70 +/- 12 vs. 66 +/-
11 years, P < 0.001) with more comorbidities, including hypertension and
heart failure. Rates of PCI in the CTO group were similar between gender
(10%), however, women with CTO were treated significantly less by CABG
compared to men (19% vs. 27%, P = 0.003). Moreover, compared to male
patients, significantly fewer women undergoing CABG had revascularization
of the CTO artery (84% vs. 93%, P = 0.03). Multivariable analysis
indicated that female gender (along with age, chronic renal failure, prior
MI and cerebro-vascular disease) were independent predictors for not
receiving CABG treatment for CTO. Conclusions Female gender differences
exist in CTO patients with both lower prevalence of CTOs at angiography
and lower revascularization rates of CTOs by CABG. Copyright &#xa9; 2015
Wiley Periodicals, Inc.

<88>
Accession Number
607754382
Author
Bang V.V.; Levy M.S.
Institution
(Bang, Levy) Lahey Hospital and Medical Center, Burlington, MA, United
States
Title
In multivessel coronary artery disease, a "state-of-the-art" randomized
clinical trial of revascularization is needed.
Source
Catheterization and Cardiovascular Interventions. 87 (1) (pp 13-14), 2016.
Date of Publication: 01 Jan 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)

<89>
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.

<90>
Accession Number
612828359
Author
Barbieri L.; Verdoia M.; Schaffer A.; Suryapranata H.; De Luca G.
Institution
(Barbieri, Verdoia, Schaffer, De Luca) Division of Cardiology, Azienda
Ospedaliera-Universitaria "Maggiore della Carita", Eastern Piedmont
University, C.so Mazzini, 18, Novara 28100, Italy
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Title
Risk and Benefits of Triple Therapy in Patients Undergoing Coronary Stent
Implantation Requiring Oral Anticoagulation: A Meta-Analysis of 16
Studies.
Source
Cardiovascular Drugs and Therapy. 30 (6) (pp 611-622), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Patients with coronary artery disease who undergo stent
implantation and have concomitant indication for long-term oral
anticoagulation represent a considerable proportion of the overall
population. To date there is still no consensus about the optimal
antithrombotic strategy to choose in this kind of patients, due to the
difficult balance between an increased risk of bleeding and thromboembolic
complications. Therefore, the aim of this study was to perform a
meta-analysis to evaluate the risk and benefits of triple antithrombotic
therapy versus dual antithrombotic therapy in patients undergoing coronary
stent implantation, requiring long-term oral anticoagulation. Methods: We
performed formal searches of PubMed, EMBASE, Cochrane central register of
controlled trials and major international scientific session abstracts
from January 1990 to September 2015 regarding the use of triple
antithrombotic therapy (TT) versus dual therapy (DT) in patients
undergoing percutaneous coronary stent implantation that required chronic
oral anticoagulation. Data regarding study design, inclusion/exclusion
criteria, number of patients, and selected endpoints was extracted by 2
investigators. Disagreements were resolved by consensus. Results: Sixteen
trials with a total of 21716 patients undergoing coronary stent
implantation with indication to long term oral anticoagulation, were
finally included. A total of 6950 received TT, whereas 14766 received DT
alone. The follow-up period ranged from 180 to 730 days. Data regarding
mortality were available in 21658 patients (99.7 %). All cause mortality
was observed in 10.4 % patients in TT versus 16.3 % in DT (OR [95 % CI]
=0.73 [0.66-0.80], p <0.001; p<inf>het</inf> <0.001). In addition, TT was
associated with a reduced incidence of MI (6.4 versus 9.8 %, OR [95 % CI]
= 0.74 [0.65-0.84], p < 0.001; p<inf>het</inf> < 0.001) and ischemic
stroke (1.8 versus 3.9 %, OR [95 % CI] = 0.55 [0.45-0.68], p < 0.001;
p<inf>het</inf> = 0.07). As expected, TT was associated with a significant
increase in major bleeding events (10.8 versus 8.5 %, OR [95 % CI] = 1.38
[1.25-1.53], p < 0.001; p<inf>het</inf> = 0.02). By meta regression
analysis we found that benefits in mortality with TT were inversely
related with the risk of bleedings (beta [95 % CI] = 2.25 (1.55; 2.95), p
< 0.00001). The benefits with TT regarding overall mortality, recurrent MI
and ischemic stroke were also confirmed in a pre-specified analysis versus
DAPT or oral anticoagulation in association with a single antiplatelet
agent. Conclusion: This meta-analysis showed that among patients
undergoing coronary stent implantation, requiring chronic OAC, the use of
a TT is associated with a significant reduction in overall mortality,
recurrent MI and ischemic stroke. As expected, we found a higher incidence
of bleedings in patients treated with triple therapy. The benefits in
mortality were lost in patients at high-risk for bleedings. Copyright
&#xa9; 2016, Springer Science+Business Media New York.

<91>
Accession Number
607381280
Author
Ghodraty M.R.; Hasani V.; Bagheri-Aghdam A.; Zamani M.M.; Pournajafian A.;
Rokhtabnak F.; Kholdebarin A.; Nader N.D.
Institution
(Ghodraty, Bagheri-Aghdam, Zamani, Pournajafian, Rokhtabnak, Kholdebarin)
Department of Anesthesiology, Firoozghar Hospital, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Hasani) Department of Anesthesiology, Rasoul Akram Medical Complex, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Nader) Department of Anesthesiology & Perioperative Care, VA Western NY
Healthcare System, SUNY-Buffalo, Buffalo, NY, United States
Title
Remifentanil infusion during emergence moderates hemodynamic and cough
responses to the tracheal tube: A randomized controlled trial.
Source
Journal of Clinical Anesthesia. 33 (pp 514-520), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective To examine the severity of cough and straining at the time of
emergence from anesthesia. Design Double-blind randomized,
placebo-controlled study. Setting University-affiliated hospital. Patients
Sixty-two American Society of Anesthesiologists 2 patients undergoing
craniotomy and excision of supratentorial cerebral tumors. Intervention
Intravenous infusion of remifentanil (REM) at 0.05 mug/kg/min or normal
saline (NS) upon termination of the surgical procedure. Measurements Heart
rate (HR) and mean arterial pressure (MAP) along with the frequency and
severity of cough response (Modified Minogue Scale) to the endotracheal
tube were recorded at different time points. The frequency of cough and
straining was analyzed with chi² tests. HRs and MAP were
analyzed by repeated-measures analysis of variance between REM and NS
groups. Main Results There was no case of significant cough in the REM
group, and all of the patients in the NS group developed some extent of
cough varying from mild retching to severe coughing episodes (P <.001).
Both the HR and MAPs were consistently lower in the REM group compared to
the NS group. Conclusion Infusion of REM at the end of craniotomy
procedures results in significant reduction of the frequency and severity
of coughing and straining. Compared to placebo, REM moderates increases in
MAP upon emergence from general anesthesia until the time of extubation.
Copyright &#xa9; 2015

<92>
Accession Number
610000600
Author
Bayes-Genis A.; Gastelurrutia P.; Camara M.-L.; Teis A.; Lupon J.; Llibre
C.; Zamora E.; Alomar X.; Ruyra X.; Roura S.; Revilla A.; San Roman J.A.;
Galvez-Monton C.
Institution
(Bayes-Genis, Teis, Lupon, Llibre, Zamora) Cardiology Service, Germans
Trias i Pujol University Hospital, Badalona, Spain
(Bayes-Genis, Lupon) Department of Medicine, Universitat Autonoma de
Barcelona, Barcelona, Spain
(Bayes-Genis, Gastelurrutia, Roura, Galvez-Monton) ICREC Research Program,
Health Science Research Institute Germans Trias i Pujol, Badalona, Spain
(Camara, Ruyra) Cardiac Surgery Service, Germans Trias i Pujol University
Hospital, Badalona, Spain
(Teis, Alomar) Clinica Creu Blanca, Barcelona, Spain
(Roura) Center of Regenerative Medicine in Barcelona, Barcelona, Spain
(Revilla, San Roman) ICICORELAB, Clinic University Hospital, Valladolid,
Spain
Title
First-in-man Safety and Efficacy of the Adipose Graft Transposition
Procedure (AGTP) in Patients With a Myocardial Scar.
Source
EBioMedicine. 7 (pp 248-254), 2016. Date of Publication: 01 May 2016.
Publisher
Elsevier
Abstract
Background: The present study evaluates the safety and efficacy of the
Adipose Graft Transposition Procedure (AGTP) as a biological regenerative
innovation for patients with a chronic myocardial scar. Methods: This
prospective, randomized single-center controlled study included 10
patients with established chronic transmural myocardial scars. Candidates
for myocardial revascularization were randomly allocated into two
treatment groups. In the control arm (n = 5), the revascularizable area
was treated with CABG and the non-revascularizable area was left
untouched. Patients in the AGTP-treated arm (n = 5) were treated with CABG
and the non-revascularizable area was covered by a biological adipose
graft. The primary endpoint was the appearance of adverse effects derived
from the procedure including hospital admissions and death, and 24-hour
Holter monitoring arrhythmias at baseline, 1 week, and 3 and 12 months.
Secondary endpoints of efficacy were assessed by cardiac MRI. Findings: No
differences in safety were observed between groups in terms of clinical or
arrhythmic events. On follow-up MRI testing, participants in the
AGTP-treated arm showed a borderline smaller left ventricular end systolic
volume (LVESV; p = 0.09) and necrosis ratio (p = 0.06) at 3 months but not
at 12 months. The AGTP-treated patient with the largest necrotic area and
most dilated chambers experienced a noted improvement in necrotic mass
size (- 10.8%), and ventricular volumes (LVEDV: - 55.2 mL and LVESV: -
37.8 mL at one year follow-up) after inferior AGTP. Interpretation: Our
results indicate that AGTP is safe and may be efficacious in selected
patients. Further studies are needed to assess its clinical value.
(ClinicalTrials.org NCT01473433, AdiFlap Trial). Copyright &#xa9; 2016 The
Authors.

<93>
Accession Number
603626181
Author
Zimarino M.; Ricci F.; Romanello M.; Di Nicola M.; Corazzini A.; De
Caterina R.
Institution
(Zimarino, Ricci, Romanello, Corazzini, De Caterina) Institute of
Cardiology, Center of Excellence on Aging, G, d'Annunzio University, C/o
Ospedale SS. Annunziata, Via dei Vestini, Chieti 66013, Italy
(Di Nicola) Laboratory of Biostatistics, Department of Experimental and
Clinical Science, G, d'Annunzio University, Chieti, Italy
Title
Complete myocardial revascularization confers a larger clinical benefit
when performed with state-of-the-art techniques in high-risk patients with
multivessel coronary artery disease: A meta-analysis of randomized and
observational studies.
Source
Catheterization and Cardiovascular Interventions. 87 (1) (pp 3-12), 2016.
Date of Publication: 01 Jan 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives To test whether a strategy of complete revascularization (CR)
as compared with incomplete myocardial revascularization (IR) - both
performed with current "state-of-the-art" percutaneous coronary
interventions (PCI) or coronary artery bypass graft (CABG) - would provide
a clinical benefit in patients with multivessel coronary artery disease
(MVCAD). Background The "optimal" extent of myocardial revascularization
remains to be determined. Methods: We performed a meta-analysis of studies
reporting on clinical outcomes of MVCAD patients treated with CR and IR,
with extensive (>80%) use of stents for PCI or arterial conduits in CABG.
Relative risk (RR) and 95% confidence intervals (CIs) for all-cause
mortality were assessed as primary endpoint, myocardial infarction (MI)
and repeat revascularization as secondary endpoints. Results A total of 28
studies were identified, including 83,695 patients with 4.7 +/- 4.3 years
of follow-up. Compared with IR, CR was associated with reduced mortality
(RR: 0.73; 95% CI 0.66-0.81) both after CABG (RR: 0.76; 95% CI 0.63-0.90)
and PCI (RR: 0.73; 95% CI 0.64-0.82). The risks of MI (RR: 0.74; 95% CI
0.64-0.85) and repeat revascularization (RR: 0.77; 95% CI 0.66-0.88) were
also lower after CR as compared with IR. Metaregression showed a
significant RR reduction of MI associated with more recent publication (P
= 0.021) and increasing prevalence of diabetes (P = 0.033). Conclusions In
MVCAD, as compared with IR, CR confers a clinical benefit that seems
larger in cohorts of patients enrolled in more recent studies and with a
higher prevalence of diabetes. Copyright &#xa9; 2015 Wiley Periodicals,
Inc.

<94>
Accession Number
602541119
Author
Goswami N.J.; Smalling R.G.; Sinha S.; Gammon R.S.; Ramaiah V.G.
Institution
(Goswami) Interventional Cardiology, St. John's - Prairie Heart,
Springfield, IL, United States
(Smalling) Interventional Cardiology, Christi Hospital, Pittsburg, KS,
United States
(Sinha) Interventional Cardiology, Fairfield Medical Center, Lancaster,
OH, United States
(Gammon) Interventional Cardiology, Austin Heart, Austin, TX, United
States
(Ramaiah) Vascular Surgery, Arizona Heart Institute, Phoenix, AZ, United
States
Title
Comparison of the boomerang wire vascular access management system versus
manual compression alone during percutaneous diagnostic and interventional
cardiovascular procedures: The boomerangTM wire vascular access management
trial II.
Source
Catheterization and Cardiovascular Interventions. 87 (1) (pp 75-81), 2016.
Date of Publication: 01 Jan 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives To evaluate the use of the BoomerangTM Wire as an adjunct to
manual compression (MC) in patients requiring diagnostic (Dx) or
interventional (Ix) percutaneous procedures. Background MC remains the
standard of care for closure of femoral artery access sites. Adjunctive
use of a device to facilitate closure, reduce time to hemostasis (TTH) and
ambulation (TTA) without increasing complication rates could reduce costs
and hospital resource demands. Methods The BoomerangTM Trial was a
prospective, multicenter, randomized, controlled trial comparing use of
the BoomerangTM wire, (Cardiva Medical, Sunnyvale, CA) in conjunction with
MC versus MC alone to achieve hemostasis in Dx and Ix patients undergoing
percutaneous procedures requiring femoral artery access. Endpoints
included TTH, TTA, major, and minor access-site related complications.
Subjects were randomized 3:1, Boomerang versus MC. Results No minor or
major device-related adverse events were reported. Nondevice related
complication rates were 3 (0.9%) in the Boomerang arm (n = 327) and 1
(0.8%) in MC arm (n = 123). Mean TTH for Boomerang vs. MC was 11.2 +/- 4.3
vs. 23.2 +/- 11 min for Dx (P < 0.0001) and 13.9 +/- 5.4 vs. 38.4 +/- 57.3
min for Ix patients (P < 0.0001). Mean TTA for Boomerang vs. MC was 3.3
+/- 3.0 vs. 4.5 +/- 2.0 hr (P < 0.0001)for Dx and 5.4 +/- 3.3 vs. 6.8 +/-
3.2 hr (P < 0.0001) for Ix patients. Conclusions BoomerangTM use, in
conjunction with MC, was associated with low rates of complications and
demonstrated that BoomerangTM as an adjunct to MC can significantly
decrease TTH and TTA after both Dx and Ix procedures. Copyright &#xa9;
2015 Wiley Periodicals, Inc.

<95>
Accession Number
612894960
Author
Dimarakis I.
Institution
(Dimarakis) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Manchester, United Kingdom
Title
Miniaturized cardiopulmonary bypass in adult cardiac surgery: a clinical
update.
Source
Expert Review of Cardiovascular Therapy. 14 (11) (pp 1245-1250), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Cardiopulmonary bypass has undoubtedly been the cornerstone
in the rapid development of cardiac surgery, allowing even the performance
of procedures beyond the scope of cardiothoracic surgery. Its use however,
is associated with significant complications that arise from the
mechanical effects of the circuit on circulating blood components as well
as the contact of blood with non-endothelial surfaces. Miniature
cardiopulmonary bypass systems have been developed in an attempt to
minimize these complications. Areas covered: Herein clinical outcomes from
the most recent studies in adult cardiac surgery are discussed. The main
benefits of miniaturisation as well as potential areas of further
application are described. Expert commentary: Data is critically appraised
in the context of current guidelines. Finally the need for further basic
science in addition to large multi-centre randomized controlled trial data
is highlighted. Copyright &#xa9; 2016 Informa UK Limited, trading as
Taylor & Francis Group.

<96>
Accession Number
609951326
Author
Khalil M.; Al-Agaty A.; Asaad O.; Mahmoud M.; Omar A.S.; Abdelrazik A.;
Mostafa M.
Institution
(Khalil, Al-Agaty, Asaad) Anesthesia Department, Cairo University, Giza,
Egypt
(Mahmoud, Abdelrazik) Critical Care Department, Cairo University, Giza,
Egypt
(Omar) Critical Care Department, Cairo University, Beni-Suef Division,
Giza, Egypt
(Mostafa) Cardiology Department, Ain-Shams University, Giza, Egypt
Title
A comparative study between propofol and dexmedetomidine as sedative
agents during performing transcatheter aortic valve implantation.
Source
Journal of Clinical Anesthesia. 32 (pp 242-247), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective The type of sedative drugs could play a major role in providing
hemodynamic stability which is crucial during transcatheter aortic valve
implantation (TAVI) procedure. The aim of this study is to compare
propofol with dexmedetomidine for conscious sedation during TAVI. Design A
prospective randomized pilot study. Patients Fifty patients with a mean
age of 74 years, American Society of Anesthesiologists 3-4, complaining
from severe aortic stenosis were enrolled in this study to undergo TAVI.
Interventions The propofol group (group P; n = 25) received a bolus dose
of 0.5 mg/kg propofol followed by a continuous intravenous infusion of
propofol at a rate of 30 to 50 mug kg^-1 min^-1, and
the dexmedetomidine group (group D; n = 25) received dexmedetomidine at a
loading dose of 1 mug/kg and then a continuous intravenous infusion of
dexmedetomidine at a rate of 0.5 mug kg^-1 h^-1.
Measurements Heart rate, mean arterial blood pressure, number of
phenylephrine boluses, oxygen saturation, sedation, and satisfaction
scores were measured just after the start of infusion of the sedation
drugs and at the end of the procedure. Postoperative complications were
also recorded. Results There was a statistically significant reduction in
the heart rate in group D in comparison to group P where it was 67.28 +/-
6.9 beats/min in the first group in comparison to 78 +/- 6.9 beats/min in
the last one (P <.001). The mean arterial blood pressure was statistically
significant lower in group D in comparison to group P (58.12 +/- 5.4 mm Hg
in group D vs 68.24 +/- 11.4 mm Hg in group P; P <.001). Also, the number
of phenylephrine boluses was higher in group D than in group P (36.5 +/-
7.17 in group D vs 20.6 +/- 2.07 in group p; P <.001). No difference
between the 2 groups regarding oxygen saturation, sedation, pain,
satisfaction scores, and postoperative complications. Conclusion During
TAVI, dexmedetomidine may be associated with significant hypotension and
bradycardia rather than propofol. Copyright &#xa9; 2016 Elsevier Inc. All
rights reserved.

<97>
Accession Number
613265024
Author
Sakrana A.A.; Nasr M.M.; Ashamallah G.A.; Abuelatta R.A.; Naeim H.A.;
Tahlawi M.E.
Institution
(Sakrana, Abuelatta, Naeim) Madina Cardiac Center, 23411, AL Madinah Al
Munawwrah, Khaled Bin Al Waleed Road, Saudi Arabia
(Sakrana, Nasr, Ashamallah) Department of Diagnostic and Interventional
Radiology, Mansoura University Hospital, 35112, 12 El-Gomhoreya Street,
Mansoura, Egypt
(Tahlawi) Zagazig University Hospital, Cardiology Department, Zagazig,
Egypt
Title
Paravalvular leak after transcatheter aortic valve implantation: is it
anatomically predictable or procedurally determined? MDCT study.
Source
Clinical Radiology. 71 (11) (pp 1095-1103), 2016. Date of Publication: 01
Nov 2016.
Publisher
W.B. Saunders Ltd
Abstract
Aim To investigate the determinants of paravalvular leak (PVL) occurring
after transcatheter aortic valve implantation (TAVI). Materials and
methods One hundred and eight patients with severe symptomatic aortic
stenosis (mean age 75.5+/-11.8 years, 72.2% male) underwent
contrast-enhanced electrocardiogram (ECG)-gated multidetector computed
tomography (MDCT) then successful TAVI. The following parameters were
determined in the late systolic phase: annular and left ventricular
outflow tract (LVOT) diameters, annular perimeter, ellipticity index,
annular area, indexed annular area, LVOT perimeter, annulus/LVOT perimeter
difference ratio, the LVOT to ascending aorta angle (< LVOT-AO). In the
diastolic phase, the extent of calcification of the aortic valve (AVC) was
assessed visually and graded semi-quantitatively as grade I, II, and III
at the annulus, LVOT, and aortic cusps levels. Pre-discharge transthoracic
echocardiography (TTE) was performed, and the PVL was graded as grade I,
II, and III. The area-dependent device-annulus sizing ratio was
calculated. Results Absence of PVL was observed in 44.44% of the patients,
30.56% had grade I PVL, 25% of the patients had grade II or above, and any
PVL was observed in 55.56%. There was no statistically significant
association between the degree of PVL and the extent or the distribution
of AVC, aortic annulus diameters, ellipticity index, annulus/LVOT
perimeter difference ratio or < LVOT-AO. The frequency of PVL was not
significantly different with the use of balloon-expandable or
self-expandable valves. A larger transcatheter heart valve (THV)/annulus
sizing ratio was associated with a lower incidence and degree of PVL
(p<0.001); there was no detectable PVL with a mean sizing ratio of
14.89+/-7.29, and grade I PVL occurred with a mean sizing ratio
12.43+/-0.84, while PVL of grade II or above occurred using the mean
sizing ratio -0.42+/-5.57. Conclusion The procedure-related THV/annulus
sizing ratio was an important determinant of the degree of PVL after TAVI,
whereas the MDCT-derived anatomical measurements of the aortic root and
AVC were not predictors of PVL. Copyright &#xa9; 2016 The Royal College of
Radiologists

<98>
Accession Number
614366366
Author
Patel A.V.; Bangalore S.
Institution
(Bangalore) Cardiac Catheterization Laboratory, Cardiovascular Outcomes
Group, Cardiovascular Clinical Research Center, New York University School
of Medicine, New York, NY 10016, United States
(Patel) Division of Cardiology, New York University School of Medicine,
New York, NY 10016, United States
(Patel) 550 1st Avenue, New York, NY 10016, United States
Title
Challenges with Evidence-Based Management of Stable Ischemic Heart
Disease.
Source
Current Cardiology Reports. 19 (2) (no pagination), 2017. Article Number:
11. Date of Publication: 01 Feb 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Stable ischemic heart disease (SIHD) is a highly
prevalent condition associated with increased costs, morbidity, and
mortality. Management goals of SIHD can broadly be thought of in terms of
improving prognosis and/or improving symptoms. Treatment options include
medical therapy as well as revascularization, either with percutaneous
coronary intervention or coronary artery bypass grafting. Herein, we will
review the current evidence base for treatment of SIHD as well as its
challenges and discuss ongoing studies to help address some of these
knowledge gaps. Recent Findings: There has been no consistent reduction in
death or myocardial infarction (MI) with revascularization vs. medical
therapy in patients with SIHD in contemporary trials. Angina and quality
of life have been shown to be relieved more rapidly with revascularization
vs. optimal medical therapy; however, the durability of these results is
uncertain. There have been challenges and limitations in several of the
trials addressing the optimal treatment strategy for SIHD due to potential
selection bias (due to knowledge of coronary anatomy prior to
randomization), patient crossover, and advances in medical therapy and
revascularization strategies since trial completion. Summary: The
challenges inherent to prior trials addressing the optimal management
strategy for SIHD have impacted the generalizability of results to
real-world cohorts. Until the results of additional ongoing trials are
available, the decision for revascularization or medical therapy should be
based on patients' symptoms, weighing the risks and benefits of each
approach, and patient preference. Copyright &#xa9; 2017, Springer
Science+Business Media New York.

<99>
Accession Number
614705442
Author
Varelmann D.J.; Muehlschlegel J.D.
Institution
(Varelmann, Muehlschlegel) Brigham and Women's Hospital, Harvard Medical
School, 75 Francis St., CWN L1, Boston, MA 02115, United States
Title
Noteworthy Literature Published in 2016 for the Cardiothoracic
Anesthesiologist.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 21 (1) (pp 8-16),
2017. Date of Publication: 01 Mar 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Clinical research and outcome studies dominated the publication spectrum
for the cardiothoracic anesthesiologist in 2016. Echocardiography is an
important tool in the armamentarium of the cardiothoracic
anesthesiologist. Technology is advancing at a fast pace: A new method to
quantify the regurgitant volume in mitral regurgitation has been described
in an experimental model and been validated in humans. Interesting studies
on key elements of our daily practice have been published: Does tranexamic
acid decrease the transfusion requirements after cardiac surgery? Are
patients with a postoperative cognitive deficit at risk for dementia 7.5
years after surgery? What is the best strategy for post-cardiac surgery
atrial fibrillation? What is the mechanism of preconditioning with
remifentanil? Large multicenter looked at the treatment strategies for
moderate and severe ischemic mitral regurgitation and benefits of
transcatheter aortic valve replacement versus the surgical approach. These
studies may give us ideas on how to tailor treatment to optimize the
patients' outcome and to minimize the associated risks. Copyright &#xa9;
The Author(s) 2016.

<100>
Accession Number
614705063
Author
London M.J.; Schwartz G.G.; Hur K.; Henderson W.G.
Institution
(London) Department of Anesthesia and Perioperative Care, University of
California, San Francisco, United States
(London) Department of Anesthesia and Perioperative Care, Department of
Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121,
United States
(Schwartz) Cardiology Section, Department of Medicine, Department of
Veterans Affairs Medical Center, Denver, CO, United States
(Hur) Center for Medication Safety, Pharmacy Benefits Management Services,
Department of Veterans Affairs Medical Center, Hines, IL, United States
(Henderson) Department of Biostatistics, University of Colorado, Denver,
United States
(Henderson) Adult and Child Ctr. for Outcomes Res. and Delivery Sci. and
Dept. of Biostatistics and Informatics, Colorado School of Public Health,
Aurora, United States
Title
Association of perioperative statin use with mortality and morbidity after
major noncardiac surgery.
Source
JAMA Internal Medicine. 177 (2) (pp 231-242), 2017. Date of Publication:
01 Feb 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The efficacy of statins in reducing perioperative
cardiovascular and other organ system complications in patients undergoing
noncardiac surgery remains controversial. Owing to a paucity of randomized
clinical trials, analyses of large databasesmay facilitate informed
hypothesis generation and more efficient trial design. OBJECTIVE To
evaluate associations of early perioperative statin use with outcomes in a
national cohort of veterans undergoing noncardiac surgery. DESIGN,
SETTING, AND PARTICIPANTS This retrospective, observational cohort
analysis included 180 478 veterans undergoing elective or emergent
noncardiac surgery (including vascular, general, neurosurgery, orthopedic,
thoracic, urologic, and otolaryngologic) who were admitted within 7 days
of surgery and sampled by the Veterans Affairs Surgical Quality
Improvement Program (VASQIP). Patients were admitted to Department of
Veterans Affairs hospitals and underwent 30-day postoperative follow-up.
Data were collected from October 1, 2005, to September 30, 2010, and
analyzed from November 28, 2013, to October 31, 2016. EXPOSURE Statin use
on the day of or the day after surgery. MAIN OUTCOMES AND MEASURES
All-cause 30-day mortality (primary outcome) and standardized 30-day
cardiovascular and noncardiovascular outcomes captured by VASQIP. Use of
statins and other perioperative cardiovascular medications was ascertained
from the Veterans Affairs Pharmacy Benefits Management research database.
RESULTS A total of 180 478 eligible patients (95.6%men and 4.4%women; mean
[SD] age, 63.8 [11.6] years) underwent analysis, and 96 486 were included
in the propensity score-matched cohort (96.3%men; 3.7%women; mean [SD]
age, 65.9 [10.6] years). At the time of hospital admission, 37.8%of
patients had an active outpatient prescription for a statin, of whom
80.8%were prescribed simvastatin and 59.5%used moderate-intensity dosing.
Exposure to a statin on the day of or the day after surgery based on an
inpatient prescription was noted in 31.5%of the cohort. Among 48 243
propensity score-matched pairs of early perioperative statin-exposed and
nonexposed patients, 30-day all-cause mortality was significantly reduced
in exposed patients (relative risk, 0.82; 95%CI, 0.75-0.89; P < .001;
number needed to treat, 244; 95%CI, 170-432). Of the secondary outcomes, a
significant association with reduced risk of any complication was noted
(relative risk, 0.82; 95%CI, 0.79-0.86; P < .001; number needed to treat,
67; 95%CI, 55-87); all were significant except for the central nervous
system and thrombosis categories, with the greatest risk reduction
(relative risk, 0.73; 95%CI, 0.64-0.83) for cardiac complications.
CONCLUSIONS AND RELEVANCE Early perioperative exposure to a statin was
associated with a significant reduction in all-cause perioperative
mortality and several cardiovascular and noncardiovascular complications.
However, the potential for selection biases in these results must be
considered.

<101>
Accession Number
614704403
Author
Jaguszewski M.; Aloysius R.; Wang W.; Bezerra H.G.; Hill J.; De Winter
R.J.; Karjalainen P.P.; Verheye S.; Wijns W.; Luscher T.F.; Joner M.;
Costa M.; Landmesser U.
Institution
(Jaguszewski, Landmesser) Department of Cardiology, Charite
Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
(Jaguszewski, Landmesser) Berlin Institute of Health (BIH), Berlin,
Germany
(Jaguszewski, Landmesser) Deutsches Zentrum fur Herz- und
Kreislaufforschung (DZHK), Berlin, Germany
(Jaguszewski) First Department of Cardiology, Medical University of
Gdansk, Gdansk, Poland, Poland
(Aloysius, Wang) Cardiovascular Imaging Core Laboratory, Harrington Heart
& Vascular Institute, Cleveland, Ohio, United States
(Bezerra, Costa) Cardiovascular Imaging Department, Case Western Reserve
University, Cleveland, Ohio, United States
(Hill) Cardiovascular Division, King's College London, London, United
Kingdom
(De Winter) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Karjalainen) Heart Center, Satakunta Central Hospital, Pori, Finland
(Verheye) Antwerp Cardiovascular Institute, Middelheim Hospital, Antwerp,
Belgium
(Wijns) Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
(Luscher) Department of Cardiology, University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Joner) CVPath Institute Inc., Gaithersburg, Maryland, United States
Title
The REMEDEE-OCT Study: An Evaluation of the Bioengineered COMBO
Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent
Compared With a Cobalt-Chromium Everolimus-Eluting Stent in Patients With
Acute Coronary Syndromes: Insights From Optical Coherence Tomography
Imaging Analysis.
Source
JACC: Cardiovascular Interventions. 10 (5) (pp 489-499), 2017. Date of
Publication: 13 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of the present study was to evaluate vascular healing
of the bioengineered COMBO Dual Therapy Stent compared with a
cobalt-chromium (CoCr) everolimus-eluting stent (EES) as assessed by
optical coherence tomography in patients with acute coronary syndromes.
Background CD34+ cells promote endothelial repair after vascular injury.
The bioengineered COMBO Dual Therapy Stent combines CD34+ cell-capturing
technology with abluminal sirolimus release, but more data from clinical
studies evaluating the vascular response are needed. Methods In a
prospective randomized multicenter clinical trial, 60 patients with acute
coronary syndromes were randomized 1:1 to COMBO or CoCr EES implantation.
The primary endpoint was the percentage of uncovered stent struts per
stent. Stent assessment by optical coherence tomography was performed at
baseline and at 60 days, followed by independent core laboratory analysis.
Results The percentage of uncovered struts per stent was higher with the
COMBO than the CoCr EES at 60 days (median 14.7% vs. 7.7%; p = 0.04).
However, no significant difference in uncovered stent struts was observed
in the strut level-based analysis at 60 days, which also accounted for
clustering (COMBO vs. CoCr EES; 13.6% vs. 6.9%; p = 0.09; generalized
linear mixed models-adjusted analysis). Neointimal thickness at 60 days
was lower with the COMBO compared with the CoCr EES (median 30.17 vs.
50.26 mum; p = 0.02; stent-level analysis). There were no significant
differences in the frequency of major adverse cardiac events and each
component of major adverse cardiac events within the study population
between the 2 groups at 30, 60, 180, 360, and 540 days post-procedure. No
target vessel stent thrombosis has been documented within 540 days.
Conclusions The present multicenter, prospective clinical study for the
first time compared the vascular response of the bioengineered COMBO Dual
Therapy Stent with a CoCr EES in patients early after acute coronary
syndrome by using intracoronary optical coherence tomographic analysis.
The percentage of uncovered stent struts per stent was somewhat higher
after COMBO versus CoCr EES implantation as detected by optical coherence
tomography, associated with reduced neointimal thickness. Copyright &#xa9;
2017 American College of Cardiology Foundation

<102>
Accession Number
614212872
Author
Girish G.; D'souza R.E.; D'souza P.; Lewis M.G.; Baker D.M.
Institution
(Girish) Department of General & Vascular Surgery, Watford General
Hospital, Watford, United Kingdom
(D'souza, Baker) Department of Vascular Surgery, Royal Free Hospital,
Royal Free London NHS Foundation Trust, London, United Kingdom
(D'souza) Social Science Research Unit and EPPI-Centre, UCL Institute of
Education, London, United Kingdom
(Lewis) Department of statistics, Public Health Evidence, South Asia
(PHESA), Manipal University, Manipal, India
Title
Role of surgical thoracic sympathetic interruption in treatment of facial
blushing: a systematic review.
Source
Postgraduate Medicine. 129 (2) (pp 267-275), 2017. Date of Publication: 17
Feb 2017.
Publisher
Taylor and Francis Inc. (325 Chestnut St, Suite 800, Philadelphia PA
19106, United States)
Abstract
Objectives: This paper aims to review the evidence to support the
effectiveness of sympathectomy as a treatment for facial blushing in terms
of relief of facial blushing, patient satisfaction, recurrence of
blushing, patients regretting treatment and its associated complications.
Methods: A systematic search strategy was performed in Ovid-Medline,
Embase, Cochrane library and NICE. Studies reporting outcomes of
sympathetic interruption in the treatment of facial blushing were
retrieved. Results: Nine studies met the inclusion criteria with 1369
patients included in the final analysis. The age range of patients was 8
to 74 years (from 7 studies) with 56% females. Mean follow up was 21
months in 8 studies (range 6 to 30 months). The pooled proportion of
patients who had good relief of facial blushing was 78.30% (95% C.I.
58.20%-98.39%). Complete satisfaction was reported in 84.02% (95% C.I.
71.71%-96.33%). Compensatory sweating and gustatory sweating were the
commonest complications occurring in 74.18% (95% C.I. 58.10%-90.26%) and
24.42% (95% C.I. 12.22%-36.61%) respectively. The estimated proportion of
patients regretting surgery was 6.79% (C.I 2.08% 11.50%). Conclusion:
Sympathetic interruption at T2 or T2-3 ganglia appears to be an effective
treatment for facial blushing. However, lack of randomized trials
comparing sympathetic interruption with non-surgical methods of treatment
and heterogeneity of included studies with respect to assessment of
outcome measures preclude strong evidence and definitive recommendations.
Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor & Francis
Group.

<103>
Accession Number
613340806
Author
Li B.; Ding Y.; Tian F.; Chen W.; Han T.; Chen Y.
Institution
(Li, Ding, Tian, Chen, Han, Chen) Department of Cardiology, Chinese PLA
General Hospital, 28 Fuxing Road, Beijing 100853, China
Title
Assessment of a Drug-Eluting Balloon for the Treatment of de novo Coronary
Lesions Guided by Optical Coherence Tomography: Study Protocol for a
Randomized Controlled Trial.
Source
Cardiology (Switzerland). 136 (4) (pp 252-257), 2017. Date of Publication:
01 Mar 2017.
Publisher
S. Karger AG
Abstract
Background: The drug-eluting balloon (DEB) is a promising tool to prevent
restenosis after coronary angioplasty. However, data on the outcomes of
DEB in de novo lesions are scarce. Vessel recoil and constrictive
remodeling are the dominant causes of restenosis after angioplasty. The
use of cutting balloons (CB) may effectively reduce elastic recoil after
balloon dilation. In this study, we evaluate the efficacy and safety of
DEB in treating de novo coronary artery lesions, using a predilation
strategy with cutting balloon (CB) dilation before DEB angioplasty.
Methods/Design: We present the design of a prospective, single-center,
open-label, randomized, 2-arm clinical trial aiming to assess whether or
not the strategy of CB dilation before DEB angioplasty reduces the primary
end point of late lumen loss (LLL) compared with drug-eluting stent (DES)
implantation alone for de novo coronary artery lesions. A total of 120
patients will be randomly enrolled into the DEB or DES group (1:1 ratio).
The primary end point is insegment LLL at 12 months as measured by optical
coherence tomography (OCT). Secondary end points include procedural
success, such as angiographic success and device success, and clinical
outcomes including all-cause death, myocardial infarction, target vessel
revascularization, target lesion revascularization, and stent thrombosis.
Discussion: The study will evaluate the clinical efficacy, angiographic
outcomes, and safety of DEB after CB dilation compared with DES for the
treatment of de novo coronary artery lesions guided by OCT. Copyright
&#xa9; 2016 S. Karger AG, Basel.

<104>
Accession Number
613094478
Author
Farag M.; Patil N.P.; Sabashnikov A.; Arif R.; Szabo G.; Kallenbach K.;
Ruhparwar A.; Karck M.; Brenner T.; Hofer S.; Weymann A.
Institution
(Farag, Arif, Szabo, Kallenbach, Ruhparwar, Karck, Weymann) Department of
Cardiac Surgery, Heart and Marfan Center, University of Heidelberg,
Heidelberg, Germany
(Patil) Department of Cardiothoracic Surgery, Royal Brompton and Harefield
NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
(Sabashnikov) Department of Cardiothoracic Surgery, Heart Center,
University of Cologne, Cologne, Germany
(Brenner, Hofer) Department of Anesthesiology, Heidelberg University
Hospital, Heidelberg, Germany
(Kallenbach) INCCI HAERZ ZENTER, Luxembourg, Germany
Title
Comparison of Two Miniaturized Cardiopulmonary Bypass Systems Regarding
Inflammatory Response.
Source
Artificial Organs. 41 (2) (pp 139-145), 2017. Date of Publication: 01 Feb
2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Cardiopulmonary bypass (CPB) is a known mediator of systemic inflammatory
response. Extracorporeal circulations are undergoing continuous
modifications and optimizations to achieve better results. Hence we aim to
compare the inflammatory response associated with two recent miniature
extracorporeal circulation systems during normothermic CPB. We measured
plasma levels of cytokines including interleukin (IL)-1beta, IL-6, IL-10,
tumor necrosis factor-alpha, migration inhibitory factor (MIF), receptor
for advanced glycation endproduct, and cluster of differentiation 40
ligand in 60 consecutive patients during the first 24 h after CPB. The
patients were prospectively randomized to one of three trial groups:
patients in group A were operated with the minimal extracorporeal
circulation circuit (MECC, Maquet, Rastatt, Germany), group B operated
with the extracorporeal circulation circuit optimized (ECC.O, Sorin,
Italy), and group C operated with a conventional extracorporeal circuit
(CECC, Maquet). Arterial blood samples were collected at intervals before,
30 min after initiation, and after termination of CPB. Further samples
were collected 6 and 24 h after CPB. IL-10 levels were significantly
raised in the CECC group as compared with either of the mini ECC-circuits
with a peak concentration at 6 h postoperatively. Human MIF concentrations
were significantly higher in the CECC group starting 30 min after CPB and
peaking at the end of CPB. The overall reduction in cytokine
concentrations in the mini-ECC groups correlated with a lower need for
blood transfusion in MECC and a shorter mechanical ventilation time for
ECC.O. Normothermic CPB using minimally invasive extracorporeal
circulation circuits can reduce the inflammatory response as measured by
cytokine levels, which may be beneficial for perioperative preservation of
pulmonary function and hemostasis in low risk patients. Copyright &#xa9;
2016 International Center for Artificial Organs and Transplantation and
Wiley Periodicals, Inc.

<105>
Accession Number
614711907
Author
Zuliani Mauro M.F.; Mangione J.A.; Costa J.R.; Costa R.; Piva E Mattos
L.A.; Staico R.; Feres F.; Siqueira D.; Sousa A.; Abizaid A.
Institution
(Zuliani Mauro, Mangione) Department of Interventional Cardiology,
Hospital Beneficencia Portuguesa, R. Maestro Cardim, 769-Bela Vista, Sao
Paulo, SP 01323-001, Brazil
(Costa, Costa, Piva E Mattos, Staico, Feres, Siqueira, Sousa, Abizaid)
Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
Title
Randomized Angiographic and Intravascular Ultrasound Comparison of
Dual-Antiplatelet Therapy vs Triple-Antiplatelet Therapy to Reduce
Neointimal Tissue Proliferation in Diabetic Patients.
Source
Journal of Invasive Cardiology. 29 (3) (pp 76-81), 2017. Date of
Publication: March 2017.
Publisher
HMP Communications
Abstract
BACKGROUND: Previous studies have suggested a benefit of cilostazol in
addition to standard dual-antiplatelet therapy (DAPT), reducing in-stent
late luminal loss and restenosis after percutaneous coronary intervention
(PCI) with bare-metal and drug-eluting stent (DES) implantation. However,
there is a paucity of intravascular ultrasound (IVUS) assessment of
neointimal tissue hyperplasia (NIH) after triple-antiplatelet therapy
(TAPT), especially in diabetic patients treated with DES. METHODS: This
prospective, placebo-controlled trial was conducted in diabetic patients
randomized (1:1) to receive either standard DAPT (aspirin and clopidogrel)
vs TAPT with cilostazol for a minimum of 12 months after PCI with Endeavor
zotarolimus-eluting stent (E-ZES). The primary endpoint was the 9-month
comparison of percentage of NIH in both groups. Additionally, we compared
in-stent late lumen loss, binary restenosis, major adverse cardiac event
(MACE; cardiac death, non-fatal myocardial infarction, and restenosis)
rates, and the incidence of vascular/bleeding complications. RESULTS: In
total, 133 diabetic patients were enrolled (cilostazol cohort = 65
patients) with 56.4% male and mean age of 60.8 years. Overall, the two
cohorts were comparable in terms of baseline clinical and angiographic
characteristics, except for the reference vessel diameter, which was
smaller among patients randomized to cilostazol (2.48 +/- 0.46 mm vs 2.69
+/- 0.48 mm; P=.01). At 9 months, there was a non-significant trend toward
less percentage of NIH obstruction in the TAPT cohort (33.2 +/- 8.29% vs
35.1 +/- 8.45%; P=.07). However, this finding did not impact angiographic
late-lumen loss (0.60 +/- 0.46 mm cilostazol group vs 0.64 +/- 0.48 mm
control group; P=.30) and binary restenosis (9.8% vs 6.8%; P=.99). MACE
rate also did not significantly differ between the cohorts (13.8%
cilostazol group vs 8.8% control group; P=.81). Of note, the addition of a
third antiplatelet agent did not increase vascular and bleeding
complications. CONCLUSION: In diabetic patients treated with E-ZES, TAPT
with cilostazol did not add any significant benefit in terms of NIH
suppression or MACE reduction.

<106>
Accession Number
614175304
Author
Gholipour Baradari A.; Habibi M.R.; Habibi V.; Nouraei S.M.
Institution
(Gholipour Baradari, Habibi) Department of Anesthesiology, Faculty of
Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Habibi, Nouraei) Department of Cardiac Surgery, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
Title
Administration of lidocaine to prevent cognitive deficit in patients
undergoing coronary artery bypass grafting and valve plasty: a systematic
review and meta-analysis.
Source
Expert Review of Clinical Pharmacology. 10 (2) (pp 179-185), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: The administration of lidocaine to maintain cognitive
function following coronary artery bypass grafting (CABG) and valve plasty
is a controversial concept in terms of its effectiveness. We performed a
systematic review to determine the effectiveness of treatment with
lidocaine in preventing the occurrence of cognitive deficit after cardiac
surgery. Area covered: To review the current literature on the subject, we
searched the PubMed database and the Cochrane Library database (up to May
2015) and compiled a list of retrieved articles. Our final review includes
only randomized controlled trials (RCTs) that compared lidocaine to a
control (placebo) following CABG and valve plasty. Statistical analysis of
the odds ratio (OR) and corresponding 95% confidence interval (CI) were
used to determine the overall effectiveness of lidocaine for the
prevention of cognitive deficit with both procedures. The Mantel-Haenszel
method was used to pool data of the outcomes of cognitive deficit
occurrence into fixed-effect model meta-analyses. Five RCTs were included
in this study, with a total of 688 patients. Perioperative administration
of lidocaine in patients undergoing cardiac surgery reduced occurrence of
cognitive deficit (OR 0.583 [95% CI 0.438-0.777]; Z = -3.680; P = 0.00;
I² = 52%). No significant difference in the early occurrence of
cognitive deficit was revealed in patients after cardiac surgery (OR 0.909
[95% CI 0.600-1.376]; Z = -0.451; P = 0.652; I² = 11%). Expert
commentary: Cognitive deficit associated with cardiac surgery is a common
postoperative event. Lidocaine is contributed to a significantly reduced
occurrence of cognitive deficit. Cognitive deficit management is
recommended. Copyright &#xa9; 2016 Informa UK Limited, trading as Taylor &
Francis Group.

<107>
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.

<108>
Accession Number
614425467
Author
Vaidya S.R.; Devarapally S.R.; Arora S.
Institution
(Vaidya, Arora) Department of Internal Medicine, Cape Fear Valley Medical
Center, 1638 Owen drive, Fayetteville, NC 28304, United States
(Devarapally) Division of Cardiology, Cape Fear Valley Medical Center,
Fayetteville, NC, United States
(Devarapally) Division of Cardiology, New York Methodist Hospital, Weill
Cornell Medical College, New York, NY, United States
(Arora) Division of Cardiology, University of North Carolina at Chapel
Hill, Chapel Hill, NC, United States
Title
Infarct related artery only versus complete revascularization in
ST-segment elevation myocardial infarction and multi vessel disease: A
meta-analysis.
Source
Cardiovascular Diagnosis and Therapy. 7 (1) (pp 16-26), 2017. Date of
Publication: 2017.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Background: The 2015 American College of Cardiology Foundation/American
Heart Association (ACCF/AHA) focused update on primary percutaneous
coronary intervention (PCI) for patients with ST-segment elevation
myocardial infarction (STEMI) only gives a class II b (weak) indication
for non-infarct artery intervention at the time of primary PCI. Recent
randomized controlled trials, however, suggest strong evidence supporting
complete revascularization. Methods: A systematic search was conducted in
PUBMED, MEDLINE, EMBASE and Cochrane central register for randomized
controlled trials comparing complete versus infarct artery (IRA) only
revascularization in patients with STEMI. A meta-analysis was performed
using the data extracted from each study. Summary risk ratios (RR) and 95%
confidence intervals (CI) were calculated for five outcomes. Results: Six
trials fulfilled the inclusion criteria yielding 1,792 patients. Follow up
ranged from 6 months to 2.5 years. The incidence of major adverse cardiac
events (MACE) was significantly lower in the complete revascularization
group compared to the IRA only revascularization (13.8% vs. 25.1%, RR
=0.51; 95% CI: 0.41-0.64, P<0.00001). It was attributed to significantly
lower repeat revascularization rate in the complete revascularization
group (8.2% vs. 18.9%, RR =0.41; 95% CI: 0.31-0.54, P<0.00001). This
meta-analysis also showed a significant reduction in cardiovascular
mortality (2.0% vs. 4.6%, RR =0.42; 95% CI: 0.24-0.74; P=0.003), non-fatal
myocardial infarction (4.37% vs. 5.76%, RR =0.64; 95% CI: 0.34-1.20;
P=0.16) and all-cause mortality rates [(4.6% vs. 6%), RR =0.75; 95% CI:
0.49-1.14, P=0.17] in the complete revascularization group, compared to
the IRA revascularization group. Conclusions: In patients who present with
STEMI, complete revascularization is associated with lower rates of MACE
and cardiovascular deaths as compared to revascularization of the IRA
alone. Even though the outcomes of all-cause mortality and nonfatal
re-infarction rates were lower in the complete revascularization group,
they were not significant.

<109>
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

<110>
Accession Number
609472397
Author
Greco G.; Ferket B.S.; D'Alessandro D.A.; Shi W.; Horvath K.A.; Rosen A.;
Welsh S.; Bagiella E.; Neill A.E.; Williams D.L.; Greenberg A.; Browndyke
J.N.; Gillinov A.M.; Mayer M.L.; Keim-Malpass J.; Gupta L.S.; Hohmann
S.F.; Gelijns A.C.; O'Gara P.T.; Moskowitz A.J.
Institution
(Greco, Ferket, Shi, Bagiella, Williams, Gupta, Gelijns, Moskowitz)
International Center for Health Outcomes and Innovation Research
(InCHOIR), Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(D'Alessandro) Department of Cardiothoracic Surgery, Montefiore Medical
Center/Albert Einstein College of Medicine, New York, NY, United States
(Horvath) Department of Cardiothoracic Surgery, NIH Heart Center at
Suburban Hospital, Bethesda, MD, United States
(Rosen, Greenberg) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Welsh) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke University Medical Center, Durham, NC, United States
(Neill) Department of Cardiothoracic Surgery, Emory University Hospital
Midtown, Atlanta, GA, United States
(Browndyke) Department of Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, NC, United States
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
(Mayer) Division of Cardiovascular Surgery, Department of Surgery,
University of Pennsylvania School of Medicine, Philadelphia, PA, United
States
(Keim-Malpass) Division of Thoracic and Cardiovascular Surgery, University
of Virginia School of Medicine, Charlottesville, VA, United States
(Hohmann) University HealthSystem Consortium, Chicago, IL, United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
MA, United States
Title
Diabetes and the association of postoperative hyperglycemia with clinical
and economic outcomes in cardiac surgery.
Source
Diabetes Care. 39 (3) (pp 408-417), 2016. Date of Publication: March 2016.
Publisher
American Diabetes Association Inc. (E-mail: membership@diabetes.org)
Abstract
Objective The management of postoperative hyperglycemia is controversial
and generally does not take into account pre-existing diabetes. We
analyzed clinical and economic outcomes associated with postoperative
hyperglycemia in cardiac surgery patients, stratifying by diabetes status.
Research Design and Methods Multicenter cohort study in 4,316 cardiac
surgery patients operated on in 2010. Glucose was measured at 6-h
intervals for 48 h postoperatively. Outcomes included cost, hospital
length of stay (LOS), cardiac and respiratory complications, major
infections, and death. Associations between maximum glucose levels and
outcomes were assessed with multivariable regression and recycled
prediction analyses. Results In patients without diabetes, increasing
glucose levels were associated with a gradual worsening of outcomes. In
these patients, hyperglycemia (>180 mg/dL) was associated with an
additional cost of $3,192 (95% CI 1,972 to 4,456), an additional hospital
LOS of 0.8 days (0.4 to 1.3), an increase in infections of 1.6% (0.5 to
2.8), and an increase in respiratory complications of 2.6% (0.0 to 5.3).
However, among patients with insulin-treated diabetes, optimal outcomes
were associated with glucose levels considered to be hyperglycemic (180 to
240 mg/dL). This level of hyperglycemia was associated with cost
reductions of $6,225 (212,886 to 2222), hospital LOS reductions of 1.6
days (23.7 to 0.4), infection reductions of 4.1% (29.1 to 0.0), and
reductions in respiratory complication of 12.5% (222.4 to 23.0). In
patients with non-insulin-treated diabetes, outcomes did not differ
significantly when hyperglycemia was present. Conclusions Glucose levels
<180 mg/dL are associated with better outcomes in most patients, but worse
outcomes in patients with diabetes with a history of prior insulin use.
These findings support further investigation of a stratified approach to
the management of patients with stress-induced postoperative hyperglycemia
based on prior diabetes status. Copyright &#xa9; 2016 by the American
Diabetes Association.

<111>
Accession Number
609689904
Author
Padulles A.; Colom H.; Bestard O.; Melilli E.; Sabe N.; Rigo R.; Niubo J.;
Torras J.; Llado L.; Manito N.; Caldes A.; Cruzado J.M.; Griny J.M.;
Lloberas N.
Institution
(Padulles) IDIBELL, Pharmacy Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Colom) Pharmacy and Pharmaceutical Technology Department, School of
Pharmacy, University of Barcelona, Barcelona, Spain
(Bestard, Melilli, Torras, Caldes, Cruzado, Griny, Lloberas) IDIBELL,
Nephrology Department, Hospital Universitari de Bellvitge, Barcelona,
Spain
(Sabe) IDIBELL, Infectious Diseases Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Rigo) IDIBELL, Biochemistry Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Niubo) IDIBELL, Microbiology Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Llado) IDIBELL, Digestive Surgery Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
(Manito) IDIBELL, Cardiology Department, Hospital Universitari de
Bellvitge, Barcelona, Spain
Title
Contribution of population pharmacokinetics to dose optimization of
ganciclovir-valganciclovir in solid-organ transplant patients.
Source
Antimicrobial Agents and Chemotherapy. 60 (4) (pp 1992-2002), 2016. Date
of Publication: April 2016.
Publisher
American Society for Microbiology (E-mail: Journals@asmusa.org)
Abstract
Treatment of solid-organ transplant (SOT) patients with ganciclovir
(GCV)-valganciclovir (VGCV) according to the manufacturer's
recommendations may result in over- or underexposure. Bayesian prediction
based on a population pharmacokinetics model may optimize GCV-VGCV dosing,
achieving the area under the curve (AUC) therapeutic target. We conducted
a two-arm, randomized, open-label, 40% superiority trial in adult SOT
patients receiving GCV-VGCV as prophylaxis or treatment of cytomegalovirus
infection. Group A was treated according to the manufacturer's
recommendations. For group B, the dosing was adjusted based on target
exposures using a Bayesian prediction model (NONMEM). Fifty-three patients
were recruited (27 in group A and 26 in group B). About 88.6% of patients
in group B and 22.2% in group A reached target AUC, achieving the 40%
superiority margin (P<0.001; 95% confidence interval [CI] difference, 47
to 86%). The time to reach target AUC was significantly longer in group A
than in group B (55.9+/-8.2 versus 15.8 2.3 days, P<0.001). A shorter time
to viral clearance was observed in group B than in group A (12.5 versus
17.6 days; P 0.125). The incidences of relapse (group A, 66.67%, and group
B, 9.01%) and late-onset infection (group A, 36.7%, and group B, 7.7%)
were higher in group A. Neutropenia and anemia were related to GCV
overexposure. GCV-VCGV dose adjustment based on a population
pharmacokinetics Bayesian prediction model optimizes GCV-VGCV exposure.
(This study has been registered at ClinicalTrials.gov under registration
no. NCT01446445.). Copyright &#xa9; 2016, American Society for
Microbiology. All Rights Reserved.

<112>
[Use Link to view the full text]
Accession Number
610791473
Author
Mody P.; Sidhu M.S.; Brilakis E.S.; Sacco J.D.; Banerjee S.; Boden W.E.
Institution
(Mody, Brilakis, Banerjee) Division of Cardiology, Department of Medicine,
University of Texas Southwestern Medical Center, 4500 S Lancaster Road
(111a), Dallas, TX 75230, United States
(Sidhu, Sacco, Boden) Division of Cardiology, Department of Medicine,
Albany Stratton Veteran's Affairs Medical Center, Albany Medical Center,
Albany Medical College, Albany, NY, United States
(Brilakis, Banerjee) VA North Texas Health Care System, Dallas, TX, United
States
Title
Antianginal Agents for the Management of Stable Ischemic Heart Disease: A
Review.
Source
Cardiology in Review. 24 (4) (pp 177-189), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Antianginal medications are an important aspect of optimal medical therapy
for the management of angina in patients with stable ischemic heart
disease. The lack of a standardized definition of effective antianginal
therapy and the lack of clear understanding of the underlying evidence
have often been cited as reasons for the large variations in the use of
these particular classes of pharmacologic agents in contemporary clinical
practice. Hence, we performed a search of the PubMed database and
identified published manuscripts examining the effect of common
antianginal agents on improving anginal parameters and on important
clinical outcomes such as mortality, myocardial infarction, and repeat
revascularization from multiple large randomized, controlled trials,
systematic reviews, meta-analyses, and outcomes data from observational
studies in patients with stable ischemic heart disease. The most commonly
used antianginal agents (beta-blockers, nitrates, calcium channel
blockers, and ranolazine) demonstrated equivalent efficacy in improving
patient reported ischemic symptoms and quantitative exercise parameters.
With regards to mortality, beta-blockers are beneficial in the setting of
depressed left ventricular systolic function. In contrast, recent evidence
points toward the lack of similar benefit of beta-blockers in patients
with preserved systolic function, even in the setting of prior myocardial
infarction. No survival benefit has been identified with the use of
calcium channel blockers, nitrates, or ranolazine. Currently, guidance
regarding objective measurement and up titration of antianginal therapy is
missing. There is an unmet need for development of potentially novel and
clinically relevant methodology to assess the intensity and/or efficacy of
antianginal therapy. &#xa9; Copyright 2015 Wolters Kluwer Health, Inc. All
rights reserved.

<113>
Accession Number
610936704
Author
Wang D.; Yang X.-L.; Chai X.-Q.; Shu S.-H.; Zhang X.-L.; Xie Y.-H.; Wei
X.; Wu Y.-J.; Wei W.
Institution
(Wang, Yang, Chai, Shu, Zhang, Xie, Wei) Department of Anesthesiology,
Affiliated Provincial Hospital of Anhui Medical University, Anhui
Provincial Hospital, Hefei 230001, China
(Wu, Wei) Institute of Clinical Pharmacology, Anhui Medical University,
Hefei 230032, China
Title
A short-term increase of the postoperative naturally circulating dendritic
cells subsets in flurbiprofen-treated patients with esophageal carcinoma
undergoing thoracic surgery.
Source
Oncotarget. 7 (14) (pp 18705-18712), 2016. Date of Publication: 2016.
Publisher
Impact Journals LLC (E-mail: editors@impactaging.com)
Abstract
The present study evaluated whether flurbiprofen increased the naturally
circulating dendritic cells (DCs) subsets in patients with esophageal
squamous cell carcinoma (ESCC) undergoing esophageal resection. Compared
to healthy donors (n=20), the significantly depressed percentages of
plasmacytoid DCs (pDCs), CD1c⁺ myeloid DCs (mDCs), and
CD141⁺ mDCs among ESCC patients (n=60) were confirmed.
Flurbiprofen was administered before skin incision and at the end of
operation in group F (n=30), as well as placebo in group C (n=30). The
postoperative suppressed percentages of pDCs, CD1c⁺ mDCs, and
CD141⁺ mDCs increased significantly following the perioperative
treatment with flurbiprofen. Flurbiprofen also significantly stimulated
the postoperative IFN-gamma and IL-17 production, but inhibited the
immunosuppressive IL-10 and TGF-beta levels. Furthermore, flurbiprofen
exerted a similar analgesic effect and brought a significantly less
sufentanil consumption compared to group C. Taken together, flurbiprofen
provided a short-term increase of postoperative naturally circulating DCs
in ESCC patients.

<114>
Accession Number
611799773
Author
Moscarelli M.; Emmanuel S.; Athanasiou T.; Speziale G.; Fattouch K.;
Casula R.
Institution
(Moscarelli) Honorary Research Fellow, NHLI, Imperial College London,
United Kingdom
(Moscarelli, Speziale) GVM Care and Research, Anthea Hospital, Bari, Italy
(Emmanuel) St Vincent's Hospital, Sydney, Australia
(Athanasiou, Casula) Department of Surgery and Cancer, Imperial College,
Paddington, London, United Kingdom
(Fattouch) GVM Care & Research, Maria Eleonora, Palermo, Italy
Title
The role of minimal access valve surgery in the elderly. A meta-analysis
of observational studies.
Source
International Journal of Surgery. Part A. 33 (pp 164-171), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Ltd
Abstract
Background Minimal access valve surgery, both mitral and aortic, may be
related to improvement in specific post-operative outcomes, therefore may
be beneficial for the subgroup of the elderly referred for valve surgery.
Methods A systematic literature review identified several different
studies, of which 6 fulfilled criteria for meta-analysis. Outcomes for a
total of 1347 patients (675 conventional standard sternotomy and 672
minimally invasive valve surgery) were assessed with a meta-analysis using
random effects modeling. Heterogeneity, subgroup analysis with quality
scoring were also assessed. The primary endpoint was early mortality.
Secondary endpoints included intra and post-operative outcomes. Results In
the context of elderly patients, minimal access valve surgery conferred
comparable early mortality to standard sternotomy (odd ratio (OR) 0.79, CI
[0.40,1.56], p = 0.50) with no heterogeneity (p = 0.13); it was also
associated with reduced mechanical intubation time (OR 0.48, CI
[0.30,0.78], p = 0.003) and reduced post-operative length of stay
(weighted mean difference (WMD) -2.91, CI [-3.09, -2.74] p < 0.00001),
however both cardio-pulmonary bypass time and cross clamp time were longer
(WMD 24.29, CI [22.97, 25.61] p < 0.00001 and WMD 8.61, CI [7.61, 9.61], p
< 0.00001, respectively); subgroup analysis demonstrated statistically
significant reduced post-operative length of stay for both minimally
invasive aortic and mitral surgery (WMD -2.84, CI [-3.07, -2.60] p <
0.00001 and WMD -2.98, CI [-3.25, -2.71] p < 0.00001 respectively).
Conclusions Despite a prolonged cardiopulmonary bypass and cross clamp
time, minimally invasive valve surgery is a safe alternative to standard
sternotomy in the elderly, with similar early mortality, and improvements
in intubation time as well as length of stay. Copyright &#xa9; 2016 IJS
Publishing Group Ltd

<115>
[Use Link to view the full text]
Accession Number
611873297
Author
Ferrick A.M.; Tian D.; Vudathaneni V.; Shevchuk O.L.; Ferrick N.J.;
Frishman W.
Institution
(Ferrick, Frishman) Division of Cardiology, Westchester Medical Center,
Macy Pavilion, Department of Medicine, New York Medical College, 100 Wood
Road, Valhalla, NY 10592, United States
(Tian) Cardiology Section, Department of Medicine, Boston University
Medical Center, Boston, MA, United States
(Vudathaneni, Shevchuk) Department of Medicine, Mount Vernon Hospital
Center, Mount Vernon, NY, United States
(Ferrick) Ross University, School of Medicine, Miramar, FL, United States
Title
Wearable cardioverter defibrillators.
Source
Cardiology in Review. 24 (6) (pp 282-287), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The use of implantable cardioverter defibrillators (ICD) has favorably
impacted the prevention and treatment of sudden cardiac death (SCD)
associated with ventricular arrhythmias. However, there are situations
where an ICD cannot be immediately implanted, even though the patient is
at high risk for SCD. The wearable cardioverter defibrillator (WCD) is a
unique technology that can bridge this gap for patients. The WCD has been
demonstrated to terminate ventricular tachycardia/fibrillation if worn and
used correctly. With proper training, it is relatively easy to put on,
maintain, and use. Most patients are compliant and are able to
consistently wear the device. The WCD negates the infection risk or
procedural complications associated with insertion and possible extraction
of leads, as with an ICD. In terms of primary prevention of ventricular
tachycardia/fibrillation in patients with a left ventricular ejection
fraction <35%, prospective, randomized studies evaluating the survival of
patients utilizing the WCD will need to be performed before
evidenced-based criteria for its use can be established. On the basis of
current data, WCD use for those awaiting heart transplant, for those with
ICD indications status post-ICD explant, and for high-risk SCD patients
with possible reversible cardiomyopathy appears to be a reasonable
approach on the basis of current data. Copyright &#xa9; 2016 Wolters
Kluwer Health, Inc.

<116>
Accession Number
609131466
Author
Vanek J.; Mayer O.; Seidlerova J.; Bruthans J.; Kielbergerova L.;
Wohlfahrt P.; Krajcoviechova A.; Filipovsky J.; Cifkova R.
Institution
(Vanek, Mayer, Seidlerova, Filipovsky) 2nd Department of Internal
Medicine, Medical Faculty of Charles University and University Hospital,
Pilsen, Czech Republic
(Mayer, Seidlerova, Filipovsky) Biomedical Center, Medical Faculty of
Charles University, Pilsen, Czech Republic
(Bruthans, Wohlfahrt, Krajcoviechova, Cifkova) Centre for Cardiovascular
Prevention of the First Faculty of Medicine, Charles University and
Thomayer's Hospital, Prague, Czech Republic
(Kielbergerova, Cifkova) Department of Neurosurgery and Department of
Neurology, University Hospital, Pilsen;, Czech Republic
(Wohlfahrt) International Clinical Research Centre, St. Anne's University
Hospital Brno, Czech Republic
Title
A comparison of secondary prevention practice in poststroke and coronary
heart disease patients.
Source
Public Health. 137 (pp 64-72), 2016. Date of Publication: 01 Aug 2016.
Publisher
Elsevier B.V.
Abstract
Objectives It is evident that patients with atherosclerotic vascular
disease (AVD) benefit from appropriate secondary prevention. In clinical
reality, the secondary prevention in AVD patients other than those with
coronary heart disease (CHD) is often overlooked. Therefore, we compared
the adherence to secondary prevention principles between poststroke and
CHD patients. Study design Descriptive (cross-sectional) study with
prospective mortality follow-up. Methods We examined 1729 chronic patients
with AVD (mean age 65.9 (+/-SD 9.6) years), 964 with CHD, and 765
poststroke (pooled data of Czech samples of EUROASPIRE III, IV, and the
ESH stroke survey). The interview was performed 6-36 months after the
coronary event/revascularization or the first ischemic stroke, while the
mortality follow-up 5 years after this interview. Results Poststroke
patients had a significantly higher risk of persistent smoking, blood
pressure >140/90 mmHg and LDL >2.5 mmol/L than CHD patients [odds ratios
adjusted for age, gender and survey were 1.63 (95% CI: 1.13-2.33), 1.38
(95% CI: 1.13-1.69) and 2.26 (95% CI: 1.84-2.78), respectively]. In
contrast, poststroke patients showed a lower risk of inappropriate glucose
control and hypertriglyceridemia [0.66 (95%CI: 0.54-0.82) and 0.74 (95%CI:
0.61-0.91), respectively]. The prescription rates of
antiplatelets/anticoagulants, antihypertensives and statins were also
significantly lower in poststroke than in CHD patients (89.4 vs 93.7, 85.9
vs 97.5, and 57.7 vs 89.8, respectively). Mortality analysis was performed
in a subsample of 815 subjects interviewed in 2006/07. The 5-year
all-cause mortality rates were 25.8% and 13.3% in poststroke and coronary
patients, respectively (P = 0.0023); the hazard ratio for stroke adjusted
for major risk factors was 1.85 (95% CI: 1.31-2.63). Conclusions Compared
to CHD patients, poststroke patients are strongly handicapped in terms of
poor adherence to secondary prevention target, prescription of basic
pharmacotherapies and mortality risk. Copyright &#xa9; 2016 The Royal
Society for Public Health

<117>
Accession Number
611820316
Author
Imori Y.; D'Ascenzo F.; Gori T.; Munzel T.; Fabrizio U.; Campo G.; Cerrato
E.; Christian Napp L.; Iannaccone M.; Ghadri J.R.; Kazemian E.; Binder
R.K.; Jaguszewski M.; Csordas A.; Capasso P.; Biscaglia S.; Conrotto F.;
Varbella F.; Garbo R.; Gaita F.; Erne P.; Luscher T.F.; Moretti C.;
Frangieh A.H.; Templin C.
Institution
(Imori, D'Ascenzo, Ghadri, Kazemian, Binder, Jaguszewski, Csordas,
Luscher, Frangieh, Templin) University Heart Center, Department of
Cardiology, University Hospital Zurich, Switzerland
(D'Ascenzo, Iannaccone, Conrotto, Gaita, Moretti) Dipartimento di Scienze
Mediche, Divisione di Cardiologia, Citta della Salute e della Scienza,
Turin, Italy
(Gori, Munzel) Medizinische Klinik und Poliklinik-Kardiologie, Angiologie
und Internistische Intensivmedizin, University Medical Center, Mainz,
Germany
(Fabrizio, Capasso, Garbo) Interventional Cardiology Department, San
Giovanni Bosco Hospital, Turin, Italy
(Campo, Biscaglia) Cardiovascular Institute, Azienda
Ospedaliero-Universitaria S. Anna, Cona, FE, Italy
(Campo, Biscaglia) Laboratorio per le Tecnologie delle Terapie Avanzate
(LTTA) Center, Ferrara, Italy
(Cerrato, Varbella) Cardiology Department, Ospedale degli Infermi, Rivoli
TO, Italy
(Christian Napp) Department of Cardiology and Angiology, Hannover Medical
School, Hannover, Germany
(Erne) Heart Centre Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
(Erne) Department of Cardiology, Klinik St. Anna, Lucerne, Switzerland
Title
Impact of postdilatation on performance of bioresorbable vascular
scaffolds in patients with acute coronary syndrome compared with
everolimus-eluting stents: A propensity score-matched analysis from a
multicenter "real-world" registry.
Source
Cardiology Journal. 23 (4) (pp 374-383), 2016. Date of Publication: 2016.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Safety and efficacy of bioresorbable vascular scaffolds (BRS)
and the role of postdilatation on outcome in acute coronary syndrome (ACS)
patients compared with those of everolimus-eluting stents (EES) remain
unknown. The aim of the study is to compare the safety and efficacy of BRS
with EES in ACS and to investigate the role of BRS postdilatation.Methods:
Consecutive ACS patients undergoing BRS implantation in 8 centers were
compared with those with EES before and after propensity score matching.
Major adverse cardiac event (MACE), myocardial infarction, and target
lesion revascularization (TLR) were the primary endpoint. Sensitivity
analysis was performed according to postdilatation after BRS implantation.
We enrolled 303 BRS and 748 EES patients; 215 from each group were
compared after matching, and 117 (55.2%) BRS patients were treated with
postdilatation. Results: After a median follow-up of 24.0 months, MACE
rates were higher in BRS patients than in EES patients (9.3% vs. 4.7%, p <
0.001), mainly driven by TLR (6.1% vs. 1.9%, p < 0.001). Stent thrombosis
increased in the BRS group (2.8% vs. 0.9%, p = 0.01). However, after
sensitivity analysis, MACE rates in BRS patients with postdilatation were
significantly lower than in those without, comparable to EES patients
(6.0% vs. 12.6% vs. 4.7%, p < 0.001). The same trend was observed for TLR
(3.4% vs. 8.4% vs. 1.9%, p < 0.001). Stent thrombosis rates were higher in
both the BRS groups than in EES patients (2.6% vs. 3.2% vs. 0.9%, p =
0.045). Conclusions: Postdilatation appears effective when using BRS in
ACS patients. MACE rates are comparable to those of EES, although scaffold
thrombosis is not negligible. Randomized prospective studies are required
for further investigation. Copyright &#xa9; 2016 Via Medica.

<118>
Accession Number
607841149
Author
Durante-Mangoni E.; Pafundi P.C.; Ravasio V.; Barbaro F.; Bassetti M.;
Chinello P.; Falcone M.; Pasticci M.B.; Scotton P.G.; Stellini R.; Tripodi
M.-F.; Utili R.; Rizzi M.
Institution
(Durante-Mangoni, Pafundi, Utili) Internal Medicine, Monaldi Hospital,
University of Naples SUN, Naples, Italy
(Ravasio, Rizzi) Infectious Diseases, Papa Giovanni XXIII Hospital,
Bergamo, Italy
(Barbaro) Infectious Diseases, Padua University Hospital, Padua, Italy
(Bassetti) Infectious Diseases Division, Santa Maria Misericordia
University Hospital, Udine, Italy
(Chinello) 2nd Division of Infectious Diseases, INMI 'L. Spallanzani',
Rome, Italy
(Falcone) Department of Public Health, Sapienza University of Rome,
Policlinico Umberto I, Rome, Italy
(Pasticci) Infectious Diseases, University of Perugia, Perugia, Italy
(Scotton) Infectious Diseases, S. Maria di Ca' Foncello Hospital, Treviso,
Italy
(Stellini) Infectious Diseases, University of Brescia, Brescia, Italy
(Tripodi) Department of Medicine and Surgery, University of Salerno,
Salerno, Italy
(Durante-Mangoni) Second University of Naples c/o Ospedale Monaldi, Via L.
Bianchi, Naples 80131, Italy
Title
Current features of infective endocarditis in persons on hemodialysis: a
prevalence study with case control design from the prospective multicenter
SEI cohort.
Source
Infection. 44 (4) (pp 467-474), 2016. Date of Publication: 01 Aug 2016.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Purpose: Persons on hemodialysis (HD) are at high risk of infective
endocarditis (IE). In non-comparative retrospective studies, a higher rate
of mortality was reported in IE on HD. We assessed risk factors, clinical
characteristics, and outcomes of IE in HD. Methods: This was a prevalence
study with a case control methodology on a set of data from the
prospectively followed cohort of the Studio Endocarditi Italiano (SEI),
conducted between 2004 and 2011. Included were 42 consecutive cases of IE
HD subjects and 126 controls not on HD, matched for age, sex, type of IE,
and heart side involved. Clinical, echocardiographic, microbiological
features, and disease complications and therapeutic modalities were
assessed. Results: HD patients were more often diabetics (42.9 vs 18.2 %
in no-HD; p = 0.007) and immune-suppressed (16.7 vs 3.2 %; p = 0.02), and
had a higher rate of predisposing cardiac conditions (45 vs 25 %; p =
0.031). A higher prevalence of health care-related acquisition and a
shorter diagnostic delay was observed in IE on HD, that was more likely to
be caused by staphylococci and less by streptococci (p < 0.002). Cardiac
surgery was performed in 38 % of HD patients and 36.5 % of no-HD patients
(p = 0.856). Complications were similar and in-hospital mortality did not
differ significantly (26.2 % in HD vs 15.9 % in no-HD; p = 0.168).
Conclusions: IE in persons on HD is characterized by distinctive clinical
features, including a higher prevalence of some important comorbidities.
Inconsistent with prior studies, we could not confirm a higher rate of
complications and mortality in HD patients with IE. Copyright &#xa9; 2016,
Springer-Verlag Berlin Heidelberg.

<119>
Accession Number
613941616
Author
Ghione M.; Wykrzykowska J.J.; Windecker S.; Serruys P.W.; Buszman P.;
Linke A.; Sohn H.Y.; Corti R.; Antoni D.; Wijns W.; Estevez-Loureiro R.;
Morice M.-C.; Van Es G.-A.; van Geuns R.J.; Juni P.; Eerdmans P.; De Vries
T.; Konik S.; Di Mario C.
Institution
(Ghione, Estevez-Loureiro, Di Mario) NIHR Cardiovascular Biomedical
Research Unit, Royal Brompton Hospital, London, United Kingdom
(Wykrzykowska) Academic Medical Centre, Amsterdam, Netherlands
(Windecker) Department of Cardiology, University of Bern, Switzerland
(Serruys, van Geuns) Thoraxcenter, Erasmus University MC, Rotterdam,
Netherlands
(Buszman) American Heart of Poland, Ustron, Poland
(Linke) Herzzentrum Leipzig, Leipzig, Germany
(Sohn) Department of Cardiology, University Hospital Munich (Innenstadt),
Munich, Germany
(Corti) HerzKlinik Hirslanden, Zurich, Switzerland
(Antoni) Department of Cardiology, Hospital Bogenhausen, Munich, Germany
(Wijns) Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst,
Belgium
(Morice) Institut Cardiovasculaire Paris-Sud, Institut Hospitalier
Jacques-Cartier, Massy, France
(Van Es, De Vries) Cardialysis, Rotterdam, Netherlands
(Juni) CTU, University of Bern, Switzerland
(Eerdmans, Konik) Biosensors Europe SA, Morges, Switzerland
(Di Mario) University Hospital Careggi, Florence, Italy
Title
Five-year outcomes of chronic total occlusion treatment with a biolimus
A9-eluting biodegradable polymer stent versus a sirolimus-eluting
permanent polymer stent in the LEADERS all-comers trial.
Source
Cardiology Journal. 23 (6) (pp 626-636), 2016. Date of Publication: 2016.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Few data are available on long-term follow-up of drug-eluting
stents in the treatment of chronic total occlusion (CTO). The LEADERS CTO
sub-study compared the long-term results in CTO and non-CTO lesions of a
Biolimus A9TM-eluting stent (BES) with a sirolimus-eluting stent (SES).
Methods: Among 1,707 patients enrolled in the prospective, multi-center,
all-comers LEADERS trial, 81 with CTOs were treated with either a BES (n =
45) or a SES (n = 36). The primary endpoint was the occurrence of major
adverse cardiac events (MACE): cardiac death, myocardial infarction (MI)
and clinically-indicated target vessel revascularization (TVR). Results:
At 5 years, the rate of MACE was numerically higher in the CTO group than
in the non-CTO group (29.6% vs. 23.3%; p = 0.173), with a significant
increase in the incidence of target lesion revascularization (TLR) (21.0
vs. 12.6; p = 0.033), but no difference in stent thrombosis (ST). Patients
with CTO receiving a BES demonstrated a lower incidence of MACE (22.2% vs.
38.9%; p = 0.147) with a significant reduction in TLR compared to patients
receiving a SES (11.1% vs. 33.3%, p = 0.0214) with an incidence similar to
that observed in the non-CTO group treated with BES (11.6%). Definite ST
at 5 years nearly halved in the BES group (4.4% vs. 8.3%, p = 0.478) with
no ST in the BES group after the first year (0% vs. 8.3%, p for
interaction = 0.009). Conclusions: The use of a BES showed a reduction in
MACE, TVR, TLR, and ST over time in the CTO subset with similar outcome as
for non-CTO lesions. Copyright &#xa9; 2016 Via Medica.

<120>
Accession Number
607132513
Author
Bonnemains L.; Cherifi A.; Girerd N.; Odille F.; Felblinger J.
Institution
(Bonnemains, Odille, Felblinger) INSERM U947, IADI, Nancy, France
(Bonnemains) Department of Cardiac Surgery, University Hospital of
Strasbourg, Strasbourg, France
(Bonnemains, Girerd) Department of Cardiology, University Hospital of
Nancy, Nancy, France
(Cherifi, Felblinger) CICIT, CHU Nancy, Nancy, France
Title
Design of the DRAGET Study: A multicentre controlled diagnostic study to
assess the detection of acute rejection in patients with heart transplant
by means of T2 quantification with MRI in comparison to myocardial
biopsies.
Source
BMJ Open. 5 (10) (no pagination), 2015. Article Number: e008963. Date of
Publication: 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Patients with heart transplant are screened for silent graft
rejection by recurrent endomyocardial biopsies. MRI can detect the
presence of oedema non-invasively by quantitatively measuring changes of
the transverse relaxation time T2 in the myocardium. Several monocentric
studies have shown that T2 quantification could help detect graft
rejection in a less invasive way. DRAGET is a national multicentre
diagnostic study designed to prove that T2 quantification by MRI can
detect graft rejection. Methods and analysis: 190 patients from 10 centres
will undergo T2 quantification and endomyocardial biopsy, within 24 h, 4
to 6 times during the first year after transplantation. T2 will be
computed by analysing a sequence of 10 images obtained from a short-axis
slice. Specific phantoms will be used to calibrate the T2 quantification
on each MR scanner to cope with the different equipment (different
vendors, magnetic field strength, etc). Specific pads with known T2 will
also be used during each examination and provide a quality check to cope
with the different experimental conditions (temperature, etc). All MRI and
biopsy data will be reinterpreted in our centre and reproducibility will
be assessed. The primary outcome will be sensitivity and specificity of
MRI. The secondary outcomes will be (1) prognostic values of T2, (2)
reproducibility of each techniques, (3) number of adverse events during
each procedures and (4) confidence of the physicians in T2. Ethics and
dissemination: Ethics approval has been obtained. The new MRI method will
be disseminated at a national level and its practical usefulness will be
assessed in centres not familiar with MRI T2 quantification. The ultimate
aim of the DRAGET project is to replace a strategy based solely on biopsy
with one based on a first-line MRI (with biopsy only when needed) for a
more efficient and less invasive detection of rejection.

<121>
Accession Number
614809198
Author
Ozturk N.K.; Baki E.D.; Kavakli A.S.; Sahin A.S.; Ayoglu R.U.; Karaveli
A.; Emmiler M.; Inanoglu K.; Karsli B.
Institution
(Ozturk, Kavakli, Sahin, Karaveli, Inanoglu) Department of Anesthesiology
and Reanimation, Antalya Education and Research Hospital, Varlik
Mahallesi, Kazim Karabekir Cadde, 07100 Antalya, Turkey
(Baki) Department of Anesthesiology and Reanimation, Afyon Kocatepe
University, Faculty of Medicine, Afyon, Turkey
(Ayoglu, Emmiler) Department of Cardiovascular Surgery, Antalya Education
and Research Hospital, 07100 Antalya, Turkey
(Karsli) Department of Algology, Akdeniz University, Faculty of Medicine,
07100 Antalya, Turkey
Title
Comparison of Transcutaneous Electrical Nerve Stimulation and Parasternal
Block for Postoperative Pain Management after Cardiac Surgery.
Source
Pain research & management. 2016 (pp 4261949), 2016. Date of Publication:
2016.
Abstract
Background. Parasternal block and transcutaneous electrical nerve
stimulation (TENS) have been demonstrated to produce effective analgesia
and reduce postoperative opioid requirements in patients undergoing
cardiac surgery. Objectives. To compare the effectiveness of TENS and
parasternal block on early postoperative pain after cardiac surgery.
Methods. One hundred twenty patients undergoing cardiac surgery were
enrolled in the present randomized, controlled prospective study. Patients
were assigned to three treatment groups: parasternal block, intermittent
TENS application, or a control group. Results. Pain scores recorded 4h,
5h, 6h, 7h, and 8h postoperatively were lower in the parasternal block
group than in the TENS and control groups. Total morphine consumption was
also lower in the parasternal block group than in the TENS and control
groups. It was also significantly lower in the TENS group than in the
control group. There were no statistical differences among the groups
regarding the extubation time, rescue analgesic medication, length of
intensive care unit stay, or length of hospital stay. Conclusions.
Parasternal block was more effective than TENS in the management of early
postoperative pain and the reduction of opioid requirements in patients
who underwent cardiac surgery through median sternotomy. This trial is
registered with Clinicaltrials.gov number NCT02725229.

<122>
Accession Number
614875246
Author
Salamati A.; Mashouf S.; Mojab F.
Institution
(Salamati, Mashouf) Faculty of Nursing and Midwifery, Islamic Azad
University (Tehran Medical Branch), Tehran, Iran, Islamic Republic of
(Mojab) School of Pharmacy, Pharmaceutical Sciences Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Title
Effect of inhalation of lavender essential oil on vital signs in open
heart surgery ICU.
Source
Iranian Journal of Pharmaceutical Research. 16 (1) (pp 404-409), 2017.
Date of Publication: Winter 2017.
Publisher
Iranian Journal of Pharmaceutical Research (E-mail: info@ijpr-online.com)
Abstract
This study evaluated the effects of inhalation of Lavender essential oil
on vital signs in open heart surgery ICU. The main complaint of patients
after open-heart surgery is dysrhythmia, tachycardia, and hypertension due
to stress and pain. Due to the side effects of chemical drugs, such as
opioids, use of non-invasive methods such as aromatherapy for relieving
stress and pain parallel to chemical agents could be an important way to
decrease the dose and side effects of analgesics. In a multicenter,
single-blind trial, 40 patients who had open-heart surgery were recruited.
Inclusion criteria were full consciousness, lack of hemorrhage, heart rate
>60 beats/min, systolic blood pressure > 100 mmHg, and diastolic blood
pressure > 60 mmHg, not using beta blockers in the operating room or ICU,
no history of addiction to opioids or use of analgesics in regular,
spontaneous breathing ability and not receiving synthetic opioids within 2
h before extubation. Ten minutes after extubation, the patients> vital
signs [including BP, HR, Central Venous Pressure (CVP), SPO2, and RR] were
measured. Then, a cotton swab, which was impregnated with 2 drops of
Lavender essential oil 2%, was placed in patients' oxygen mask and
patients breathed for 10 min. Thirty minutes after aromatherapy, the vital
signs were measured again. Main objective of this study was the change in
vital sign before and after aromatherapy. Statistical significance was
accepted for P < 0.05. There was a significant difference in systolic
blood pressure (p 0.001 >), diastolic blood pressure (p = 0.001), and
heart rate (p = 0.03) before and after the intervention using paired
t-test. Although, the results did not show any significant difference in
respiratory rate (p = 0.1), SpO2 (p = 0.5) and CVP (p = 0.2) before and
after inhaling Lavender essential oil. Therefore, the aromatherapy could
effectively reduce blood pressure and heart rate in patients admitted to
the open heart surgery ICU and can be used as an independent nursing
intervention in stabilizing mentioned vital signs. The limitations of our
study were sample size and lack of control group. Randomized clinical
trials with larger sample size are recommended. Copyright &#xa9; 2017 by
School of Pharmacy.

<123>
Accession Number
614828959
Author
Azarfarin R.; Dashti M.; Totonchi Z.; Ziyaeifard M.; Mehrabanian M.;
Alizadehasl A.; Gorjipour F.
Institution
(Azarfarin, Alizadehasl) Echocardiography Research Center, Rajaie
Cardiovascular, Medical, and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Dashti) Department of Anesthesiology, Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Totonchi, Ziyaeifard, Mehrabanian, Gorjipour) Rajaie Cardiovascular,
Medical, and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Efficacy of the "head-up position" in returning cardiopulmonary bypass
blood to the patient and reducing the required blood transfusion: A
randomized trial.
Source
Iranian Heart Journal. 18 (1) (pp 6-15), 2017. Date of Publication: 2017.
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: All intraoperative strategies that may assist an
anesthesiologist with lowering the blood transfusion rate must be
considered. We assessed the efficacy of the 30degree head-up position at
the end of cardiopulmonary bypass (CPB) in returning CPB reservoir blood
to patients, reducing the transfusion rate, and conferring hemodynamic
stability after the transfer of patients to the intensive care unit (ICU).
Methods: In a single-center clinical trial, 88 adult patients undergoing
elective isolated coronary artery bypass graft surgery were randomly
allocated to the head-up group (n=44), in which the 30degree head-up
position was applied during separation from CPB, and the supine group
(n=44), in which weaning from CPB was performed in the supine position.
All the patients had left ventricular ejection fractions > 35%. The
primary end point was the returned volume of filtered CPB blood to the
patients. The secondary outcome measures were intraoperative and early
postoperative hemodynamic parameters. Additionally, blood products
transfused during surgery and in the 1st 6 hours following ICU admission
were recorded. Results: There were no statistically significant
differences in intraoperative and early postoperative hemodynamics between
the 2 groups except in the returned blood volume to the patients after
separation from CPB (714 +/- 99 mL in the head-up position group vs 285
+/- 78 mL in the supine group; P = 0.0001). There were no significant
differences between the 2 groups regarding the transfused blood products
during surgery and the 1st 6 hours following ICU admission. Conclusions:
Using the 30degree head-up position at the end of CPB conferred a higher
return of blood to the patients but did not significantly reduce
postoperative transfusion. Copyright &#xa9; 2017, Iranian Heart
Association. All rights reserved.

<124>
Accession Number
614828952
Author
Kuwata S.; Taramasso M.; Guidotti A.; Nietlispach F.; Maisano F.
Institution
(Kuwata, Taramasso, Guidotti, Maisano) UniversitatsSpital Zurich, Zurich,
Switzerland
(Nietlispach) University Heart Center Zurich, Zurich University Hospital,
Zurich, Switzerland
Title
Evaluation of Valtech's transcatheter mitral valve repair device.
Source
Expert Review of Medical Devices. 14 (3) (pp 189-195), 2017. Date of
Publication: 04 Mar 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Functional mitral regurgitation is a debilitating condition,
related to worsening of functional capacity and heart failure
symptomatology. Cardioband (Valtech Cardio, Or Yehuda, Israel) is a novel
technology designed for transcatheter repair of the mitral valve in the
treatment of functional MR. Areas covered: A brief summary to direct the
reader to important further reading, relevant websites;
www.valtechcardio.com. An article about this device, relevant websites;
www.ncbi.nlm.nih.gov/pubmed using search word 'Cardioband'. Expert
commentary: This device has been designed to be completely implantable
percutaneously in a closed beating heart fashion. The adjustability
features under the beating heart and guided by echocardiography allow to
provide a tailored therapy to each particular mitral valve and
regurgitation condition. Copyright &#xa9; 2017 Informa UK Limited, trading
as Taylor & Francis Group.

<125>
Accession Number
614848415
Author
Renda G.; Ricci F.; Giugliano R.P.; De Caterina R.
Institution
(Renda, Ricci, De Caterina) Institute of Cardiology and Center of
Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
(Giugliano) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, TIMI Study Group, Boston, Massachusetts, United States
Title
Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial
Fibrillation and Valvular Heart Disease.
Source
Journal of the American College of Cardiology. 69 (11) (pp 1363-1371),
2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background Valvular heart disease (VHD) and atrial fibrillation (AF) often
coexist. Phase III trials comparing non-vitamin K antagonist oral
anticoagulants (NOACs) with warfarin excluded patients with
moderate/severe mitral stenosis or mechanical heart valves, but variably
included patients with other VHD and valve surgeries. Objectives This
study aimed to determine relative safety and efficacy of NOACs in patients
with VHD. Methods We performed a meta-analysis of the 4 phase III AF
trials of the currently available NOACs versus warfarin in patients with
coexisting VHD to assess pooled estimates of relative risk (RR) and 95%
confidence intervals (CIs) for stroke/systemic embolic events (SSEE),
major bleeding, intracranial hemorrhage (ICH), and all-cause death.
Results Compared with warfarin, the rate of SSEE in patients treated with
higher-dose NOACs was lower and consistent among 13,585 patients with (RR:
0.70; 95% CI: 0.58 to 0.86) or 58,098 without VHD (RR: 0.84; 95% CI: 0.75
to 0.95; interaction p = 0.13). Major bleeding in patients on higher-dose
NOACs versus warfarin was similar and consistent among patients with (RR:
0.93; 95% CI: 0.68 to 1.27) or without VHD (RR: 0.85; 95% CI: 0.70 to
1.02; interaction p = 0.63 for VHD/no-VHD difference). Intracranial
hemorrhage was lower with higher-dose NOACs than with warfarin
irrespective of VHD (RR: 0.47; 95% CI: 0.24 to 0.93, and 0.49; 95% CI:
0.41 to 059, respectively; interaction p = 0.91). No protective effect of
higher-dose NOACs in preventing all-cause death seemed to be present in
patients with VHD versus without VHD (RR:1.01; 95% CI: 0.90 to 1.14 vs.
RR: 0.88; 95% CI: 0.82 to 0.94, respectively; interaction p = 0.03).
Conclusions High-dose NOACs provide overall efficacy and safety similar in
AF patients with or without VHD. Copyright &#xa9; 2017 The Authors

<126>
Accession Number
614796560
Author
van Gils L.; Tchetche D.; Lhermusier T.; Abawi M.; Dumonteil N.; Olivares
R.R.; de Nicolas J.M.; Stella P.R.; Carrie D.; De Jaegere P.P.; Van
Mieghem N.M.
Institution
(van Gils, De Jaegere, Van Mieghem) Erasmus Medical Center, Rotterdam,
Netherlands
(Tchetche, Dumonteil, de Nicolas) Clinique Pasteur, Toulouse, France
(Lhermusier, Carrie) Hopital Rangueil, Toulouse, France
(Abawi, Olivares, Stella) University Medical Center Utrecht, Utrecht,
Netherlands
Title
Transcatheter heart valve selection and permanent pacemaker implantation
in patients with pre-existent right bundle branch block.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e005028. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Right bundle branch block is an established predictor for new
conduction disturbances and need for a permanent pacemaker (PPM) after
transcatheter aortic valve replacement. The aim of the study was to
evaluate the absolute rates of transcatheter aortic valve replacement
related PPM implantations in patients with pre-existent right bundle
branch block and categorize for different transcatheter heart valves.
Methods and Results-We pooled data on 306 transcatheter aortic valve
replacement patients from 4 high-volume centers in Europe and selected
those with right bundle branch block at baseline without a previously
implanted PPM. Logistic regression was used to evaluate whether PPM rate
differed among transcatheter heart valves after adjustment for
confounders. Mean age was 83+/-7 years and 63% were male. Median Society
of Thoracic Surgeons score was 6.3 (interquartile range, 4.1-10.2). The
following transcatheter valve designs were used: Medtronic CoreValve
(n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT (ES-XT; n=124) and
Edwards Sapien 3 (ES-3; n=32; Edwards Lifesciences, Irvine, CA); and
Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough,
MA). Overall permanent pacemaker implantation rate post-transcatheter
aortic valve replacement was 41%, and per valve design: 75% with Lotus,
46% with CoreValve, 32% with ES-XT, and 34% with ES-3. The indication for
PPM implantation was total atrioventricular block in 98% of the cases.
Lotus was associated with a higher PPM rate than all other valves. PPM
rate did not differ between ES-XT and ES-3. Ventricular paced rhythm at
30-day and 1-year follow-up was present in 81% at 89%, respectively.
Conclusions-Right bundle branch block at baseline is associated with a
high incidence of PPM implantation for all transcatheter heart valves. PPM
rate was highest for Lotus and lowest for ES-XT and ES-3. Pacemaker
dependency remained high during followup. Copyright &#xa9; 2017 The
Authors.

<127>
Accession Number
614796531
Author
El Amrousy D.M.; Elshmaa N.S.; El-Kashlan M.; Hassan S.; Elsanosy M.;
Hablas N.; Elrifaey S.; El-Feky W.
Institution
(El Amrousy, Hassan, Elsanosy, Hablas, Elrifaey) Pediatric Department,
Tanta University Hospital, Tanta, Egypt
(El-Feky) Cardiothoracic Surgery Department, Tanta University Hospital,
Tanta, Egypt
(Elshmaa, El-Kashlan) Department of Anesthesia and Surgical ICU, Faculty
of Medicine, Tanta University, Tanta, Egypt
Title
Efficacy of prophylactic dexmedetomidine in preventing postoperative
junctional ectopic tachycardia after pediatric cardiac surgery.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e004780. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Postoperative junctional ectopic tachycardia is one of the most
serious arrhythmias that occur after pediatric cardiac surgery, difficult
to treat and better to be prevented. Our aim was to assess the efficacy of
prophylactic dexmedetomidine in preventing junctional ectopic tachycardia
after pediatric cardiac surgery. Methods and Results-A prospective
controlled study was carried out on 90 children who underwent elective
cardiac surgery for congenital heart diseases. Patients were randomized
into 2 groups. Group I (dexmedetomidine group): 60 patients received
dexmedetomidine; Group II (Placebo group): 30 patients received the same
amount of normal saline intravenously. The primary outcome was the
incidence of postoperative junctional ectopic tachycardia. Secondary
outcomes included bradycardia, hypotension, vasoactive inotropic score,
ventilation time, pediatric cardiac care unit stay, length of hospital
stay, and perioperative mortality. The incidence of junctional ectopic
tachycardia was significantly reduced in the dexmedetomidine group (3.3%)
compared with the placebo group (16.7%) with P < 0.005. Heart rate while
coming off cardiopulmonary bypass was significantly lower in the
dexmedetomidine group (130.6+/-9) than the placebo group (144+/-7.1) with
P < 0.001. Mean ventilation time, and mean duration of intensive care unit
and hospital stay (days) were significantly shorter in the dexmedetomidine
group than the placebo group (P < 0.001). However, there was no
significant difference between the 2 groups as regards mortality,
bradycardia, or hypotension (P > 0.005). Conclusion-Prophylactic use of
dexmedetomidine is associated with significantly decreased incidence of
postoperative junctional ectopic tachycardia in children after congenital
heart surgery without significant side effects. Copyright &#xa9; 2017 The
Authors.

<128>
Accession Number
614739338
Author
Kang S.-H.; Chung W.-Y.; Lee J.M.; Park J.-J.; Yoon C.-H.; Suh J.-W.; Cho
Y.-S.; Doh J.-H.; Cho J.M.; Bae J.-W.; Youn T.-J.; Chae I.-H.
Institution
(Kang, Park, Yoon, Suh, Cho, Youn, Chae) Division of Cardiology,
Department of Internal Medicine, College of Medicine, Seoul National
University, Cardiovascular Center, Seoul National University Bundang
Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South
Korea
(Chung) Department of Internal Medicine, Boramae Medical Center, Seoul,
South Korea
(Lee) Department of Internal Medicine, Seoul National University Hospital,
Seoul, South Korea
(Doh) Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, South
Korea
(Cho) Kyung Hee University Hospital at Gangdong, Seoul, South Korea
(Bae) Chungbuk National University Hospital, Cheongju, South Korea
Title
Angiographic outcomes of Orsiro biodegradable polymer sirolimus-eluting
stents and Resolute Integrity durable polymer zotarolimus-eluting stents:
Results of the ORIENT trial.
Source
EuroIntervention. 12 (13) (pp 1623-1631), 2017. Date of Publication: 2017.
Publisher
EuroPCR
Abstract
Aims: We performed a randomised controlled open-label non-inferiority
trial to compare angiographic outcomes between the ultra-thin strut,
biodegradable hybrid polymer Orsiro sirolimus-eluting stent (O-SES) and
the durable biocompatible polymer Resolute Integrity zotarolimus-eluting
stent (R-ZES). Methods and results: A total of 372 patients planned to
undergo percutaneous coronary revascularisation were randomly assigned 2:1
to treatment with O-SES or R-ZES (250 and 122 patients, respectively).
O-SES was non-inferior to R-ZES for the primary endpoint, in-stent late
lumen loss at nine months (median 0.06 mm [interquartile range, -0.09 to
0.24 mm] versus 0.12 mm [-0.07 to 0.32 mm]; p for non-inferiority <0.001;
p for superiority=0.205). Percent diameter stenosis was significantly
lower in the O-SES group than in the R-ZES group (15.0 [10.0 to 20.0]
versus 20.0 [13.3 to 26.0]; p=0.002). Target lesion failure occurred in
2.4% and 3.3% of the O-SES and R-ZES groups, respectively (p=0.621).
Subgroup analyses showed consistently similar outcomes between the two
groups in terms of the primary endpoint, except for the diabetic subgroup.
Conclusions: O-SES was non-inferior to R-ZES in terms of in-stent late
loss at nine months. Angiographic restenosis and clinical adverse events
were low in both groups. This study confirms the good safety and efficacy
profiles of both contemporary coronary stents. Copyright &#xa9; Europa
Digital & Publishing 2017. All rights reserved.

<129>
Accession Number
614877490
Author
Sciahbasi A.; Ferrante G.; Fischetti D.; Miklin D.J.; Sarandrea A.;
Schirripa V.; Guarracini F.; Arya A.; Loreni G.; Bruni A.; Rigattieri S.;
Marini M.; Vagnarelli S.; Scevola G.; Reimers B.; Hindricks G.; Cohen M.
Institution
(Sciahbasi, Rigattieri) Interventional Cardiology, Sandro Pertini
Hospital, ASL RM2, Rome, Italy
(Ferrante, Reimers) Humanitas Research Hospital, IRCCS, Rozzano, Italy
(Fischetti) Interventional Cardiology, Vito Fazzi Hospital, Lecce, Italy
(Miklin, Cohen) Cardiovascular Division, Department of Medicine,
University of Miami, FL, USA
(Sarandrea) HSE Management, Rome, Italy
(Schirripa) Department of Cardiology, Ospedale Grassi, Ostia, Rome, Italy
(Guarracini, Marini) Department of Cardiology, S. Chiara Hospital, Trento,
Italy
(Arya, Hindricks) Department of Electrophysiology, Heart Center,
University of Leipzig, Germany
(Loreni, Scevola) Interventional Radiology, Sandro Pertini Hospital, ASL
RM2, Rome, Italy
(Bruni, Vagnarelli) Interventional Radiology, San Giovanni Hospital, Rome,
Italy
Title
Radiation dose among different cardiac and vascular invasive procedures:
The RODEO study.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: February 13, 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Interventional radiology and cardiology procedures contribute
significantly to the collective dose of radiation exposure from medical
interventions. Recent and dedicated studies comparing directly these
procedures in term of patient radiation exposure are lacking. Our aim was
to compare radiation exposure among different interventional procedures
performed under fluoroscopic guidance. Methods: The RODEO study (NCT:
02972736) is an international observational retrospective multicenter
study enrolling all patients undergoing diagnostic or interventional
procedures performed by different interventional operators (i.e.
radiologists, interventional cardiologists or electrophysiologists) in 6
centers, without exclusion criteria. The primary end-point of the study
was the comparison of dose area product (DAP) among interventional
cardiology, electrophysiology or interventional radiology procedures.
Results: A total of 17,711 procedures were included in the study: 13,522
interventional cardiology, 2352 electrophysiology and 1864 interventional
radiology procedures. The highest DAP values were observed for
interventional radiology procedures (74Gy*cm² [Interquartile
range 27-178Gy*cm²]), followed by interventional cardiology
(40Gy*cm² [22-78Gy*cm²]) and electrophysiology
procedures (13Gy*cm² [4-44Gy*cm²], p<0.0001). In
term of specific procedures, the highest DAP values were observed in
structural or valvular cardiac procedures (134Gy*cm²
[51-260Gy*cm²]) whereas the lowest DAP values in pacemaker
insertion (11Gy*cm² [4-28Gy*cm²]). Conclusion: In
this large multicenter study, the highest radiation exposure was observed
in procedures performed by interventional radiologists. However, among
specific procedures, structural or valvular cardiac procedures were
associated with the highest radiation exposure. Copyright &#xa9; 2017
Elsevier B.V.

<130>
Accession Number
614799510
Author
Zarbock A.; Kellum J.A.; van Aken H.; Schmidt C.; Kullmar M.; Rosenberger
P.; Martens S.; Gorlich D.; Meersch M.
Institution
(Zarbock) From the Department of Anaesthesiology, Intensive Care Medicine
and Pain Medicine (A.Z., H.V.A., C.S., M.K., M.M.) and Department of
Cardiac Surgery (S.M.), University Hospital Munster, Munster, Germany;
Center for Critical Care Nephrology, Department of Critical Care Medicine,
University of Pittsburgh, Pittsburgh, Pennsylvania (J.A.K.); Department of
Anaesthesiology and Intensive Care Medicine, University Hospital Tubingen,
Tubingen, Germany (P.R.); and Institute of Biostatistics and Clinical
Research, University of Munster, Munster, Germany (D.G.).
Title
Long-term Effects of Remote Ischemic Preconditioning on Kidney Function in
High-risk Cardiac Surgery Patients: Follow-up Results from the RenalRIP
Trial.
Source
Anesthesiology. (no pagination), 2017. Date of Publication: 13 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: In a multicenter, randomized trial, the authors enrolled
patients at high-risk for acute kidney injury as identified by a Cleveland
Clinic Foundation score of 6 or more. The authors enrolled 240 patients at
four hospitals and randomized them to remote ischemic preconditioning or
control. The authors found that remote ischemic preconditioning reduced
acute kidney injury in high-risk patients undergoing cardiac surgery. The
authors now report on the effects of remote ischemic preconditioning on
90-day outcomes. METHODS:: In this follow-up study of the RenalRIP trial,
the authors examined the effect of remote ischemic preconditioning on the
composite endpoint major adverse kidney events consisting of mortality,
need for renal replacement therapy, and persistent renal dysfunction at 90
days. Secondary outcomes were persistent renal dysfunction and dialysis
dependence in patients with acute kidney injury. RESULTS:: Remote ischemic
preconditioning significantly reduced the occurrence of major adverse
kidney events at 90 days (17 of 120 [14.2%]) versus control (30 of 120
[25.0%]; absolute risk reduction, 10.8%; 95% CI, 0.9 to 20.8%; P = 0.034).
In those patients who developed acute kidney injury after cardiac surgery,
2 of 38 subjects in the remote ischemic preconditioning group (5.3%) and
13 of 56 subjects in the control group (23.2%) failed to recover renal
function at 90 days (absolute risk reduction, 17.9%; 95% CI, 4.8 to 31.1%;
P = 0.020). Acute kidney injury biomarkers were also increased in patients
reaching the major adverse kidney event endpoint compared to patients who
did not. CONCLUSIONS:: Remote ischemic preconditioning significantly
reduced the 3-month incidence of a composite endpoint major adverse kidney
events consisting of mortality, need for renal replacement therapy, and
persistent renal dysfunction in high-risk patients undergoing cardiac
surgery. Furthermore, remote ischemic preconditioning enhanced renal
recovery in patients with acute kidney injury. Copyright &#xa9; by 2017,
the American Society of Anesthesiologists, Inc. Wolters Kluwer Health,
Inc. All Rights Reserved.

<131>
Accession Number
614798887
Author
Vezzani A.; Manca T.; Brusasco C.; Santori G.; Cantadori L.; Ramelli A.;
Gonzi G.; Nicolini F.; Gherli T.; Corradi F.
Institution
(Vezzani, Manca, Ramelli, Nicolini, Gherli) Department of Surgery,
University Hospital of Parma, Parma, Italy
(Brusasco, Corradi) Anaesthesia and Intensive Care Unit, E.O. Ospedali
Galliera, Mura Della Cappuccine 14, Genoa 16128, Italy
(Santori) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Cantadori) Department of Emergency Medicine, Fidenza Hospital, AUSL of
Parma, Parma, Italy
(Gonzi) Department of Cardiology, University Hospital of Parma, Parma,
Italy
Title
A randomized clinical trial of ultrasound-guided infra-clavicular
cannulation of the subclavian vein in cardiac surgical patients:
short-axis versus long-axis approach.
Source
Intensive Care Medicine. (pp 1-8), 2017. Date of Publication: 13 Mar 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: The aim of this study was to compare the success rate and safety
of short-axis versus long-axis approaches to ultrasound-guided subclavian
vein cannulation. Methods: A total of 190 patients requiring central
venous cannulation following cardiac surgery were randomized to either
short-axis or long-axis ultrasound-guided cannulation of the subclavian
vein. Each cannulation was performed by anesthesiologists with at least 3
years' experience of ultrasound-guided central vein cannulation (>150
procedures/year, 50% short-axis and 50% long-axis). Success rate,
insertion time, number of needle redirections, number of separate skin or
vessel punctures, rate of mechanical complications, catheter
misplacements, and incidence of central line-associated bloodstream
infection were documented for each procedure. Results: The subclavian vein
was successfully cannulated in all 190 patients. The mean insertion time
was significantly shorter (p = 0.040) in the short-axis group (69 +/- 74
s) than in the long-axis group (98 +/- 103 s). The short-axis group was
also associated with a higher overall success rate (96 vs. 78%, p <
0.001), first-puncture success rate (86 vs. 67%, p = 0.003), and
first-puncture single-pass success rate (72 vs. 48%, p = 0.002), and with
fewer needle redirections (0.39 +/- 0.88 vs. 0.88 +/- 1.15, p = 0.001),
skin punctures (1.12 +/- 0.38 vs. 1.28 +/- 0.54, p = 0.019), and
complications (3 vs. 13%, p = 0.028). Conclusions: The short-axis
procedure for ultrasound-guided subclavian cannulation offers advantages
over the long-axis approach in cardiac surgery patients. Copyright &#xa9;
2017 Springer-Verlag Berlin Heidelberg and ESICM