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<1>
Accession Number
603700041
Author
Armstrong P.W.; Zheng Y.; Westerhout C.M.; Rosell-Ortiz F.; Sinnaeve P.;
Lambert Y.; Lopes R.D.; Bluhmki E.; Danays T.; Van De Werf F.
Institution
(Armstrong, Zheng, Westerhout) Canadian VIGOUR Centre, University of
Alberta, 2-132 Li Ka Shing Centre for Health Research Innovation,
Edmonton, AB T6G 2E1, Canada
(Rosell-Ortiz) Empresa Publica de Emergencias Sanitarias, Almeria, Spain
(Sinnaeve, Van De Werf) Department of Cardiology, University Hospital
Gasthuisberg, Leuven, Belgium
(Lambert) Centre Hospitalier de Versailles, SAMU 78 and Mobile Intensive
Care Unit, Versailles, France
(Lopes) Duke University Medical Centre, Duke Clinical Research Institute,
Durham, NC, United States
(Bluhmki) Boehringer Ingelheim, Berkshire, United Kingdom
(Danays) Boehringer Ingelheim France, Reims, France
Title
Reduced dose tenecteplase and outcomes in elderly ST-segment elevation
myocardial infarction patients: Insights from the STrategic Reperfusion
Early after Myocardial infarction trial.
Source
American Heart Journal. 169 (6) (pp 890-898), 2015. Date of Publication:
01 Jun 2015.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Elderly patients with ST-segment elevation myocardial
infarction (STEMI) have worse outcomes and a greater risk of intracranial
bleeding than nonelderly patients. Baseline characteristics, clinical
outcomes, and the relationship of the tenecteplase (TNK) dose reduction to
the efficacy, safety, and electrocardiographic indicators of reperfusion
efficacy were evaluated in STEMI patients >75 years. Methods The STREAM
trial evaluated early presenting STEMI patients who could not undergo
primary percutaneous coronary intervention within 1 hour of first medical
contact. Because of excess intracranial hemorrhage (ICH) in patients >75
years, the dose of TNK was reduced by 50%. Results Before dose amendment,
there were 3 (7.1%) of 42 elderly patients with ICH; 2 of these were
fatal, whereas no ICH occurred in the 93 elderly patients who received
half-dose TNK postamendment. The median extent of ST-segment elevation
resolution (>50%) and proportion of patients with >2 mm in the
electrocardiogram lead with greatest ST-segment elevation was comparable
in elderly patients preamendment and postamendment (63.2% vs 56.0% and
43.6% vs 40.0%, respectively). Patients requiring rescue coronary
intervention after TNK was also similar (42.9% vs 44.1%). The primary
composite end point (30-day all-cause death, cardiogenic shock, congestive
heart failure, and reinfarction) was 31.0% before versus 24.7%
postamendment. onclusions Our data, from a modest-sized population of
elderly STEMI patients, indicate that half-dose TNK reduces the likelihood
of ICH without compromising reperfusion efficacy. These observations are
hypothesis generating and warrant further confirmation in randomized
clinical trials in the elderly. Copyright &#xa9; 2015 Elsevier Inc. All
rights reserved.

<2>
Accession Number
613978612
Author
Stowell C.P.; Whitman G.; Granger S.; Gomez H.; Assmann S.F.; Massey M.J.;
Shapiro N.I.; Steiner M.E.; Bennett-Guerrero E.
Institution
(Stowell) Blood Transfusion Service, Department of Pathology,
Massachusetts General Hospital, Harvard Medical School, Boston, Mass,
United States
(Whitman) Division of Cardiac Surgery, Department of Surgery, Johns
Hopkins Hospital, Baltimore, Md, United States
(Granger, Assmann) New England Research Institutes, Watertown, Mass,
United States
(Gomez) Department of Critical Care Medicine, Center for Critical Care
Nephrology, University of Pittsburgh, Pittsburgh, Pa, United States
(Massey, Shapiro) Center for Vascular Biology Research, Beth Israel
Deaconess Medical Center, Boston, Mass, United States
(Shapiro) Harvard Medical School, Boston, Mass, United States
(Steiner) Department of Pediatrics, University of Minnesota, Minneapolis,
Minn, United States
(Bennett-Guerrero) Department of Anesthesiology, Duke University Medical
Center, Durham, NC, United States
Title
The impact of red blood cell storage duration on tissue oxygenation in
cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (3) (pp 610-619.e2),
2017. Date of Publication: 01 Mar 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Although storage alters red blood cells, several recent,
randomized trials found no differences in clinical outcomes between
patients transfused with red blood cells stored for shorter versus longer
periods of time. The objective of this study was to see whether storage
impairs the in vivo ability of erythrocytes to traverse the
microcirculation and deliver oxygen at the tissue level. Methods A subset
of subjects from a clinical trial of cardiac surgery patients randomized
to receive transfusions of red blood cells stored <10 days or >21 days
were assessed for thenar eminence and cerebral tissue hemoglobin oxygen
saturation (S<inf>t</inf>O<inf>2</inf>) via the use of near-infrared
spectroscopy and sublingual microvascular blood flow via side-stream
darkfield videomicroscopy. Results Among 55 subjects, there was little
change in the primary endpoint (thenar eminence S<inf>t</inf>O<inf>2</inf>
from before to after transfusion of one unit) and the change was similar
in the 2 groups: +1.7% (95% confidence interval, -0.3, 3.8) for
shorter-storage and +0.8% (95% confidence interval, -1.1, 2.9) for
longer-storage; P = .61). Similarly, no significant differences were
observed for cerebral S<inf>t</inf>O<inf>2</inf> or sublingual
microvascular blood flow. These parameters also were not different from
preoperatively to 1 day postoperatively, reflecting the absence of a
cumulative effect of all red blood cell units transfused during this
period. Conclusions There were no differences in thenar eminence or
cerebral S<inf>t</inf>O<inf>2</inf>, or sublingual microcirculatory blood
flow, in cardiac surgery patients transfused with red blood cells stored
<10 days or >21 days. These results are consistent with the clinical
outcomes in the parent study, which also did not differ, indicating that
storage may not impair oxygen delivery by red blood cells in this setting.
Copyright &#xa9; 2016 The American Association for Thoracic Surgery

<3>
Accession Number
613977260
Author
Goldman S.; Cheung A.; Bavaria J.E.; Petracek M.R.; Groh M.A.; Schaff H.V.
Institution
(Goldman) Lankenau Heart Group, Lankenau Hospital, Wynnewood, Pa, United
States
(Cheung) Division of Cardiovascular Surgery, St Paul's Hospital -
University of British Columbia, Vancouver, British Columbia, Canada
(Bavaria) Division of Cardiovascular Surgery, Hospital of the University
of Pennsylvania, Philadelphia, Pa, United States
(Petracek) Department of Cardiac Surgery, Vanderbilt University Medical
Center, Nashville, Tenn, United States
(Groh) Asheville Heart, Mission Health and Hospitals, Asheville, NC,
United States
(Schaff) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn,
United States
Title
Midterm, multicenter clinical and hemodynamic results for the Trifecta
aortic pericardial valve.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (3) (pp 561-569.e2),
2017. Date of Publication: 01 Mar 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To evaluate the midterm hemodynamic performance and clinical
outcomes of the Trifecta aortic pericardial valve. Methods In a
multicenter, prospective, nonrandomized, follow-up study, 710 patients
underwent surgical implantation of a pericardial stented aortic prosthesis
(Trifecta valve; St Jude Medical, St. Paul, Minn). The valve is
constructed from bovine pericardium mounted externally onto a titanium
stent. Subjects were followed on an annual basis over 6 years. Results
Operations were performed from 2007 to 2009, and mean age was 72.4 +/- 9.3
years; 471 of 710 (66.3%) were men. Preoperatively, 361 of 710 (50.8%) of
patients were in New York Heart Association class III or IV, and at 6
years postoperatively, 92 of 96 (95.8%) were New York Heart Association
class I or II. Six years postoperatively, average mean gradient across all
valve sizes was 11.0 mm Hg, and the average effective orifice area index
was 0.80 cm²/m². The proportion of patients without
moderate-to-severe valvular regurgitation at 6 years was 95.2% (80/84).
Six years postoperatively, freedom from valve-related mortality,
nonstructural dysfunction, and paravalvular leak were 98.3%, 98.6%, and
98.9%, respectively, and freedom from reoperation due to structural valve
deterioration was 97.3% (95% confidence limits, 98.6-94.7). Conclusion
These midterm results demonstrate that the Trifecta valve is a safe and
effective valve substitute with excellent hemodynamic performance and
durability that is maintained through the 6-year follow-up period.
Copyright &#xa9; 2016 The American Association for Thoracic Surgery

<4>
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.

<5>
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.

<6>
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.

<7>
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.

<8>
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

<9>
[Use Link to view the full text]
Accession Number
614134459
Author
Zhai A.B.; Haddad H.
Institution
(Zhai, Haddad) Division of Cardiology, Department of Medicine, University
of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada
Title
The impact of obesity on heart failure.
Source
Current Opinion in Cardiology. 32 (2) (pp 196-202), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review Obesity, a growing global health problem, contributes to
the development of heart failure. However, increased BMI seems protective
for those with established disease, a phenomenon known as the 'obesity
paradox'. In this review, we outline the mechanism through which obesity
can contribute to the development of heart failure, explore the concept of
obesity paradox, and highlight the challenges that obesity presents for
advanced heart failure therapy. Recent findings Although the mechanism
underlying the obesity paradox is complex, meta-Analysis shows that
intentional weight loss through bariatric surgery can indeed improve
cardiac structure and function. With regard to ventricular assist device
therapy in obese patients, recent studies demonstrate that while obesity
was indeed associated with higher likelihood of complications, there were
no statistically significant differences in terms of mortality or
delisting from cardiac transplant waiting list. Summary Obesity is
strongly associated with the development of heart failure, through direct
and indirect mechanisms. Although clear consensus regarding weight
reduction in this patient population is lacking, there is mounting
clinical evidence that intentional weight loss may be beneficial, in spite
of the well-recognized obesity paradox, particularly as the presence of
obesity presents unique challenges in the advanced therapy of heart
failure patients. &#xa9; Copyright 2017 Wolters Kluwer Health, Inc. All
rights reserved.

<10>
Accession Number
614132184
Author
Altarabsheh S.E.; Deo S.V.; Dunlay S.M.; Erwin P.J.; Obeidat Y.M.; Navale
S.; Markowitz A.H.; Park S.J.
Institution
(Altarabsheh) Division of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Deo, Markowitz, Park) Division of Cardiovascular Surgery, University
Hospitals, Harrington Heart and Vascular Institute, Case Western Reserve
University, Cleveland, Ohio, United States
(Dunlay) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
(Erwin) Mayo Clinic Libraries, Rochester, Minnesota, United States
(Obeidat) Department of Cardiac Surgery, AlMana General Hospital,
Alkhobar, Saudi Arabia
(Navale) Division of Epidemiology and Biostatistics, Case Western Reserve
University, Cleveland, Ohio, United States
Title
Meta-Analysis of Usefulness of Concomitant Mitral Valve Repair or
Replacement for Moderate Ischemic Mitral Regurgitation With Coronary
Artery Bypass Grafting.
Source
American Journal of Cardiology. 119 (5) (pp 734-741), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Moderate ischemic mitral regurgitation (MR) is often present in patients
undergoing coronary artery bypass grafting (CABG). However, the clinical
benefit of repairing moderate MR during CABG is unproven. We searched
multiple databases to identify original studies comparing isolated CABG
versus combined CABG and MR surgery (mitral valve surgery with coronary
artery bypass grafting [MVCABG]); survival (either early or midterm) was
the primary end point. Risk ratio (RR) or standardize mean difference was
selected as the effect estimates; survival was compared by pooling hazard
ratios. All results are presented with 95% CIs; p <0.05 is statistically
significant. Eleven studies (7 retrospective and 4 randomized controlled
trials; 547 MVCABG and 900 CABG patients) were included in our
meta-analysis. Concomitant mitral valve repair significantly prolonged
surgical duration (p <0.01). Early mortality (MVCABG 6.9% and CABG 6%) was
comparable (RR 1.3 [0.9 to 1.8]; p = 0.11). At follow-up, the MVCABG
patients had similar New York Heart Association class (standardize mean
difference -0.73 (-1.64 to 0.18; p = 0.11). However, patients who
underwent concomitant mitral valve surgery had less MR at follow-up
(recurrent significant MR, RR 0.37 [0.22 to 0.62]; p = 0.001; mean MR
grade, mean difference = 0.39 [0.26 to 0.59]; p <0.001). Midterm survival
rate (mean follow-up 5 years) was comparable in both groups (hazard ratio
for mortality in the MVCABG cohort 1.1 [0.9 to 1.3]; p = 0.38). In
conclusion, concomitant repair of moderate ischemic MR leads to improved
mitral valve competence at follow-up; however, this was not translated
into any functional or survival benefit for adding valve repair to CABG
for these patients at 5 years of follow-up. Copyright &#xa9; 2016 Elsevier
Inc.

<11>
Accession Number
611367901
Author
Bhattacharjee H.K.; Jalaludeen A.; Bansal V.; Krishna A.; Kumar S.;
Subramanium R.; Ramachandran R.; Misra M.
Institution
(Bhattacharjee, Jalaludeen, Bansal, Krishna, Kumar, Misra) Department of
Surgical Disciplines, All India Institute of Medical Sciences, New Delhi,
India
(Subramanium, Ramachandran) Department of Anaesthesiology, All India
Institute of Medical Sciences, New Delhi, India
Title
Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder
pain following laparoscopic cholecystectomy: a randomised controlled
trial.
Source
Surgical Endoscopy and Other Interventional Techniques. 31 (3) (pp
1287-1295), 2017. Date of Publication: 01 Mar 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The incidence of shoulder pain (SP) following laparoscopic
cholecystectomy (LC) varies between 21 and 80 %. A few randomised
controlled trials and meta-analysis have shown lesser SP in LC performed
under low-pressure carbon dioxide pneumoperitoneum (LPCP) than under
standard-pressure carbon dioxide pneumoperitoneum (SPCP). However, the
possible compromise in adequate exposure and effective working space
during LPCP has negatively influenced its uniform adoption for LC.
Materials and methods: All consecutive patients undergoing elective LC for
gallstone disease who met the inclusion and exclusion criteria were
enroled. Fourty patients were randomised to SPCP group (pressure of 14
mmHg) and 40 to LPCP group (pressure of 9-10 mmHg). Primary outcome
measured was incidence of SP and its severity on visual analogue scale
(VAS) at 4, 8, 24 h and 7 days after LC. Secondary outcomes measured were
procedural time, technical difficulty, surgeons' satisfaction score on
exposure and working space, intra-operative changes in heart rate and
blood pressure, abdominal pain and analgesic requirement. Analyses were
performed using Stata software. Results: There was no conversion to open
surgery, bile duct injury or need to increase intra-abdominal pressure on
either group. Twenty-three patients (57.5 %) in SPCP group and nine
patients (22.5 %) in LPCP group had SP (p = 0.001). The severity of SP was
significantly more in SPCP group at 8 and 24 h (p = 0.009 and 0.005,
respectively). Both the groups had similar procedural time, surgeons'
satisfaction score, intra-operative changes in heart rate and blood
pressure. Conclusion: The incidence and severity of SP following LC
performed at LPCP are significantly less compared to that in SPCP. The
safety, efficacy and surgeons' satisfaction appear to be comparable in
both the groups. Hence, a routine practice of low-pressure carbon dioxide
pneumoperitoneum may be recommended in selected group of patients
undergoing laparoscopic cholecystectomy. Clinical trial registration
number: CTRI/2016/02/006590. Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<12>
[Use Link to view the full text]
Accession Number
612362404
Author
Barile L.; Fominskiy E.; Di Tomasso N.; Alpizar Castro L.E.; Landoni G.;
De Luca M.; Bignami E.; Sala A.; Zangrillo A.; Monaco F.
Institution
(Barile, Di Tomasso, Landoni, De Luca, Bignami, Zangrillo, Monaco)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Via Olgettina 60, Milano 20132, Italy
(Barile, Landoni, Sala, Zangrillo) Department of Cardiac Surgery,
Vita-Salute San Raffaele University, Milan, Italy
(Fominskiy) Department of Anesthesia and Intensive Care, Academician en
Meshalkin Novosibirsk State Budget Research Institute of Circulation
Pathology, Novosibirsk, Russian Federation
(Alpizar Castro) Department of Anesthesia, Mexico Hospital, San Jose,
Costa Rica
Title
Acute Normovolemic Hemodilution Reduces Allogeneic Red Blood Cell
Transfusion in Cardiac Surgery: A Systematic Review and Meta-analysis of
Randomized Trials.
Source
Anesthesia and Analgesia. 124 (3) (pp 743-752), 2017. Date of Publication:
01 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: To better understand the role of acute normovolemic
hemodilution (ANH) in a surgical setting with high risk of bleeding, we
analyzed all randomized controlled trials (RCTs) in the setting of cardiac
surgery that compared ANH with standard intraoperative care. The aim was
to assess the incidence of ANH-related number of allogeneic red blood cell
units (RBCu) transfused. Secondary outcomes included the rate of
allogeneic blood transfusion and estimated total blood loss. METHODS:
Twenty-nine RCTs for a total of 2439 patients (1252 patients in the ANH
group and 1187 in the control group) were included in our meta-analysis
using PubMed/MEDLINE, Cochrane Controlled Trials Register, and EMBASE.
RESULTS: Patients in the ANH group received fewer allogeneic RBCu
transfusions (mean difference = -0.79; 95% confidence interval [CI], -1.25
to -0.34; P =.001; I² = 95.1%). Patients in the ANH group were
overall transfused less with allogeneic blood when compared with controls
(356/845 [42.1%] in the ANH group versus 491/876 [56.1%] in controls; risk
ratio = 0.74; 95% CI, 0.62 to 0.87; P <.0001; I² = 72.5%), and
they experienced less postoperative blood loss (388 mL in ANH versus 450
mL in control; mean difference = -0.64; 95% CI, -0.97 to -0.31; P <.0001;
I² = 91.8%). CONCLUSIONS: ANH reduces the number of allogeneic
RBCu transfused in the cardiac surgery setting together with a reduction
in the rate of patients transfused with allogeneic blood and with a
reduction of bleeding. Copyright &#xa9; 2017 International Anesthesia
Research Society.

<13>
Accession Number
614209668
Author
Yamamoto M.; Shimura T.; Kano S.; Kagase A.; Kodama A.; Sago M.; Tsunaki
T.; Koyama Y.; Tada N.; Yamanaka F.; Naganuma T.; Araki M.; Shirai S.;
Watanabe Y.; Hayashida K.
Institution
(Yamamoto, Shimura, Kagase, Kodama, Sago, Tsunaki) Department of
Cardiology, Toyohashi Heart Center, Toyohashi, Japan
(Kano, Koyama) Department of Cardiology, Nagoya Heart Center, Nagoya,
Japan
(Tada) Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
(Yamanaka) Department of Cardiology, Syonan Kamakura Hospital, Shonan,
Japan
(Naganuma) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Araki) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
(Watanabe) Department of Cardiology, Teikyo University School of Medicine,
Tokyo, Japan
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Title
Prognostic Value of Hypoalbuminemia After Transcatheter Aortic Valve
Implantation (from the Japanese Multicenter OCEAN-TAVI Registry).
Source
American Journal of Cardiology. 119 (5) (pp 770-777), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Hypoalbuminemia, a frailty criterion, belongs to a group of co-morbidities
not captured as a traditional risk factor. We assessed its prognostic
value in patients who underwent transcatheter aortic valve implantation
(TAVI). The study included 1,215 consecutive patients from the Optimized
Catheter Valvular Intervention -TAVI Japanese multicenter registry.
Hypoalbuminemia was defined as serum albumin level <3.5 g/dl. Baseline
characteristics, procedural outcomes, and all-cause, cardiovascular and
noncardiovascular mortality rates after TAVI were compared between
patients with albumin level <3.5 g/dl (hypo[h]-ALB group, n = 284) and
those with albumin level >3.5 g/dl (nonhypo[nh]-ALB group, n = 931).
Several baseline characteristics differed significantly between both
groups, including age (85.1 +/- 5.1 vs 84.2 +/- 4.9 years, p = 0.012),
ejection fraction (58.5 +/- 14.3% vs 62.9 +/- 12.4%, p <0.001), baseline
kidney function, or liver disease. The 30-day mortality rate in all
patients showed significant differences between the 2 groups (3.9% vs
1.3%, p = 0.005). During a mean follow-up of 330 days, cumulative
all-cause, cardiovascular, and noncardiovascular mortality rates were
significantly higher in the hALB group than in the nhALB group (log-rank
test, p <0.001, p = 0.0021, and p <0.001, respectively). The groups were
also analyzed using a propensity matching model for adjusting the baseline
differences. The analysis revealed that the poorer prognosis of the hALB
group in terms of cumulative all-cause and noncardiovascular mortality was
retained (p = 0.038, and p = 0.0068, respectively); however, differences
in cardiovascular mortality rates in the 2 groups were attenuated (p =
0.93). In conclusion, hypoalbuminemia was associated with poor prognosis,
highlighted by the increase in noncardiovascular mortality. Baseline
albumin level could be a useful marker for risk stratification before
TAVI. Copyright &#xa9; 2016 Elsevier Inc.

<14>
Accession Number
614271517
Author
Fernandez Gonzalez L.; Garcia SanRoman K.; Astorga Burgo J.C.; Blanco Mata
R.; Arriola Meabe J.; Alcibar Villa J.C.
Institution
(Fernandez Gonzalez, Garcia SanRoman, Astorga Burgo, Blanco Mata, Arriola
Meabe, Alcibar Villa) Seccion de Cardiologia Intervencionista, Servicio de
Cardiologia, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
Title
Experience in the use of Angio-SeTM al during intra-aortic balloon
counterpulsation weaning.
Source
Cirugia Cardiovascular. 24 (1) (pp 45-46), 2017. Date of Publication: 01
Jan 2017.
Publisher
Elsevier Doyma (E-mail: editorial@elsevier.com)
Abstract
Due to the big experience with Angio-SealTM Device (St. Jude Medical) in
our center to close femoral puncture during cardiac catheterization, we
investigated whether the Angio-SealTM could be used safely and could
achieve hemostasis fastly when removing an IABP. We prospectely studied 33
consecutive patients (Age: mean 64,1 years [50-83 years]) in which the
Angio-SealTM 8F device was planned to be used to achieve vascular
hemostasis after removal of an IABP between January to December of 2015 in
the Cardiac Intensive care unit of Cruces University Hospital. IABP was
implanted due to several causes (cardiogenic shock due to STEMI, after
cardiac surgery, high risk PCI...). The primary endpoint was a composite
of any type of major (retroperitoneal bleeding, vessel occlusion, loss of
distal pulses, vascular surgery and death) and minor vascular complication
(hematoma, AV fistula or pseudoaneurism). IABP was continued for 1-7 days
(mean 4 days). The device was successfully deployed in all of the
patients. There were no major and only 2 minor complications (hematoma >10
cm). No patients required additional compression although most of them
were treated with antiplatelet drugs. Removal of IABP with the
Angio-SealTM 8F device is a fast, effective and safe procedure that could
improve the hemostasis and the confort of the patients compared with the
manual compression or other compression decides. We need further
randomized studies comparing Angio-SealTM with conventional methods of
compression to recommend routine use. Copyright &#xa9; 2016 Sociedad
Espanola de Cirugia Toracica-Cardiovascular

<15>
Accession Number
613834196
Author
Alexander G.C.; Iyer G.; Lucas E.; Lin D.; Singh S.
Institution
(Alexander, Iyer, Lucas, Lin) Department of Epidemiology, Johns Hopkins
Bloomberg School of Public Health, Baltimore, Md, United States
(Alexander, Iyer, Lucas, Lin, Singh) Center for Drug Safety and
Effectiveness, Johns Hopkins University, Baltimore, Md, United States
(Alexander, Singh) Division of General Internal Medicine, Department of
Medicine, Johns Hopkins Medicine, Baltimore, Md, United States
Title
Cardiovascular Risks of Exogenous Testosterone Use Among Men: A Systematic
Review and Meta-Analysis.
Source
American Journal of Medicine. 130 (3) (pp 293-305), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Purpose We sought to evaluate whether exogenous testosterone therapy is
associated with increased risk of serious cardiovascular events as
compared with other treatments or placebo. Methods Study selection
included randomized controlled trials (RCTs) and observational studies
that enrolled men aged 18 years or older receiving exogenous testosterone
for 3 or more days. The primary outcomes were death due to all causes,
myocardial infarction, and stroke. Secondary outcomes were other hard
clinical outcomes such as heart failure, arrhythmia, and cardiac
procedures. Peto odds ratio was used to pool data from RCTs. Risk of bias
was assessed using Cochrane Collaboration tool and Newcastle and Ottawa
scale, respectively. The strength of evidence was evaluated using the
Grades of Recommendation, Assessment, Development, and Evaluation Working
Group approach. Results A total of 39 RCTs and 10 observational studies
were included. Meta-analysis was done using data from 30 RCTs. Compared
with placebo, exogenous testosterone treatment did not show any
significant increase in risk of myocardial infarction (odds ratio [OR]
0.87; 95% CI, 0.39-1.93; 16 RCTs), stroke (OR 2.17; 95% CI, 0.63-7.54; 9
RCTs), or mortality (OR 0.88; 95% CI, 0.55-1.41; 20 RCTs). Observational
studies showed marked clinical and methodological heterogeneity. The
evidence was rated as very low quality due to the high risk of bias,
imprecision, and inconsistency. Conclusions We did not find any
significant association between exogenous testosterone treatment and
myocardial infarction, stroke, or mortality in randomized controlled
trials. The very low quality of the evidence precludes definitive
conclusion on the cardiovascular effects of testosterone. Copyright &#xa9;
2016 Elsevier Inc.

<16>
Accession Number
614088346
Author
Brascia D.; Reichart D.; Onorati F.; Perrotti A.; Ruggieri V.G.; Bounader
K.; Verhoye J.P.; Santarpino G.; Fischlein T.; Maselli D.; Dominici C.;
Mariscalco G.; Gherli R.; Rubino A.S.; De Feo M.; Bancone C.; Gatti G.;
Santini F.; Dalen M.; Saccocci M.; Faggian G.; Tauriainen T.; Kinnunen
E.-M.; Nicolini F.; Gherli T.; Rosato S.; Biancari F.
Institution
(Brascia, Tauriainen, Kinnunen, Biancari) Department of Surgery, Oulu
University Hospital, Oulu, Finland
(Reichart) Hamburg University Heart Center, Hamburg, Germany
(Onorati, Faggian) Division of Cardiovascular Surgery, Verona University
Hospital, Verona, Italy
(Perrotti) Department of Thoracic and Cardio-Vascular Surgery, University
Hospital Jean Minjoz, Besancon, France
(Ruggieri, Bounader, Verhoye) Division of Cardiothoracic and Vascular
Surgery, Pontchaillou University Hospital, Rennes, France
(Santarpino, Fischlein) Cardiovascular Center, Paracelsus Medical
University, Nuremberg, Germany
(Maselli, Dominici) Department of Cardiac Surgery, St. Anna Hospital,
Catanzaro, Italy
(Mariscalco) Department of Cardiovascular Sciences, Clinical Science Wing,
University of Leicester, Glenfield Hospital, Leicester, United Kingdom
(Gherli) Unit of Cardiac Surgery, Department of Cardiosciences, Hospital
S. Camillo-Forlanini, Rome, Italy
(Rubino) Centro Cuore Morgagni, Pedara, Italy
(De Feo, Bancone) Division of Cardiac Surgery, Department of
Cardiothoracic Sciences, Second University of Naples, Naples, Italy
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Santini) Division of Cardiac Surgery, University of Genoa, Genoa, Italy
(Dalen) Department of Molecular Medicine and Surgery, Department of
Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet,
Karolinska University Hospital, Stockholm, Sweden
(Saccocci) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino IRCCS, University of Milan, Milan, Italy
(Nicolini, Gherli) Division of Cardiac Surgery, University of Parma,
Parma, Italy
(Rosato) National Center for Epidemiology, Surveillance and Health
Promotion, Istituto Superiore di Sanita, Rome, Italy
Title
Validation of Bleeding Classifications in Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 119 (5) (pp 727-733), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Perioperative bleeding is a determinant of poor outcome in patients
undergoing coronary artery bypass grafting (CABG), but there is a lack of
adequate stratification of its severity. The ability of the European
registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition
of Perioperative Bleeding (UDPB), Study of Platelet Inhibition and Patient
Outcomes (PLATO), Clopidogrel and Aspirin Optimal Dose Usage to Reduce
Recurrent Events-Seventh Organization to Assess Strategies in Ischemic
Syndromes (CURRENT-OASIS 7), Efficacy and Safety of Subcutaneous
Enoxaparin in Non-Q Wave Coronary Events (ESSENCE), and SafeTy and
Efficacy of Enoxaparin in Percutaneous coronary intervention patients, an
internationaL randomized Evaluation (STEEPLE) bleeding classifications to
predict early mortality, stroke, acute kidney injury (AKI) stage 3, and
deep sternal wound infection/mediastinitis was investigated in 3,730
patients from the prospective, multicentre E-CABG registry. Increasing
grades of the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 classifications
were associated with increasing risks of early mortality, had similar
receiver-operating characteristic area under the curves (>0.7), and were
predictive also when adjusted for EuroSCORE II. The E-CABG and UDPB
classifications had satisfactory area under the curves (>0.6) in
predicting stroke, AKI stage 3, and deep sternal wound
infection/mediastinitis even when adjusted for EuroSCORE II. The PLATO and
CURRENT-OASIS 7 classifications had similar predictive ability for stroke
and AKI stage 3 as confirmed by multivariate analysis adjusted for
EuroSCORE II but showed inferior ability in predicting severe wound
infection compared to the E-CABG and UDPB classifications. The STEEPLE and
ESSENCE classifications had a poor ability of predicting all these adverse
events. Decision curve analysis showed a benefit of the E-CABG bleeding
classification over the other classifications in predicting all adverse
events. In conclusion, the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7
bleeding classifications have a satisfactory ability in predicting adverse
events after CABG. Decision curve analysis showed that the E-CABG bleeding
classification had the best predictive performance. Copyright &#xa9; 2016
Elsevier Inc.

<17>
[Use Link to view the full text]
Accession Number
614085331
Author
Praz F.; Siontis G.C.M.; Verma S.; Windecker S.; Juni P.
Institution
(Praz, Siontis, Windecker) Department of Cardiology, Bern University
Hospital, Bern, Switzerland
(Verma) Division of Cardiac Surgery, Canada
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute, University of Toronto, Toronto, ON, Canada
Title
Latest evidence on transcatheter aortic valve implantation vs. surgical
aortic valve replacement for the treatment of aortic stenosis in high and
intermediate-risk patients.
Source
Current Opinion in Cardiology. 32 (2) (pp 117-122), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review The goal of this review is to summarize the current
evidence supporting the use of transcatheter aortic valve implantation
(TAVI) in high and intermediate-risk patients. The focus is on the five
randomized controlled trials comparing TAVI with surgical aortic valve
replacement (SAVR) published to date, as well as two recent meta-Analyses.
Recent findings TAVI has profoundly transformed the treatment of elderly
patients presenting with symptomatic severe aortic stenosis. In
experienced hands, the procedure has become well tolerated and the results
more predictable. So far, two trials using two different devices
[Placement of Aortic Transcatheter Valve (PARTNER) 1A and US CoreValve
High Risk] have shown that TAVI is able to compete in terms of mortality
with SAVR in high-risk patients. These findings have been extended to the
intermediate-risk population in two recently published randomized
controlled trials [PARTNER 2 and Nordic Aortic Valve Intervention
(NOTION)]. The two meta-Analyses suggested improved survival in both high
and intermediate-risk patients during the first 2 years following the
intervention. The survival benefit was only found in patients treated via
the transfemoral access, and appeared more pronounced in women. Summary
Individual randomized trials enrolling high and intermediate-risk patients
have established the noninferiority of TAVI in comparison with SAVR,
whereas subsequent meta-Analyses suggest superiority of transfemoral TAVI
in terms of a sustained survival benefit 2 years after valve implantation
irrespective of the surgical risk category. The benefit of TAVI appears
more pronounced in women than in men. &#xa9; Copyright 2017 Wolters Kluwer
Health, Inc. All rights reserved.

<18>
Accession Number
614072929
Author
Varela Barca L.; Lopez Menendez J.; Martin Garcia M.; Redondo Palacios A.;
Centella Hernandez T.; Miguelena Hycka J.; Munoz Perez R.; Rodriguez-Roda
Stuart J.
Institution
(Varela Barca, Lopez Menendez, Martin Garcia, Redondo Palacios, Centella
Hernandez, Miguelena Hycka, Munoz Perez, Rodriguez-Roda Stuart) Hospital
Universitario Ramon y Cajal, Madrid, Spain
Title
Paravalvular abcess in bacterial endocarditis: Influence in postoperative
prognosis.
Source
Cirugia Cardiovascular. 24 (1) (pp 2-7), 2017. Date of Publication: 01 Jan
2017.
Publisher
Elsevier Doyma (E-mail: editorial@elsevier.com)
Abstract
Objective Paravalvular abscess (PAb) increases mortality, complexity and
complications associated with infectious endocarditis (IE) surgery. We
analysed the impact of PAb in different clinical presentations of IE.
Methods Retrospective, observational study that included all patients
undergoing heart surgery because of EI between 2002 and 2015 in one
center. Clinical follow-up was performed after discharge. Results 169
patients were operated, and there was a PAb present in the 33% of them.
Abscess was associated with increased perioperative mortality (30.9% vs.
23.4%)) and permanent pacemaker implantation (15.2% vs. 9.3%). PAb was
significantly more frequent in aortic (50.0%) than in mitral (20.3%)
surgery, as well as in native (44.4%) versus prosthetic (26.2%) IE. The
presence of abscess significantly increased surgical mortality in aortic
IE (21,4% vs. 3.6%; P=.043), with no significant differences in mitral IE
(25,5% vs. 25%; P=.97). It was also associated with higher but no
significantly increased mortality in native endocarditis (29.6% vs.
19.7%), with similar results in prosthetic IE (32,1% vs. 31,4%). After a
median follow-up of 51 months after discharge, survival (70.6% with PAb
vs. 75.7% without PAb) and re-infection (13.3% vs. 10,2%) were similar
among patients with and without PAb. Conclusion The presence of PAb was
associated with poor prognosis in IE, especially in aortic and native
valve involvement. When indicated, early surgery could be beneficial in
these patients to prevent abscess formation. After discharge patients had
a similar long-term prognosis. Copyright &#xa9; 2016 Sociedad Espanola de
Cirugia Toracica-Cardiovascular

<19>
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.

<20>
Accession Number
614116973
Author
Drake-Brockman T.F.E.; Ramgolam A.; Zhang G.; Hall G.L.; von
Ungern-Sternberg B.S.
Institution
(Drake-Brockman, Ramgolam, von Ungern-Sternberg) Department of Anaesthesia
and Pain Management, Princess Margaret Hospital for Children, Perth, WA,
Australia
(Drake-Brockman, von Ungern-Sternberg) School of Medicine and
Pharmacology, University of Western Australia, Perth, WA, Australia
(Zhang) Centre for Genetic Origins of Health and Disease, University of
Western Australia, Perth, WA, Australia
(Hall) Centre of Child Health Research, University of Western Australia,
Perth, WA, Australia
(Ramgolam, Hall, von Ungern-Sternberg) Children's Lung Health, Telethon
Kids Institute, Perth, WA, Australia
(Zhang) School of Public Health, Curtin University, Perth, WA, Australia
(Hall) School of Physiotherapy and Exercise Science, Curtin University,
Perth, WA, Australia
(Zhang) Centre for Genetic Origins of Health and Disease, Curtin
University, Perth, WA, Australia
Title
The effect of endotracheal tubes versus laryngeal mask airways on
perioperative respiratory adverse events in infants: a randomised
controlled trial.
Source
The Lancet. 389 (10070) (pp 701-708), 2017. Date of Publication: 18 Feb
2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Perioperative respiratory adverse events (PRAE) are the most
common critical incidents in paediatric anaesthesia and occur more often
in infants. Use of laryngeal mask airways (LMAs) is associated with
reduced PRAE compared with endotracheal tubes in older children (>1 year).
We aimed to evaluate the effect of these devices on the incidence of PRAE
in infants. Methods We did a randomised controlled trial at the Princess
Margaret Hospital for Children in Perth (WA, Australia) by recruiting
infants (aged 0-12 months) undergoing general (with or without regional or
local) anaesthesia with anticipated fentanyl dose 1 mug/kg or lower for
minor elective surgery. We excluded patients contraindicated for LMA or
endotracheal tube; who had known cardiac disease or airway or thoracic
malformations; who were receiving midazolam premedication; who were
undergoing airway, thoracic, or abdomen surgery at the time of
participation; and if the parents did not speak English. Written parental
or guardian consent was obtained before enrolment. Participants were
randomly assigned (1:1), by computer-generated variable block
randomisation, to receive an LMA (PRO-Breathe, Well Lead Medical Co Ltd,
Panyu, China) or an endotracheal tube (Microcuff, Halyard Health Inc,
Atlanta, GA, USA). Sealed randomisation envelopes were used to conceal
device assignment. An interim analysis was planned once half the number of
infants needed (145) had been recruited. The primary outcome was incidence
of PRAE, assessed in the intention-to-treat population. The institutional
ethics committee at the Princess Margaret Hospital for Children granted
ethical approval (1786/EP). The trial is registered with the Australian
New Zealand Clinical Trials Registry (ACTRN12610000250033). Findings The
trial began on July 8, 2010, and was ended early on May 7, 2015, after the
interim analysis results met the study stopping rules. During this time,
239 infants were assessed and 181 eligible infants were randomly assigned
to receive an LMA (n=85) or an endotracheal tube (n=95). Four infants were
not included in the analysis (two due to cancelled procedures, one did not
meet inclusion criteria, and one with missing dataset). In the
intention-to-treat analysis, PRAE occurred in 50 (53%) infants in the
endotracheal tube group and in 15 (18%) infants in the LMA group (risk
ratio [RR] 2.94, 95% CI 1.79-4.83, p<0.0001). Laryngospasm and
bronchospasm (major PRAE) were recorded in 18 (19%) infants in the
endotracheal tube group and in three (4%) infants in the LMA group (RR
5.30, 95% CI 1.62-17.35, p=0.002). No deaths were reported. Interpretation
In infants undergoing minor elective procedures, LMAs were associated with
clinically significantly fewer PRAE and lower occurrence of major PRAE
(laryngospasm and bronchospasm) than endotracheal tubes. This difference
should be a consideration in airway device selection. Funding Princess
Margaret Hospital Foundation, National Health and Australian Medical
Research Council, Stan Perron Charitable Trust, and Callahan Estate.
Copyright &#xa9; 2017 Elsevier Ltd

<21>
Accession Number
612947787
Author
Likosky D.S.; Paugh T.A.; Harrington S.D.; Wu X.; Rogers M.A.M.; Dickinson
T.A.; DeLucia A.; Benedetti B.R.; Prager R.L.; Zhang M.; Paone G.
Institution
(Likosky, Paugh, Wu, Benedetti, Prager) Department of Cardiac Surgery,
University of Michigan, Ann Arbor, Michigan, United States
(Rogers) Department of Internal Medicine, University of Michigan, Ann
Arbor, Michigan, United States
(Zhang) Department of Biostatistics, University of Michigan, Ann Arbor,
Michigan, United States
(Harrington) Heart and Vascular Institute, Henry Ford Macomb Hospitals,
Clinton Township, Michigan, United States
(Dickinson) Department of Surgery, Mayo Clinic, Rochester, Minnesota,
United States
(DeLucia) Department of Cardiac Surgery, Bronson Methodist Hospital,
Kalamazoo, Michigan, United States
(Paone) Division of Cardiac Surgery, Department of Surgery, Henry Ford
Hospital, Detroit, Michigan, United States
Title
Prediction of Transfusions After Isolated Coronary Artery Bypass Grafting
Surgical Procedures.
Source
Annals of Thoracic Surgery. 103 (3) (pp 764-772), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier USA
Abstract
Background Although blood transfusions are common and have been associated
with adverse sequelae after cardiac surgical procedures, few
contemporaneous models exist to support clinical decision making. This
study developed a preoperative clinical decision support tool to predict
perioperative red blood cell transfusions in the setting of isolated
coronary artery bypass grafting. Methods We performed a multicenter,
observational study of 20,377 patients undergoing isolated coronary artery
bypass grafting among patients at 39 hospitals participating in the
Michigan Society of Thoracic and Cardiovascular Surgeons Quality
Collaborative's PERFusion measures and outcomes (PERForm) registry between
2011 and 2015. Candidates' preoperative risk factors were identified based
on previous work and clinical input. The study population was randomly
divided into a 70% development sample and a 30% validation sample. A
generalized linear mixed-effect model was developed to predict
perioperative red blood cell transfusion. The model's performance was
assessed for calibration and discrimination. Sensitivity analysis was
performed to assess the robustness of the model in different clinical
subgroups. Results Transfusions occurred in 36.8% of patients. The final
regression model included 16 preoperative variables. The correlation
between the observed and expected transfusions was 1.0. The risk
prediction model discriminated well (receiver operator characteristic
[ROC]<inf>development</inf>, 0.81; ROC<inf>validation</inf>, 0.82) and had
satisfactory calibration (correlation between observed and expected rates
was r = 1.00). The model performance was confirmed across medical centers
and clinical subgroups. Conclusions Our risk prediction model uses 16
readily obtainable preoperative variables. This model, which provides a
patient-specific estimate of the need for transfusion, offers clinicians a
guide for decision making and evaluating the effectiveness of blood
management strategies. Copyright &#xa9; 2017 The Society of Thoracic
Surgeons

<22>
Accession Number
611879756
Author
Lim W.Y.; Ramasamy A.; Lloyd G.; Bhattacharyya S.
Institution
(Lim, Ramasamy, Lloyd, Bhattacharyya) Echocardiography Laboratory,
Valvular Heart Disease Clinic, Barts Heart Centre, St Bartholomew's
Hospital, Institute of Cardiovascular Sciences, UCL, London EC1 7AB,
United Kingdom
Title
Meta-analysis of the impact of intervention versus symptom-driven
management in asymptomatic severe aortic stenosis.
Source
Heart. 103 (4) (pp 268-272), 2017. Date of Publication: 15 Feb 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: The management of patients with asymptomatic, severe aortic
stenosis (AS) is controversial. We performed a meta-analysis to examine
the impact on outcomes of aortic valve replacement (AVR) in patients with
severe asymptomatic AS versus a symptom-driven intervention approach.
Methods: A search for studies that examined the outcomes of AVR and
management of asymptomatic severe AS was performed. We examined the end
points of all-cause mortality, cardiac mortality and sudden cardiac death.
Our analysis compared early AVR in asymptomatic patients with a
symptom-driven AVR approach (excluding symptomatic patients who did not
undergo AVR). Results: Four observational studies were identified with a
total of 1300 patients. There was significant heterogeneity between
studies (I²=72%). Using a random-effects model, there was a
trend towards reduced overall mortality in patients undergoing early AVR
compared with a symptom-driven AVR approach (OR 0.54, 95% CI 0.26 to 1.12,
p=0.1). There was no significant reduction in cardiac mortality or sudden
death (OR 0.78, p=0.85, and OR 0.34, p=0.25, respectively). Conclusions:
Although there was a trend towards reduced overall mortality when
comparing early AVR in patients with asymptomatic, severe AS to a
symptomdriven AVR approach, there was no significant difference in cardiac
mortality or sudden death. An individual approach focusing on individual
risk stratification and operative mortality is required until more robust,
randomised trial data are available. Copyright &#xa9; 2017 BMJ Publishing
Group Limited.

<23>
Accession Number
614572612
Author
Ekstrom B.; Mehrabian P.; Strodtbeck W.; Vorenkamp K.; Warren D.
Institution
(Ekstrom, Mehrabian, Strodtbeck, Vorenkamp, Warren) Virginia Mason Medical
Center, United States
Title
Single view anterior-posterior contrast-enhanced epidurography for
confirmation of thoracic epidural catheter placement is highly concordant
between expert reviewers.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st Annual Regional
Anesthesiology and Acute Pain Medicine Meeting of the American Society of
Regional Anesthesia and Pain Medicine, ASRA 2016. United States.
Conference Start: 20160331. Conference End: 20160402. 41 (5) (no
pagination), 2016. Date of Publication: September-October 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction Thoracic epidural analgesia is commonly employed for
treatment of postoperative pain after major abdominal or thoracic surgery;
however, failure of analgesia is a common complication of therapy with an
incidence estimated at 13-47% in published heterogeneous cohorts.
Contrast-enhanced epidurography informs two leading causes of failure:
incorrect placement of the epidural catheter and inadequate spread of
infusate. However, epidurography has not been widely adopted for use in
acute pain management given perceived inconvenience and questions of its
value in that setting. In this study we evaluate our institution's
simplified approach employing single anterior-posterior post-contrast
portable roentgenograms. We investigate the validity of this technique by
assessing concordance of epidurogram interpretation, and record technical
factors that reduced reliability. We hypothesized that independent review
by blinded Anesthesiology Pain Medicine specialists would reveal a high
level of inter-rater reliability, thus demonstrating the precision of this
imaging modality. Materials and methods (NA for case report) After
approval by our institutional review board, we searched our internal
epidural quality data to identify patients who had epidurograms for
confirmation of thoracic epidural catheter placement during the study
period. These images were anonymized and placed in a secure directory in
our PACS and independently reviewed by three pain medicine boarded
anesthesiologists who were blinded to each patient's history. The
reviewers recorded presence or absence of epidural contrast, technical
adequacy of the study and characteristics of epidural spread. The
interpretations were evaluated for absolute agreement and correlation via
Fleiss' kappa. The incidences of positive or negative interpretations were
recorded, as well as factors which led to disagreement and negative or
positive interpretation. All statistical analyses were performed with
Excel 2013. Results/Case report This abstract reports the preliminary
findings related to the first 49 epidurograms identified in our study
period. The raters agreed on their interpretation of whether or not the
contrast was in the epidural space for 94% of images (46/49), with a kappa
value of 0.86 (p << 0.01). Please see Table 1 for additional findings.
Discussion Epidurography has been previously shown to be a safe technique
for confirmation of epidural catheter placement and may be predictive of
spread of epidural infusate. We present an efficient approach to
epidurography in acute pain management that can be reliably interpreted
with strong correlation between independent, blinded expert reviewers.
Inadequate quality of imaging strongly correlated with reduced reliability
of interpretation. Midline contrast alone was not specific for epidural
location. Further research is needed to determine what training is
appropriate for the interpretation of epidurograms, to further define
their role in acute pain management, and to evaluate their clinical and
economic impact. (Table presented).

<24>
Accession Number
614572598
Author
Walker J.
Institution
(Walker) University of California, San Diego, United States
Title
Pulsed-radiofrequency lesion of the left stellate ganglion provides
durable suppression of drug-resistant ventricular arrhythmia.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st Annual Regional
Anesthesiology and Acute Pain Medicine Meeting of the American Society of
Regional Anesthesia and Pain Medicine, ASRA 2016. United States.
Conference Start: 20160331. Conference End: 20160402. 41 (5) (no
pagination), 2016. Date of Publication: September-October 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction Electrical Storm (ES) is defined by life-threatening
recurrent ventricular tachycardia (VT) or fibrillation (VF). Various
treatments have been used for ES, including: anti-arrhythmic medications,
surgical sympathectomy, electrical cardioversion or defibrillation,
ablation, and continuous left-sided stellate ganglion block and
neurolysis.[1] Local anesthetic blockade of the left stellate ganglion
produces effective but transient suppression of ventricular
arrhythmias.[2,3] Surgical sympathectomy has been used for long-term
management of ES, but may be contraindicated in critically ill patients or
due to anatomic abnormalities. Pulsed radio frequency ablation (PRFA) may
provide an effective and durable treatment alternative.[4- 6] Results/Case
report Permission was obtained by the patient to use his healthcare
information for this purpose. The patient is an 85 year old male with
ischemic cardiomyopathy, aortic stenosis, hypertension, non-insulin
dependent diabetes, and hypothyroidism who developed post-CABG VT and VF
refractory to pharmacological interventions, requiring trans-venous pacing
at 100bpm. Due to his critical status electrophysiologic interventions and
ICD placement were not feasible. On post-op day 7, a left stellate
ganglion block with bupivacaine suppressed VT and VF for 4 hours. On
post-op day 10 the left stellate ganglion was treated with PRFA. Under
fluoroscopic guidance, three, three-minute PRFA lesions (5Hz, 50 msec
pulse width) were applied in a triangular configuration along the
anterolateral aspect of T1 vertebral body using a 22 gauge, 10 cm radio
frequency cannula with 10 mm active tip. Fifteen minutes post-block,
pacing was discontinued, revealing normal sinus rhythm (NSR) henceforth.
Vasoactive and anti-arrhythmics infusions were subsequently weaned and
discontinued and the patient was extubated on post-op day 11.
Unfortunately, on post-op day 12, the patient expired after rupture of a
newly diagnosed AAA. Notably, NSR persisted through the rupture and
throughout the resuscitation efforts, despite extreme hypotension.
Discussion There is literature supporting the treatment of
tachyarrhythmias subsequent to central nervous system disease with
stellate ganglion block going back over 4 decades.[1,2,3] This is an
option also for recalcitrant catecholaminergic polymorphic ventricular
tachycardia where implantable cardioverter-defibrillator (ICD) shocks may
trigger new arrhythmias, and for which more invasive techniques, such as
surgery with left cardiac sympathetic denervation or ablation, may be
contraindicated. PRFA overs an advantage over other modalities because it
avoids the potential complications of an invasive surgical procedure (and
general anesthesia) compared to the site-specific nature of PRFA, as well
as offering a longer term solution than a block. Given the nature of a
case report, there are limitations in selection bias and internal
validity. A larger randomized prospective double-blinded clinical
controlled study with 2 arms is needed to demonstrate efficacy and
longevity of this approach over conventional approach. Moreover, given the
significant advantages of PRFA, more studies are needed not only to
delineate the mechanism behind it but also expand its use beyond the known
indications.(Figure Presented).

<25>
Accession Number
614572262
Author
Babazade R.; Turan A.; Kurz A.; Devereaux P.J.; Zimmerman N.M.; Hutcherson
M.T.; Naylor A.J.; Ali W.; Esa S.; Parlow J.; Gilron I.; Honar H.; Salmasi
V.; Sessler D.I.
Institution
(Babazade, Turan, Kurz, Devereaux, Zimmerman, Hutcherson, Naylor, Ali,
Esa, Parlow, Gilron, Honar, Salmasi, Sessler) Cleveland Clinic Foundation,
United States
Title
Clonidine does not reduce pain or opioid consumption after non-cardiac
surgery: A randomized, controlled trial.
Source
Regional Anesthesia and Pain Medicine. Conference: 41st Annual Regional
Anesthesiology and Acute Pain Medicine Meeting of the American Society of
Regional Anesthesia and Pain Medicine, ASRA 2016. United States.
Conference Start: 20160331. Conference End: 20160402. 41 (5) (no
pagination), 2016. Date of Publication: September-October 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction Multimodal analgesia combines various classes of medications
with the principal goal of interrupting pain transmission and moderating
the response to noxious stimulation at various levels to improve efficacy
while simultaneously diminishing side effects (1). Commonly used
non-opioid multimodal analgesics include N-Methyl-D-aspartate antagonists,
anticonvulsants, nonsteroidal anti-inflammatory agents, local anesthetics,
and alpha-2-adrenoceptor agonists (2) . Clonidine is an
alpha-2-adrenoceptor agonist which has analgesic properties (3). However,
the analgesic efficacy of perioperative clonidine remains unclear. We
therefore tested the hypothesis that clonidine reduces both pain scores
and cumulative opioid consumption during the initial 72 hours after
non-cardiac surgery. Materials and methods (NA for case report) With
approval of the Institutional Review Board at the Cleveland Clinic
(15-251, 2/26/2015) and written consent, patients having elective,
noncardiac surgery were enrolled in the POISE-2 sub-study. 624 patients
having elective non-cardiac surgery under general or spinal anesthesia
were included in this sub-study of the PeriOperative ISchemia Evaluation-2
(POISE-2) a randomized, controlled trial (4, 5). Patients were randomized
to 0.2 mg oral clonidine or placebo 2 to 4 hours before surgery, followed
by 0.2 mg/d transdermal clonidine patch or placebo patch which was
maintained until 72 hours after surgery. Postoperative pain scores and
opioid consumption were assessed for 72 hours after surgery Results/Case
report Clonidine had no effect on opioid consumption compared to placebo,
with an estimated ratio of means (95% CI) of 0.98 (0.70, 1.38); P = 0.92.
Median [Q1, Q3] opioid consumption was 63 [30, 154] mg morphine
equivalents in the clonidine group which was similar to 60 [30, 128] mg
morphine equivalents in the placebo group. Furthermore, there was no
significant effect on pain scores, with an estimated difference in means
(95% CI) of 0.12 (-0.02, 0.26) points; P = 0.10. Mean pain scores per
patient were (3.6 +/- 1.8) for clonidine patients and (3.6 +/- 1.8) for
placebo patients Discussion Clonidine was reported to be analgesic in many
previous trials, a conclusion summarized in a 2012 meta-analysis of
available trials (Fig 1). Nonetheless, clonidine was not superior on
either opioid consumption or pain scores in our patients, which is by far
the largest trial in this area. An updated meta-analysis which includes
all available data does not support clonidine providing any important
postoperative analgesia. Given that perioperative clonidine does not
reduce the risk of myocardial infarction or death, does not provide useful
analgesia, and promotes clinically important hypotension and bradycardia,
there appears to be little indication for using the drug prophylactically
in patients having non-cardiac surgery.

<26>
Accession Number
614336405
Author
Hansen H.S.; Bligaard N.; Thuesen L.; Kelbaek H.; Thayssen P.; Aaroe J.;
Hansen P.R.; Lassen J.F.; Saunamaki K.; Junker A.; Ravkilde J.; Abildgaard
U.; Tilsted H.H.; Engstrom T.; Jensen J.S.; Botker H.E.; Galatius S.;
Larsen C.T.; Kristensen S.D.; Krusell L.R.; Abildstrom S.Z.; Christiansen
E.H.; Meng M.; Okkels L.; Stephansen G.; Jeppesen J.L.; Galloe A.M.
Institution
(Galloe, Kelbaek) Department of Cardiology, Zealand University Hospital,
Roskilde, Denmark
(Thuesen, Ravkilde) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Hansen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Hansen, Abildgaard, Stephansen, Jensen) Department of Cardiology,
Copenhagen University Hospital, Gentofte, Denmark
(Christiansen) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Lassen, Engstrom) Department of Cardiology, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark
(Jeppesen) Department of Medicine, Amager Hvidovre Hospital, Glostrup,
University of Copenhagen, Copenhagen, Denmark
(Bligaard) Department of Cardiology, Copenhagen University Hospital,
Bispebjerg, Denmark
Title
10-Year Clinical Outcome After Randomization to Treatment by Sirolimus- or
Paclitaxel-Eluting Coronary Stents.
Source
Journal of the American College of Cardiology. 69 (6) (pp 616-624), 2017.
Date of Publication: 14 Feb 2017.
Publisher
Elsevier USA
Abstract
Background First-generation drug-eluting coronary stents (DES) were
introduced in 2003 to 2004, and their use resulted in a considerable
reduction in the development of in-stent restenosis at the cost of an
increased risk of late stent thromboses. Objectives This study followed
clinical outcomes of patients included in a large randomized trial for 10
years to enable detection of late changes in annual event rates that could
necessitate medical attention. Methods A total of 2,098 unselected
all-comer patients (50% with acute coronary syndrome) were randomly
assigned to have a first-generation DES implanted. This study recorded the
occurrence of a major adverse cardiac event (MACE) assessed as the
composite of cardiac death, myocardial infarction, and target vessel
revascularization. Stent thromboses were also assessed. Results Of the
2,098 unselected patients, 73.1% were still alive after 10 years. During
the follow-up period, MACE occurred in 346 (32.5%) in the group receiving
a sirolimus-eluting stent and in 342 (33.1%) in the group receiving a
paclitaxel-eluting stent (hazard ratio: 0.96; 95% confidence interval:
0.83 to 1.11; p = 0.60), with a steady annual rate of 2.6% after the first
year. Definite, probable, and possible stent thrombosis appeared in 279
patients (13.3%), with no difference between stent types and with a steady
annual rate of 1.3% after the first year. Conclusions Among the surviving
patients, the long-term annual MACE rate and the stent thrombosis rate
appeared constant for both stent types, with no apparent late changes.
Although there is no need for extraordinary medical attention for these
patients, the absence of declines in annual event rates calls for
continuous surveillance. (Danish Organization on Randomized Trials With
Clinical Outcome II [SORT OUT II]; NCT00388934) Copyright &#xa9; 2017
American College of Cardiology Foundation

<27>
Accession Number
614206742
Author
Reyes-Umpierrez D.; Davis G.; Cardona S.; Pasquel F.J.; Peng L.; Jacobs
S.; Vellanki P.; Fayfman M.; Haw S.; Halkos M.; Guyton R.A.; Thourani
V.H.; Umpierrez G.E.
Institution
(Reyes-Umpierrez, Davis, Cardona, Pasquel, Jacobs, Vellanki, Fayfman, Haw,
Umpierrez) Department of Medicine, Diabetes and Endocrinology Section,
Grady Health System, Emory University, School of Medicine, 49 Jesse Hill
Jr. Drive, Atlanta, GA 30303, United States
(Peng) Rollins School of Public Health, Emory University, Atlanta, GA
30303, United States
(Halkos, Guyton, Thourani) Joseph B. Whitehead Department of Surgery,
Emory University, Atlanta, GA 30303, United States
Title
Inflammation and oxidative stress in cardiac surgery patients treated to
intensive versus conservative glucose targets.
Source
Journal of Clinical Endocrinology and Metabolism. 102 (1) (pp 309-315),
2017. Date of Publication: 01 Jan 2017.
Publisher
Endocrine Society (E-mail: mzendell@endo-society.org)
Abstract
Objective: We aimed to determine (a) longitudinal changes of inflammatory
and oxidative stress markers and (b) the association between markers of
inflammation and perioperative complications in coronary artery bypass
surgery (CABG) patients treated with intensive vs conservative blood
glucose (BG) control. Methods: Patients with diabetes (n = 152) and
without diabetes with hyperglycemia (n = 150) were randomized to intensive
(n = 151; BG: 100-140 mg/dL) or to conservative (n = 151; BG: 141-180
mg/dL) glycemic targets. Plasma cortisol, high-sensitivity C-reactive
protein (hsCRP), tumor necrosis factor-a, interleukin-6 (IL-6),
thiobarbituric acid-reactive substances, and 2'-7'-dichlorofluorescein
were measured prior to and at days 3, 5, and 30 after surgery. Results:
Intensive glycemic control resulted in lower mean BG (132 +/- 14 mg/dL vs
154 +/- 17 mg/dL, P < 0.001) in the intensive care unit. Plasma cortisol
and inflammatory markers increased significantly from baseline after the
third and fifth day of surgery (P < 0.001), and returned to baseline
levels at 1month of follow-up. Patients with perioperative complications
had higher levels of cortisol, hsCRP, IL-6, and oxidative stress markers
compared with those without complications. There were no significant
differences in inflammatory and oxidative stress markers between patients,
with or without diabetes or complications, treated with intensive or
conventional glucose targets. Conclusion: We report no significant
differences in circulating markers of acute inflammatory and oxidative
stress response in cardiac surgery patients, with or without diabetes,
treated with intensive (100-140 mg/dL) or conservative (141-180 mg/dL)
insulin regimens. Copyright &#xa9; 2017 by the Endocrine Society.

<28>
Accession Number
612895793
Author
Geerdink L.M.; du Marchie Sarvaas G.J.; Kuipers I.M.; Helbing W.A.;
Delhaas T.; ter Heide H.; Rozendaal L.; de Korte C.L.; Singh S.K.; Ebels
T.; Hazekamp M.G.; Haas F.; Bogers A.J.J.C.; Kapusta L.
Institution
(Geerdink, Kapusta) Department of Pediatric Cardiology, Radboud University
Medical Center, Nijmegen, Netherlands
(Geerdink) Department of Pediatric Cardiology and Intensive Care Medicine,
Hannover Medical School, Hannover, Germany
(du Marchie Sarvaas) Center for Congenital Heart Diseases, University
Medical Center Groningen, Groningen, Netherlands
(Kuipers) Department of Pediatric Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Helbing) Department of Pediatric Cardiology, Erasmus Medical Center,
Rotterdam, Netherlands
(Delhaas) Department of Pediatric Cardiology, Maastricht University
Medical Center, Maastricht, Netherlands
(ter Heide) Department of Pediatric Cardiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Rozendaal) Department of Pediatric Cardiology, Leiden University Medical
Center, Leiden, Netherlands
(de Korte) Department of Radiology, Medical Ultrasound Imaging Center,
Radboud University Medical Center, Nijmegen, Netherlands
(Singh) Department of Cardiothoracic Surgery, Isala Clinics, Zwolle,
Netherlands
(Ebels) Department of Cardiothoracic Surgery, University Medical Center
Groningen, Groningen, Netherlands
(Hazekamp) Department of Cardiothoracic Surgery, Leiden University Medical
Center, Leiden, Netherlands
(Haas) Department of Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Bogers) Department of Cardiothoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Kapusta) Department of Pediatric Cardiology, Tel Aviv Sourasky Medical
Center, Tel Aviv, Israel
Title
Surgical outcome in pediatric patients with Ebstein's anomaly: A
multicenter, long-term study.
Source
Congenital Heart Disease. 12 (1) (pp 32-39), 2017. Date of Publication: 01
Jan 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Objective: Surgical outcomes of pediatric patients with Ebstein's anomaly
are often described as part of all-age-inclusive series. Our objective is
to focus on patients treated surgically in childhood (0-18 y). We study
the intended treatment (biventricular or 1.5 ventricle repair or
univentricular palliation), freedom from unplanned reoperation and
survival of this specific age group, in a nationwide study. Design:
Records of all Ebstein's anomaly patients born between 1980 and 2013 were
reviewed. Demographic variables, intraoperative procedures and
postoperative outcomes were analyzed. Results: Sixty-three patients
underwent 109 operations. Median follow-up after diagnosis was 121 months
(range 0-216 months). Twenty-nine (46%) patients required surgery in the
first year of life, including 21 who required neonatal surgery. The
intended treatment was biventricular (n = 37, 59%) and 1.5 ventricle (n =
5, 8%) repair or univentricular (n = 21, 33%) palliation. The one-, five-,
and 10-year freedom from unplanned reoperation was 89%, 79%, and 75%
respectively. There were nine (14%) in hospital deaths (within 30 d after
surgery). Causes of death were low cardiac output syndrome, cardiac
failure, hypoxemia, pulmonary hypertension or an unknown cause. There were
no late deaths. Conclusions: Surgery in childhood represents the worse
spectrum of disease, biventricular repair is often not applied. Patients
often face revision surgery. Mortality is limited to the immediate
postsurgical period. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<29>
Accession Number
614197149
Author
Akowuah E.; Goodwin A.T.; Owens W.A.; Hancock H.C.; Maier R.; Kasim A.;
Mellor A.; Khan K.; Murphy G.; Mason J.
Institution
(Akowuah, Goodwin, Owens, Mellor, Khan) The James Cook University
Hospital, South Tees Hospitals NHS Foundation Trust, Cardiothoracic
Division, Marton Road, Middlesbrough TS4 3BW, United Kingdom
(Hancock, Maier, Kasim) Durham University, Durham Clinical Trials Unit,
School of Medicine, Pharmacy and Health, Queen's Campus, University
Boulevard, Thornaby, Stockton-on-Tees TS17 6BH, United Kingdom
(Murphy) University of Leicester, Clinical Sciences Wing, Glenfield
General Hospital, Department of Cardiovascular Sciences, Leicester LE3
9QP, United Kingdom
(Mason) University of Warwick, Warwick Medical School, Coventry CV4 7AL,
United Kingdom
Title
Manubrium-limited ministernotomy versus conventional sternotomy for aortic
valve replacement (MAVRIC): Study protocol for a randomised controlled
trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 46. Date of
Publication: 28 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Aortic valve replacement is one of the most common cardiac
surgical procedures performed worldwide. Conventional aortic valve
replacement surgery is performed via a median sternotomy; the sternum is
divided completely from the sternal notch to the xiphisternum. Minimally
invasive aortic valve replacement, using a new technique called
manubrium-limited ministernotomy, divides only the manubrium from the
sternal notch to 1 cm below the manubrio-sternal junction. More than one
third of patients undergoing conventional sternotomy develop clinically
significant bleeding requiring post-operative red blood cell transfusion.
Case series data suggest a potentially clinically significant difference
in red blood cell transfusion requirements between the two techniques.
Given the implications for National Health Service resources and patient
outcomes, a definitive trial is needed. Methods/design: This is a
single-centre, single-blind, randomised controlled trial comparing aortic
valve replacement surgery using manubrium-limited ministernotomy
(intervention) and conventional median sternotomy (usual care). Two
hundred and seventy patients will be randomised in a 1:1 ratio between the
intervention and control arms, stratified by baseline logistic EuroSCORE
and haemoglobin value. Patients will be followed for 12 weeks from
discharge following their index operation. The primary outcome is the
proportion of patients who receive a red blood cell transfusion
post-operatively within 7 days of surgery. Secondary outcomes include red
blood cell and blood product transfusions, blood loss, re-operation rates,
sternal wound pain, quality of life, markers of inflammatory response,
hospital discharge, health care utilisation, cost and cost effectiveness
and adverse events. Discussion: This is the first trial to examine aortic
valve replacement via manubrium-limited ministernotomy versus conventional
sternotomy when comparing red blood cell transfusion rates following
surgery. Surgical trials present significant challenges; strengths of this
trial include a rigorous research design, standardised surgery performed
by experienced consultant cardiothoracic surgeons, an agreed anaesthetic
regimen, patient blinding and consultant-led patient recruitment. The
MAVRIC trial will demonstrate that complex surgical trials can be
delivered to exemplary standards and provide the community with the
knowledge required to inform future care for patients requiring aortic
valve replacement surgery. Trial registration: International Standard
Randomised Controlled Trial Number (ISRCTN) ISRCTN29567910. Registered on
3 February 2014. Copyright &#xa9; 2017 The Author(s).

<30>
[Use Link to view the full text]
Accession Number
611009612
Author
Dong C.; Yu J.; Liu Q.; Wu C.; Lu Y.
Institution
(Dong, Yu, Liu, Wu, Lu) Department of Anesthesiology, Third Affiliated
Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
(Lu) Department of Anesthesiology, First Affiliated Hospital of Anhui
Medical University, Hefei, Anhui Province, China
Title
Application of CO<inf>2</inf> waveform in the alveolar recruitment
maneuvers of hypoxemic patients during one-lung ventilation.
Source
Medicine (United States). 95 (24) (no pagination), 2016. Article Number:
e3900. Date of Publication: 21 Jun 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Deterioration of gas exchange during one-lung ventilation (OLV) is caused
by both total collapse of the nondependent lung and partial collapse of
the dependent lung. Alveolar recruitment maneuver improves lung function
during general anesthesia. The objective of this study was to investigate
whether there is an indirect relationship between the changes of
CO<inf>2</inf> expirogram and the selective lung recruitment. To further
improve the oxygenation and gas exchange, we compare adjust setting of
ventilated parameters based on CO<inf>2</inf> expirogram and a preset
setting of ventilated parameters during OLV in patients undergoing
right-side thoracic surgery. Thirty patients met the requirements criteria
that were studied at 3 time points: during two-lung ventilation (TLV),
during OLV with preset ventilation parameters (OLV-PP), and during OLV
with adjustable ventilation parameters (OLV-AP) that are in accordance
with CO<inf>2</inf> expirogram. Adjustable ventilation parameters such as
tidal volume (VT), respiratory rate (RR), positive end-expiratory pressure
(PEEP), and the ratio of inspiratory to expiratory were adjusted by
utilizing the phase III slopes of CO<inf>2</inf> expirogram, which
together with the relationship between the changes of CO<inf>2</inf>
expirogram and the selective lung recruitment. During OLV, the phase III
slopes of CO<inf>2</inf> expirogram in patients with pulse oxymetry
(SpO<inf>2</inf>) decreased less than 93% after the OLVPP, and were
absolutely different from that during TLV. After OLV-AP, the phase III
slopes of CO<inf>2</inf> expirogram and SpO<inf>2</inf> were similar to
those during TLV. During OLV, however, parameters of ventilation setting
in both OLV-PP and OLV-AP are obviously different. This study indicates
that alveolar recruitment by utilizing CO<inf>2</inf> expirogram probably
improves SpO<inf>2</inf> level during one-lung ventilation. Copyright
&#xa9; 2016 Wolters Kluwer Health, Inc. All rights reserved.

<31>
[Use Link to view the full text]
Accession Number
609165672
Author
Violi F.; Lip G.Y.H.; Pignatelli P.; Pastori D.
Institution
(Violi, Pignatelli, Pastori) Center of Atherothrombosis, I Medical Clinic,
Department of Internal Medicine and Medical Specialties, Sapienza
University of Rome, Umberto i Policlinic of Rome, Viale del Policlinico
155, Rome 00161, Italy
(Lip) Centre for Cardiovascular Sciences, City Hospital, University of
Birmingham, Birmingham, United Kingdom
Title
Interaction between dietary Vitamin K intake and anticoagulation by
Vitamin K antagonists: is it really true?: A systematic review.
Source
Medicine (United States). 95 (10) (no pagination), 2016. Article Number:
e2895. Date of Publication: 04 Mar 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Educational advice is often given to patients starting treatment with
vitamin K Antagonists (VKAs). A great emphasis is made on nutritional
information. Common belief is that dietary vitamin K intake could
counteract the anticoagulant effect by VKAs and for many years, patients
have been discouraged to consume vitamin-K-rich foods, such as green leafy
vegetables. The objective of this study is to summarize the current
evidence supporting the putative interaction between dietary vitamin K
intake and changes in INR with the VKAs. Data sources are MEDLINE via
PubMed and Cochrane database. All clinical studies investigating the
relationship between dietary vitamin K and measures of anticoagulation
were included. We excluded all studies of supplementation of vitamin K
alone. We performed a systematic review of the literature up to October
2015, searching for a combination of "food," "diet," "vitamin K,"
"phylloquinone," "warfarin," "INR," "coagulation," and "anticoagulant."
Two dietary interventional trials and 9 observational studies were
included. We found conflicting evidence on the effect of dietary intake of
vitamin K on coagulation response. Some studies found a negative
correlation between vitamin K intake and INR changes, while others
suggested that a minimum amount of vitamin K is required to maintain an
adequate anticoagulation. Median dietary intake of vitamin K1 ranged from
76 to 217mg/day among studies, and an effect on coagulation may be
detected only for high amount of vitamin intake (>150mg/day). Most studies
included patients with various indications for VKAs therapy, such as
atrial fibrillation, prosthetic heart valves, and venous thromboembolism.
Thus, INR target was dishomogeneous and no subanalyses for specific
populations or different anticoagulants were conducted. Measures used to
evaluate anticoagulation stability were variable. The available evidence
does not support current advice to modify dietary habits when starting
therapy with VKAs. Restriction of dietary vitamin K intake does not seem
to be a valid strategy to improve anticoagulation quality with VKAs. It
would be, perhaps, more relevant to maintain stable dietary habit,
avoiding wide changes in the intake of vitamin K. Copyright &#xa9; 2016
Wolters Kluwer Health, Inc. All rights reserved.

<32>
Accession Number
608481020
Author
von Scheidt W.; Pauschinger M.; Ertl G.
Institution
(von Scheidt) I. Medizinische Klinik, Klinikum Augsburg, Herzzentrum
Augsburg-Schwaben, Stenglinstr. 2, Augsburg 86156, Germany
(Pauschinger) Medizinische Klinik 8, Kardiologie, Paracelsus Medizinische
Privatuniversitat, Universitatsklinikum Nurnberg, Nurnberg, Germany
(Ertl) Medizinische Klinik und Poliklinik I, Deutsches Zentrum fur
Herzinsuffizienz - Comprehensive Heart Failure Center,
Universitatsklinikum Wurzburg, Wurzburg, Germany
Title
Long-term intravenous inotropes in low-output terminal heart failure?.
Source
Clinical Research in Cardiology. 105 (6) (pp 471-481), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Intravenous inotropic therapy may be necessary to achieve short-term
survival in end-stage heart failure patients with cardiogenic shock or
extreme low output and severe organ hypoperfusion. However, mid- or
long-term intravenous inotropic therapy is associated with an increased
mortality in advanced stage D heart failure patients using
beta-adrenoceptor agonists (dobutamine) or PDE-3-inhibitors (milrinone).
Intermittent levosimendan may evolve as a reasonable therapeutic option.
Randomized trials or other meaningful scientific evidence addressing the
optimal treatment of exclusively the most threatened subgroup of
hospitalized patients with persistent severe organ hypoperfusion are
missing, but urgently needed. Despite a lack of other beneficial
pharmacological options, the use of long-term intravenous inotropic
therapy as a treatment for refractory heart failure or as an obligatory
criterion for high urgency (HU) listing of heart transplant candidates
with a median waiting time of 66 days in Germany is not based on
scientific evidence. In addition, it might create a disincentive to
achieve the HU status as well as keeping it, thereby potentially exposing
the patient to an unnecessary additional risk. Upcoming new allocation
algorithms may possibly help to improve the inadequate present situation.
There is need for both, a better definition and a better treatment of high
risk terminal heart failure requiring high urgent transplant listing.
Copyright &#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<33>
Accession Number
610467093
Author
Kim J.H.; Chae S.-C.; Oh D.J.; Kim H.-S.; Kim Y.J.; Ahn Y.; Cho M.C.; Kim
C.J.; Yoon J.-H.; Park H.-Y.; Jeong M.H.
Institution
(Kim, Ahn, Jeong) Heart Center of Chonnam National University Hospital,
Gwangju, South Korea
(Chae) Department of Internal Medicine, Kyungpook National University
Hospital, Daegu, South Korea
(Oh) Cardiovascular Center University Guro Hospital, Seoul, South Korea
(Kim) Department of Internal Medicine, Seoul National University Hospital,
Seoul, South Korea
(Kim) Department of Cardiology, Yeungnam University Medical Center, Daegu,
South Korea
(Cho) Cardiology Division, Department of Internal Medicine, Chungbuk
National University Hospital, Cheongju, South Korea
(Kim) Department of Internal Medicine, Kyunghee University College of
Medicine, Seoul, South Korea
(Yoon) Department of Internal Medicine, Yonsei University Wonju College of
Medicine, Wonju, South Korea
(Park) Division of Cardiovascular and Rare Diseases, Center for Biomedical
Sciences, National Institute of Health, Osong, South Korea
Title
Multicenter cohort study of acute myocardial infarction in Korea - Interim
analysis of the Korea acute myocardial infarction registry-national
institutes of health registry.
Source
Circulation Journal. 80 (6) (pp 1427-1436), 2016. Date of Publication:
2016.
Publisher
Japanese Circulation Society
Abstract
Background:The Korea Acute Myocardial Infarction Registry (KAMIR)-National
Institutes of Health (NIH) registry has the aim of evaluating the clinical
characteristics, management, and long-term outcomes of patients with acute
myocardial infarction (AMI) in Korea.Methods and Results:Patients
hospitalized for AMI in 20 tertiary university hospitals in Korea have
been enrolled since November 2011. The study is expected to complete the
scheduled enrollment of approximately 13,000 patients in October 2015, and
follow-up duration is up to 5 years for each patient. As of October 2015,
an interim analysis of 13,623 subjects was performed to understand the
baseline clinical profiles of the study population. The mean age was 64.1
years, 73.5% were male, and 48.2% were diagnosed with ST-segment elevation
AMI. Hypertension is a leading cause of AMI in Korea (51.2%), followed by
smoking (38.5%) and diabetes mellitus (28.6%). Percutaneous coronary
intervention was performed in 87.4% and its success rate was very high
(99.4%). In-hospital, 1-year, and 2-year mortality rates were 3.9%, 4.3%,
and 8.6%, respectively. The rates of major adverse cardiac events at 1 and
2 years were 9.6% and 18.8%, respectively.Conclusions:This analysis
demonstrated the clinical characteristics of Korean AMI patients in
comparison with those of other countries. It is necessary to develop
guidelines for Asian populations to further improve their prognosis.
Copyright &#xa9; 2016, Japanese Circulation Society. All rights reserved.

<34>
Accession Number
607237513
Author
White J.; Withers K.L.; Lencioni M.; Carolan-Rees G.; Wilkes A.R.; Wood
K.A.; Patrick H.; Cunningham D.; Griffith M.
Institution
(White) Cedar, Cardiff University, Cardiff Medicentre, Heath Park, Cardiff
CF14 4UJ, United Kingdom
(Withers, Carolan-Rees, Wilkes) Cedar, Cardiff & Vale University Health
Board, Cardiff Medicentre, Heath Park, Cardiff CF14 4UJ, United Kingdom
(Lencioni, Griffith) University Hospitals Birmingham NHS Foundation Trust,
Birmingham, United Kingdom
(Wood) Duke University School of Nursing, 307 Trent Drive, DUMC 3322,
Durham, NC 27710, United States
(Patrick) National Institute for Health and Care Excellence, 10 Spring
Gardens, London SW1A 2BU, United Kingdom
(Cunningham) National Institute for Cardiovascular Outcomes Research
(NICOR), UCL Institute of Cardiovascular Science, 3rd Floor 170 Tottenham
Court Road, London W1T 7HA, United Kingdom
Title
Cardiff cardiac ablation patient-reported outcome measure (C-CAP):
validation of a new questionnaire set for patients undergoing catheter
ablation for cardiac arrhythmias in the UK.
Source
Quality of Life Research. 25 (6) (pp 1571-1583), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Springer International Publishing
Abstract
Purpose: To formally test and validate a patient-reported outcome measure
(PROM) for patients with cardiac arrhythmias undergoing catheter ablation
procedures in the UK [Cardiff Cardiac Ablation PROM (C-CAP)]. Methods: A
multicentre, prospective, observational cohort study with consecutive
patient enrolment from three UK sites was conducted. Patients were sent
C-CAP questionnaires before and after an ablation procedure. Pre-ablation
C-CAP1 (17 items) comprised four domains: patient expectations; condition
and symptoms; restricted activity and healthcare visits; medication and
general health. Post-ablation C-CAP2 (19 items) comprised five domains
including change in symptoms and procedural complications. Both
questionnaires also included the generic EQ-5D-5L tool (EuroQol).
Reliability, validity, and responsiveness measures were calculated.
Results: A total of 517 valid pre-ablation and 434 post-ablation responses
were received; questionnaires showed good feasibility and item
acceptability. Internal consistency was good (Cronbach's alpha >0.7) and
test-retest reliability was acceptable for all scales. C-CAP scales showed
high responsiveness (effect size >0.8). Patients improved significantly (p
< 0.001) following ablation across all disease-specific and global scales.
Minimal clinically important difference was calculated. Improvement beyond
the smallest detectable change of 9 points (symptom severity scale), 3
points (frequency and duration of symptoms scale), and 8 points (impact on
life scale) indicates an important change. Amendments to the C-CAP
questionnaires were identified through the validation process and made to
produce the final tools. Conclusions: The final C-CAP questionnaires are
valid, reliable, and responsive tools for measuring symptom change,
impact, and expectations in patients undergoing ablation for cardiac
arrhythmias. C-CAP questionnaires provide a tool with disease-specific and
generic domains to explore how cardiac ablation procedures in the UK
impact upon patients' lives. Copyright &#xa9; 2016, The Author(s).

<35>
Accession Number
610930390
Author
Cassese S.; Kufner S.; Xhepa E.; Byrne R.A.; Kreutzer J.; Ibrahim T.;
Tiroch K.; Valgimigli M.; Tolg R.; Fusaro M.; Schunkert H.; Laugwitz
K.-L.; Mehilli J.; Kastrati A.
Institution
(Cassese, Kufner, Xhepa, Byrne, Kreutzer, Fusaro, Schunkert, Kastrati)
Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich,
Germany
(Ibrahim, Laugwitz) 1. medizinische Klinik, Klinikum rechts der Isar,
Technische Universitat Munchen, Lazarettstrasse 36, Munich 80636, Germany
(Tiroch) Department of Cardiology, Helios Klinikum Wuppertal, Universitat
Witten/Herdecke, Wuppertal, Germany
(Valgimigli) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Tolg) Herzzentrum der Segeberger Kliniken Gruppe, Bad Segeberg, Germany
(Mehilli) Department of Cardiology, Ludwig-Maximilians-Universitat,
Munich, Germany
(Schunkert, Laugwitz, Mehilli, Kastrati) DZHK (German Centre for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
Title
Three-year efficacy and safety of new- versus early-generation
drug-eluting stents for unprotected left main coronary artery disease
insights from the ISAR-LEFT MAIN and ISAR-LEFT MAIN 2 trials.
Source
Clinical Research in Cardiology. 105 (7) (pp 575-584), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: In percutaneous coronary intervention (PCI) patients
new-generation drug-eluting stent (DES) has reduced adverse events in
comparison to early-generation DES. The aim of the current study was to
investigate the long-term clinical efficacy and safety of new-generation
DES versus early-generation DES for PCI of unprotected left main coronary
artery (uLMCA) disease. Methods: The patient-level data from the ISAR-LEFT
MAIN and ISAR-LEFT MAIN 2 randomized trials were pooled. The clinical
outcomes of PCI patients assigned to new-generation DES (everolimus- or
zotarolimus-eluting stent) versus early-generation DES (paclitaxel- or
sirolimus-eluting stent) were studied. The primary endpoint was the
composite of death, myocardial infarction (MI), target lesion
revascularization and stroke (MACCE, major adverse cardiac and
cerebrovascular event). Results: In total, 1257 patients were available.
At 3 years, the risk of MACCE was comparable between patients assigned to
new-generation DES or early-generation DES (28.2 versus 27.5 %, hazard
ratio-HR 1.03, 95 % confidence intervals-CI 0.83-1.26; P = 0.86).
Definite/probable stent thrombosis was low and comparable between
new-generation DES and early-generation DES (0.8 versus 1.6 %, HR 0.52, 95
% CI 0.18-1.57; P = 0.25); in patients treated with new-generation DES no
cases occurred beyond 30 days. Diabetes increased the risk of MACCE in
patients treated with new-generation DES but not with early-generation DES
(P<inf>interaction</inf> = 0.004). Conclusions: At 3-year follow-up, a PCI
with new-generation DES for uLMCA disease shows comparable efficacy to
early-generation DES. Rates of stent thrombosis were low in both groups.
Diabetes significantly impacts the risk of MACCE at 3 years in patients
treated with new-generation DES for uLMCA disease. ClinicalTrials.gov
Identifiers: NCT00133237; NCT00598637. Copyright &#xa9; 2015,
Springer-Verlag Berlin Heidelberg.

<36>
Accession Number
608199883
Author
Ong P.; Sechtem U.
Institution
(Ong, Sechtem) Department of Cardiology, Robert-Bosch-Krankenhaus,
Auerbachstrase 110, Stuttgart 70376, Germany
Title
Controversies in the treatment of patients with STEMI and multivessel
disease: is it time for PCI of all lesions?.
Source
Clinical Research in Cardiology. 105 (6) (pp 467-470), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Several randomized trials have suggested a benefit for multivessel PCI in
patients with STEMI and multivessel disease. However, none of the studies
compared multivessel PCI with a staged PCI-approach which is the current
guideline recommended approach. The results of the trials may overestimate
the beneficial effect of the multivessel PCI approach because the control
group did not receive any ischaemia testing for evaluation of the
significance of remaining lesions. Thus, unfavourable aspects of the
multivessel PCI approach such as overestimation of non-culprit lesions at
the time of acute coronary angiography, complications associated with PCI
of the non-culprit lesion (i.e. dissection, no-reflow, acute stent
thrombosis) or increased risk for contrast induced nephropathy may have
gone unnoticed as the comparative management pathway was unusual and
likely inferior to the guideline recommended approach. We believe that
culprit lesion only PCI and staged evaluation of remaining areas of
myocardial ischaemia with subsequent PCI is still preferable in patients
with STEMI and multivessel disease but a randomized study comparing this
approach with multivessel PCI is needed. Copyright &#xa9; 2016,
Springer-Verlag Berlin Heidelberg.

<37>
Accession Number
611162720
Author
Walpot J.; Sadreddini M.
Institution
(Walpot, Sadreddini) Department of Cardiology, Admiraal De Ruyter
Ziekenhuis, Vlissingen and Goes, Netherlands
Title
Left Atrial Compression Caused by an Intrapericardial Hematoma after
Coronary Artery Bypass Graft Surgery.
Source
Journal of Emergency Medicine. 51 (3) (pp 274-277), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Left atrial compression (LAC) is an uncommon condition that
causes left ventricular inflow obstruction. The clinical and pathologic
features are similar to those of mitral stenosis. Impaired left
ventricular filling may cause hypotension, syncope, or shock. The
increased left atrial pressure causes retrograde increase of the pressure
throughout the pulmonary circulation with subsequent signs of congestion.
Case Report An 84-year-old man presented with LAC caused by a focal
tamponade related to a pericardial hematoma as a complication of coronary
artery bypass graft (CABG) surgery. The formation of the hematoma occurred
3 weeks postsurgery. The echocardiographic study before discharge at day
12 after CABG surgery showed neither a focal hematoma nor a tamponade. The
diagnosis was made 6 days later. Why Should an Emergency Physician Be
Aware of This? Intrapericardial tamponade caused by bleeding is a known
complication of CABG surgery in the early postoperative stage. However,
emergency physicians should be aware that a postoperative hematoma may
also present as a focal tamponade because of postoperative adhesion by
scar formation. The literature of LAC is limited. The most reported causes
of LAC are compression caused by structures of the gastrointestinal tract,
followed by thoracic aortic pathology. A Medline search for the terms
"left atrial compression and hematoma" and "left atrial compression and
intrapericardial hematoma" found only 31 and 4 hits, respectively. We also
briefly discuss the import role of bedside echocardiography in the
diagnostic process of LAC in the emergency medicine department. Copyright
&#xa9; 2016 Elsevier Inc.

<38>
Accession Number
609133663
Author
Chu E.W.; Chernoguz A.; Divino C.M.
Institution
(Chu, Chernoguz, Divino) Division of Genery Surgery, Department of
Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place,
Box 1259, New York, NY 10029, United States
Title
The evaluation of clopidogrel use in perioperative general surgery
patients: A prospective randomized controlled trial.
Source
American Journal of Surgery. 211 (6) (pp 1019-1025), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The perioperative safety profile of clopidogrel, a potent
antiplatelet agent used in the management of cardiovascular disease, is
unknown, and there are no evidence-based guidelines recommending for
either its interruption or continuation at this time. The aim of this
study was to determine whether patients who are maintained on clopidogrel
before general surgical procedures are at increased risk of perioperative
bleeding complications. Methods Patients receiving clopidogrel at the time
of elective general surgery were randomized to either discontinue
clopidogrel 1 week before surgery (group A) or continue clopidogrel into
surgery (group B). All other antiplatelet and anticoagulant agents were
discontinued before surgery. The primary end points were perioperative
bleeding requiring intraoperative or postoperative transfusion of blood or
blood components and bleeding-related readmission, reoperation, or
mortality within 90 days of surgery. The secondary end points were
perioperative myocardial infarction or cerebrovascular accidents within 90
days of surgery. Results Thirty-nine patients were enrolled and underwent
43 general surgical operations. Twenty-one procedures were randomized to
group A and 22 to group B. The most commonly performed individual
procedures were open inguinal hernia repair (23%), laparoscopic
cholecystectomy (21%), open ventral hernia repair (15%), laparoscopic
ventral hernia repair (11%), and laparoscopic inguinal hernia repair (9%).
No perioperative mortalities, bleeding events requiring blood transfusion,
or reoperations occurred. One readmission for intra-abdominal hematoma
requiring percutaneous drainage occurred in each group (group A: 4.8% vs
group B: 4.5%; P = 1.0). No myocardial infarctions or cerebrovascular
accidents were observed or reported. Conclusions The outcomes from this
prospective study suggest that, patients undergoing commonly performed
elective general surgical procedures can be safely maintained on
clopidogrel without increased perioperative bleeding risk. Copyright
&#xa9; 2016 Elsevier Inc.

<39>
Accession Number
611233468
Author
Tan Z.; Zhou L.; Qin Z.; Luo M.; Chen H.; Xiong J.; Li J.; Liu T.; Du L.;
Zhou J.
Institution
(Tan, Zhou, Qin, Luo, Xiong, Li, Liu, Du) Department of Anesthesiology and
Translational Neuroscience Center, West China Hospital, China
(Chen, Zhou) Department of Laboratory Medicine, West China Hospital,
Sichuan University, No. 37, Guoxue Xiang, Chengdu, Sichuan 610041, China
Title
Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products
after Cardiac Surgery.
Source
Medicine (United States). 95 (17) (no pagination), 2016. Article Number:
e3424. Date of Publication: 01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Patients undergoing cardiac surgery often experience abnormal bleeding,
due primarily to cardiopulmonary bypass (CPB)-induced activation of
platelets. Sevoflurane may inhibit platelet activation, raising the
possibility that administering it during CPB may reduce blood loss.
Patients between 18 and 65 years old who were scheduled for cardiac
surgery under CPB at our hospital were prospectively enrolled and
randomized to receive intravenous anesthetics alone (control group, n =
77) or together with sevoflurane (0.5-1.0 vol/%) from an oxygenator
(sevoflurane group, n = 76). The primary outcome was postoperative blood
loss, the secondary outcome was postoperative need for blood products.
Volume of blood loss was 48% lower in the sevoflurane group than the
control group at 4 hours after surgery, and 33% lower at 12 hours after
surgery. Significantly fewer patients in the sevoflurane group lost >700
mL blood within 24 hours (9 of 76 vs 28 of 77, P < 0.001). As a result,
the sevoflurane group received significantly smaller volumes of packed red
blood cells (1.25 +/- 2.36 vs 2.23 +/- 3.75 units, P = 0.011) and fresh
frozen plasma (97 +/- 237 vs 236 +/- 344 mL, P = 0.004). Thus the
sevoflurane group was at significantly lower risk of requiring complex
blood products after surgery (adjusted odds ratio [OR] 0.34, 95%
confidence interval [CI] 0.17-0.68, P = 0.002). Sevoflurane inhalation
from an oxygenator during CPB may reduce blood loss and need for blood
products after cardiac surgery. &#xa9; Copyright 2016 Wolters Kluwer
Health, Inc. All rights reserved.

<40>
Accession Number
611761312
Author
Sun Y.-P.; Homma S.
Institution
(Sun, Homma) Columbia University Medical Center, New York, NY, United
States
Title
Patent foramen ovale and stroke.
Source
Circulation Journal. 80 (8) (pp 1665-1673), 2016. Date of Publication:
2016.
Publisher
Japanese Circulation Society
Abstract
A patent foramen ovale (PFO) is common and found in nearly 25% of healthy
individuals. The majority of patients with PFO remain asymptomatic and
they are not at increased risk for developing a stroke. The presence of
PFO, however, has been found to be higher in patients with cryptogenic
stroke, suggesting there may be a subset of patients with PFO who are
indeed at risk for stroke. Paradoxical embolization of venous thrombi
through the PFO, which then enter the arterial circulation, is
hypothesized to account for this relationship. Although aerated-saline
transesophageal echocardiography is the gold standard for diagnosis,
aerated-saline transthoracic echocardiography and transcranial Doppler are
often used as the initial diagnostic tests for detecting PFO. Patients
with cryptogenic stroke and PFO are generally treated with antiplatelet
therapy in the absence of another condition for which antico-agulation is
necessary. Based on the findings of 3 large randomized clinical trials,
current consensus guidelines do not recommend percutaneous closure, though
this is an area of controversy. The following review discusses the
relationship of PFO and cryptogenic stroke, focusing on the epidemiology,
pathophysiological mechanisms, diagnostic tools, associated
clinical/anatomic factors and treatment. Copyright &#xa9; 2016, Japanese
Circulation Society. All Rights Reserved.

<41>
Accession Number
607332891
Author
de Waha S.; Seeburger J.; Ender J.; Desch S.; Eitel I.; Reinhardt A.; Poss
J.; Fuernau G.; Noack T.; Merk D.R.; Schuler G.; Sievers H.-H.; Mohr
F.-W.; Thiele H.
Institution
(de Waha, Desch, Eitel, Reinhardt, Poss, Fuernau, Thiele) Department of
Cardiology, Angiology and Intensive Care Medicine, Medical Clinic II
(Cardiology/Angiology/Intensive Care Medicine), University Heart Center
Luebeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160,
Lubeck 23538, Germany
(de Waha, Desch, Eitel, Reinhardt, Poss, Fuernau, Thiele) German Center
for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck,
Lubeck, Germany
(Seeburger, Noack, Merk, Mohr) Department of Cardiac Surgery, Heart
Center, University of Leipzig, Leipzig, Germany
(Ender) Department of Anesthesiology, Heart Center, University of Leipzig,
Leipzig, Germany
(Schuler) Department of Internal Medicine/Cardiology, Heart Center,
University of Leipzig, Leipzig, Germany
(Sievers) Department of Cardiac and Thoracic Vascular Surgery, University
Heart Center Luebeck, University Hospital Schleswig-Holstein, Lubeck,
Germany
Title
Deep sedation versus general anesthesia in percutaneous edge-to-edge
mitral valve reconstruction using the MitraClip system.
Source
Clinical Research in Cardiology. 105 (6) (pp 535-543), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Percutaneous edge-to-edge mitral valve reconstruction (PMVR)
has emerged as a treatment option in patients with severe mitral
regurgitation not considered suitable candidates for surgery. The majority
of PMVR procedures are performed under general anesthesia (GA), although
deep sedation (DS) appears to be an attractive alternative. We thus sought
to assess the impact on intensive care unit (ICU) length of stay,
efficacy, and safety of DS in comparison to GA in patients undergoing PMVR
using the MitraClip system. Methods: Sixty consecutive patients
underwent PMVR procedures at two centers. The first 30 patients were
treated by GA followed by 30 patients undergoing DS under different
settings. The primary clinical endpoint was ICU length of stay. The
primary efficacy endpoint included procedural success and procedural
duration. The safety endpoint was defined as a composite of death, stroke,
cardiogenic shock, moderate and severe bleeding as well as pneumonia.
Results: The ICU length of stay was significantly shorter in the DS group
in comparison to GA patients (p = 0.001). The hospital length of stay did
not differ following DS in comparison to GA (p = 0.96). Procedural success
was high in both groups (100 versus 96.7 %, p = 0.34) at similar
procedural duration time (p = 0.60). No difference between GA and DS was
observed with respect to the occurrence of the combined safety endpoint (p
= 0.47). Conclusions: In comparison to GA, DS reduces the ICU length of
stay in PMVR without negative effects on safety and efficacy. Prospective
randomized trials are needed to confirm these findings. Copyright &#xa9;
2015, Springer-Verlag Berlin Heidelberg.

<42>
Accession Number
614204424
Author
Narayanan M.A.; Reddy Y.N.V.; Baskaran J.; Deshmukh A.
Institution
(Narayanan, Baskaran) Division of Cardiovascular Diseases, University of
Minnesota Medical Center, Minneapolis, MN, United States
(Reddy, Deshmukh) Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, United States
Title
Complete versus target vessel revascularization in ST-elevation myocardial
infarction-analysis of results from published metaanalysis of randomized
controlled trials.
Source
Journal of Thoracic Disease. 8 (11) (pp E1532-E1533), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)

<43>
Accession Number
614204401
Author
Wang N.; Tsai Y.-C.; Niles N.; Tchantchaleishvili V.; Di Eusanio M.; Yan
T.D.; Phan K.
Institution
(Wang, Phan) Department of Medicine, University of Sydney, Sydney,
Australia
(Tsai, Niles, Yan, Phan) The Collaborative Research (CORE) Group,
Macquarie University, Sydney, Australia
(Tchantchaleishvili) Department of Cardiothoracic Surgery, Mayo Clinic,
Rochester, MN, United States
(Di Eusanio) Cardiac Surgery Unit, Cardiovascular Department, 'G. Mazzini'
Hospital Piazza Italia, Teramo, Italy
Title
Transcatheter aortic valve implantation (TAVI) versus sutureless aortic
valve replacement (SUAVR) for aortic stenosis: A systematic review and
meta-analysis of matched studies.
Source
Journal of Thoracic Disease. 8 (11) (pp 3283-3293), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: With improving technologies and an increasingly elderly
populations, there have been an increasing number of therapeutic options
available for patients requiring aortic valve replacement. Recent evidence
suggests that transcatheter aortic valve implantation (TAVI) is one
suitable option for high risk inoperable patients, as well as high risk
operable patients. Sutureless valve technology has also been developed
concurrently, with facilitates surgical aortic valve replacement (SUAVR)
by allow resection and replacement of the native aortic valve with minimal
sutures and prosthesis anchoring required. For patients amenable for both
TAVI and SUAVR, the evidence is unclear with regards to the benefits and
risks of either approach. The objectives are to compare the perioperative
outcomes and intermediate-term survival rates of TAVI and SUAVR in matched
or propensity score matched studies. Methods: A systematic literature
search was performed to include all matched or propensity score matched
studies comparing SUAVR versus TAVI for severe aortic stenosis. A
meta-analysis with odds ratios (OR) and mean differences were performed to
compare key outcomes including paravalvular regurgitation and short and
intermediate term mortality. Results: Six studies met our inclusion
criteria giving a total of 741 patients in both the SUAVR and TAVI arm of
the study. Compared to TAVI, SUAVR had a lower incidence of paravalvular
leak (OR =0.06; 95% CI: 0.03-0.12, P<0.01). There was no difference in
perioperative mortality, however SUAVR patients had significantly better
survival rates at 1 (OR =2.40; 95% CI: 1.40-4.11, P<0.01) and 2 years (OR
=4.62; 95% CI: 2.62-8.12, P<0.01). Conclusions: The present study supports
the use of minimally invasive SUAVR as an alternative to TAVI in high risk
patients requiring aortic replacement. The presented results require
further validation in prospective, randomized controlled studies.
Copyright &#xa9; Journal of Thoracic Disease.

<44>
Accession Number
614204223
Author
Ramos M.B.; Botana-Rial M.; Garcia-Fontan E.; Fernandez-Villar A.;
Torreira M.G.
Institution
(Ramos, Garcia-Fontan) Thoracic Surgery Department, Alvaro Cunqueiro
University Clinical Hospital, EOXI Vigo, Spain
(Botana-Rial, Fernandez-Villar) Pneumology Department, Senior Lecturer in
Comprehensive Adult Dental Care, Faculty of Medicine and Dentistry,
University of Santiago de Compostela, A Coruna, Spain
(Torreira) Comprehensive Adult Dental Care, Faculty of Medicine and
Dentistry, University of Santiago de Compostela, A Coruna, Spain
Title
Update in the extraction of airway foreign bodies in adults.
Source
Journal of Thoracic Disease. 8 (11) (pp 3452-3456), 2016. Date of
Publication: 2016.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Foreign body (FB) aspiration into the airway is lees common in adults than
children. Nevertheless its incidence does not decrease through time. We
present clinical relevant aspects of airway FBs on the basis of a
selective review of pertinent literature retrieved by a search in the
PubMed database. The most common aspirated FBs by adults are organics,
especially fragments of bones and seeds. Symptoms usually are cough,
chocking and dyspnea. Right localization, especially bronchus intermedius
and right lower lobe, is more frequent. Chest radiography can be normal in
up to 20% of the cases and FBs can be detected in 26% of the patients. FBs
can safely remove in the majority of patients under flexible bronchoscopy.
Surgical treatment must be reserved for cases in which bronchoscope fails
or there are irreversible bronchial or lung complications. Copyright
&#xa9; Journal of Thoracic Disease.

<45>
Accession Number
611308796
Author
Geng J.; Ye X.; Liu C.; Xie J.; Chen J.; Xu B.; Wang B.
Institution
(Geng, Xie, Chen, Xu) Department of Cardiology, Drum Tower Hospital,
Nanjing University Medical School, Nanjing, China
(Geng, Wang) Department of Cardiology, Huai'An First People's Hospital,
Nanjing Medical University, Huai'an, Jiangsu, China
(Ye) Department of Endocrinology, Zhejiang Provincial People's Hospital,
Hangzhou, China
(Liu) Department of Cardiology, Yangzhou No.1 People's Hospital, Yangzhou,
China
Title
Outcomes of off- and on-hours admission in ST-segment elevation myocardial
infarction patients undergoing primary percutaneous coronary intervention.
Source
Medicine (United States). 95 (27) (no pagination), 2016. Article Number:
e4093. Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Studies evaluating the outcomes of patients with ST-segment elevation
myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (PCI) are scarce, particularly in China. The purpose of
present study was therefore to compare the impact of off-hours and
on-hours admission on clinical outcomes in STEMI patients from China. We
retrospectively analyzed 1594 patients from 4 hospitals. Of these, 903
patients (56.65%) were admitted during off-hours (weekdays from 18:00 to
08:00, weekends and holidays) and 691 (43.35%) were during on-hours
(weekdays from 08:00 to 18:00). Patients admitted during off-hours had
higher thrombolysis in myocardial infarction risk score (4.67 +/- 2.27 vs
4.39 +/- 2.10, P = 0.012) and longer door-to-balloon time (72 [50-96] vs
64 [42-92] minutes, P < 0.001) than those admitted during on-hours.
Off-hours admission had no association with in-hospital (unadjusted odds
ratio 2.069, 95% confidence interval [CI] 0.956-4.480, P = 0.060) and
long-term mortality (unadjusted hazards ratio [HR] 1.469, 95%CI
0.993-2.173, P = 0.054), even after adjustment for confounders. However,
long-term outcomes, the composite of deaths and other adverse events,
differed between groups with an unadjusted HR of 1.327 (95%CI,
1.102-1.599, P = 0.003), which remained significant in regression models.
In a subgroup analysis, off-hours admission was associated with higher
long-term mortality in the high-risk subgroup (unadjusted HR 1.965, 95%CI
1.103-3.512, P = 0.042), but not in low- and moderate-risk subgroups. This
study showed no association between off-hours admission and in-hospital
and long-term mortality. Stratified analysis indicated that off-hours
admission was significantly associated with long-term mortality in the
high-risk subgroup. Copyright &#xa9; 2016 the Author(s).

<46>
[Use Link to view the full text]
Accession Number
611308740
Author
Bundhun P.K.; Zafooruddin Sani Soogund M.; Pursun M.; Chen M.-H.
Institution
(Bundhun, Chen) Institute of Cardiovascular Diseases, First Affiliated
Hospital, Guangxi Medical University, Nanning, Guangxi 530027, China
(Zafooruddin Sani Soogund, Pursun) Guangxi Medical University, Nanning,
Guangxi, China
Title
Stent thrombosis and adverse cardiovascular outcomes observed between six
months and five years with sirolimus-eluting stents and other drug-eluting
stents in patients with Type 2 diabetes mellitus complicated by coronary
artery disease.
Source
Medicine (United States). 95 (27) (no pagination), 2016. Article Number:
e4130. Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
This study aimed to compare 6 months to 5 years stent thrombosis (ST) and
adverse cardiovascular outcomes associated with sirolimus-eluting stents
(SES) and other drug-eluting stents (DES) in patients with type 2 diabetes
mellitus (T2DM). Electronic databases were searched for studies comparing
SES with other DES in patients with T2DM. Total ST, definite ST, probable
ST, and other adverse cardiovascular outcomes reported between 6 months
and 5 years were considered as the clinical end points in this study. Odds
ratios (ORs) with 95% confidence intervals (CIs) were calculated for
categorical variables and the pooled analyses were performed with RevMan
5.3 software. Twenty-nine studies involving a total number of 25,729
patients with diabetes were included in this meta-analysis. SES were not
associated with significantly higher total, definite, and probable STs
with OR: 0.95, 95% CI: 0.77-1.17, P = 0.62; OR: 0.94, 95% CI: 0.65-1.37, P
= 0.76; and OR: 1.05, 95% CI: 0.77-1.45, P = 0.74, respectively. SES were
also noninferior to the other non-sirolimus eluting drug eluting stents
(non-SE DES) in terms of all-cause mortality, cardiac death, myocardial
infarction, and stroke with OR: 0.92, 95% CI: 0.82-1.03, P = 0.16; OR:
1.09, 95% CI: 0.88-1.35, P = 0.44; OR: 0.92, 95% CI: 0.80-1.06, P = 0.26;
and OR: 0.79, 95% CI: 0.49-1.28, P = 0.43, respectively. Target vessel
revascularization, target lesion revascularization, and major adverse
cardiac events were also similarly reported between SES and non-SE DES
with OR: 1.04, 95% CI: 0.83-1.31, P = 0.72; OR: 1.25, 95% CI: 0.95-1.64, P
= 0.11; and OR: 1.06, 95% CI: 0.90-1.25, P = 0.49, respectively. During
this particular follow-up period, SES were not associated with any
increase in ST among these patients with T2DM. Mortality and other adverse
cardiovascular outcomes were also not significantly different between
these 2 groups. Hence, SES should be considered neither superior nor
inferior to other DES. They are expected to be equally effective and safe
to use in patients with T2DM. Copyright &#xa9; 2016 the Author(s).

<47>
[Use Link to view the full text]
Accession Number
611308738
Author
Bundhun P.K.; Bhurtu A.; Chen M.-H.
Institution
(Bundhun, Bhurtu, Chen) Institute of Cardiovascular Diseases, First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
530027, China
Title
Impact of coronary artery bypass surgery and percutaneous coronary
intervention on mortality in patients with chronic kidney disease and on
dialysis.
Source
Medicine (United States). 95 (27) (no pagination), 2016. Article Number:
e4129. Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Controversies have been observed among previously published and recently
published studies comparing coronary artery bypass surgery (CABG) and
percutaneous coronary intervention (PCI) in patients with chronic kidney
disease (CKD) and patients on chronic dialysis. This study aimed to show
the impact of CABG and PCI on mortality in these patients. Electronic
databases were searched for studies comparing CABG and PCI in patients
with CKD. The primary outcome was all-cause death whereas the secondary
endpoints included other adverse cardiovascular outcomes reported. Causes
of death were also analyzed. Odds ratios (ORs) with 95% confidence
intervals (CIs) were used to express the pooled effect on discontinuous
variables and the pooled analyses were performed with RevMan 5.3. Eighteen
studies involving a total number of 69,456 patients (29,239 patients in
the CABG group and 40,217 patients in the PCI group) were included in this
meta-analysis. Short-term mortality insignificantly favored PCI with OR:
1.24, 95% CI: 0.93-1.65; P = 0.15. Mortality at 1 year was similar in both
groups with OR: 0.99, 95% CI: 0.91-1.08; P = 0.86, whereas the long-term
mortality significantly favored CABG in patients with CKD and in patients
on chronic dialysis with OR: 0.81, 95% CI: 0.70-0.94; P = 0.007 and OR:
0.81, 95% CI: 0.69-0.96; P = 0.01, respectively. In patients with CKD, the
impact of CABG on the short-term mortality was insignificantly higher
compared to PCI whereas at 1 year, a similar impact was observed. However,
the impact of PCI on mortality was significantly higher during a long-term
follow-up period in patients with CKD and in patients on chronic dialysis.
Nevertheless, due to a high level of heterogeneity observed among several
subgroups analyzed, randomized trials are required to completely solve
this issue. Copyright &#xa9; 2016 the Author(s).

<48>
Accession Number
611766317
Author
Huffman M.D.; Karmali K.N.; Berendsen M.A.; Andrei A.-C.; Kruse J.;
Mccarthy P.M.; Malaisrie S.C.
Institution
(Huffman, Karmali) 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
(Berendsen) Northwestern University, Galter Health Sciences Library, 303
E. Chicago Avenue, Chicago, IL 60611, United States
(Andrei) Northwestern University, Department of Surgery, 676 N.Saint Clair
St., Suite 1700, Chicago, IL 60611, United States
(Kruse) Northwestern Medicine, Bluhm Cardiovascular Institute, 201 East
Huron, Galter 11-140, Chicago, IL 60611, United States
(Mccarthy) Northwestern University, Division of Cardiac Surgery, 201 E.
Huron Street, Galter 11-140, Chicago, IL 60611, United States
(Malaisrie) Northwestern University, Division of Cardiac Surgery, 201 E.
Huron Street, Galter 11-140, Chicago, IL 60611, United States
Title
Concomitant atrial fibrillation surgery for people undergoing cardiac
surgery.
Source
Cochrane Database of Systematic Reviews. 2016 (8) (no pagination), 2016.
Article Number: CD011814. Date of Publication: 22 Aug 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: People with atrial fibrillation (AF) often undergo cardiac
surgery for other underlying reasons and are frequently offered
concomitant AF surgery to reduce the frequency of short- and long-term AF
and improve short- and long-term outcomes. Objectives: To assess the
effects of concomitant AF surgery among people with AF who are undergoing
cardiac surgery on short-term and long-term (12 months or greater)
health-related outcomes, health-related quality of life, and costs. Search
methods: Starting from the year when the first "maze" AF surgery was
reported (1987), we searched the Cochrane Central Register of Controlled
Trials (CENTRAL) in the Cochrane Library (March 2016), MEDLINE Ovid (March
2016), Embase Ovid (March 2016), Web of Science (March 2016), the Database
of Abstracts of Reviews of Effects (DARE, April 2015), and Health
Technology Assessment Database (HTA, March 2016). We searched trial
registers in April 2016. We used no language restrictions. Selection
criteria: We included randomised controlled trials evaluating the effect
of any concomitant AF surgery compared with no AF surgery among adults
with preoperative AF, regardless of symptoms, who were undergoing cardiac
surgery for another indication. Data collection and analysis: Two review
authors independently selected studies and extracted data. We evaluated
the risk of bias using the Cochrane 'Risk of bias' tool. We included
outcome data on all-cause and cardiovascular-specific mortality, freedom
from atrial fibrillation, flutter, or tachycardia off antiarrhythmic
medications, as measured by patient electrocardiographic monitoring
greater than three months after the procedure, procedural safety, 30-day
rehospitalisation, need for post-discharge direct current cardioversion,
health-related quality of life, and direct costs. We calculated risk
ratios (RR) for dichotomous data with 95% confidence intervals (CI) using
a fixed-effect model when heterogeneity was low (I² < 50%) and
random-effects model when heterogeneity was high (I² > 50%). We
evaluated the quality of evidence using the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) framework to create a
'Summary of findings' table. Main results: We found 34 reports of 22
trials (1899 participants) with five additional ongoing studies and three
studies awaiting classification. All included studies were assessed as
having high risk of bias across at least one domain. The effect of
concomitant AF surgery on all-cause mortality was uncertain when compared
with no concomitant AF surgery (7.0% versus 6.6%, RR 1.14, 95% CI 0.81 to
1.59, I² = 0%, 20 trials, 1829 participants, low-quality
evidence), but the intervention increased freedom from atrial
fibrillation, atrial flutter, or atrial tachycardia off antiarrhythmic
medications > three months (51.0% versus 24.1%, RR 2.04, 95% CI 1.63 to
2.55, I² = 0%, eight trials, 649 participants, moderate-quality
evidence). The effect of concomitant AF surgery on 30-day mortality was
uncertain (2.3% versus 3.1%, RR 1.25 95% CI 0.71 to 2.20, I² =
0%, 18 trials, 1566 participants, low-quality evidence), but the
intervention increased the risk of permanent pacemaker implantation (6.0%
versus 4.1%, RR 1.69, 95% CI 1.12 to 2.54, I² = 0%, 18 trials,
1726 participants, moderate-quality evidence). Investigator-defined
adverse events, including but limited to, need for surgical re-exploration
or mediastinitis, were not routinely reported but were not different
between the two groups (other adverse events: 24.8% versus 23.6%, RR 1.07,
95% CI 0.85 to 1.34, I² = 45%, nine trials, 858 participants),
but the quality of this evidence was very low. Authors' conclusions: For
patients with AF undergoing cardiac surgery, there is moderate-quality
evidence that concomitant AF surgery approximately doubles the risk of
freedom from atrial fibrillation, atrial flutter, or atrial tachycardia
off anti-arrhythmic drugs while increasing the risk of permanent pacemaker
implantation. The effects on mortality are uncertain. Future, high-quality
and adequately powered trials will likely affect the confidence on the
effect estimates of AF surgery on clinical outcomes. Copyright &#xa9; 2016
The Cochrane Collaboration.

<49>
Accession Number
607780801
Author
Kleber F.X.; Rittger H.; Ludwig J.; Schulz A.; Mathey D.G.; Boxberger M.;
Degenhardt R.; Scheller B.; Strasser R.H.
Institution
(Kleber, Schulz) Cardio Centrum Berlin, Academic Teaching Institution,
Charite University Medicine Berlin, Unter den Linden 21, Berlin 10117,
Germany
(Rittger, Ludwig) Universitatsklinikum Erlangen, Erlangen, Germany
(Mathey) Universitares Herz- und Gefaszentrum Hamburg, Hamburg, Germany
(Boxberger) Medical Scientific Affairs, B. Braun Melsungen AG, Melsungen,
Germany
(Degenhardt) Center for Cardiovascular Diseases, Rotenburg a.d. Fulda,
Germany
(Scheller) Universitatsklinikum des Saarlandes, Homburg, Saar, Germany
(Strasser) Technische Universitat Dresden, Herzzentrum Dresden,
Universitatsklinik Dresden, Dresden, Germany
Title
Drug eluting balloons as stand alone procedure for coronary bifurcational
lesions: results of the randomized multicenter PEPCAD-BIF trial.
Source
Clinical Research in Cardiology. 105 (7) (pp 613-621), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Objectives: We set out to investigate the benefit of distal main or side
branch treatment with a DCB compared to POBA in coronary bifurcation
lesions. Background: The standard treatment of bifurcation lesions is
application of a DES to the main branch with provisional side branch
stenting. While this resulted in considerable improvement in overall MACE
rate suboptimal side branch results remained a problem. Methods: The study
was performed from 2011 to 2013 in six German centers. Native bifurcation
lesions were included if side branch vessel diameter was >2 and <3.5 mm
and no proximal main branch lesions was found. After successful
predilatation randomization was performed to either DCB application or no
further treatment. Follow-up angiograms for QCA analysis were done after 9
months. Primary endpoint was late lumen loss (LLL). Results: 64 patients
were successfully randomized. Minimal lumen diameter and grade of stenosis
were equal in both groups. Only five stents were used as bail out.
Angiographic follow-up was achieved in 75 % of patients. No patient died.
There was one NSTEMI in the POBA group. Restenosis rate was 6 % in the DCB
group vs 26 % in the POBA group (p = 0.045). TLR was necessary in one
patient of the DCB group vs three patients of the POBA. The primary
endpoint LLL was 0.13 mm in the DCB vs 0.51 mm in the POBA group (p =
0.013). Conclusion: In bifurcation lesions that show only class A or B
dissection and recoil not beyond 30 % the use of DCBs is a sound strategy.
Copyright &#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<50>
Accession Number
608521295
Author
Ali-Hassan-Sayegh S.; Mirhosseini S.J.; Shahidzadeh A.; Rahimizadeh E.;
Sarrafan-Chaharsoughi Z.; Ghodratipour Z.; Lotfaliani M.; Rezaeisadrabadi
M.; Dehghan H.R.; Bireta C.; Weymann A.; Sabashnikov A.; Popov A.-F.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Shahidzadeh, Rahimizadeh,
Sarrafan-Chaharsoughi, Ghodratipour, Lotfaliani, Rezaeisadrabadi)
Cardiovascular Research Centre, Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Mirhosseini) Department of Cardiovascular Surgery, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Dehghan) Dept. of Hlth. Technol. Assess. and Bio-statistics, Shahid
Sadoughi Univ. of Medical Sciences, Yazd, Iran, Islamic Republic of
(Bireta) Department of Thoracic and Cardiovascular Surgery, University
Hospital Goettingen, Goettingen, Germany
(Weymann, Sabashnikov, Popov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
Title
Appropriate bolus administration of glycoprotein IIb/IIIa inhibitors for
patients with acute coronary syndromes undergoing percutaneous coronary
intervention: Intracoronary or intravenous? A comprehensive and updated
meta-analysis and systematic review.
Source
Kardiologia Polska. 74 (2) (pp 104-118), 2016. Date of Publication: 2016.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
This systematic review with meta-analysis sought to compare the efficacy
and safety of intracoronary (IC) vs. intravenous (IV) administration of
glycoprotein (GP) IIb/IIIa receptor inhibitors on clinical outcomes
following percutaneous coronary intervention in patients with acute
coronary syndromes (ST-segment elevation myocardial infarction or
non-ST-segment-elevation acute coronary syndrome). Methods: Medline,
Embase, Elsevier, and Sciences online databases as well as Google Scholar
literature were used to select appropriate studies with randomised
controlled design. The primary end-points were mortality and target vessel
revascularisation (TVR), whereas the secondary end points were incidence
of thrombolysis in myocardial infarction score 3 flow (TIMI 3 flow means
complete perfusion in distal coronary artery bed), re-myocardial
infarction (re-MI), major bleeding, stent thrombosis left ventricular
ejection fraction (LVEF), and heart failure (HF). The literature search of
all major databases retrieved 1006 studies. After screening, a total of 18
trials (5812 patients) were identified with reported outcomes. Results:
Pooled analysis showed IC administration of GP IIb/IIIa receptor
inhibitors can significantly increase LVEF (WMD 4.97; 95% CI 3.34-6.60; p
= 0.000) and the incidence of TIMI 3 flow (OR of 0.77; 95% CI 0.64-0.92; p
= 0.005), and significantly decrease in incidence of HF (OR of 1.927; 95%
CI 1.189-3.124; p = 0.008). Incidences of TVR, re-MI, major bleeding,
stent thrombosis, and mortality showed no significant differences between
the IC and IV groups. Conclusions: Overall, the most appropriate route of
administration of GP IIb/IIIa inhibitors for patients with acute coronary
syndromes appeared to be an IC injection that could increase LVEF and TIMI
3 flow and decrease the incidence of HF. Furthermore, the IC
administration was not associated with increased adverse event rates when
compared to IV injection. Copyright &#xa9; 2016 Polskie Towarzystwo
Kardiologiczne.

<51>
Accession Number
610088275
Author
Kim J.-S.; Lee H.; Suh Y.; Pak H.-N.; Hong G.-R.; Shim C.Y.; Yu C.-W.; Lee
H.-J.; Kang W.-C.; Shin E.-S.; Choi R.-K.; Kar S.; Park J.-W.; Lim D.-S.;
Jang Y.
Institution
(Kim, Lee, Suh, Pak, Hong, Shim, Jang) Severance Cardiovascular Hospital,
Yonsei University College of Medicine, Seoul, South Korea
(Yu, Lim) Korea University Anam Hospital, Seoul, South Korea
(Lee, Choi) Sejong General Hospital, Seoul, South Korea
(Kang) Gil Hospital, Gachon University, Incheon, South Korea
(Shin) Ulsan University Hospital, University of Ulsan College of Medicine,
Ulsan, South Korea
(Kar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Park) Department of Cardiology, Angiology, and Pneumology, Coburg
Hospital, Coburg, Germany
(Park) Department of Cardiology, Charite University Berlin, Campus
Benjamin Franklin, Berlin, Germany
Title
Left atrial appendage occlusion in non-valvular atrial fibrillation in a
Korean multi-center registry.
Source
Circulation Journal. 80 (5) (pp 1123-1130), 2016. Date of Publication:
2016.
Publisher
Japanese Circulation Society
Abstract
Background: The aim of this study was to evaluate clinical outcome after
left atrial appendage (LAA) occlusion in real clinical practice and
compare between Amplatzer cardiac plug (ACP) and Watchman. Methods and
Results: From October 2010 to February 2015, 96 successful LAA occlusion
procedures were performed using either ACP (n=50) or Watchman device
(n=46) in non-valvular atrial fibrillation (AF) patients (59 male; age,
65.1+/-9.4 years; CHADS<inf>2</inf>, 2.5+/-1.2;
CHA<inf>2</inf>DS<inf>2</inf>-VAS<inf>C</inf>, 3.9+/-1.6; HAS-BLED,
2.7+/-1.3). The procedure success rate was 96.8%. There were serious
complications in 4 patients (4.1%; 2 cardiac tamponade, 1 device
embolization, and 1 major bleed). The anticoagulation cessation rate after
6 weeks was 92.7%. During mean 21.9-month follow-up, the incidence of
death, stroke, systemic embolization and major bleeding was 5.2%, 4.2%, 0%
and 1.0%, respectively. On transesophageal echocardiography of 93 patients
within 6 months after the procedure, 24 residual leaks were observed
(25.8%; 2 mild, 18 moderate, and 4 major). Clinical outcome was similar
for the 2 devices, but peridevice leakage was more frequent with the
Watchman than the ACP. Conclusions: LAA occlusion was feasible in
non-valvular AF patients with high risk of stroke and hemorrhage. The ACP
and Watchman devices were similar in terms of procedural and clinical
outcomes. Copyright &#xa9; 2016, Japanese Circulation Society. All rights
reserved.

<52>
Accession Number
611386880
Author
Potena L.; Solidoro P.; Patrucco F.; Borgese L.
Institution
(Potena, Borgese) Heart and Lung Transplant Program, Academic Hospital S.
Orsola-Malpighi, Bologna University, Bologna, Italy
(Solidoro, Patrucco) Lung Transplant Center, Cardiovascular Thoracic
Department, A.O.U. Citta della Salute e della Scienza di Torino, Turin,
Italy
Title
Treatment and prevention of cytomegalovirus infection in heart and lung
transplantation: an update.
Source
Expert Opinion on Pharmacotherapy. 17 (12) (pp 1611-1622), 2016. Date of
Publication: 12 Aug 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
ABSTRACT: Introduction: Heart and lung transplantation are standard
therapeutic strategies to improve survival and quality of life in selected
patients with end-stage heart or lung diseases. Cytomegalovirus (CMV) is
one the most clinically relevant and frequent post-transplant infectious
agents, which may cause direct acute syndromes, and chronic indirect
graft-related injury. Despite effective antiviral drugs being available to
prevent and treat CMV infection, due to the immunosuppression burden and
the specific characteristics of thoracic grafts, CMV infection remains a
major clinical problem in heart and lung transplant recipients. Areas
covered: We performed an extensive literature search focused on studies
specifically including heart or lung transplantation, when available, or
kidney transplant recipients when data on thoracic transplants were not
available. We discuss the pros and cons supporting the use of currently
available drugs and strategies for CMV prevention and treatment,
highlighting current unmet needs. Expert opinion: While (Val)Ganciclovir
remains the cornerstone of anti-CMV therapy, prolonged universal
prophylaxis may expose a large number of patients to an excess of drug
toxicity. Additional drugs with lower toxicity may be available in the
context of anti-CMV prophylaxis, and effective CMV-risk stratification, by
means of novel immune monitoring assays, which may help to customize the
therapeutic approach. Copyright &#xa9; 2016 Informa UK Limited, trading as
Taylor & Francis Group.

<53>
Accession Number
605166715
Author
Gurbel P.A.; Navarese E.P.; Tantry U.S.
Institution
(Gurbel, Tantry) Sinai Center for Thrombosis Research, Cardiac
Catheterization Laboratory, 2401 W. Belvedere Ave, Baltimore, MD 21215,
United States
(Navarese) Department of Internal Medicine Pulmonology and Vascular
Medicine, Division of Cardiology, Heinrich-Heine-University, Dusseldorf,
Germany
Title
What is the best anticoagulant therapy during primary percutaneous
coronary intervention for acute myocardial infarction?.
Source
Polskie Archiwum Medycyny Wewnetrznej. 125 (6) (pp 461-470), 2015. Date of
Publication: 2015.
Publisher
Medycyna Praktyczna (E-mail: listy@mp.pl)
Abstract
Both ST-segment elevation myocardial infarction and percutaneous coronary
intervention (PCI) are associated with a highly prothrombotic state, and
thrombin plays a critical role during occlusive clot generation and
subsequent occurrence of an ischemic event. Therefore, a strategy of
anticoagulation plus dual antiplatelet therapy has been regarded as de
facto standard therapy during primary PCI (pPCI). Recently, there has been
great controversy surrounding the role of bivalirudin versus
unfractionated heparin in pPCI. Earlier, the results of the HORIZONS-AMI
trial, particularly those regarding the long-lasting mortality benefit,
provided a strong rationale for recommending bivalirudin therapy in pPCI.
However, the mortality benefit of bivalirudin observed in HORIZONS-AMI has
not been repeated in more contemporary studies or demonstrated in recent
meta-analyses. The current report will provide a concise review of the
controversy surrounding the optimal anticoagulant therapy for pPCI. Recent
evidence suggests that unfractionated heparin deserves strong
reconsideration despite the reports of pharmacologic weaknesses,
particularly when used with a strategy of selective glycoprotein IIb/IIIa
therapy, and it appears that a strategy of bivalirudin therapy in pPCI
should be reserved for patients at high bleeding risk. Copyright &#xa9; by
Medycyna Praktyczna, Krakow 2015.

<54>
Accession Number
610067157
Author
Antonic M.; Lipovec R.; Gregorcic F.; Juric P.; Kosir G.
Institution
(Antonic, Lipovec, Gregorcic, Juric, Kosir) Department for Cardiac
Surgery, University Medical Center Maribor, Maribor, Slovenia
Title
Perioperative ascorbic acid supplementation does not reduce the incidence
of postoperative atrial fibrillation in on-pump coronary artery bypass
graft patients.
Source
Journal of Cardiology. 69 (1) (pp 98-102), 2017. Date of Publication: 01
Jan 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Atrial fibrillation is the most common arrhythmia following
cardiac surgery. It is associated with increased hemodynamic instability,
systemic embolization, and complications linked to anticoagulant therapy.
Oxidative stress and consequent electrophysiological remodeling have been
proposed as a cause of postoperative atrial fibrillation. Ascorbic acid
supplementation was suggested as a novel and effective preventive agent.
The aim of this study was to evaluate the capability of ascorbic acid to
reduce the incidence of postoperative atrial fibrillation in coronary
artery bypass grafting (CABG) patients. Methods A prospective randomized
single-center trial was conducted in patients scheduled for an elective
on-pump CABG surgery. Subjects in the ascorbic acid group received 2 g of
ascorbic acid 24 h and 2 h before the surgery and 1 g twice a day for five
days after the surgery. Postoperatively, the patients were monitored for
atrial fibrillation and other complications. Results The ascorbic acid
group consisted of 52 patients and the control group included 53 patients.
The groups were well matched for baseline demographics, preoperative
medications, comorbidities, and had similar intraoperative
characteristics. The incidence of atrial fibrillation in the ascorbic acid
group was 13.5% and 18.9% in the control group (p = 0.314). No difference
was found between groups in the time of occurrence of atrial fibrillation
(3.71 +/- 1.89 vs. 2.91 +/- 1.58 days after the surgery; p = 0.342). There
was also no difference in the other observed postoperative complications.
Conclusions The results of this study do not support the effectiveness of
ascorbic acid supplementation in reducing the incidence of postoperative
atrial fibrillation in elective on-pump CABG patients. Copyright &#xa9;
2016 Japanese College of Cardiology

<55>
[Use Link to view the full text]
Accession Number
611864515
Author
Rizik D.G.; Hermiller J.B.; Simonton C.A.; Klassen K.J.; Kereiakes D.J.
Institution
(Rizik) HonorHealth, Scottsdale-Lincoln Health Network, 10101 N. 92nd
Street #101, Scottsdale, AZ 85258, United States
(Klassen) HonorHealth, Scottsdale Shea Medical Center, Scottsdale, AZ,
United States
(Hermiller) St Vincent Heart Center, Indianapolis, IN, United States
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Kereiakes) Christ Hospital, Heart and Vascular Center, Lindner Research
Center, Cincinnati, OH, United States
Title
Bioresorbable vascular scaffolds for the treatment of coronary artery
disease: What have we learned from randomized-controlled clinical trials?.
Source
Coronary Artery Disease. 28 (1) (pp 77-89), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Although current everolimus-eluting coronary stents have shown improved
event-free survival within the first year following implantation compared
with bare-metal stents or earlier generation drug-eluting stents, they
remain associated with an ongoing risk for adverse outcomes (thrombosis,
myocardial infarction, and restenosis) beyond 1 year at rates similar to
those observed following bare-metal stent deployment. This ongoing very
late hazard has been attributed to the permanent presence of the metal
frame and/or polymer in these stents. The Absorb everolimus-eluting
bioresorbable vascular scaffold (Absorb BVS) has been developed to provide
mechanical support and drug-delivery functions similar to metallic
drug-eluting stents, followed by complete resorption with recovery of more
normal vascular structure and function, thus avoiding the limitations
associated with permanent metallic endovascular prostheses. Absorb BVS has
shown safety and efficacy in the dedicated clinical trial development
program of Abbott Vascular and in an array of investigator-sponsored
studies involving a broad spectrum of clinical (patient) as well as
coronary anatomic complexity. Longer-term evidence, largely limited to
single-arm studies, appears to reflect durable safety and efficacy and
suggests Absorb BVS to be an attractive therapeutic option. Interim
evidence from a series of randomized-clinical trials (RCTs) comparing
Absorb BVS with the Xience cobalt-chromium metallic everolimus-eluting
stent has shown noninferiority of Absorb BVS with respect to target lesion
failure (composite occurrence of cardiac death, target vessel-related
myocardial infarction, and ischemia-driven target lesion
revascularization) beyond the first year, with no statistically
significant differences in other safety/efficacy measures. However,
concerns do exist in terms of increased rates of scaffold thrombosis, the
risk for which may be mitigated by improved patient and lesion selection,
procedural technique, and device iteration. We provide an overview of the
evolution of percutaneous coronary intervention, in-vivo characterization
of Absorb BVS resorption, and a summary with a critical evaluation of
available evidence from RCTs, pooled analyses, and meta-analyses of RCTs
for the safety and efficacy of Absorb BVS obtained primarily following the
treatment of noncomplex coronary lesions in patients with stable ischemic
heart disease and/or stabilized acute coronary syndromes. Copyright &#xa9;
2016 Wolters Kluwer Health, Inc.

<56>
Accession Number
608668727
Author
Izumo M.; Takeuchi M.; Seo Y.; Yamashita E.; Suzuki K.; Ishizu T.; Sato
K.; Oshima S.; Aonuma K.; Otsuji Y.; Akashi Y.J.
Institution
(Izumo, Suzuki, Akashi) Division of Cardiology, Department of Internal
Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
(Takeuchi) Department of Laboratory and Transfusion Medicine, University
of Occupational and Environmental Health, School of Medicine, Kitakyushu,
Japan
(Seo, Ishizu, Sato, Aonuma) Cardiovascular Division, Faculty of Medicine,
University of Tsukuba, Tsukuba, Japan
(Yamashita, Oshima) Division of Cardiology, Gunma Prefectural
Cardiovascular Center, Gunma, Japan
(Otsuji) Second Department of Internal Medicine, University of
Occupational and Environmental Health, School of Medicine, Kitakyushu,
Japan
Title
Prognostic implications in patients with symptomatic aortic stenosis and
preserved ejection fraction: Japanese multicenter aortic stenosis,
retrospective (JUST-R) registry.
Source
Journal of Cardiology. 69 (1) (pp 110-118), 2017. Date of Publication: 01
Jan 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Current prognostic implication of symptomatic patients with
aortic stenosis (AS) remains undetermined. This study investigated the
current prognostic implications of AS-related symptoms and the effect of
aortic valve replacement (AVR) on outcome. Methods We enrolled 586
consecutive patients with severe AS (aortic valve area <1.0
cm²) with preserved left ventricular ejection fraction (>50%).
All patients were stratified into the following four groups based on the
predominant symptoms: Group 1, asymptomatic (n = 316); Group 2, chest pain
(n = 41); Group 3, heart failure (n = 192); or Group 4, syncope (n = 37).
Results AS-related symptoms were diagnosed in 270 patients (46.1%), among
whom 182 patients (32.2%) received AVR. Thirty-nine patients (6.7%) had
cardiac death during the mean follow-up of 16 +/- 14 months. AVR was
associated with significant reduction in cardiac death in Groups 3 (p <
0.001) and 4 (p = 0.004) whereas no significant prognostic advantage of
AVR was observed in Groups 1 or 2. Cox proportional-hazard multivariate
analysis revealed that age, heart failure, and mean pressure gradient (PG)
were associated with increased risk of cardiac death in all patients
regardless of AVR [hazard ratio (HR): 1.079, 2.090, and 1.008
respectively, all p < 0.05]. In the patients without AVR, age, heart
failure, syncope, and mean PG were independently associated with cardiac
death (HR: 1.130, 3.639, 4.638, and 1.008, all p < 0.05). Conclusion This
retrospective study demonstrated the current associations between the
types of AS symptoms and prognosis in Japanese patients with severe AS.
Copyright &#xa9; 2016 Japanese College of Cardiology

<57>
Accession Number
614212199
Author
Pourdjabbar A.; Hibbert B.; Chong A.-Y.; Le May M.R.; Labinaz M.; Simard
T.; Daniel Ramirez F.; Lugomirski P.; Maze R.; Froeschl M.; Glove C.; Dick
A.; Marquis J.-F.; Bernick J.; Wells G.; So D.Y.F.
Institution
(Pourdjabbar, Hibbert, Chong, Le May, Labinaz, Simard, Daniel Ramirez,
Lugomirski, Maze, Froeschl, Glove, Dick, Marquis, So) Division of
Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
(Bernick, Wells) Cardiovascular Methods Centre, University of Ottawa Heart
Institute, Ottawa, ON, Canada
Title
A randomised study for optimising crossover from ticagrelor to clopidogrel
in patients with acute coronary syndrome.
Source
Thrombosis and Haemostasis. 117 (2) (pp 303-310), 2017. Date of
Publication: 2017.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
Ticagrelor has been endorsed by guidelines as the P2Y<inf>12</inf>
inhibitor of choice in patients with acute coronary syndrome. Clinically,
some patients on ticagrelor will require a switch to clopidogrel; however,
the optimal strategy and pharmacodynamics effects of switching remain
unknown. Patients with an indication to switch were randomly assigned to
either a bolus arm (Clopidogrel 600 mg bolus followed by 75 mg daily,
n=30) or a no-bolus arm (Clopidogrel 75 mg daily, n=30). Blood samples
were collected at baseline, 12, 24, 48, 54, 60 and 72 hours (h) for
assessment of platelet reactivity. The primary outcome was
P2Y<inf>12</inf> reactivity units (PRU) at 72 h. Secondary outcomes
included: PRUs at each time point, incidence of high on-treatment platelet
reactivity (HPR), major adverse cardiac events (MACE) and TIMI bleeding at
30 days. Serial PRUs increased after switching to clopidogrel in both
groups. At 72 h, no difference in PRU was observed (165.8 +/- 71.0 vs
184.1 +/- 67.7, bolus vs no bolus, respectively, p=0.19). At 48 h the PRUs
were significantly lower in the bolus arm (114 +/- 73.1 vs 165.1 +/- 70.5,
respectively; p=0.0076) and at 72 h, there was a significant reduction in
incidence of HPR (26.7% vs 56.7%, p=0.02). No differences in MACE or TIMI
bleeding were observed. Although a bolus strategy was not associated with
improved platelet inhibition at 72 h; at 48 h, platelet inhibition was
superior with reduced incidence of HPR. Larger studies will be required to
determine its clinical significance. Until then, decision for giving a
bolus of clopidogrel at the time of a switch may in part be dependent on
the indication for switching, especially if there are concerns for
bleeding risk. Copyright &#xa9; Schattauer 2017.

<58>
Accession Number
613702373
Author
Hu X.; Yuan L.; Wang H.; Li C.; Cai J.; Hu Y.; Ma C.
Institution
(Hu, Yuan, Wang, Li, Cai, Hu, Ma) Department of Anaesthesiology, The
Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
Title
Efficacy and safety of vitamin C for atrial fibrillation after cardiac
surgery: A meta-analysis with trial sequential analysis of randomized
controlled trials.
Source
International Journal of Surgery. 37 (pp 58-64), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Ltd
Abstract
Objectives Antioxidant supplement is an option in preventing postoperative
atrial fibrillation (AF) after cardiac surgery. However, the benefits and
adverse effects of vitamin C have not been well assessed. We aimed to
systematically evaluate the efficacy and safety of vitamin C in preventing
postoperative AF in adult patients after cardiac surgery. Methods PubMed,
EMBASE, and the Cochrane library databases from inception to September
2016 were searched. Randomized controlled trials (RCTs) that evaluated the
efficacy and safety of vitamin C in preventing postoperative AF in adult
patients after cardiac surgery were identified. The primary outcome was
the incidence of postoperative AF. Secondary outcomes included the length
of intensive care unit (ICU) stay, length of hospital stay, and stroke
events. Results Eight RCTs incorporating 1060 patients were included.
Compared with placebo group, vitamin C treatment was associated with a
substantial reduction in postoperative AF (OR, 0.47; 95% CI, 0.36-0.62;
evidence rank: moderate), with no significant heterogeneity (I²
44%; P = 0.09). Trial sequential analysis showed that the cumulative
Z-curve crossed the trial sequential monitoring boundary for benefit,
establishing sufficient and conclusive evidence. In addition, vitamin C
administration was not associated with any length of stay, including in
the ICU (evidence rank: low) and hospital (evidence rank: low),
respectively. Conclusions Short-term treatment with vitamin C is safe, and
may reduce the incidence of postoperative AF after cardiac surgery. Future
studies as well as more high quality RCTs are still warranted to confirm
the effects of different durations of vitamin C on cardiac surgery.
Copyright &#xa9; 2016 IJS Publishing Group Ltd

<59>
Accession Number
614490762
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, Antalya 07100, 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, Antalya 07100, Turkey
(Karsli) Department of Algology, Akdeniz University, Faculty of Medicine,
Antalya 07100, Turkey
Title
Comparison of transcutaneous electrical nerve stimulation and parasternal
block for postoperative pain management after cardiac surgery.
Source
Pain Research and Management. 2016 (no pagination), 2016. Article Number:
4261949. Date of Publication: 2016.
Publisher
Pulsus Group Inc.
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, 5
h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block
group than in the TENS and control groups. Totalmorphine 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. Copyright &#xa9;
2016 Mathieu Gregoire et al.

<60>
Accession Number
614200909
Author
O'Byrne M.L.; Gillespie M.J.; Kennedy K.F.; Dori Y.; Rome J.J.; Glatz A.C.
Institution
(O'Byrne) Division of Cardiology, Children's National Medical Center,
George Washington University School of Medicine and Health Sciences,
United States
(O'Byrne) Department of Pediatrics, George Washington University School of
Medicine and Health Sciences, United States
(Gillespie, Dori, Rome, Glatz) Division of Cardiology, The Children's
Hospital of Philadelphia, United States
(Gillespie, Dori, Rome, Glatz) Department of Pediatrics, Perelman School
of Medicine, The University of Pennsylvania, Philadelphia, United States
(Kennedy) Mid America Heart Institute St. Luke's Health System, United
States
(Glatz) Center for Clinical Epidemiology and Biostatistics, Perelman
School of Medicine at the University of Pennsylvania, United States
Title
The influence of deficient retro-aortic rim on technical success and early
adverse events following device closure of secundum atrial septal defects:
An Analysis of the IMPACT Registry.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp 102-111),
2017. Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Concern regarding aortic erosion has focused attention on the
retro-aortic rim in patients undergoing device closure of atrial septal
defects (ASD), but its effect on early outcomes is not well studied.
Methods: A multicenter retrospective cohort study of patients undergoing
device occlusion of ASD between 1/2011-10/2014 was performed, using data
from the IMproving Pediatric and Adult Congenital Treatment Registry.
Subjects were divided between those with retro-aortic rim <5 and >5 mm.
Primary outcomes were technical failure and major early adverse events.
Case times were measured as surrogates of technical complexity. The effect
of deficient retro-aortic rim on primary outcomes was assessed using
hierarchical logistic regression, adjusting for other suspected covariates
and assessing whether they represent independent risk factors. Results:
1,564 subjects (from 77 centers) were included, with deficient
retro-aortic rim present in 40%. Technical failure occurred in 91 subjects
(5.8%) and a major early adverse event in 64 subjects (4.1%). Adjusting
for known covariates, the presence of a deficient retro-aortic rim was not
significantly associated with technical failure (OR: 1.3, 95% CI: 0.9-2.1)
or major early adverse event (OR: 0.7, 95% CI: 0.4-1. 2). Total case (P =
0.01) and fluoroscopy time (P = 0.02) were greater in subjects with
deficient rim, but sheath time was not significantly different (P = 0.07).
Additional covariates independently associated with these outcomes were
identified. Conclusion: Deficient retro-aortic rim was highly prevalent
but not associated with increased risk of technical failure or early
adverse events. Studies with longer follow-up are necessary to assess
other outcomes, including device erosion. &#xa9; 2016 Wiley Periodicals,
Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<61>
Accession Number
614429183
Author
Sanchez Munoz M.C.; De Kock M.; Forget P.
Institution
(Sanchez Munoz) Anesthesiology Department, Cliniques Universitaires
Saint-Luc, Institute of Neuroscience (Pole CEMO), Universite Catholique de
Louvain, Brussels, Belgium
(De Kock) Anesthesiology department, Centre hospitalier de Wallonie
Picarde (CHWAPI), Tournai, Belgium
(Forget) Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel
(UZ Brussel), department of Anesthesiology and Perioperative Medicine,
Brussels, Belgium
Title
What is the place of clonidine in anesthesia? Systematic review and
meta-analyses of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 38 (pp 140-153), 2017. Date of
Publication: 01 May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective A place for clonidine has been suggested for many
indications in perioperative medicine. The aim of this systematic review
and these meta-analyses is to systematically, and quantitatively, evaluate
these potential indications of clonidine. Design, setting, patients and
interventions We selected and analyzed (qualitatively and, when possible,
quantitatively) the available literature published on PubMed/Medline and
on the Cochrane database. Inclusion criteria included: human randomized
controlled trials involving adults who received perioperative systemic
(oral, intramuscular, transdermal and intravenous) clonidine for every
type of surgery. Measurements and main results We identified 775 trials
and thereafter excluded 718 and analyzed 57 trials concerning, in total,
14,790 patients of whom 7408 received clonidine and 6836 received placebo.
Most important results shows that, in qualitative and quantitative
analyses, clonidine vs placebo reduces analgesics consumption in,
respectively, (159 vs 154 patients: 24%, 95%CI[16%-32%]; p < 0.001),
reduces nausea and vomiting (risk ratio, in 180 vs 181 patients: 0.35,
95%CI[0.25-0.51]; p < 0.001), improves hemodynamic stability (reduction of
HR: 14.9 bpm, 95%CI[10.4-19.5]; p < 0.001; reduction of the MAP: 12.5 mm
Hg, 95%CI[7.14-17.86]; p < 0.001); 1 min after tracheal intubation, in 67
vs 68 patients), prevents postoperative shivering (risk ratio, in 140 vs
140 patients: 0.17, 95%CI[0.10-0.29]; p < 0.001). On the other hand,
clonidine does not have any influence on renal and cardiac outcomes
(adverse events rates, in 5873 vs 5533 patients: 0.00, 95%CI[- 0.10-0.11];
p = 0.96) and does not prolong awakening time. Conclusions In conclusion,
these systematic review and meta-analyses of 57 trials confirm that
clonidine improves pain control, reduces PONV, improves hemodynamic and
sympathetic stability, with no adverse consequences on renal function or
awakening time, but does not influence cardiac outcome in the general
population, after non-cardiac surgery. Nevertheless, given the high
heterogeneity between the studies, this does not exclude different results
in patient subgroups or specific procedures. Copyright &#xa9; 2017

<62>
[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.

<63>
Accession Number
614474364
Author
Al-Amran F.G.; Hadi N.R.; Mahdi L.A.-S.
Institution
(Al-Amran) Al-Najaf Center for Cardiothoracic Surgery, Iraq
(Hadi) Department of Pharmacology and Therapeutics, Faculty of Medicine,
University of Kufa, Iraq
(Mahdi) Ministry of Health and Environment, Iraq
Title
Effect of montelukast on myocardial ischemia reperfusion injury after
coronary artery bypass graft surgery.
Source
World Heart Journal. 8 (3) (pp 261-270), 2016. Date of Publication: 2016.
Publisher
Nova Science Publishers, Inc. (E-mail: Journals@novapublishers.com)
Abstract
Background. Ischemic heart disease is a major leading cause of death
worldwide. Coronary artery bypass grafting surgery (CABG) is one of the
most effective strategies to revascularize ischemic myocardium. However,
this procedure is usually associated with ischemic reperfusion injury that
can cause long-term myocardial disability and increased mortality rate.
Montelukast, a leukotriene antagonist, had been shown in many experimental
studies to be protective against reperfusion injury in many tissue types,
including the myocardium. In this study, we attempted to investigate the
role of montelukast in protecting patients undergoing bypass surgery from
cardiac injury. Subjects and Methods. Forty patients who were undergoing
elective bypass surgery at the Al-Najaf Cardio-surgery Center were
enrolled in a controlled clinical trial and randomly divided into two
groups: Group 1 (MK group) consists of 20 patients who took a 10 mg
montelukast tablet 2 days before surgery and another one day after
surgery. Group 2 (Non-MK group) consists of 20 patients who did not take
montelukast. Results. In the montelukast treated patients, the
concentrations of cardiac troponin 1 (cTn-I) and interleukin (IL)-1beta
were significantly lower (p < 0.05) and the concentration of
high-sensitive C-reactive protein (hsCRP) was non-significantly lower (p >
0.05) compared to patients not receiving montelukast. Reduced glutathione
(GSH) concentration was significantly higher (p < 0.05) in
montelukast-treated patients than in patients not treated with
montelukast. Conclusions. Montelukast protects against myocardial injury
and inflammation from ischemia reperfusion and enhances antioxidant
potential by increasing GSH. Copyright &#xa9; 2016 Nova Science
Publishers, Inc.

<64>
[Use Link to view the full text]
Accession Number
613333945
Author
Li T.; Sun Z.-L.; Xie Q.-Y.
Institution
(Li) Department of Emergency, First Affiliated Hospital, Zhejiang
University, Hangzhou, China
(Sun, Xie) Department of Cardiology, Xiangya Hospital, Central South
University, No. 87 Xiangya Road, Kaifu District, Changsha 410008, China
Title
Meta-analysis identifies serum c-reactive protein as an indicator of
atrial fibrillation risk after coronary artery bypass graft.
Source
American Journal of Therapeutics. 23 (6) (pp e1586-e1596), 2016. Date of
Publication: 28 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
A meta-analysis-based study was conducted to examine the clinical value of
serum C-reactive protein (CRP) levels in predicting postoperative atrial
fibrillation (POAF) in patients with coronary artery disease (CAD) who
underwent coronary artery bypass graft. Computer-based search of
scientific literature databases was performed to identify relevant studies
in strict accordance with our inclusion and exclusion criteria. Data
extracted from the selected studies were used to perform metaanalysis
using the STATA 12.0 statistical software. Standardized mean differences
(SMDs) with their 95% confidence interval (95% CI) were calculated. The
database search strategy initially identified 62 articles (Chinese 5 17,
English 5 45). After multiple levels of screening and validation, 15
case-control studies (Chinese 5 1, English 5 14), containing of a total of
3110 atrial fibrillation patients (POAF 5 925, non-POAF 5 2185), were
selected for our meta-analysis. The meta-analysis results confirmed that
serum CRP level was remarkably higher in patients with POAF compared with
non-POAF (SMD 5 1.36; 95% CI, 0.44-2.28; P 5 0.004). Ethnicity-stratified
analysis revealed that elevated serum CRP levels were associated with an
increased risk of POAF in white patients with CAD (SMD 5 0.85; 95% CI,
0.12-1.58; P 5 0.022), but not Asian patients with CAD (SMD 5 3.31, 95%
CI, 20.04 to 6.66; P 5 0.053). Elevated CRP levels, indicating profound
inflammation, may be associated with significantly increased risk of POAF
in patients with CAD who underwent coronary artery bypass graft. Thus,
serum CRP levels are important for early diagnosis and monitoring of POAF
in high-risk patients. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc.

<65>
Accession Number
373457689
Author
Alavi S.M.; Ghoreishi S.M.; Chitsazan M.; Ghandi I.; Fard A.J.; Hosseini
S.S.; Mahjoobifard M.; Fani K.
Institution
(Alavi, Ghoreishi, Ghandi, Mahjoobifard, Fani) Department of Cardiac
Anesthesiology, Rajaei Cardiovascular Medical and Research Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Chitsazan) Rajaei Cardiovascular Medical and Research Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Fard) Masih Daneshvari Research Institute of Tuberculosis and Lung
Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Hosseini) Department of Cardiovascular Surgery, Shaheed Rajaei
Cardiovascular Medical and Research Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Patient-controlled analgesia after coronary bypass: Remifentanil or
sufentanil?.
Source
Asian Cardiovascular and Thoracic Annals. 22 (6) (pp 694-699), 2014. Date
of Publication: July 2014.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: adequate pain control after cardiac surgery is mandatory to
reduce its remarkable morbidity. In this study, we aimed to compare the
efficacy of patient-controlled analgesia with remifentanil or sufentanil
for pain management after coronary artery bypass grafting. Methods: 249
patients who underwent coronary artery bypass were randomly assigned to
receive patient-controlled analgesia with remifentanil or sufentanil
during the first 24 h postoperatively. Pain intensity during
patient-controlled analgesia was assessed using 4 different pain rating
scales. Results: patients given remifentanil had lower Visual Analog Scale
scores at 24 h compared to those given sufentanil (p=0.002). The Numeric
Rating Scale at 24 h was also significantly lower in patients using
remifentanil (p=0.004). The Faces Pain Scale scores at 4, 18, and 24 h
were significantly lower in patients using remifentanil compared to those
using sufentanil (p=0.045, 0.036, and 0.011, respectively). No significant
differences between groups were seen in the pain intensity assessed by the
Behavior Rating Scale at any time point during the first 24 h
postoperatively. Conclusion: our study showed that both remifentanil and
sufentanil patient-controlled analgesia can provide acceptable analgesia
after coronary artery bypass. The difference between their efficacies was
inconspicuous until 24 h postoperatively. Remifentanil seems to result in
better pain relief at 24 h postoperatively. &#xa9; 2013 The Author(s).

<66>
Accession Number
373457684
Author
Sapkota R.; Shrestha U.K.; Sayami P.
Institution
(Sapkota, Shrestha, Sayami) Department of Cardiothoracic and Vascular
Surgery, Manmohan Cardiothoracic Vascular and Transplant Center,
Kathmandu, Nepal
Title
Intercostal muscle flap and intracostal suture to reduce post-thoracotomy
pain.
Source
Asian Cardiovascular and Thoracic Annals. 22 (6) (pp 706-711), 2014. Date
of Publication: July 2014.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Thoracotomy is considered to be the most painful surgical
access, the main culprit being intercostal nerve injury. Despite the use
of many techniques, this remains a major problem, pointing towards
prevention as a better strategy. The effect of protecting both the upper
and lower intercostal nerves during surgery has attracted many
researchers. Method: A prospective study spanning 15 months was undertaken
in 48 patients randomized to a conventional group (n=25) and a study group
(n=23). Pericostal sutures in the former and intracostal sutures in the
latter were used for closure. An intercostal muscle flap was harvested at
the start of the operation in the study group only. The groups were
comparable in terms of baseline characteristics. With a similar pain
protocol, pain scores and analgesic consumption were recorded and
analyzed. Results: Times for pedicle harvest, intracostal suture, and
pericostal suture were 5.2+/-1.56, 3.657plusmn;0.71, and 6.47+/-1.20 min,
respectively, in the study group. Total operative time was similar in both
groups. Postoperative pain scores and the overall frequency of pain were
consistently lower in the study group. Conclusion: these techniques lead
to a reduction in the acute and chronic post-thoracotomy pain, without
increasing complications. &#xa9; 2013 The Author(s).

<67>
Accession Number
373427083
Author
Sharma P.; Malhotra A.; Gandhi S.; Garg P.; Bishnoi A.; Gandhi H.
Institution
(Sharma, Malhotra, Gandhi, Garg, Bishnoi, Gandhi) Department of
Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology and
Research Center, New Civil Hospital Campus, Asarwa, Ahmedabad 380016,
Gujarat, India
Title
Preoperative levosimendan in ischemic mitral valve repair.
Source
Asian Cardiovascular and Thoracic Annals. 22 (5) (pp 539-545), 2014. Date
of Publication: June 2014.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Levosimendan is a new calcium sensitizing drug with
vasodilatory and inotropic properties, which is used for the treatment of
postoperative low cardiac output syndrome and difficult weaning from
cardiopulmonary bypass. Objective: To evaluate the hemodynamic effects of
levosimendan during and after coronary artery bypass grafting on
cardiopulmonary bypass and mitral valve repair in patients with low left
ventricular ejection fractions (<30%). Methods: 40 patients were enrolled
in this double-blind prospective randomized controlled trial. They
received either levosimendan or a placebo preoperatively (n=20) for 24 h.
Clinical parameters were measured before and after administration. Any
adverse events during and after drug administration and postoperative
complications were evaluated. Results: Patients treated with levosimendan
exhibited a higher cardiac index and mean arterial pressure intraoperative
and in the early postoperative period, compared to the control group.
Patients treated with levosimendan required less ventilatory support
(p<0.0001) and had shorter intensive care unit (p<0.0001) and hospital
stay (p<0.0001). Conclusions: Preoperative treatment with levosimendan in
patients undergoing coronary artery bypass grafting and mitral valve
repair resulted in improved hemodynamics and a stable postoperative
course. &#xa9; The Author(s) 2013.

<68>
Accession Number
614474464
Author
Parepa I.-R.; Suceveanu A.-I.; Mazilu L.; Mohamed A.; Nita D.; Tuta L.-A.
Institution
(Parepa, Suceveanu, Mazilu, Tuta) "Ovidius" University, Faculty of
Medicine, Constanta, Romania
(Mohamed, Nita) "Vasile Candea" Army Centre for Cardiovascular Diseases,
Bucharest, Romania
Title
Preventing cardiac complications after non-cardiac non-vascular surgery by
using perioperative statin therapy - a prospective study in Constanta
county, Romania.
Source
Farmacia. 65 (1) (pp 120-124), 2017. Date of Publication: 2017.
Publisher
Romanian Society for Pharmaceutical Sciences (Str. Traian Vuia 6, sector
2, Bucharest 020956, Romania)
Abstract
The aim of the study was to evaluate if statins reduce the risk of cardiac
events when given during perioperative period in patients who undergo
non-cardiac, non-vascular surgery. 1,380 "statin-naive" patients with no
evidence of cardiac disease were randomised for: rosuvastatin 10 mg/day (n
= 691), and placebo (n = 689), given 10 days before and 20 days after
surgery and were followed-up 3 months after surgery. Endpoint was defined
as new-onset angina, silent cardiac ischemia, non-fatal acute coronary
syndrome or fatal coronary heart disease. 82 patients (5.95%) suffered
cardiac events during follow-up: 31 from statin arm and 51 from placebo
arm (p = 0.0029). After adjusting for variables, the statin arm had a
relative-risk reduction of 39% (p = 0.0189) for cardiac events. No
significant decrease in LDL-cholesterol was found in statin patients (p =
0.5664). Perioperative statin therapy was protective against cardiac
complications of non-cardiac non-vascular surgery, irrespective of its
lipid-lowering effect. Copyright &#xa9; 2017, Romanian Society for
Pharmaceutical Sciences. All rights reserved.

<69>
Accession Number
614472931
Author
Takagi H.
Institution
(Takagi) Alice (All-Literature Investigation of Cardiovascular Evidence)
Group, Department of Cardiovascular Surgery, Shizuoka Medical Center,
762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Title
Vitamins and abdominal aortic aneurysm.
Source
International Angiology. 36 (1) (pp 21-30), 2017. Date of Publication:
February 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: To summarize the association of vitamins (B6, B12, C, D, and
E) and abdominal aortic aneurysm (AAA), we reviewed clinical studies with
a comprehensive literature research and meta-analytic estimates. EVIDENCE
ACQUISITION: To identify all clinical studies evaluating the association
of vitamins B6/B12/C/D/E and AAA, databases including MEDLINE, EMBASE, and
the Cochrane Central Register of Controlled Trials were searched through
April 2015, using Web-based search engines (PubMed and OVID). For each
case-control study, data regarding vitamin levels in both the AAA and
control groups were used to generate standardized mean differences (SMDs)
and 95% confidence intervals (CIs). EVIDENCE SYNTHESIS: Pooled analyses of
the 4 case-control studies demonstrated significantly lower circulating
vitamin B6 levels (SMD, -0.33; 95% CI, -0.55 to -0.11; P=0.003) but
non-significantly lower vitamin B12 levels (SMD, -0.42; 95% CI, -1.09 to
0.25; P=0.22) in patients with AAA than subjects without AAA. Pooled
analyses of the 2 case-control studies demonstrated significantly lower
levels of circulating vitamins C (SMD, -0.71; 95% CI, -1.23 to -0.19;
P=0.007) and E (SMD, -1.76; 95% CI, -2.93 to 0.60; P=0.003) in patients
with AAA than subjects without AAA. Another pooled analysis of the 3
case-control studies demonstrated significantly lower circulating Vitamin
D (25-hydroxyVitamin D) levels (SMD, -0.25; 95% CI, -0.50 to -0.01;
P=0.04) in patients with AAA than subjects without AAA. In a double-blind
controlled trial, 4.0-year treatment with a high-dose folic acid and
vitamin B6/B12 multivitamin in kidney transplant recipients did not reduce
a rate of AAA repair despite significant reduction in homocysteine level.
In another randomized, double-blind, placebo-controlled trial, 5.8-year
supplementation with alpha-tocopherol (Vitamin E) had no preventive effect
on large AAA among male smokers. CONCLUSIONS: In clinical setting,
although low circulating vitamins B6/C/D/E (not B12) levels are associated
with AAA presence, vitamins B6/B12/E supplementation may not reduce AAA
incidence. Copyright &#xa9; 2015 EDIZIONI MINERVA MEDICA.

<70>
Accession Number
610654032
Author
Biancari F.; D'Errigo P.; Rosato S.; Pol M.; Tamburino C.; Ranucci M.;
Seccareccia F.
Institution
(Biancari) Department of Surgery, Oulu University Hospital, Oulu, Finland
(D'Errigo, Rosato, Seccareccia) National Center for Epidemiology,
Surveillance and Health Promotion, Istituto Superiore di Sanita, Via Giano
della Bella 34, Rome 00161, Italy
(Pol) First Faculty of Medicine, Institute of Anatomy, Charles University
in Prague, Prague, Czech Republic
(Tamburino) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia, ICU-IRCCS
Policlinico San Donato, San Donato Milanese, Milan, Italy
Title
Transcatheter aortic valve replacement in nonagenarians: early and
intermediate outcome from the OBSERVANT study and meta-analysis of the
literature.
Source
Heart and Vessels. 32 (2) (pp 157-165), 2017. Date of Publication: 01 Feb
2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
The purpose of this study was to evaluate the outcome of nonagenarians
after transcatheter aortic valve replacement (TAVR) from the OBSERVANT
study and to pool the results of the literature on this topic. Aortic
stenosis is the most common acquired valvular heart disease in the Western
countries, and its prevalence is linked to the phenomenon of population
aging. TAVR can be considered as a wise approach to treat nonagenarians,
but data on its safety and effectiveness are scarce. Data on 80 patients
aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A
systematic review and meta-analysis of published data were performed.
Thirty-day mortality in the OBSERVANT series was 6.3 %. None of these
patients experienced stroke. Permanent pacemaker implantation was
necessary in 20 % of patients. Paravalvular regurgitation was observed in
57.5 %. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 %. Ten
series provided data on 1227 nonagenarians who underwent TAVR. Pooled
30-day mortality rate was 7.1 %, stroke 2.8 %, vascular access
complication 8.8 %, and permanent pacemaker implantation 10.6 %.
Paravalvular regurgitation was observed in 60.1 % of patients. Pooled 1-,
2-, and 3-year survival rates were 79.2, 68.2, and 55.6 %. Transapical
TAVR was associated with a significantly higher risk of early mortality
compared with transfemoral TAVR. The results of OBSERVANT study and
aggregate data meta-analysis suggest that in nonagenarians, TAVR is
associated with low postoperative morbidity and excellent intermediate
survival. Transapical TAVR in these very elderly is associated with high
postoperative mortality. Copyright &#xa9; 2016, Springer Japan.

<71>
Accession Number
610649700
Author
De Vecchis R.; Baldi C.; Cantatrione S.
Institution
(De Vecchis, Cantatrione) Cardiology Unit, Presidio Sanitario Intermedio
"Elena d'Aosta", ASL Napoli 1 Centro, via Cagnazzi 29, Naples 80137, Italy
(Baldi) Heart Department, Interventional Cardiology, A.O.U. "San Giovanni
di Dio e Ruggi D'Aragona", Salerno, Italy
Title
Transcatheter closure of PFO as secondary prevention of cryptogenic
stroke.
Source
Herz. 42 (1) (pp 45-50), 2017. Date of Publication: 01 Feb 2017.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
This article covers the main unsolved issues regarding the potential role
that the patent foramen ovale (PFO) plays in the genesis of so-called
cryptogenic stroke. Some brief notions of the anatomy and epidemiology of
the PFO are outlined. Subsequently, the results of the three trials on
secondary prevention (medical therapy vs. transcatheter closure) in
patients with PFO and a history of cryptogenic stroke are presented. The
conflicting results of numerous meta-analyses derived from the three
randomized controlled trials are discussed. Official scientific guidelines
dispute an alleged superior efficacy of transcatheter PFO occlusion in
comparison with antithrombotic therapy alone (anticoagulants or
antiplatelet agents), except for selected cases of patients with
documented PFO and a concomitant clinical-instrumental picture of deep
venous thrombosis. Nevertheless, considering recent doubts about the
presumptive thrombogenic and arrhythmogenic potential of PFO occlusion,
which concerns only one of the septal occluders previously used, further
in-depth investigations are warranted, centered on the use of newer
dedicated devices to be tested in comparison with antithrombotic regimens
alone. Copyright &#xa9; 2016, Springer Medizin Verlag.

<72>
Accession Number
613645680
Author
Browndyke J.N.; Berger M.; Harshbarger T.B.; Smith P.J.; White W.; Bisanar
T.L.; Alexander J.H.; Gaca J.G.; Welsh-Bohmer K.; Newman M.F.; Mathew J.P.
Institution
(Browndyke, Welsh-Bohmer) Geriatric Behavioral Health Division, Department
of Psychiatry and Behavioral Sciences, Duke University Medical Center,
Durham, NC, United States
(Browndyke) Institute for Brain Sciences, Duke University, Durham, NC,
United States
(Browndyke, Harshbarger) Brain Imaging and Analysis Center, Duke
University, Durham, NC, United States
(Berger) Division of Neuroanesthesiology, Department of Anesthesiology,
Duke University Medical Center, Durham, NC, United States
(Harshbarger) Department of Radiology, Duke University Medical Center,
Durham, NC, United States
(Smith) Behavioral Medicine Division, Department of Psychiatry and
Behavioral Sciences, Duke University Medical Center, Durham, NC, United
States
(White, Bisanar, Newman, Mathew) Department of Anesthesiology, Duke
University Medical Center, Durham, NC, United States
(Alexander) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Gaca) Division of Cardiothoracic Surgery, Department of Surgery, Duke
University Medical Center, Durham, NC, United States
Title
Resting-State Functional Connectivity and Cognition After Major Cardiac
Surgery in Older Adults without Preoperative Cognitive Impairment:
Preliminary Findings.
Source
Journal of the American Geriatrics Society. 65 (1) (pp e6-e12), 2017. Date
of Publication: 01 Jan 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To look for changes in intrinsic functional brain connectivity
associated with postoperative changes in cognition, a common complication
in seniors undergoing major surgery, using resting-state functional
magnetic resonance imaging. Design: Objective cognitive testing and
functional brain imaging were prospectively performed at preoperative
baseline and 6 weeks after surgery and at the same time intervals in
nonsurgical controls. Setting: Academic medical center. Participants:
Older adults undergoing cardiac surgery (n = 12) and nonsurgical older
adult controls with a history of coronary artery disease (n = 12); no
participants had cognitive impairment at preoperative baseline
(Mini-Mental State Examination score >27). Measurements: Differences in
resting-state functional connectivity (RSFC) and global cognitive change
relationships were assessed using a voxel-wise intrinsic connectivity
method, controlling for demographic factors and pre- and perioperative
cerebral white matter disease volume. Analyses were corrected for multiple
comparisons (false discovery rate P <.01). Results: Global cognitive
change after cardiac surgery was significantly associated with intrinsic
RSFC changes in regions of the posterior cingulate cortex and right
superior frontal gyrus-anatomical and functional locations of the brain's
default mode network (DMN). No statistically significant relationships
were found between global cognitive change and RSFC change in nonsurgical
controls. Conclusion: Clinicians have long known that some older adults
develop postoperative cognitive dysfunction (POCD) after anesthesia and
surgery, yet the neurobiological correlates of POCD are not well defined.
The current results suggest that altered RSFC in specific DMN regions is
positively correlated with global cognitive change 6 weeks after cardiac
surgery, suggesting that DMN activity and connectivity could be important
diagnostic markers of POCD or intervention targets for potential POCD
treatment efforts. &#xa9; 2016, Copyright the Authors Journal compilation
&#xa9; 2016, The American Geriatrics Society

<73>
[Use Link to view the full text]
Accession Number
614437815
Author
Siontis K.C.; Yao X.; Gersh B.J.; Noseworthy P.A.
Institution
(Siontis) From Division of Cardiovascular Medicine, University of
Michigan, Ann Arbor, United States
(Yao) Division of Health Care Policy and Research, Department of Health
Sciences Research, United States
(Gersh, Noseworthy) Division of Cardiovascular Diseases, 200 1st St SW,
Mayo Clinic, Rochester, MN 55905, United States
Title
Direct Ora.
Source
Circulation. 135 (7) (pp 714-716), 2017. Date of Publication: 14 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<74>
Accession Number
614029465
Author
Cajita M.I.; Denhaerynck K.; Dobbels F.; Berben L.; Russell C.L.; Davidson
P.M.; De Geest S.
Institution
(Cajita, Davidson) School of Nursing, Johns Hopkins University, Baltimore,
Maryland, United States
(Denhaerynck, Berben, De Geest) Institute of Nursing Science, Department
of Public Health, University of Basel, Basel, Switzerland
(Dobbels, De Geest) Academic Center for Nursing and Midwifery, Department
of Public Health and Primary Care, KU Leuven, Leuven, Belgium
(Russell) School of Nursing and Health Studies, University of
Missouri-Kansas City, Kansas City, Missouri, United States
Title
Health literacy in heart transplantation: Prevalence, correlates and
associations with health behaviors-Findings from the international BRIGHT
study.
Source
Journal of Heart and Lung Transplantation. 36 (3) (pp 272-279), 2017. Date
of Publication: 01 Mar 2017.
Publisher
Elsevier USA
Abstract
Background Health literacy (HL) is a major determinant of health outcomes;
however, there are few studies exploring the role of HL among heart
transplant recipients. The objectives of this study were to: (1) explore
and compare the prevalence of inadequate HL among heart transplant
recipients internationally; (2) determine the correlates of HL; and (3)
assess the relationship between HL and health-related behaviors. Methods A
secondary analysis was conducted using data of the 1,365 adult patients
from the BRIGHT study, an international multicenter, cross-sectional study
that surveyed heart transplant recipients across 11 countries and 4
continents. Using the Subjective Health Literacy Screener, inadequate HL
was operationalized as being confident in filling out medical forms none/a
little/some of the time (HL score of 0 to 2). Correlates of HL were
determined using backward stepwise logistic regression. The relationship
between HL and the health-related behaviors were examined using
hierarchical logistic regression. Results Overall, 33.1% of the heart
transplant recipients had inadequate HL. Lower education level (adjusted
odds ratio [AOR] 0.24, p < 0.001), unemployment (AOR 0.69, p = 0.012) and
country (residing in Brazil, AOR 0.25, p < 0.001) were shown to be
associated with inadequate HL. Heart transplant recipients with adequate
HL had higher odds of engaging in sufficient physical activity (AOR 1.6, p
= 0.016). HL was not significantly associated with the other health
behaviors. Conclusions Clinicians should recognize that almost one third
of heart transplant participants have inadequate health literacy.
Furthermore, they should adopt communication strategies that could
mitigate the potential negative impact of inadequate HL. Copyright &#xa9;
2017 International Society for Heart and Lung Transplantation

<75>
Accession Number
613210196
Author
Chan J.L.; Kobashigawa J.A.; Reich H.J.; Ramzy D.; Thottam M.M.; Yu Z.;
Aintablian T.L.; Liou F.; Patel J.K.; Kittleson M.M.; Czer L.S.; Trento
A.; Esmailian F.
Institution
(Chan, Kobashigawa, Reich, Ramzy, Thottam, Yu, Aintablian, Liou, Patel,
Kittleson, Czer, Trento, Esmailian) Cedars-Sinai Heart Institute, Los
Angeles, California, United States
(Chan, Reich, Ramzy, Trento, Esmailian) Department of Surgery,
Cedars-Sinai Medical Center, Los Angeles, California, United States
Title
Intermediate outcomes with ex-vivo allograft perfusion for heart
transplantation.
Source
Journal of Heart and Lung Transplantation. 36 (3) (pp 258-263), 2017. Date
of Publication: 01 Mar 2017.
Publisher
Elsevier USA
Abstract
Background The Organ Care System, an ex-vivo heart perfusion platform,
represents an alternative to the current standard of cold organ storage
that sustains the donor heart in a near-physiologic state. It is unknown
whether using the Organ Care System influences 2-year outcomes after heart
transplantation. We reviewed our institutional experience to compare
2-year outcomes for patients randomized to the Organ Care System or
standard cold storage. Methods Between 2011 and 2013, heart transplant
candidates from a single tertiary-care medical center enrolled within the
PROCEED II trial were randomized to either standard cold storage or the
Organ Care System. Outcomes assessed included 2-year survival, freedom
from cardiac allograft vasculopathy (CAV), non-fatal major cardiac events
(NF-MACE), biopsy-proven cellular rejection (CMR) and biopsy-proven
antibody-mediated rejection (AMR). Results Thirty-eight patients were
randomized to the Organ Care System (n = 19) or cold storage group (n =
19). There was no significant difference in 2-year patient survival (Organ
Care System: 72.2%; cold storage: 81.6%; p = 0.38). Similarly, there were
no differences in freedom from CAV, NF-MACE, CMR or AMR. The Organ Care
System group had significantly longer total ischemia time (361 +/- 96
minutes vs 207 +/- 50 minutes; p < 0.001) and shorter cold ischemia time
(134 +/- 45 minutes vs 207 +/- 50 minutes; p < 0.001) compared with the
cold storage group. Conclusion The Organ Care System did not appear to be
associated with significant differences in intermediate results compared
with conventional strategies. These results suggest that this ex-vivo
allograft perfusion system is a promising and valid platform for donor
heart transportation. Copyright &#xa9; 2017 International Society for
Heart and Lung Transplantation

<76>
[Use Link to view the full text]
Accession Number
612853486
Author
Zhang Y.; Zhang X.; Chi D.; Wang S.; Wei H.; Yu H.; Li Q.; Liu B.
Institution
(Zhang, Zhang, Chi, Wang, Yu, Li, Liu) Department of Anesthesiology, West
China Hospital of Sichuan University, No. 37, Wai Nan Guo Xue Xiang,
Chengdu, Sichuan 610041, China
(Wei) Department of Anesthesiology, First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
Title
Remote ischemic preconditioning for prevention of acute kidney injury in
patients undergoing on-pump cardiac surgery a systematic review and
meta-analysis.
Source
Medicine (United States). 95 (37) (no pagination), 2016. Article Number:
e3465. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Remote ischemic preconditioning (RIPC) may attenuate acute kidney injury
(AKI). However, results of studies evaluating the effect of RIPC on AKI
after cardiac surgery have been controversial and contradictory. The aim
of this meta-analysis is to examine the association between RIPC and AKI
after on-pump cardiac surgery. The authors searched relevant studies in
PubMed, EMBASE, and the Cochrane Library through December 2015. We
considered for inclusion all randomized controlled trials that the role of
RIPC in reducing AKI and renal replacement therapy (RRT) among patients
underwent on-pump cardiac surgical procedures. We collected the data on
AKI, initiation of RRT, serum creatinine (sCr) levels, and in-hospital
mortality. Random-and fixed-effect models were used for pooling data.
Nineteen trials including 5100 patients were included. The results of this
meta-analysis showed a significant benefit of RIPC for reducing the
incidence of AKI after cardiac interventions (odds ratio [OR]= 0.84; 95%
confidence interval [CI], 0.73-0.98; P = 0.02). No significant difference
was found in the incidence of RRT between RIPC and control (OR, 0.76, 95%
CI, 0.46-1.24; P= 0.36). In addition, compared with standard medical care,
RIPC showed no significant difference in postoperative sCr (IV 0.07; 95%
CI,-0.03 to 0.16; P = 0.20; postoperative day 1; IV 0.00; 95% CI,-0.08 to
0.09; P= 0.92; postoperative day 2; IV 0.04; 95% CI,-0.05 to 0.12; P=
0.39; postoperative day 3), and inhospital mortality (OR, 1.21, 95% CI,
0.64-2.30; P = 0.56). According to the results from present meta-analysis,
RIPC was associated with a significant reduction AKI after on-pump cardiac
surgery but incidence of RRT, postoperative sCr, and in-hospital
mortality. Further high-quality randomized controlled trials and
experimental researches comparing RIPC are desirable. Copyright &#xa9;
2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights
reserved.

<77>
[Use Link to view the full text]
Accession Number
613915008
Author
Wan L.; Liao M.; Li L.; Qian W.; Hu R.; Chen K.; Chuanhan Zhang; Yao W.
Institution
(Wan, Liao, Qian, Hu, Chen, Chuanhan Zhang, Yao) Department of
Anesthesiology, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
(Li) Department of Physiology, Hubei University of Chinese Medicine,
Wuhan, China
Title
McGrath Series 5 videolaryngoscope vs Airtraq DL videolaryngoscope for
double-lumen tube intubation: A randomized trial.
Source
Medicine (United States). 95 (51) (pp e5739), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Many studies have shown Airtraq videolaryngoscope provided
faster tracheal intubation and a higher success rate than other
videolaryngoscopes. Recently, different types of videolaryngoscopes have
been reported for use in double-lumen tube (DLT) intubation. However, the
advantages and disadvantages between them remain undetermined for DLT
intubation. In this study, we compared the Airtraq DL videolaryngoscope
with the McGrath Series 5 videolaryngoscope for DLT intubation by
experienced anesthesiologists. Methods: Ninety patients with expected
normal airways were randomly allocated to either the Airtraq orMcGrath
group. The primary outcome was DLT intubation time. The secondary outcomes
were glottic view, success rate, subjective ease of intubation (100-mm
visual analog scale, 0=easy; 100=difficult), incidence of DLT malposition,
and postoperative intubation-related complication. Results: The airway
characteristics were comparable between the 2 groups. Cormack and Lehane
grades significantly improved with the use of the McGrath and Airtraq
videolaryngoscopes, compared with the Macintosh laryngoscope. The
intubation success rate on the first attempt was 93% in the Airtraq group
and 95% in the McGrath group (P>0.05). The intubation time in the McGrath
group is longer than that in the Airtraq group (39.9 [9.1]s vs 28.6
[13.6]s, P>0.05). But intubation difficulty score, the incidence of DLT
malposition and intubation-related complication were comparable between
groups (P>0.05). Conclusions: When using videolaryngoscopes for DLT
intubation, the Airtraq DL is superior to the McGrath Series 5 in
intubation time, but it does not decrease intubation difficulty.
Abbreviations: ASA = American Society of Anaesthesiologists, DLT =
double-lumen tube, FOB = fibreoptic bronchoscopy, SARI = simplified airway
risk index, SLT = single-lumen tube. Copyright &#xa9; 2016 the Author(s).

<78>
Accession Number
608880453
Author
Haiek C.; Fernandez-Pereira C.; Santaera O.; Mieres J.; Rifourcat I.;
Lloberas J.; Larribau M.; Pocovi A.; Rodriguez-Granillo A.M.; Sarmiento
R.A.; Antoniucci D.; Rodriguez A.E.
Institution
(Haiek) Interventional Cardiology Department, Sanatorio De La Trinidad,
Quilmes, Buenos Aires Province, Argentina
(Fernandez-Pereira) Interventional Cardiology Department, Clinica IMA,
Adrogue, Buenos Aires Province, Argentina
(Fernandez-Pereira, Mieres, Rodriguez-Granillo, Rodriguez) Clinical
Research Department, Centro De Estudios En Cardiologia Intervencionista,
Buenos Aires City, Argentina
(Santaera) Interventional Cardiology Department, Clinica Privada
Provincial, Merlo, Buenos Aires Province, Argentina
(Mieres) Interventional Department, Sanatorio Las Lomas, San Isidro,
Buenos Aires Province, Argentina
(Rifourcat) Interventional Cardiology Department, Instituto De Diagnostico
Y Tratamiento De Afecciones Cardiovasculares, La Plata, Buenos Aires
Province, Argentina
(Lloberas) Interventional Cardiology Department, Sanatorio San Miguel, San
Miguel, Buenos Aires Province, Argentina
(Larribau) Interventional Cardiology Department, Hospital Espanol, Godoy
Cruz City, Mendoza Province, Argentina
(Pocovi) Interventional Cardiology Department, Centro Medico Talar, San
Isidro, Buenos Aires Province, Argentina
(Sarmiento) Interventional Cardiology Department, Hospital El Cruce,
Florencio Varela, Buenos Aires Province, Argentina
(Antoniucci) Cardiology Department, Careggi Hospital, Firenze, Italy
(Rodriguez) Cardiology Department, Sanatorio Otamendi Y Miroli, Buenos
Aires City, Argentina
Title
Second vs. First generation drug eluting stents in multiple vessel disease
and left main stenosis: Two-year follow-up of the observational,
prospective, controlled, and multicenter ERACI IV registry.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp 37-46), 2017.
Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To compare second generation drug eluting stents (2DES) with
first generation (1DES) for the treatment of patients (pts) with multiple
coronary vessel disease (MVD). Background: Although 2DES improved safety
and efficacy compared to 1DES, MVD remains a challenge for percutaneous
coronary interventions. Methods: ERACI IV was a prospective,
observational, and controlled study in pts with MVD including left main
and treated with 2DES (Firebird 2, Microport). We included 225 pts in 15
sites from Argentina. Primary endpoint was the incidence of major adverse
cardiovascular events (MACCE) defined as death, myocardial infarction
(MI), cerebrovascular accident (CVA) and unplanned revascularization; and
to compare with 225 pts from ERACI III study (1DES). PCI strategy was
planned to treat lesions >70% in vessels > 2.00 mm, introducing a modified
Syntax score (SS) where severe lesions in vessels < 2.0 mm and
intermediate lesions were not scored. Results: Baseline characteristics
showed that compared to ERACI III, ERACI IV pts had higher number of
diabetics (P = 0.02), previous revascularization (P = 0.007), unstable
angina IIb/IIIc (P < 0.001) and three vessels/left main disease (P =
0.003). Modified SS was 22.2 +/- 11. At 2 years of follow-up ERACI IV
group had significantly lower incidence of death+ MI + CVA, (P = 0.01) and
MACCE (P = 0.001). MACCE rate was similar in diabetics, (5.8%) and
nondiabetics (7.0%). After performing a matched propensity score, MACCE
remain significantly lower in ERACI IV (P = 0.005). Conclusion: This
registry showed that 2DES in MVD has a remarkable low incidence of MACCE
in unadjusted and adjusted analysis. &#xa9; 2016 Wiley Periodicals, Inc.
Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<79>
Accession Number
613145958
Author
Asgar A.; Chandrasekhar J.; Mikhail G.; Webb J.; Lefevre T.; Tamburino C.;
Hildick-Smith D.; Hambrecht R.; Van Belle E.; Widder J.; Dumonteil N.;
Hink U.; Jeger R.; Linke A.; Deliargyris E.; Gao P.; Mehran R.;
Hengstenberg C.; Anthopoulos P.; Dangas G.
Institution
(Asgar) Division of Cardiology, Montreal Heart Institute, Montreal, Canada
(Chandrasekhar, Mehran, Dangas) Icahn School of Medicine at Mount Sinai,
The Zena and Michael a. Wiener Cardiovascular Institute, New York, NY,
United States
(Mikhail) Imperial College Healthcare NHS Trust, Hammersmith Hospital,
London, United Kingdom
(Webb) Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada
(Lefevre) Ramsay Generale De Sante, Institut Hospitalier Jacques Cartier,
Massy, France
(Tamburino) Department of Cardiology, University of Catania, Catania,
Italy
(Hildick-Smith) Sussex Cardiac Centre-Brighton & Sussex University
Hospitals NHS Trust, Brighton, East Sussex, United Kingdom
(Hambrecht) Department of Cardiology and Angiology, Klinikum Links Der
Weser, Bremen, Germany
(Van Belle) Centre Hospitalier Universitaire De Lille, Lille, France
(Widder) Department of Cardiology and Angiology, Hannover Medical School,
Hannover, Germany
(Dumonteil) Department of Cardiology, Rangueil University Hospital,
Toulouse, France
(Hink) Cardiology Department, Johannes Gutenberg University Hospital,
Mainz, Germany
(Jeger) Department of Cardiology, University Hospital Basel, Basel,
Switzerland
(Linke) Department of Internal Medicine/Cardiology, University of Leipzig,
Heart Centre, Germany
(Deliargyris, Gao) The Medicines Company, Parsippany, NJ, United States
(Hengstenberg) DZHK (German Centre for Cardiovascular Research), Partner
Site Munich Heart Alliance, Munich, Germany, and Deutsches Herzzentrum
Munchen, Technische Universitat Munchen, Munich, Germany
(Anthopoulos) The Medicines Company, Zurich, Switzerland
Title
Sex-based differences in outcomes with bivalirudin or unfractionated
heparin for transcatheter aortic valve replacement: Results from the
BRAVO-3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp 144-153),
2017. Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Women comprise almost 50% of patients undergoing transcatheter
aortic valve replacement (TAVR) and previous studies have indicated higher
rates of procedural complications and bleeding in women compared to men.
It is unknown whether men and women demonstrate a differential response to
bivalirudin versus unfractionated heparin (UFH) in TAVR. We sought to
evaluate outcomes by sex and type of anticoagulant from the Bivalirudin
Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement
(BRAVO-3) trial of transfemoral TAVR. Methods: BRAVO-3 was a randomized
multicenter trial comparing transfemoral TAVR with bivalirudin versus UFH
(31 centers, n = 802). The primary endpoint was 48 h major bleeding
defined as Bleeding Academic Research Consortium (BARC) type >3b. Major
adverse cardiovascular events (MACE) were a composite of 30-day death,
myocardial infarction, or stroke. Net adverse cardiovascular events (NACE)
were a composite of BARC >3b bleeding or 30-day MACE. We examined the
outcomes in men and women. Results: The total cohort included 49% women (n
= 391, 195 received bivalirudin and 196 UFH) and 51% men (n = 411, 209
received bivalirudin and 202 UFH). Women were older than men with fewer
comorbidities including coronary artery disease, atrial fibrillation,
diabetes but similar EuroSCORE I. Women received smaller sheath and device
sizes compared with men without differences in the use of vascular closure
devices. At 48-hr post-TAVR there was no difference in bleeding or
vascular complications in women compared to men. The use of bivalirudin
did not result in significantly lower bleeding at 48 hr or 30-days
compared to UFH. Conclusions: There was no difference in early outcomes
with bivalirudin versus UFH in men or women undergoing contemporary TAVR.
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<80>
Accession Number
613084377
Author
Rossini R.; Angiolillo D.J.; Musumeci G.; Capodanno D.; Lettino M.;
Trabattoni D.; Pilleri A.; Calabria P.; Colombo P.; Bernabo P.; Ferlini
M.; Ferri M.; Tarantini G.; De Servi S.; Savonitto S.
Institution
(Rossini, Musumeci) Dipartimento Cardiovascolare, ASST Papa Giovanni
XXIII, Bergamo, Italy
(Angiolillo) College of Medicine-Jacksonville, University of Florida,
Jacksonville, FL, United States
(Capodanno) Dipartimento Di Cardiologia, Ospedale Ferrarotto, Universita
Di Catania, Italy
(Lettino) U.O.C. Cardiologia Clinica I, Istituto Clinico Humanitas,
Rozzano, (MI), Italy
(Trabattoni) Dipartimento Di Scienze Cardiovascolari, Centro Cardiologico
Monzino, IRCCS, Universita Degli Studi Di Milano, Milano, Italy
(Pilleri) SSD Centro di valutazione e consulenza cardiologica, Azienda
Ospedaliera Brotzu, Presidio San Michele, Cagliari, Italy
(Calabria) UO Emodinamica, Ospedale Misericordia, Grosseto, USL Toscana
Sudest, Italy
(Colombo) Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale
Metropolitano, Milano, Italy
(Bernabo) Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera,
Genova, Italy
(Ferlini, De Servi) SC Cardiologia, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
(Ferri) S.C. Di Cardiologia, Arcispedale S. Maria Nuova, IRCCS, Reggio
Emilia, Italy
(Tarantini) Dipartimento Di Scienze Cardiache, Toraciche E Vascolari,
Universita Di Padova, Italy
(Savonitto) Dipartimento Cardiovascolare, Ospedale A. Manzoni, Lecco,
Italy
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine-Jacksonville, Jacksonville, FL, United States
(Lettino) Dipartimento Cardiovascolare, Humanitas Research Hospital,
Rozzano, Milano, Italy
Title
Antiplatelet therapy and outcome in patients undergoing surgery following
coronary stenting: Results of the surgery after stenting registry.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp E13-E25),
2017. Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of the present study was to define the feasibility and
clinical impact of complying with national consensus recommendations on
perioperative management of antiplatelet therapy in patients with coronary
stents undergoing cardiac and noncardiac surgery. Background: There are
limited evidence-based recommendations on the perioperative management of
antiplatelet therapy in stented patients undergoing surgery. Methods: The
recommendations provided by the national consensus document were applied
in a multicenter, prospective registry of consecutive patients with prior
coronary stenting undergoing any type of surgery at 19 hospitals in Italy.
The primary end-point was in-hospital net adverse clinical events (NACE)
represented by the composite of all-cause death, myocardial infarction,
probable/definite stent thrombosis and Bleeding Academic Research
Consortium (BARC) grade >3 bleeding. Patients were followed for 30 days.
Results: A total of 1,082 patients were enrolled. Adherence to consensus
recommendations occurred in 85% of the cases. Perioperative aspirin and
dual antiplatelet therapy were maintained in 69.7 and 10.5% of the cases,
respectively. In-hospital NACE rate was 12.7%, being significantly higher
in patients undergoing cardiac surgery (36.3% vs. 7.3%, P < 0.01), mainly
due to BARC 3 bleeding events (32.3%). At 30 days, MACE rates were similar
(3.5% vs. 3.5%, P = NS) in patients undergoing cardiac and noncardiac
surgery, whereas BARC >3 bleeding events were significantly higher with
cardiac surgery (36.3% vs. 5.6%, P < 0.01). Conclusions: The results of
this registry demonstrate the safety and feasibility of applying a
national consensus document on the perioperative management of
antiplatelet therapy in stented patients undergoing surgery. &#xa9; 2016
Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<81>
Accession Number
613701529
Author
Lee S.-Y.; Shin D.-H.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi D.; Jang Y.;
Hong M.-K.
Institution
(Lee) Department of Internal Medicine, Sanbon Hospital, Wonkwang
University College of Medicine, Gunpo, South Korea
(Shin, Kim, Kim, Ko, Choi, Jang, Hong) Division of Cardiology, Severance
Cardiovascular Hospital, Yonsei University Health System, Seul, South
Korea
(Shin, Kim, Kim, Ko, Choi, Jang, Hong) Cardiovascular Research Institute,
Yonsei University College of Medicine, Seul, South Korea
(Jang, Hong) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seul, South Korea
Title
Intravascular Ultrasound Predictors of Major Adverse Cardiovascular Events
After Implantation of Everolimus-eluting Stents for Long Coronary Lesions.
Source
Revista Espanola de Cardiologia. 70 (2) (pp 88-95), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Ediciones Doyma, S.L. (E-mail: suscripciones@doyma.es)
Abstract
Introduction and objectives There are limited data on the usefulness of
intravascular ultrasound (IVUS) for long coronary lesions treated with
second-generation drug-eluting stents. We evaluated IVUS predictors of
major adverse cardiovascular events (MACE) 12 months after implantation of
everolimus-eluting stents for long coronary lesions. Methods A total of
804 patients who underwent both postintervention IVUS examination and long
everolimus-eluting stent (> 28 mm in length) implantation were included
from 2 randomized trials. MACE was defined as a composite of cardiac
death, myocardial infarction, and target-lesion revascularization. Results
MACE occurred in 24 patients (3.0%) over 12 months. On multivariable Cox
regression analysis, independent IVUS predictors of MACE included the
postintervention minimum lumen area (MLA) at the target lesion (HR =
0.623; 95%CI, 0.433-0.895; P = .010) and the ratio of MLA/distal reference
segment lumen area (HR = 0.744; 95%CI, 0.572-0.969; P = .028). The MLA and
MLA-to-distal reference segment lumen area ratio that best predicted
patients with MACE from those without these events were 5.0 mm²
and 1.0, respectively. Patients with MLA < 5.0 mm² or a distal
reference segment lumen area had a higher risk of MACE (HR = 6.231; 95%CI,
1.859-20.891; P = .003) than those without MACE. Conclusions Patients with
a postintervention IVUS-measured MLA of < 5.0 mm² or a distal
reference segment lumen area were at risk for MACE after long
everolimus-eluting stent implantation. Full English text available from:
www.revespcardiol.org/en Copyright &#xa9; 2016 Sociedad Espanola de
Cardiologia

<82>
Accession Number
614249298
Author
Iyigun T.; Kaya M.; Gulbeyaz S.O.; Fistikci N.; Uyanik G.; Yilmaz B.; Onan
B.; Erkanli K.
Institution
(Iyigun, Kaya, Yilmaz, Onan, Erkanli) Department of Cardiovascular Surgery
Clinic, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery
Training and Research Hospital, Istanbul, Turkey
(Gulbeyaz) Department of Plastic and Reconstructive Surgery, Istanbul
Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and
Research Hospital, Istanbul, Turkey
(Fistikci) Department of Psychiatry, Bakirkoy Research and Training
Hospital, Istanbul, Turkey
(Uyanik) Departments of Psychology, Istanbul Mehmet Akif Ersoy Thoracic
and Cardiovascular Surgery Training and Research Hospital, Istanbul,
Turkey
Title
Patient body image, self-esteem, and cosmetic results of minimally
invasive robotic cardiac surgery.
Source
International Journal of Surgery. 39 (pp 88-94), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Patient-reported outcome measures reveal the quality of
surgical care from the patient's perspective. We aimed to compare body
image, self-esteem, hospital anxiety and depression, and cosmetic outcomes
by using validated tools between patients undergoing robot-assisted
surgery and those undergoing conventional open surgery. Materials and
methods This single-center, multidisciplinary, randomized, prospective
study of 62 patients who underwent cardiac surgery was conducted at
Hospital from May 2013 to January 2015. The patients were divided into two
groups: the robotic group (n = 33) and the open group (n = 29). The study
employed five different tools to assess body image, self-esteem, and
overall patient-rated scar satisfaction. Results There were statistically
significant differences between the groups in terms of self-esteem scores
(p = 0.038), body image scores (p = 0.026), overall Observer Scar
Assessment Scale (p = 0.013), and overall Patient Scar Assessment Scale (p
= 0.036) scores in favor of the robotic group during the postoperative
period. Robot-assisted surgery protected the patient's body image and
self-esteem, while conventional open surgery decreased these levels but
without causing pathologies. Preoperative depression and anxiety level was
reduced by both robot-assisted surgery and conventional open surgery. The
groups did not significantly differ on Patient Satisfaction Scores and
depression/anxiety scores. Conclusion The results of this study clearly
demonstrated that a minimally invasive approach using robotic-assisted
surgery has advantages in terms of body image, self-esteem, and cosmetic
outcomes over the conventional approach in patients undergoing cardiac
surgery. Copyright &#xa9; 2017 IJS Publishing Group Ltd

<83>
Accession Number
613239491
Author
Secco G.G.; Rittger H.; Hoffmann S.; Richardt G.; Abdel-Wahab M.; Reinecke
H.; Lotan C.; Werner G.; Sievert H.; Foin N.; Di Mario C.
Institution
(Secco) Department of Clinical and Experimental Medicine, University of
Eastern Piedmont, Novara, Italy
(Rittger) Medizinische Klinik 2, Universitatsklinikum Erlangen, Erlangen,
Germany
(Hoffmann) Vivantes Klinikum Am Urban, Berlin, Germany
(Richardt, Abdel-Wahab) Department of Cardiology, Heart Center, Segeberger
Kliniken GmbH, Bad Segeberg, Germany
(Reinecke) Department of Cardiology and Angiology, University Hospital
Munster, Munster, Germany
(Lotan) Hadassah-Hebrew University Medical Center, Jerusalem, Israel
(Werner) Klinikum Darmstadt, Darmstadt, Germany
(Sievert) Cardiovascular Center Frankfurt, Frankfurt, Germany
(Foin) Department of Bioengineering, Imperial College London, London,
United Kingdom
(Di Mario) Biomedical Research Unit, Royal Brompton & Harefield NHS
Foundation Trust, London, United Kingdom
Title
The Glider registry.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp E1-E6), 2017.
Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Provisional stenting of the side-branch (SB) is the
universally accepted gold standard while there is still controversy on the
usefulness of routine dilatation of the SB ostium. Recrossing the struts
of a previously deployed stent with a wire and a balloon can prove
challenging and is occasionally unsuccessful, mainly because the balloon
tip hits a stent strut. This prospective multicenter international
registry tested the crossing ability procedural results of a new-dedicated
ultrashort balloon specifically designed for side branch dilatation
(Glider, TriReme Medical, Pleasanton, CA, USA). Methods: One hundred and
twenty five patients (for a total of 131 bifurcation lesions) were
enrolled in the registry between January 2009 and May 2012. The Glider was
used as first choice in alternative to conventional balloon (group I, 72%)
or as bail-out after unsuccessful previous attempt at crossing with small
conventional low-profile balloons (group II, 28%). Postprocedural coronary
artery dissections and in-hospital MACE (death, myocardial infarction and
repeat revascularization) were assessed. Technical success was defined as
the ability of the Glider to recross the struts of a previously deployed
stent while procedural success was defined as less of residual 50%
diameter stenosis at the origin of the SB with a final TIMI 3 and/or
freedom from in-hospital MACE. Results: Technical success was achieved,
respectively, in 92% (group I), and 83% (group II). Clinical and
angiographic procedural success was achieved in 98% of the lesions. In
Group II, no other balloon of the same size could cross in cases where
Glider could not. A total of 13 complications were observed, including
nine ostial SB dissection four of which needed a second stent on the SB,
one stent loss, two severe coronary spasms, and two by thrombus formation.
Conclusion: The unique possibility offered by this short dedicated balloon
to orientate its beveled tip provides an effective strategy for recrossing
stent struts when conventional low profile balloons fail achieving greater
SB ostial expansion thus reducing the incidence of strut malapposition
during provisional treatment of bifurcational lesions. &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<84>
[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.

<85>
Accession Number
614405558
Author
Larsen P.D.; Holley A.S.; Sasse A.; Al-Sinan A.; Fairley S.; Harding S.A.
Institution
(Larsen, Holley) University of Otago, Wellington, New Zealand
(Larsen, Holley, Sasse, Fairley, Harding) Wellington Cardiovascular
Research Group, New Zealand
(Sasse, Al-Sinan, Fairley, Harding) Department of Cardiology, Wellington
Hospital, New Zealand
Title
Comparison of Multiplate and VerifyNow platelet function tests in
predicting clinical outcome in patients with acute coronary syndromes.
Source
Thrombosis Research. 152 (pp 14-19), 2017. Date of Publication: 01 Apr
2017.
Publisher
Elsevier Ltd
Abstract
Introduction This study examined the ability of two widely used "point of
care" platelet function assays, VerifyNow and Multiplate, to predict
adverse outcomes in patients with acute coronary syndromes (ACS). Methods
We examined platelet reactivity using VerifyNow and Multiplate
P2Y<inf>12</inf> assays in patients with ACS and the relationship between
platelet reactivity and both MACE (defined as a composite of death,
myocardial infarction, stroke, stent thrombosis and unplanned
revascularisation) and TIMI major bleeding at 1 year. Results In 619 ACS
patients, 65 patients (10.5%) had experienced MACE at 1 year and 6
patients (1%) had TIMI major bleeding events. The two measures of platelet
reactivity were only moderately correlated (Rho = 0.43, p = 0.0001). Both
measures demonstrated a statistically significant relationship with MACE,
with area under the curve for VerifyNow of 0.632 (0.001) and for
Multiplate of 0.577 (p = 0.04), and neither measure showed a significant
relationship with bleeding. Logistic regression analysis found that only
VerifyNow was a statistical predictor of MACE (p = 0.01). MACE occurred in
16% of those classified as having HPR using VerifyNow compared to 7% in
those without HPR (odds ratio of 2.6 (95% CI 1.5-4.4, p = 0.001). In those
classified as having HPR by the Multiplate assay, MACE occurred in 13%
compared to 9% of those without HPR (Odds ratio 1.5 95% CI 0.9-2.5, p =
0.11). Conclusion The two points of care platelet function tests examined
in this study were only moderately correlated. The VerifyNow assay
demonstrated a stronger relationship to MACE than the Multiplate assay.
Copyright &#xa9; 2017 Elsevier Ltd

<86>
Accession Number
614557331
Author
Erdem O.; Memetoglu M.E.; Tekin A.I.; Arslan U.; Akkaya O.; Kutlu R.;
Golbasi I.
Institution
(Erdem) School of Medicine, Akdeniz University, Antalya, Turkey
(Memetoglu) School of Medicine, Akdeniz University, Antalya, Turkey
(Tekin) School of Medicine, Akdeniz University, Antalya, Turkey
(Arslan) School of Medicine, Akdeniz University, Antalya, Turkey
(Akkaya) School of Medicine, Akdeniz University, Antalya, Turkey
(Kutlu) Denizli State Hospital, Denizli, Turkey
(Golbasi) School of Medicine, Akdeniz University, Antalya, Turkey
Title
Effects of intraoperative diltiazem infusion on flow changes in arterial
and venous grafts in coronary artery bypass graft surgery.
Source
Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade
Brasileira de Cirurgia Cardiovascular. 30 (4) (pp 459-465), 2015. Date of
Publication: 01 Jul 2015.
Abstract
OBJECTIVE: This study aimed to show the effects of intra-operative
diltiazem infusion on flow in arterial and venous grafts in coronary
artery bypass graft surgery.
METHODS: Hundred fourty patients with a total of 361 grafts [205 (57%)
arterial and 156 (43%) venous] underwent isolated coronary surgery. All
the grafts were measured by intraoperative transit time flow meter
intra-operatively. Group A (n=70) consisted of patients who received
diltiazem infusion (dose of 2.5 microgram/kg/min), and Group B (n=70)
didn't receive diltiazem infusion.
RESULTS: Mean graft flow values of left internal mammary artery were 53
ml/min in Group A and 40 ml/min in Group B (P<0.001). Pulsatility index
(PI) values of left internal mammary artery for Group A and Group B were
2.6 and 3.0 respectively (P<0.001). No statistically significant
difference was found between venous graft parameters.
CONCLUSION: We recommend an effect of diltiazem infusion in increasing
graft flows in coronary artery bypass graft operations.

<87>
Accession Number
614502036
Author
Feng Y.; Wang J.; Zhang Y.; Wang S.
Institution
(Feng) Department of Anesthesiology, Affiliated Hospital of Qingdao
University, Qingdao, Shandong, China (mainland)
(Wang) Department of Anesthesiology, Binzhou City People's Hospital,
Binzhou, Shandong, China (mainland)
(Zhang) Department of Anesthesiology, Binzhou City People's Hospital,
Binzhou, Shandong, China (mainland)
(Wang) Department of Anesthesiology, Affiliated Hospital of Qingdao
University, Qingdao, Shandong, China (mainland)
Title
One-Lung Ventilation with Additional Ipsilateral Ventilation of Low Tidal
Volume and High Frequency in Lung Lobectomy.
Source
Medical science monitor : international medical journal of experimental
and clinical research. 22 (pp 1589-1592), 2016. Date of Publication: 11
May 2016.
Abstract
BACKGROUND To investigate the protective effects of additional ipsilateral
ventilation of low tidal volume and high frequency on lung functions in
the patients receiving lobectomy. MATERIAL AND METHODS Sixty patients
receiving lung lobectomy were randomized into the conventional one-lung
ventilation (CV) group (n=30) and the ipsilateral low tidal volume high
frequency ventilation (LV) group (n=30). In the CV group, patients
received only contralateral OLV. In the LV group, patients received
contralateral ventilation and additional ipsilateral ventilation of low
tidal volume of 1-2 ml/kg and high frequency of 40 times/min. Normal lung
tissues were biopsied for the analysis of lung injury. Lung injury was
scored by evaluating interstitial edema, alveolar edema, neutrophil
infiltration, and alveolar congestion. RESULTS At 30 min and 60 min after
the initiation of one-lung ventilation and after surgery, patients in the
LV group showed significantly higher ratio of the partial pressure of
arterial oxygen to the fraction of inspired oxygen than those in the CV
group (P<0.001). Lung injury was significantly less severe (2.7+/-0.7) in
the LV group than in the CV group (3.1+/-0.7) (P=0.006). CONCLUSIONS
Additional ipsilateral ventilation of low tidal volume and high frequency
can decrease the risk of hypoxemia and alleviate lung injury in patients
receiving lobectomy.

<88>
[Use Link to view the full text]
Accession Number
614480708
Author
Zhou H.; Wu W.; Tang X.; Zhou J.; Shen Y.
Institution
(Zhou, Wu, Tang, Zhou, Shen) aDepartment of Respiration, The First
Affiliated Hospital, Zhejiang University, Hangzhou bDepartment of
Radiology, Jilin Provincial Tumor Hospital, Changchun, China
Title
Effect of hyperthermic intrathoracic chemotherapy (HITHOC) on the
malignant pleural effusion: A systematic review and meta-analysis.
Source
Medicine. 96 (1) (pp e5532), 2017. Date of Publication: 01 Jan 2017.
Abstract
BACKGROUND: Although hyperthermic intraperitoneal chemotherapy (HIPEC) has
been widely used to treat malignant ascites or as a preventive strategy
for microscopic carcinomatosis following surgical resection of abdominal
tumors, application of hyperthermic intrathoracic chemotherapy (HITHOC) in
the treatment of malignant pleural effusion is limited. The objective of
the current study was to conduct a systematic review and meta-analysis on
the application of HITHOC in the palliative treatment of malignant pleural
effusion.
METHODS: After thorough searching of online databases, total 27 articles
were included into qualitative systematic review and 5 of them were used
to conduct qualitative meta-analysis.
RESULTS: It was found that most of HITHOC was used in combination of
cytoreductive surgery (CRS) including pleurectomy/decortication or after
surgical resection of primary tumors, which mainly were lung cancer,
thymoma or thymic carcinoma, breast cancer, and ovarian cancer. Patients
who received HITHOC had significantly longer median survival length
compared to the patients without HITHOC (Hedges g = 0.763, P < 0.001). In
addition, HITHOC therapy was favored (Hedges g = 0.848, P < 0.001) in
terms of median survival length, tumor-free survival rate, with tumor
survival rate or Karnofsky performance status (KPS) scale.
CONCLUSION: HITHOC is a safe and effective therapy in controlling pleural
effusion and increasing patient's survival rate.

<89>
Accession Number
614565935
Author
Mirmansouri A.; Imantalab V.; Jouryabi A.M.; Kanani G.; Nabi B.N.; Farzi
F.; Biazar G.; Tehran S.G.; Tarbiat M.
Institution
(Mirmansouri, Imantalab, Jouryabi) Fellowship of Anesthesia in Cardiac
Surgery, Anesthesiology Research Center, Guilan University of Medical
Sciences (GUMS), Rasht, Iran, Islamic Republic of
(Kanani) Department of Cardaic Surgery, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
(Nabi) Fellowship of Anesthesia and Pain (FIPP), Anesthesiology
Department, Anesthesiology Research Center, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
(Farzi, Biazar, Tehran) Anesthesiology Research Center, Guilan University
of Medical Sciences (GUMS), Rasht, Iran, Islamic Republic of
(Tarbiat) Department of Anesthesiology, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
Title
Effect of selenium on stress response in coronary artery bypass graft
surgery: A clinical trial.
Source
Anesthesiology and Pain Medicine. 7 (1) (no pagination), 2017. Article
Number: e43864. Date of Publication: February 2017.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: In spite of significant improvements in surgical and
anesthetic techniques, acute stress response to surgery remains a main
cause of mortality and morbidity in coronary artery bypass graft (CABG)
surgery patients. Therefore, doing research to find safe and effective
modalities with more cardio protective properties seems necessary.
Objectives: In this study, we sought to determine whether intravenous
injection of 600 mug Selenium (Se) prior to surgery would limit stress
response measured by blood sugar. Methods: This double blind clinical
trial was conducted at a referral center of cardiac surgery affiliated to
Guilan University of Medical Sciences (GUMS) from June 2015 to October
2015. 73 eligible patients candidate for elective isolated CABG surgery
were enrolled in the trial. They were randomly allocated to either Se
group (n = 36) receiving 600 mug Se prior to surgery or control group (n =
37). Our evaluation was based on blood sugar (BS) which was measured at
four point times, including before induction of anesthesia (T0), at the
end of CPB (T1), 24 hours (T2) and 48 hours (T3) after surgery. Results:
The data obtainedfrom 73 patients in group S (n=36)andgroupC(n=37) were
analyzed. Therewasnosignificant difference between the two groups
regarding the baseline characteristics. In both groups, a sharp rise in BS
levels was observed following CPB (P = 0.0001). Although the trend of BS
changes was remarkable in both groups (P = 0.0001), there was no
statistically significant difference between the groups at all point times
including T0 (P = 0.45), T1 (P = 0.48), T2 (P = 0.92), and T3 (P = 0.42).
Within the study time, our patients were monitored for any adverse effect
but nothing was observed. Conclusions: This investigation showed that
intravenous single dose of 600 mug Se was safe in CABG patients, but had
no positive effect on stress response to surgery. Copyright &#xa9; 2016,
Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM).

<90>
Accession Number
614524760
Author
Barbero C.; Ricci D.; Stura E.C.; Pellegrini A.; Marchetto G.; Qarra S.E.;
Boffini M.; Passera R.; Valentini M.C.; Rinaldi M.
Institution
(Barbero, Ricci, Stura, Pellegrini, Marchetto, Qarra, Boffini, Rinaldi)
Department of Cardiovascular and Thoracic Surgery, University of Turin,
Corso Bramante 88, Turin 10126, Italy
(Passera) Department of Nuclear Medicine, University of Turin, Turin,
Italy
(Valentini) Department of Neuroradiology, University of Turin, Turin,
Italy
Title
Magnetic resonance imaging for cerebral lesions during minimal invasive
mitral valve surgery: Study protocol for a randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 76. Date of
Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recent data have highlighted a higher rate of neurological
injuries in minimal invasive mitral valve surgery (MIMVS) compared with
the standard sternotomy approach; therefore, the role of specific clamping
techniques and perfusion strategies on the occurrence of this complication
is a matter of discussion in the medical literature. The purpose of this
trial is to prospectively evaluate major, minor and silent neurological
events in patients undergoing right mini-thoracotomy mitral valve surgery
using retrograde perfusion and an endoaortic clamp or a transthoracic
clamp. Methods/design: A prospective, blinded, randomized controlled study
on the rate of neurological embolizations during MIMVS started at the
University of Turin in June 2014. Major, minor and silent neurological
events are being investigated through standard neurological evaluation and
magnetic resonance imaging assessment. The magnetic resonance imaging
protocol includes conventional sequences for the morphological and
quantitative assessment and nonconventional sequences for the white matter
microstructural evaluation. Imaging studies are performed before surgery
as baseline assessment and on the third postoperative day and, in patients
who develop postoperative ischemic lesions, after 6 months. Discussion:
Despite recent concerns raised about the endoaortic setting with
retrograde perfusion, we expect to show equivalence in terms of
neurological events of this technique compared with the transthoracic
clamp in a selected cohort of patients. With the first results expected in
December 2016 the findings would be of help in confirming the efficacy and
safety of MIMVS. Trial registration: ClinicalTrials.gov, Identifier:
NCT02818166. Registered on 8 February 2016 - trial retrospectively
registered. Copyright &#xa9; The Author(s).

<91>
Accession Number
614518952
Author
Mitaka C.; Ohnuma T.; Murayama T.; Kunimoto F.; Nagashima M.; Takei T.;
Iguchi N.; Tomita M.
Institution
(Mitaka) Department of Anesthesiology, Tokyo Medical and Dental University
Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
(Mitaka) Department of Anesthesiology and Pain Medicine, Juntendo
University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Ohnuma, Murayama) Intensive Care Unit, Department of Anesthesiology,
Saitama Medical Center, Jichi Medical University, 1-847 Amanuma,
Ohmiya-ku, Saitama 330-8503, Japan
(Kunimoto) Intensive Care Unit, Gunma University Hospital, 3-39-15 Shouwa,
Maebashi, Gunma 371-8511, Japan
(Nagashima, Takei) Intensive Care Unit, Yokohama City Minato Red Cross
Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama, Kanagawa 231-8682,
Japan
(Iguchi) Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka,
Suita, Osaka 565-0871, Japan
(Tomita) Clinical Research Center, Tokyo Medical and Dental University
Hospital of Medicine 1-5-45 Yushima, Tokyo 113-8519, Japan
Title
Effects of low-dose atrial natriuretic peptide infusion on cardiac
surgery-associated acute kidney injury: A multicenter randomized
controlled trial.
Source
Journal of Critical Care. 38 (pp 253-258), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Purpose To evaluate the effects of atrial natriuretic peptide (ANP) on
renal function and medical costs in patients with acute kidney injury
(AKI) associated with cardiac surgery. Materials and methods The Japanese
trial for AKI in Post-cardiovascular surgery patients by ANP (JAPAN) was a
prospective, multicenter, randomized, double-blind, placebo-controlled
study conducted in 11 hospitals in Japan. Acute kidney injury was defined
as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours.
The patients were randomly assigned to receive ANP (0.02 mug
kg^-1 min^-1) or placebo. The primary end point was a
change in renal function. The secondary end points were a need for renal
replacement therapy, the lengths of intensive care unit and hospital
stays, and medical costs incurred over the 90-day follow-up. Results Of
the 77 randomized patients, 37 were in the ANP group and 40 were in the
placebo group. Although ANP significantly (P =.018) increased urine
output, it did not significantly improve renal function compared with
placebo. There were no significant differences between the groups in the
renal replacement therapy rate, the lengths of the intensive care unit and
hospital stays, or medical costs. Conclusion Atrial natriuretic peptide
infusion did not show a renoprotective effect or cost-saving effect in the
treatment of cardiac surgery-associated AKI. Copyright &#xa9; 2016 The
Authors

<92>
Accession Number
614518941
Author
Liu X.; Xie G.; Zhang K.; Song S.; Song F.; Jin Y.; Fang X.
Institution
(Liu, Xie, Zhang, Song, Song, Jin, Fang) Department of Anesthesiology and
Intensive Care Medicine, the First Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou, China
Title
Dexmedetomidine vs propofol sedation reduces delirium in patients after
cardiac surgery: A meta-analysis with trial sequential analysis of
randomized controlled trials.
Source
Journal of Critical Care. 38 (pp 190-196), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Purpose It is uncertain whether dexmedetomidine is better than propofol
for sedation in postcardiac surgery patients. The purpose of this
meta-analysis was to compare the effects of dexmedetomidine and propofol
sedation on outcomes in adult patients after cardiac surgery. Methods
Randomized controlled trials comparing outcomes in cardiac surgery
patients sedated with dexmedetomidine or propofol were retrieved from
PubMed, Embase, Web of Science, the Cochrane Library, and
Clinicaltrials.Gov until May 23, 2016. Results A total of 969 patients in
8 studies met the selection criteria. The results revealed that
dexmedetomidine was associated with a lower risk of delirium (risk ratio,
0.40;95% confidence interval [CI], 0.24-0.64; P =.0002), a shorter length
of intubation (hours; mean difference, - 0.95; 95% CI, - 1.26 to - 0.64; P
<.00001), but a higher incidence of bradycardia (risk ratio 3.17; 95% CI,
1.41-7.10; P =.005) as compared to propofol. There were no statistical
differences in the incidence of hypotension or atrial fibrillation, or the
length of intensive care unit stay between dexmedetomidine and propofol
sedation regimens. Conclusions Dexmedetomidine sedation could reduce
postoperative delirium and was associated with shorter length of
intubation, but might increase bradycardia in patients after cardiac
surgery compared with propofol. Copyright &#xa9; 2016 The Authors

<93>
Accession Number
614518935
Author
Brascia D.; Garcia-Medina N.; Kinnunen E.-M.; Tauriainen T.; Airaksinen
J.; Biancari F.
Institution
(Brascia, Garcia-Medina, Kinnunen, Tauriainen, Biancari) Department of
Surgery, Oulu University Hospital, Oulu, Finland
(Airaksinen) Heart Center, Turku University Hospital, Turku, Finland
Title
Impact of transfusion on stroke after cardiovascular interventions:
Meta-analysis of comparative studies.
Source
Journal of Critical Care. 38 (pp 157-163), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Purpose To evaluate the impact of transfusion on the development of stroke
after cardiovascular interventions. Methods A literature search was
performed to identify comparative studies on the impact of blood
transfusion on the occurrence of stroke after adult cardiac surgery and
interventional cardiology procedures. Results Twenty-four studies compared
the outcome of 80 283 patients who received and 2 260 709 patients who did
not receive blood transfusion after cardiovascular interventions. Pooled
analysis showed that transfused patients had a higher risk of
postoperative stroke (2.1% vs 0.9%; P <.001; risk ratio [RR], 2.563; 95%
confidence interval [CI], 1.615-4.069; I² = 94%) compared with
patient who did not receive blood transfusion. The leave-one-out analysis
confirmed the consistency of the overall series (RR ranged from 2.367 [95%
CI, 1.978-2.834] to 2.676 [95% CI, 1.679-4.265]). Transfusion was
associated with increased risk of stroke after either interventional
cardiology interventions (3.2% vs 1.1%; RR, 3.325; 95% CI, 1.579-7.004) or
cardiac surgery (1.9% vs 0.8%; RR, 2.260; 95% CI, 1.845-2.769). Generic
inverse variance analysis of 11 studies reporting adjusted odds ratios for
baseline characteristics showed that transfusion after cardiovascular
interventions was an independent predictor of stroke (RR, 1.53; 95% CI,
1.10-2.14; I² = 0%). Conclusion Blood transfusion is associated
with a significantly increased risk of postoperative stroke in patients
undergoing cardiovascular interventions. Registration The present
meta-analysis is registered in PROSPERO, code CRD42016046426. Copyright
&#xa9; 2016 Elsevier Inc.

<94>
Accession Number
614518928
Author
Zhu Y.; Yin H.; Zhang R.; Wei J.
Institution
(Zhu, Yin, Zhang) Department of Intensive Care Unit, Guangzhou Red Cross
Hospital, Medical College, Jinan University, Guangzhou, Guangdong 510220,
China
(Wei) Department of Cardiology, Guangzhou Red Cross Hospital, Medical
College, Jinan University, Guangzhou, Guangdong 510220, China
Title
High-flow nasal cannula oxygen therapy vs conventional oxygen therapy in
cardiac surgical patients: A meta-analysis.
Source
Journal of Critical Care. 38 (pp 123-128), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Introduction The use of high-flow nasal cannula (HFNC) for the treatment
of many diseases has gained increasing popularity. In the present
meta-analysis, we aimed to assess the efficacy and safety of HFNCs
compared with conventional oxygen therapy (COT) in adult postextubation
cardiac surgical patients. Method We reviewed the Embase, PubMed, Cochrane
Central Register of Controlled Trials, Wanfang databases, and the China
National Knowledge Infrastructure. Two investigators independently
collected the data and assessed the quality of each study. RevMan 5.3 was
used for the present meta-analysis. Results We included 495 adult
postextubation cardiac surgical patients. There was no significant
heterogeneity among the studies. Compared with COT, HFNCs were associated
with a significant reduction in the escalation of respiratory support
(risk ratio, 0.61; 95% confidence interval [CI], 0.46-0.82; z = 3.32, P
<.001). There were no significant differences in the reintubation rate
(risk ratio, 0.96; 95% CI, 0.04-24.84; z = 0.02, P =.98) or length of
intensive care unit stay (weighted mean difference, 0.13; 95% CI, -0.88 to
7.92; z = 1.57, P =.12) between the 2 groups. No severe complications were
reported in either group. Conclusions The HFNC could reduce the need for
escalation of respiratory support compared with COT, and it could be
safely administered in adult postextubation cardiac surgical patients.
Copyright &#xa9; 2016 Elsevier Inc.

<95>
Accession Number
614515058
Author
Duque-Sosa P.; Martinez-Urbistondo D.; Echarri G.; Callejas R.; Iribarren
M.J.; Rabago G.; Monedero P.; Garcia-Fernandez N.; Garcia C.; Barrios
J.M.; Novoa E.; Hualde J.B.; Pascual O.A.; Alvarez S.C.; Astillero I.P.;
Moreira B.C.; Iradier P.H.; Caballero L.-M.P.; Mate R.G.; Hernandez J.P.;
Crespo M.-J.T.; Panero B.M.; Bronchal M.-J.D.; Garcia-Heras E.A.; Refojo
F.A.; Arias L.F.; Suarez F.E.F.; Fraile L.I.; Roux C.; Belda I.; Matute
P.; Gomez E.T.; Alvarez-Fuente E.; Ruiz-Granado P.; Aguilar G.;
Garcia-Marquez C.; Fernando C.; Puig J.; Carbonell J.A.; Arocas B.;
Badenes R.; Pastor E.; Gomez A.; Belda F.J.; Rodriguez M.O.; Barcena M.A.;
Hernandez J.A.B.; Loureiro M.A.P.; Caamano R.P.-R.; Martinez M.A.V.;
Vazquez V.V.; Alvarez A.L.; Lorenzo C.E.; Fernandez A.R.; Tamayo J.P.;
Rodriguez G.B.; Lamas M.V.; Martinez S.J.; Gomez A.C.; Siguenza J.B.F.;
Garcia E.B.; Contreras J.M.M.; Irriguible T.T.; Marti P.R.; Del Campo
M.T.M.; Nunez A.G.S.; Brey A.G.; Collado I.G.; Casas R.B.; Garciperez
J.F.; Giralt S.S.; Rico G.A.; Toha A.C.; Roux D.P.; Martin L.G.; Borja
M.M.; Pajares A.D.P.; De Las Heras B.P.; Martin E.E.; Perez P.A.; Dapena
R.C.; Lopez S.A.; TorrentsFernandez M.A.; Gonzalez M.D.C.; PerisCuello X.;
RomaGarcia-Campomanes F.; Del Campo A.G.; Seoane E.C.; Palacios V.B.;
Alvarez A.C.; Cardenal M.F.L.; Belaustegui M.C.; Lera M.R.; Martinez N.R.;
Genoves D.B.; Moreno C.L.A.; Rubio R.J.; Fernandez F.J.G.; Cuadros S.I.;
Marquez E.A.; Gonzalez F.F.; Sanchez M.G.; Luque A.G.; Navarro M.R.;
Ortega M.G.; Oriach J.G.; Galo M.N.; Arce I.N.; Amaya J.F.; Dominguez
C.B.; Varo D.C.; Guerrero J.M.A.; Ysasi A.
Institution
(Duque-Sosa, Echarri, Callejas, Iribarren, Monedero, Garcia-Fernandez)
Department of Anesthesia and Critical Care, Clinica Universidad de
Navarra, Pamplona, Navarra, Spain
(Martinez-Urbistondo) Department of Internal Medicine, Division of
Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra,
Pamplona, Navarra, Spain
(Rabago) Department of Cardiovascular Surgery, Clinica Universidad de
Navarra, Pamplona, Navarra, Spain
(Garcia) Hospital General de Alicante, Spain
(Barrios, Novoa) Hospital Gregorio Maranon de Madrid, Spain
(Hualde, Pascual, Alvarez) Complejo Hospitalario de Navarra, Spain
(Astillero, Moreira, Iradier, Caballero, Mate, Hernandez, Crespo, Panero,
Bronchal, Garcia-Heras) Complejo Hospitalario Toledo, Spain
(Refojo, Arias) Complejo Hospitalario Universitario A Coruna, Spain
(Suarez, Fraile) Hospital Central de Asturias, Spain
(Roux, Belda, Matute) Hospital Clinic Barcelona, Spain
(Gomez, Alvarez-Fuente, Ruiz-Granado) Hospital Clinico Universitario de
Valladolid, Spain
(Aguilar, Garcia-Marquez, Fernando, Puig, Carbonell, Arocas, Badenes,
Pastor, Gomez, Belda) Hospital Clinico Universitario Valencia, Spain
(Rodriguez, Barcena, Hernandez) Hospital de Basurto Bilbao, Spain
(Loureiro, Caamano, Martinez, Vazquez, Alvarez, Lorenzo, Fernandez,
Tamayo, Rodriguez, Lamas) Hospital Do Meixoeiro Vigo, Spain
(Martinez, Gomez, Siguenza, Garcia, Contreras, Irriguible, Marti, Del
Campo, Nunez, Brey) Hospital Germans Trias i Pujol, Spain
(Collado, Casas, Garciperez, Giralt, Rico) Hospital Infanta Cristina de
Badajoz, Spain
(Toha, Roux, Martin, Borja, Pajares, De Las Heras, Martin, Perez, Dapena,
Lopez) Hospital Ramon y Cajal Madrid, Spain
(TorrentsFernandez, Gonzalez, PerisCuello, RomaGarcia-Campomanes, Del
Campo) Hospital Universitari Vall d'Hebron, Spain
(Seoane) Hospital Universitario Puerta del Mar de Cadiz, Spain
(Palacios, Alvarez, Cardenal, Belaustegui, Lera, Martinez) Hospital
Valdecilla Santander, Spain
(Genoves, Moreno, Rubio) Hospital Virgen Arrixaca Murcia, Spain
(Fernandez, Cuadros, Marquez, Gonzalez, Sanchez) Hospital Virgen Macarena
Sevilla, Spain
(Luque, Navarro, Ortega, Oriach, Galo, Arce, Amaya, Dominguez, Varo,
Guerrero) Hospital Virgen Victoria Malaga, Spain
(Ysasi) Hospital Rambla Tenerife, Spain
Title
Perioperative hemoglobin area under the curve is an independent predictor
of renal failure after cardiac surgery. Results from a Spanish multicenter
retrospective cohort study.
Source
PLoS ONE. 12 (2) (no pagination), 2017. Article Number: e0172021. Date of
Publication: February 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Perioperative anemia is an important risk factor for cardiac
surgery-associated acute kidney injury (CSA-AKI). Nonetheless, the
severity of the anemia and the time in the perioperative period in which
the hemoglobin level should be considered as a risk factor is conflicting.
The present study introduces the concept of perioperative hemoglobin area
under the curve (pHb-AUC) as a surrogate marker of the evolution of
perioperative hemoglobin concentration. Through a retrospective analysis
of prospectively collected data, we assessed this new variable as a risk
factor for the development of acute kidney injury after cardiac surgery in
966 adult patients who underwent cardiac surgery with cardiopulmonary
bypass, at twentythree academic hospitals in Spain. Exclusion criteria
were patients on renal replacement therapy, who needed a reoperation
because of bleeding and/or with missing perioperative hemoglobin or
creatinine values. Using a multivariate regression analysis, we found that
a pHb-AUC <19 g/dL was an independent risk factor for CSA-AKI even after
adjustment for intraoperative red blood cell transfusion (OR 1.41, p
<0.05). It was also associated with mortality (OR 2.48, p <0.01) and
prolonged hospital length of stay (4.67 +/- 0.99 days, p <0.001) Copyright
&#xa9; 2017 Duque-Sosa et al. This is an open access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<96>
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.

<97>
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).

<98>
Accession Number
614482803
Author
Li B.; Lang X.; Cao L.; Wang Y.; Lu Y.; Feng S.; Yang Y.; Chen J.; Jiang
H.
Institution
(Li, Lang, Cao, Wang, Lu, Feng, Yang, Chen, Jiang) Kidney Disease Center,
The First Affiliated Hospital, School of Medicine, Zhejiang University,
Qinchun Road 79#, Hangzhou 310003, China
(Li, Lang, Cao, Wang, Lu, Feng, Yang, Chen, Jiang) Kidney Disease
Immunology Laboratory, The Third Grade Laboratory, State Administration of
Traditional Chinese Medicine of P.R. China, Hangzhou, China
(Li, Lang, Cao, Wang, Lu, Feng, Yang, Chen, Jiang) Key Laboratory of
Multiple Organ Transplantation, Ministry of Health, Hangzhou, China
(Li, Lang, Cao, Wang, Lu, Feng, Yang, Chen, Jiang) Key Laboratory of
Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, China
Title
Effect of remote ischemic preconditioning on postoperative acute kidney
injury among patients undergoing cardiac and vascular interventions: a
meta-analysis.
Source
Journal of Nephrology. 30 (1) (pp 19-33), 2017. Date of Publication: 01
Feb 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
It is currently controversial whether remote ischemic preconditioning
(RIPC) reduces the incidence of acute kidney injury (AKI) in patients
undergoing cardiovascular interventions. The main objective of this
meta-analysis was to investigate whether RIPC provides renal protection
for patients undergoing cardiac or vascular surgery. We searched the
PubMed database (1966-Oct 2015), Embase database (1966-Oct 2015), Google
Scholar, Cochrane Library, ClinicalTrials Database and Open Grey. Then we
conducted a meta-analysis of the randomized controlled trials that met the
inclusion criteria of our study. The interventions included use of an
inflatable tourniquet around the limbs or cross-clamping of the iliac
arteries before surgery (RIPC groups) and general cardiovascular
intervention (control groups). The main outcomes examined included the
incidence of AKI; changes in acute kidney injury biomarkers; and use of
renal replacement therapy. Other outcomes examined included in-hospital
mortality and the lengths of hospital stay and intensive care unit (ICU)
stay. Finally, we screened 26 eligible studies containing 6699 patients
who underwent cardiac or vascular interventions with RIPC (n = 3343) or
without RIPC (n = 3356). The AKI incidence was decreased in the RIPC group
as was the length of ICU stay. There were no differences in the changes in
AKI biomarkers, use of renal replacement therapy or in-hospital mortality
between the two groups. Remote ischemic preconditioning may decrease the
occurrence of AKI in cardiovascular surgery patients. Since studies
included have a significant heterogeneity, meta-analyses using a stricter
inclusion criteria are needed to clarify the renoprotection effect of
RIPC. Copyright &#xa9; 2016, The Author(s).

<99>
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.

<100>
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

<101>
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.

<102>
Accession Number
614517183
Author
Putzu A.; Boscolo Berto M.; Belletti A.; Pasotti E.; Cassina T.; Moccetti
T.; Pedrazzini G.
Institution
(Putzu, Cassina) Department of Cardiovascular Anesthesia and Intensive
Care, Cardiocentro Ticino, Lugano, Switzerland
(Boscolo Berto, Pasotti, Moccetti, Pedrazzini) Department of Cardiology,
Cardiocentro Ticino, Lugano, Switzerland
(Belletti) Department of Anesthesia and Intensive Care, Istituto di
Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific
Institute, Milan, Italy
Title
Prevention of Contrast-Induced Acute Kidney Injury by Furosemide With
Matched Hydration in Patients Undergoing Interventional Procedures: A
Systematic Review and Meta-Analysis of Randomized Trials.
Source
JACC: Cardiovascular Interventions. 10 (4) (pp 355-363), 2017. Date of
Publication: 27 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The objective of this meta-analysis of randomized trials was to
evaluate if the administration of furosemide with matched hydration using
the RenalGuard System reduces contrast-induced acute kidney injury
(CI-AKI) in patients undergoing interventional procedures. Background
CI-AKI is a serious complication following angiographic procedures and a
powerful predictor of unfavorable early and long-term outcomes. Methods
Online databases were searched up to October 1, 2016, for randomized
controlled trials. The primary outcome was the incidence of CI-AKI, and
the secondary outcomes were need for renal replacement therapy, mortality,
stroke, and adverse events. Results A total of four trials (n = 698)
published between 2011 and 2016 were included in the analysis and included
patients undergoing percutaneous coronary procedures and transcatheter
aortic valve replacement. RenalGuard therapy was associated with a lower
incidence of CI-AKI compared with control treatment (27 of 348 [7.76%]
patients vs. 75 of 350 [21.43%] patients; odds ratio [OR]: 0.31; 95%
confidence interval [CI]: 0.19 to 0.50; I² = 4%; p < 0.00001)
and with a lower need for renal replacement therapy (2 of 346 [0.58%]
patients vs. 12 of 348 [3.45%] patients; OR: 0.19; 95% CI: 0.05 to 0.76;
I² = 0%; p = 0.02). No major adverse events occurred in
patients undergoing RenalGuard therapy. Conclusions The main finding of
this meta-analysis is that furosemide with matched hydration by the
RenalGuard System may reduce the incidence of CI-AKI in high-risk patients
undergoing percutaneous coronary intervention or transcatheter aortic
valve replacement. However, further independent high-quality randomized
trials should elucidate the effectiveness and safety of this prophylactic
intervention in interventional cardiology. Copyright &#xa9; 2017 American
College of Cardiology Foundation

<103>
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

<104>
Accession Number
614570177
Author
Xiong B.; Nie D.; Cao Y.; Zou Y.; Yao Y.; Qian J.; Rong S.; Huang J.
Institution
(Xiong, Cao, Zou, Yao, Qian, Rong, Huang) Department of Cardiology, The
Second Affiliated Hospital of Chongqing Medical University, Chongqing
400010, China
(Nie) Department of Gastroenterology, The First Affiliated Hospital of
Chengdu Medical College, Chengdu, Sichuan, 610500, China
Title
Preoperative Statin Treatment for the Prevention of Acute Kidney Injury in
Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomised
Controlled Trials.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
July 19, 2016.
Publisher
Elsevier Ltd
Abstract
Background: The effect of preoperative statin treatment (PST) on the risk
of postoperative acute kidney injury (AKI) after cardiac surgery remains
controversial. We performed a meta-analysis of randomised controlled
trials (RCT) to investigate whether PST could improve the renal outcomes
in patients undergoing cardiac surgery. Methods: We conducted a
comprehensive search on PubMed, Embase and Cochrane Central Register of
Controlled Trials. Randomised controlled trials which reported incidence
of AKI and renal replacement treatment (RRT), mean change of serum
creatine (SCr) and C-reactive protein (CRP), length of stay in intensive
care unit (LOS-ICU) and hospital (LOS-HOS) were included. Results: A total
of nine RCTs, covering 3,201 patients were included. Based on the results
of our meta-analysis, PST could not reduce the incidence of AKI (risk
ratio (RR) 1.12, 95% confidence interval (CI) 0.97 to 1.29, p = 0.37), and
RRT (RR 1.13, 95% CI 0.45 to 2.85, p = 0.80). Furthermore, SCr was not
likely to be improved by PST (weighted mean difference (WMD) 0.03, 95% CI
0.00 to 0.06, p = 0.055). However, the level of CRP (WMD -5.93, 95% CI
11.71 to 0.15, p = 0.044) in patients treated with PST was significantly
lower than that of patients administered with placebo. In addition, no
significant difference was observed in LOS-ICU and LOS-HOS between PST and
control groups. Conclusion: Our meta-analysis suggests that PST cannot
provide any benefit for improving renal complications and clinical
outcomes, but may slightly reduce postoperative inflammation in patients
undergoing cardiac surgery. In the future, more powerful RCTs will be
needed to confirm these findings. Copyright &#xa9; 2017 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ).

<105>
Accession Number
614559816
Author
Nelson L.M.; Andreassen A.K.; Andersson B.; Gude E.; Eiskjaer H.; Radegran
G.; Dellgren G.; Gullestad L.; Gustafsson F.
Institution
(Nelson) 1 Department of Cardiology, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark. 2 Department of Cardiology, Oslo
University Hospital, Rikshospitalet, and Faculty of Medicine, University
of Oslo, Oslo, Norway. 3 Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden. 4 Department of Cardiology, Aarhus
University Hospital, Skejby, Aarhus, Denmark. 5 The Section for Heart
Failure and Valvular Disease, Skane University Hospital and Lund
University, Department of Clinical Sciences, Cardiology, Lund, Sweden. 6
Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
Title
Effect of Calcineurin Inhibitor-Free Everolimus-Based Immunosuppressive
Regimen on Albuminuria and Glomerular Filtration Rate after Heart
Transplantation.
Source
Transplantation. (no pagination), 2017. Date of Publication: 23 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Albuminuria in maintenance heart transplantation (HTx) is
associated with poor renal response when switching to a calcineurin
inhibitor (CNI)-lowered or free immunosuppressive regimen using everolimus
(EVR), but the significance of albuminuria associated with EVR treatment
after early CNI withdrawal in de novo HTx is unknown. METHODS: We tested
if glomerular filtration rate (mGFR, measured by CrEDTA clearance) was
associated with urine albumin/creatinine ratio (UACR) post-HTx in a
subgroup of patients included in the SCHEDULE trial, where de novo HTx
patients (n=115) were randomized to EVR with complete CNI elimination 7-11
weeks post-HTx or standard CNI immunosuppression. RESULTS: In 66 patients
UACR measures were available at 1 year. In 7 patients in the EVR group a
CNI was reintroduced within 12 months. Median mGFR was significantly
higher in the EVR group both 1 and 3 years post-HTx (p=0.0004, p=0.03).
Median UACR at 1 year was significantly higher in the EVR group (p=0.002).
There was no correlation between log(UACR) at 1 year and mGFR at 1 or 3
years (r=-0.01, p=0.9; r=0.15, p=0.26), and in the EVR group nor between
log(UACR) at 1 year and change in mGFR (DELTA1-3 years) (r=0.27, p=0.14).
Excluding patients in the EVR group in whom a CNI was reintroduced did not
significantly change the results. CONCLUSIONS: The effects of EVR with
early CNI withdrawal after HTx on albuminuria and renal function appear
dissociated; hence the clinical significance of albuminuria in this
setting is uncertain and should not necessarily rule out EVR-based
immunosuppression. Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All
rights reserved.

<106>
Accession Number
614558803
Author
Tabarsi N.; Guan M.; Simmonds J.; Toma M.; Kiess M.; Tsang V.; Ruygrok P.;
Konstantinov I.; Shi W.; Grewal J.
Institution
(Tabarsi, Guan, Toma, Kiess, Grewal) Division of Cardiology, St. Paul's
Hospital, University of British Columbia, Vancouver, British Columbia,
Canada
(Simmonds, Tsang) Division of Cardiology, Great Ormond Street Hospital for
Children, London, United Kingdom
(Ruygrok) Division of Cardiology, Auckland City Hospital, Auckland, New
Zealand
(Konstantinov, Shi) Division of Cardiothoracic Surgery, Royal Children's
Hospital, Melbourne, Australia
Title
Meta-Analysis of the Effectiveness of Heart Transplantation in Patients
With a Failing Fontan.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: September 07, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The Fontan procedure is increasingly being used to palliate univentricular
physiology. It is a complex anatomic and physiologic repair that can fail
at any age, often leaving heart transplantation as the only remaining
solution. A meta-analysis was performed to achieve the aim of
systematically evaluating the existing evidence for survival after heart
transplantation in patients who have undergone a Fontan palliation.
MEDLINE, Embase, PubMed, and Web of Science were searched for original
research studies. The primary outcome was mortality at 1 and 5 years after
transplantation. Five hundred eighty-two records were screened, after the
removal of duplicates, 12 retrospective observational studies were
selected for inclusion in our meta-analysis. This encompassed a total of
351 Fontan patients undergoing heart transplantation. Mean age was 14
years (range 7 to 24 years) and 65% were men. One- and 5-year survival
rates after heart transplantation were found to be 80.3% (95% CI 75.9% to
84.2%) and 71.2% (95% CI 66.3% to 75.7%), respectively. No significant
association was found between age, gender, and pulmonary pressures and
1-year mortality. In conclusion, in the largest analysis to date, we found
that heart transplantation in younger patients after Fontan procedure has
an acceptable early and mid-term mortality. It is comparable to published
mortality data of heart transplantation for other forms of congenital
heart disease. Heart transplantation in the younger failing Fontan
population appears to be a reasonable option when all other avenues have
been exhausted and appropriate screening has taken place. Copyright &#xa9;
2017 Elsevier Inc.

<107>
Accession Number
614533311
Author
Rafiq S.; Johansson P.I.; Kofoed K.F.; Lund J.T.; Olsen P.S.; Bentsen S.;
Steinbruchel D.A.
Institution
(Rafiq, Lund, Olsen, Bentsen, Steinbruchel) Department of Cardiothoracic
Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital,
Copenhagen O, Denmark
(Johansson) Capital Region Blood Bank, Section for Transfusion Medicine,
Rigshospitalet, Copenhagen University Hospital, Copenhagen O, Denmark
(Kofoed) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen O, Denmark
Title
Thrombelastographic hypercoagulability and antiplatelet therapy after
coronary artery bypass surgery (TEG-CABG trial): a randomized controlled
trial.
Source
Platelets. (pp 1-8), 2017. Date of Publication: 24 Feb 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
A hypercoagulable state has, in observational studies, been associated
with increased risk of thromboembolic events. The aim of this trial was to
study whether dual antiplatelet therapy (DAPT) with clopidogrel in
addition to aspirin could reduce the rate of graft occlusions,
thromboembolic events, and death compared to aspirin monotherapy in
hypercoagulable patients undergoing coronary artery bypass surgery. A
total of 1683 patients were screened for eligibility, among which 165
patients were randomized and 133 patients underwent multislice computed
tomography scan to evaluate their grafts. Thrombelastography (TEG) and
multiplate aggregometry were performed before and after surgery, and again
at three months follow up. TEG hypercoagulability was defined as the
maximum amplitude above 69 mm. At three months follow up, 17 out of 66
(25.7%) DAPT patients and 15 of 67 (22.4%) aspirin patients had
significant graft stenosis or occlusions (p = 0.839). Saphenous vein
grafts (SVGs) were stenosed or occluded in 15 (22.7%) patients in the DAPT
group and 7 (10.4%) in the aspirin group (p = 0.167). Thromboembolic
events and death after the second postoperative day (when clopidogrel was
started) were numerically, but not statistically, lower in the DAPT group,
3 (3.8%) vs. 8 (9.9%), p = 0.211. In univariate logistic regression
analysis, only postoperative day 4 platelet response to aspirin measured
with multiplate was correlated with graft occlusion, OR 1.020
[1.002-1.039], p = 0.033. This is the first trial to test the hypothesis
of intensified antiplatelet therapy in hypercoagulable patients. Due to
the low enrollment and high loss to follow up, our results can only be
viewed as hypothesis generating. We found a high rate of graft occlusions
in this patient population. Our results were not suggestive of that DAPT
improved saphenous vein graft patency. A trend was observed in patients on
DAPT toward fewer MI and deaths. Postoperative response to aspirin therapy
was found to be associated with early SVG occlusion. Copyright &#xa9; 2017
Taylor & Francis

<108>
Accession Number
614529437
Author
Ip W.T.K.; Chandramouli C.; Smith J.A.; McLennan P.L.; Pepe S.; Delbridge
L.M.D.
Institution
(Ip, Chandramouli, Delbridge) Cardiac Phenomics Laboratory, Department of
Physiology, University of Melbourne, Melbourne, Vic, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Monash
University, Melbourne, Vic, Australia
(Smith) Department of Surgery, School of Clinical Sciences at Monash
Health, Monash University, Melbourne, Vic, Australia
(McLennan) Graduate School of Medicine, Centre for Human Applied
Physiology, University of Wollongong, Sydney, NSW, Australia
(Pepe) Murdoch Children's Research Institute, Department of Paediatrics,
University of Melbourne, Royal Children's Hospital, Melbourne, Vic,
Australia
Title
A Small Cohort Omega-3 PUFA Supplement Study: Implications of Stratifying
According to Lipid Membrane Incorporation in Cardiac Surgical Patients.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
September 16, 2015.
Publisher
Elsevier Ltd
Abstract
Background: Epidemiological studies and randomised clinical trials (RCTs)
report disparate findings in relation to omega-3 polyunsaturated fatty
acids (n-3 PUFA) benefit for cardiac patients. With RCTs interpretation is
potentially confounded by background n-3 PUFA intake. The goal of this
pilot, small cohort, pre-surgical supplementation study was to evaluate
postoperative atrial fibrillation (AF) and cardiac molecular expression
profiles employing two data analysis approaches - by treatment
randomisation and by stratification using measured n-3 PUFA. Methods:
Patients (n = 20) received 3. g/day of fish or placebo oil (FO vs PO) in a
double blind randomised protocol prior to elective coronary artery graft
and valve surgery. Groups were matched for age, gender, and mean treatment
duration (~20 days). Resected atrial myocardium was sampled for assay of
viability metabolic markers, and blood obtained for erythrocyte membrane
lipid measurement. Results: There was substantial overlap of cell membrane
n-3 PUFA content across PO and FO groups, and no group treatment effects
on AF incidence or myocardial molecular marker levels were detected. In
contrast, data stratification using membrane n-3 PUFA content (at 8% total
membrane lipid) achieved significant separation of patients (by n-6:n-3
PUFA ratio), a significant differential cardiac expression of the marker
peroxisomal proliferator-activated receptor, but no difference in AF
incidence. Conclusions: This small n-3 PUFA case study demonstrates that
the same cohort may yield differing findings when evaluated using
randomisation or stratification approaches based on direct molecular
measures in cell membranes. Copyright &#xa9; 2017 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ).

<109>
Accession Number
614524495
Author
Scholz-Kreisel P.; Spix C.; Blettner M.; Eckerle S.; Faber J.; Wild P.;
Merzenich H.; Hennewig U.
Institution
(Scholz-Kreisel, Blettner, Merzenich) Institute for Medical Biostatistics,
Epidemiology and Informatics University Medicine of the Johannes
Gutenberg-University Mainz Mainz Germany
(Spix) German Childhood Cancer Registry at the Institute for Medical
Biostatistics, Epidemiology and Informatics University Medicine of the
Johannes Gutenberg-University Mainz Mainz Germany
(Eckerle, Faber) Department of Pediatric Hematology/Oncology University
Medicine of the Johannes Gutenberg-University Mainz Mainz Germany
(Wild) Preventive Cardiology and Preventive Medicine, Center for
Cardiology University Medical Center of the Johannes Gutenberg-University
Mainz Mainz Germany
(Wild) Center for Thrombosis and Hemostasis University Medical Center of
the Johannes Gutenberg-University Mainz Mainz Germany
(Wild) German Center for Cardiovascular Research (DZHK), Partner Site
RhineMain Mainz Germany
(Wild) Center for Translational Vascular Biology (CTVB) University Medical
Center of the Johannes Gutenberg-University Mainz Mainz Germany
(Hennewig) Department of Paediatric Haematology and Oncology Center for
Paediatrics, University Hospital Giesen and Marburg Giessen Germany
Title
Prevalence of cardiovascular late sequelae in long-term survivors of
childhood cancer: A systematic review and meta-analysis.
Source
Pediatric Blood and Cancer. (no pagination), 2017. Date of Publication:
2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Cardiovascular diseases are well-known late effects of
childhood cancer and research on these late effects is a highly important
emerging field. We conducted a systematic review with a meta-analysis to
give an overview of the current evidence and the prevalence of late
cardiovascular events. Procedure: We included publications in which the
study populations were children and adolescents who survived cancer.
Outcome was defined as all cardiovascular clinical and subclinical
endpoints or diagnoses appearing at least one year after cancer diagnosis.
A systematic overview is presented for all included studies. A
quantitative meta-analysis was conducted for hypertension and stroke.
Results: Sixty-four papers were included in the review. The age range at
cancer diagnosis was 0-24 years; age at the end of follow-up ranged from 7
to 71 years. Prevalence of cardiovascular late effects varied from 0% for
stroke up to 70% for subclinical hypertension. Large heterogeneity was
found regarding study size, study design, definition of endpoints, and
investigation/examination method. The weighted average prevalence was
19.7% for hypertension and 2.3% for stroke. As no specific results for
gender, cancer therapy, or age at cancer diagnosis were present in most
papers, a detailed comparison and pooled analysis was difficult.
Conclusion: This review showed the vast range of cardiovascular late
effects after childhood or adolescent cancer therapy. The differences
between the papers prevented drawing a conclusive picture of the
prevalence of cardiovascular late effects. Large cohort studies and better
reporting are needed to improve the knowledge on this topic. Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<110>
Accession Number
614518916
Author
Cevallos P.C.; Armstrong A.K.; Glatz A.C.; Goldstein B.H.; Gudausky T.M.;
Leahy R.A.; Petit C.J.; Shahanavaz S.; Trucco S.M.; Bergersen L.J.
Institution
(Cevallos, Bergersen) Department of CardiologyBoston Children's
HospitalBoston, Massachusetts
(Armstrong) Department of CardiologyNationwide Children's
HospitalColumbus, Ohio
(Glatz) Cardiac Center, The Children's Hospital of
PhiladelphiaPhiladelphia, Pennsylvania
(Goldstein) Department of CardiologyCincinnati Children's
HospitalCincinnati, Ohio
(Gudausky) Division of CardiologyChildren's Hospital of
WisconsinMilwaukee, Wisconsin
(Leahy) Department of CardiologyKosair Children's HospitalLouisville,
Kentucky
(Petit) Department of CardiologyChildren's Healthcare of Atlanta Sibley
Heart CenterAtlanta
(Shahanavaz) Division of Pediatric CardiologySt. Louis Children's
HospitalSt. Louis, Missouri
(Trucco) Division of Pediatric CardiologyChildren's Hospital of
PittsburghPittsburgh, Pennsylvania
Title
Radiation dose benchmarks in pediatric cardiac catheterization: A
prospective multi-center C3PO-QI study.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study sought to update benchmark values to use a quality
measure prospectively. Background: Congenital Cardiac Catheterization
Outcomes Project - Quality Improvement (C3PO-QI), a multi-center registry,
defined initial radiation dose benchmarks retrospectively across common
interventional procedures. These data facilitated a dose metric endorsed
by the American College of Cardiology in 2014. Methods: Data was collected
prospectively by 9 C3PO-QI institutions with complete case capture between
1/1/2014 and 6/30/2015. Radiation was measured in total air kerma (mGy),
dose area product (DAP) (muGy*M²), DAP per body weight, and
fluoroscopy time (min), and reported by age group as median,
75^th and 95^th%ile for the following six
interventional procedures: (1) atrial septal defect closure; (2) aortic
valvuloplasty; (3) treatment of coarctation of the aorta; (4) patent
ductus arteriosus closure; (5) pulmonary valvuloplasty; and (6)
transcatheter pulmonary valve implantation. Results: The study was
comprised of 1,680 unique cases meeting inclusion criteria. Radiation
doses were lowest for pulmonary valvuloplasty (age <1 yrs, median mGy: 59,
DAP: 249) and highest in transcatheter pulmonary valve implantation (age
>15 yrs, median mGy: 1835, DAP: 17990). DAP/kg standardized outcome
measures across weights within an age group and procedure type
significantly more than DAP alone. Radiation doses decreased for all
procedures compared to those reported previously by both median and median
weight-based percentile curves. These differences in radiation exposure
were observed without changes in median fluoroscopy time. Conclusions:
This study updates previously established benchmarks to reflect QI efforts
over time. These thresholds can be applied for quality measurement and
comparison. Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<111>
Accession Number
614488909
Author
Jennings D.L.; Baker W.L.
Institution
(Jennings) Department of Pharmacy, NewYork Presbyterian Columbia
University Irving Medical Center, New York, NY, United States
(Baker) School of Pharmacy, University of Connecticut, Storrs, CT, United
States
Title
Pre-cardiac transplant amiodarone use is not associated with postoperative
mortality: An updated meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: January 13, 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Amiodarone remains the preferred agent for the treatment and
prevention of life-threatening ventricular arrhythmias in patients with
end-stage heart failure. While several reports suggest that pre-operative
amiodarone exposure worsens outcomes in heart transplant recipients, other
studies have failed to validate this relationship. We sought to clarify
this issue by performing a meta-analysis of the available literature
surrounding this topic. Methods: We searched Medline, SCOPUS and the
Cochrane Central Register of Controlled Trials through December 15th 2016,
as well as proceedings from related conferences over the prior 3years.
Included studies evaluated patients undergoing cardiac transplantation who
had received pre-transplant amiodarone and reported postoperative
mortality. Outcomes were pooled using a Hartung-Knapp random-effects model
producing odds ratios (OR) and 95% confidence intervals (CI). Statistical
heterogeneity was evaluated using the Cochrane Q statistic p-value and
I² value. Publication bias was assessed by visual inspection of
funnel plots and using Egger's weighted regression statistic. Results:
Nine studies including 16,509 participants were included in the overall
analysis. Use of pre-transplant amiodarone was not associated with an
increase in postoperative mortality versus control (OR 1.38, 95% 0.8 to
2.36). Moderate statistical heterogeneity was present (I²
=45.8%, p =0.06); visual inspection of funnel plot analysis did not
suggest publication bias. No association was noted between a longer
duration of follow-up and higher odds of mortality with amiodarone use (p
=0.91). Conclusion: Meta-analysis of the available evidence suggests that
pre-operative amiodarone exposure does not increase mortality in cardiac
transplant recipients. Copyright &#xa9; 2017 Elsevier B.V.

<112>
Accession Number
614485541
Author
Chang Y.-S.; Wang J.-X.; Chang D.-W.
Institution
(Chang) Department of Cardiovascular Surgery, The First Affiliated
Hospital of Xi'an Jiaotong University, Xi'an, China
(Wang) Department of Surgery, The First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
(Chang) Faculty of Mathematics and Information Science, Shaanxi Normal
University, Xi'an, China
Title
Outcomes of Coronary Artery Bypass and Stents for Unprotected Left Main
Coronary Stenosis.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: This study assessed the short-, medium-, and long-term
outcomes of coronary artery bypass grafting vs stenting for patients with
unprotected left main coronary artery disease through a meta-analysis of
randomized controlled trials. Methods: PubMed, Embase, Scopus, Web of
Science, Cochrane Library, and major conference proceedings databases were
systematically searched for randomized controlled trials of coronary
artery bypass grafting compared with stents in unprotected left main
coronary artery disease. End points assessed were all-cause death,
myocardial infarction, major adverse cardiac and cerebrovascular events,
target vessel revascularization, and cerebral stroke. A meta-analysis was
conducted according to predefined clinical end points. Results: All-cause
death and stroke were similar between stenting and coronary artery bypass
grafting at 1 year and at follow-up beyond 1 year. The incidence of
myocardial infarction was similar between stenting and coronary artery
bypass grafting at each separate time point. The incidence of repeat
revascularization was similar between the two groups at 30 days but was
higher for stenting at 1 year and beyond. There was a trend toward fewer
major adverse cardiac and cerebrovascular events after stenting compared
with coronary artery bypass grafting at 30 days, but this difference was
no longer significant at 1 year and reversed at follow-up beyond 1 year.
Conclusions: The early advantages of stenting over coronary artery bypass
grafting have been shown to progressively shift to coronary artery bypass
grafting over time. Further larger sample randomized controlled trials are
warranted to confirm the results. Copyright &#xa9; 2017 The Society of
Thoracic Surgeons.

<113>
Accession Number
614484093
Author
Moreno R.
Institution
(Moreno) University Hospital La Paz, Paseo de la Castellana, 261, Madrid
28046, Spain
Title
Antithrombotic Therapy After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiovascular Drugs. (pp 1-7), 2017. Date of
Publication: 16 Feb 2017.
Publisher
Springer International Publishing
Abstract
Current guidelines for patients who are undergoing transcatheter aortic
valve implantation but who do not require anticoagulation recommend double
antiplatelet therapy for 3-6 months after the procedure, followed by
aspirin indefinitely. However, these guidelines are based on expert
consensus rather than clinical trials. Several randomized trials are
currently evaluating alternative antithrombotic strategies, and
recommendations will likely change when their results become available.
Copyright &#xa9; 2017 Springer International Publishing Switzerland

<114>
Accession Number
614483231
Author
Nicolosi G.L.
Institution
(Nicolosi) Cardiologia, A.R.C., Policlinico S.Giorgio, Pordenone, Italy
Title
Potential uselessness and futility of left atrial appendage occlusion and
patent foramen ovale closure in cardioembolic stroke.
Source
Journal of Cardiovascular Medicine. (no pagination), 2017. Date of
Publication: 16 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
International guidelines indicate that interventional closure of left
atrial appendage and patent foramen ovale may be considered in selected
patients for stroke prevention. These procedures appear, however, from the
published literature, at high risk of uselessness and futility in the
single case, if not even capable to induce harm and adverse events. In
fact, all reported systematic reviews and meta-analyses have not shown in
a convincing manner the superiority of these procedures in stroke
prevention, taking into account the occurrence of possible complications
also, as compared with alternative medical treatment. On the basis of
these considerations, it becomes very difficult to define always and
unequivocally how adequate and complete was the information when given to
each single candidate patient before the procedure by the Heart Team, the
left atrial appendage occlusion Team or patent foramen ovale closure Team,
potentially involved in conflict of interest. Before indicating these
procedures, a complete diagnostic work-up should then be planned for each
single patient to identify and treat not only one, but all concomitant
risk factors and potential different cardioembolic sources. It could also
be suggested to have, for each single candidate patient, a second
independent opinion from physicians not involved in the procedure and
possibly not operating in the same institution. This prudential approach
could reduce in each single case the risk of uselessness, futility and
even potential harm and adverse events of those procedures. Copyright
&#xa9; 2017 Italian Federation of Cardiology. All rights reserved.

<115>
Accession Number
614490443
Author
Moledina D.G.; Isguven S.; McArthur E.; Thiessen-Philbrook H.; Garg A.X.;
Shlipak M.; Whitlock R.; Kavsak P.A.; Coca S.G.; Parikh C.R.
Institution
(Moledina, Isguven, Thiessen-Philbrook, Parikh) Program of Applied
Translational Research, Department of Medicine, Yale School of Medicine,
New Haven, Connecticut
(McArthur) Institute for Clinical Evaluative Sciences Western, London,
Ontario, Canada
(Garg) Division of Nephrology, Department of Medicine, and Department of
Epidemiology and Biostatistics, University of Western Ontario, London,
Ontario, Canada
(Shlipak) Kidney Health Research Collaborative, San Francisco Veterans
Affairs Medical Center, University of California, San Francisco, San
Francisco, California
(Whitlock) Division of Cardiac Surgery, Population Health Research
Institute, McMaster University, Hamilton, Ontario, Canada
(Kavsak) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, Ontario, Canada
(Coca) Department of Internal Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY
(Parikh) Department of Internal Medicine, Veterans Affairs Medical Center,
West Haven, Connecticut
Title
Plasma Monocyte Chemotactic Protein-1 Is Associated With Acute Kidney
Injury and Death After Cardiac Operations.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Monocyte chemotactic protein-1 (MCP-1; chemokine C-C ligand-2
[CCL-2]) is upregulated in ischemia-reperfusion injury and is a promising
biomarker of inflammation in cardiac operations. Methods: We measured
preoperative and postoperative plasma MCP-1 levels in adults undergoing
cardiac operations to evaluate the association of perioperative MCP-1
levels with acute kidney injury (AKI) and death in Translational Research
Investigating Biomarker Endpoints in AKI (TRIBE-AKI), a prospective,
multicenter, observational cohort. Results: Of the 972 participants in the
study, AKI developed in 329 (34%), and severe AKI developed in 45 (5%).
During a median follow-up of 2.9 years (interquartile range, 2.2 to 3.5
years), 119 participants (12%) died. MCP-1 levels were significantly
higher in those who developed AKI and died than in those without AKI and
death. Participants with a preoperative MCP-1 level in the highest tertile
(>196 pg/mL) had an increased AKI risk than those in the lowest tertile
(<147 pg/mL; odds ratio [OR], 1.43l; 95% confidence interval [CI], 1.00 to
2.05). The association appeared similar but was not significant for the
severe AKI outcome (OR, 1.48; 95% CI, 0.62 to 3.54). Compared with
participants with preoperative MCP-1 level in the lowest tertile, those in
the highest tertile had higher adjusted risk of death (hazard ratio, 1.82;
95% CI, 1.40 to 2.38). Similarly, participants in the highest tertile had
a higher adjusted risk of death (hazard ratio, 1.95; 95% CI, 1.09-3.49)
than those with a postoperative MCP-1 level in the lowest tertile.
Conclusions: Higher plasma MCP-1 is associated with increased AKI and risk
of death after cardiac operations. MCP-1 could be used as a biomarker to
identify high-risk patients for potential AKI prevention strategies in the
setting of cardiac operations. Copyright &#xa9; 2017 The Society of
Thoracic Surgeons.