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<1>
Accession Number
614288344
Author
Lee S.M.K.; Leem J.; Park J.H.; Yoon K.H.; Woo J.S.; Lee J.M.; Kim J.-B.;
Kim W.; Lee S.
Institution
(Lee, Leem, Lee) Department of Clinical Korean Medicine, Graduate School,
Kyung Hee University, Seoul, South Korea
(Park, Yoon) Department of Acupuncture and Moxibustion, College of Korean
Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
(Woo, Lee, Kim, Kim) Division of Cardiology, Kyung Hee University
Hospital, Kyung Hee University, Seoul, South Korea
Title
Close look at the experiences of patients enrolled in a clinical trial of
acupuncture treatment for atrial fibrillation in Korea: A qualitative
study nested within a randomised controlled trial.
Source
BMJ Open. 7 (2) (no pagination), 2017. Article Number: e013180. Date of
Publication: 01 Feb 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To explore the experiences of patients with atrial fibrillation
(AF) in the context of a prospective, two-parallel-armed,
participant-blinded and assessorblinded sham-controlled randomised trial.
Design: A nested qualitative study within an ongoing randomised controlled
trial to explore acupuncture's antiarrhythmic effects on drug refractory
acupuncture in persistent atrial fibrillation (AF) (ACU-AF trial).
Participants: Participants were recruited using purposeful sampling and a
maximum variation strategy with regard to treatment allocation (treatment
or control) and protocol completion (completion or non-completion).
Setting: This was a single-centre in-depth interview qualitative study
conducted at a tertiary-level university hospital in Seoul, Republic of
Korea. Results: Data saturation was reached after 8 participants. Thematic
analysis identified that most patients were not aware of their condition
until medical check-up; physician referral was the main reason for trial
participation, and patients had high expectations regardless of previous
acupuncture experiences. Patients tended to depend on their physicians'
opinions because they felt helpless of their condition. No one questioned
their assigned treatment groups and generally believed acupuncture
treatment was different for cardiovascular diseases. A few patients
expressed disappointment in the strict and rigid protocols, in which most
practitioners refrained from explaining their acupuncture procedures.
Conclusions: For cardiovascular patients their physician's advice was one
of the biggest reasons for enrolling in the acupuncture trial therefore
relying on standard recruitment methods may not be effective. Fortunately
both real and sham acupuncture groups in our sample were receiving
treatment as intended, but in the future, designing a more pragmatic trial
(better reflecting clinical settings, expanding the inclusion criteria and
using more treatment points) will allow researchers to better explore the
comprehensive effects of acupuncture. The findings of this study will
allow researchers to improve the currently ongoing ACU-AF trial and to
further help interpretation of main trial outcomes once the trial is
completed.

<2>
Accession Number
614021021
Author
Cortez D.; Barham W.; Ruckdeschel E.; Sharma N.; McCanta A.C.; von
Alvensleben J.; Sauer W.H.; Collins K.K.; Kay J.; Patel S.; Nguyen D.T.
Institution
(Cortez, von Alvensleben, Collins, Kay, Patel) Department of Cardiology,
Children's Hospital of Colorado, Aurora, Colorado, United States
(Cortez, von Alvensleben, Sauer, Collins, Kay, Patel, Nguyen) Department
of Cardiology, University of Colorado, Aurora, Colorado, United States
(Cortez, Barham) Division of Cardiovascular Sciences, Lund University,
Lund, Sweden
(Cortez, Sharma) Department of Electrophysiology, Penn State Milton S.
Hershey Medical Center, Hershey, Pennsylvania, United States
(Ruckdeschel) Department of Adult and Pediatric Cardiology, Children's
Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
(McCanta) Department of Cardiology, CHOC Children's, Orange, California,
United States
Title
Noninvasive Predictors of Ventricular Arrhythmias in Patients With
Tetralogy of Fallot Undergoing Pulmonary Valve Replacement.
Source
JACC: Clinical Electrophysiology. 3 (2) (pp 162-170), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Inc
Abstract
Objectives This study sought to test the hypothesis that a
vectorcardiographic parameter, the QRS vector magnitude (QRSVm), can risk
stratify those patients at risk for sustained spontaneous ventricular
arrhythmias (VAs) or ventricular arrhythmia inducibility (VAI) in a large
cohort of patients with tetralogy of Fallot (TOF). Background Patients
with TOF have an increased risk of VAs, but predicting those at risk can
often be challenging. Methods Blinded retrospective analyses of 177 TOF
patients undergoing pulmonary valve replacement (PVR) between 1997 and
2015 were performed. VAI was evaluated by programmed electrical
stimulation in 48 patients. QRS intervals and QRSVm voltage measurements
were assessed from resting 12-lead electrocardiograms, and risk of VA was
determined. Clinical characteristics, including imaging and cardiac
catheterizations, were used for other modality comparisons. Results
Sustained spontaneous VA occurred in 12 patients and inducible VA in 18
patients. Age and QRSVm were significant univariate predictors of VA.
QRSVm was the only independent predictor of VAI (p < 0.001). Using a root
mean square QRS value of 1.24 mV, the positive and negative predictive
values were 47.9% and 97.8%, respectively, for spontaneous sustained VA.
For VAI, using a QRSVm cutoff of 1.31 mV, positive and negative predictive
values were 63.0% and 95.3%, respectively. Conclusions In TOF patients
undergoing PVR, older age was associated with increased spontaneous VA
risk. Lower QRSVm predicted spontaneous VA or VAI risk with high negative
predictive values. QRSVm is the only independent predictor of VAI. These
clinical features may help further risk stratify TOF patients requiring
therapies to prevent sudden death. Copyright &#xa9; 2017 American College
of Cardiology Foundation

<3>
Accession Number
614114891
Author
Bajaj A.; Pancholy S.; Sethi A.; Rathor P.
Institution
(Bajaj, Pancholy) The Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Bajaj, Pancholy) The Common Wealth Medical College, Scranton, PA, United
States
(Sethi) St. Luke's Cardiology Associates, Bethlehem, PA, United States
(Rathor) Zhengzhou University, China
Title
Safety and feasibility of PCI in patients undergoing TAVR: A systematic
review and meta-analysis.
Source
Heart and Lung: Journal of Acute and Critical Care. 46 (2) (pp 92-99),
2017. Date of Publication: 01 Mar 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
We aimed to evaluate the safety and feasibility of PCI (percutaneous
coronary intervention) for coronary artery disease (CAD) in patients
undergoing transcatheter aortic valve replacement (TAVR) by performing a
meta-analysis. A systemic search of the database was performed. Studies
were included comparing TAVR versus TAVR with PCI for significant CAD in
patients undergoing TAVR for severe aortic stenosis. The primary outcome
was 30 day mortality and secondary outcomes were myocardial infarction,
stroke, life threatening bleeding, major access site vascular
complications and renal failure. There were no significant differences in
30 day and six months-one year mortality between TAVR and TAVR with PCI
group. There were also no significant differences in myocardial
infarction, stroke, and life threatening bleeding and major access site
vascular complications between the two groups. PCI in addition to TAVR in
patients with concomitant severe aortic stenosis and CAD is safe and
feasible and does not increase procedural risk. Copyright &#xa9; 2016
Elsevier Inc.

<4>
Accession Number
614111787
Author
Paraskevas K.I.; Nduwayo S.; Saratzis A.N.; Naylor A.R.
Institution
(Paraskevas, Nduwayo, Saratzis, Naylor) The Department of Vascular Surgery
at Leicester Royal Infirmary, Leicester, United Kingdom
Title
Carotid Stenting Prior to Coronary Bypass Surgery: An Updated Systematic
Review and Meta-Analysis.
Source
European Journal of Vascular and Endovascular Surgery. 53 (3) (pp
309-319), 2017. Date of Publication: 01 Mar 2017.
Publisher
W.B. Saunders Ltd
Abstract
Objectives The aim was to determine 30-day outcomes in patients with
concurrent carotid and cardiac disease who underwent carotid artery
stenting (CAS) followed by coronary artery bypass grafting (CABG). Methods
This was a systematic review with searches of PubMed/Medline, Embase, and
Cochrane databases. "Same-day" procedures involved CAS + CABG being
performed on the same day, and "staged" interventions involved at least 1
day's delay between undergoing CAS and then CABG. Results There were 31
eligible studies (2727 patients), with 80% being neurologically
asymptomatic with unilateral stenoses. Overall, the 30-day death/stroke
rate was 7.9% (95% confidence interval [CI] 6.9-9.2), while
death/stroke/MI was 8.8% (95% CI 7.3-10.5). Staged CAS + CABG was
associated with 30-day death/stroke rate of 8.5% (95% CI 7.3-9.7) compared
with 5.9% (95% CI 4.0-8.5) after "same-day" procedures. Outcomes following
CAS + CABG in neurologically symptomatic patients were poorer, with
procedural stroke rates of 15%. There were five antiplatelet (APRx)
strategies: (a) no APRx (death/stroke/MI, 4.2%; no data on bleeding
complications); (b) single APRx before CAS and CABG, then dual APRx after
CABG (death/stroke/MI, 6.7%; 7.3% bleeding complications); (c) dual APRx
pre-CAS down to one APRx pre-CABG (death/stroke/MI, 10.1%; 2.8% bleeding
complications); (d) dual APRx pre-CAS, both stopped pre-CABG
(death/stroke/MI, 14.4%); (e) dual APRx pre-CAS and continued through CABG
(death/stroke/MI, 16%). There were insufficient data on bleeding
complication in the last two strategies. Conclusions In a cohort of
predominantly asymptomatic patients with unilateral carotid stenoses, the
30-day rate of death/stroke was about 8%. Notwithstanding the effect of
potential biases, this meta-analysis did not find evidence that outcomes
after same-day CAS + CABG were higher than after staged interventions.
However, outcomes were poorer in neurologically symptomatic patients. More
data are required to establish the optimal antiplatelet strategy in
patients undergoing same-day or staged CAS + CABG. Copyright &#xa9; 2016
European Society for Vascular Surgery

<5>
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Accession Number
613995767
Author
Mariscalco G.; Wozniak M.J.; Dawson A.G.; Serraino G.F.; Porter R.; Nath
M.; Klersy C.; Kumar T.; Murphy G.J.
Institution
(Mariscalco, Wozniak, Dawson, Serraino, Nath, Kumar, Murphy) Leicester
Cardiovascular Biomedical Research Unit, Department of Cardiovascular
Sciences, University of Leicester, Glenfield Hospital, Leicester LE39QP,
United Kingdom
(Porter) Department of Anaesthesia and Critical Care, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, United Kingdom
(Klersy) Service of Biometry and Clinical Epidemiology, IRCCS Policlinico
San Matteo Foundation, Pavia, Italy
Title
Body Mass Index and Mortality among Adults Undergoing Cardiac Surgery: A
Nationwide Study with a Systematic Review and Meta-Analysis.
Source
Circulation. 135 (9) (pp 850-863), 2017. Date of Publication: 28 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: In an apparent paradox, morbidity and mortality are lower in
obese patients undergoing cardiac surgery, although the nature of this
association is unclear. We sought to determine whether the obesity paradox
observed in cardiac surgery is attributable to reverse epidemiology, bias,
or confounding. Methods: Data from the National Adult Cardiac Surgery
registry for all cardiac surgical procedures performed between April 2002
and March 2013 were extracted. A parallel systematic review and
meta-analysis (MEDLINE, Embase, SCOPUS, Cochrane Library) through June
2015 were also accomplished. Exposure of interest was body mass index
categorized into 6 groups according to the World Health Organization
classification. Results: A total of 401 227 adult patients in the cohort
study and 557 720 patients in the systematic review were included. A
U-shaped association between mortality and body mass index classes was
observed in both studies, with lower mortality in overweight (adjusted
odds ratio, 0.79; 95% confidence interval, 0.76-0.83) and obese class I
and II (odds ratio, 0.81; 95% confidence interval, 0.76-0.86; and odds
ratio, 0.83; 95% confidence interval, 0.74-0.94) patients relative to
normal-weight patients and increased mortality in underweight individuals
(odds ratio, 1.51; 95% confidence interval, 1.41-1.62). In the cohort
study, a U-shaped relationship was observed for stroke and low cardiac
output syndrome but not for renal replacement therapy or deep sternal
wound infection. Counter to the reverse epidemiology hypotheses, the
protective effects of obesity were less in patients with severe chronic
renal, lung, or cardiac disease and greater in older patients and in those
with complications of obesity, including the metabolic syndrome and
atherosclerosis. Adjustments for important confounders did not alter our
results. Conclusions: Obesity is associated with lower risks after cardiac
surgery, with consistent effects noted in multiple analyses attempting to
address residual confounding and reverse causation. Copyright &#xa9; 2017
American Heart Association, Inc.

<6>
Accession Number
613939231
Author
Wang Y.; Shi X.; Du R.; Chen Y.; Zhang Q.
Institution
(Wang, Shi, Du, Chen, Zhang) Department of Cardiology, West China
Hospital, Sichuan University, 37 Guoxue Street, Chengdu, Sichuan 610041,
China
Title
Off-pump versus on-pump coronary artery bypass grafting in patients with
diabetes: a meta-analysis.
Source
Acta Diabetologica. 54 (3) (pp 283-292), 2017. Date of Publication: 01 Mar
2017.
Publisher
Springer-Verlag Italia s.r.l. (E-mail: springer@springer.it)
Abstract
Aims: The effects of off-pump CABG (OFF-CABG) versus on-pump CABG
(ON-CABG) in diabetic patients remain controversial. The aim of our study
was to compare mortality and postoperative morbidity between OFF-CABG and
ON-CABG for diabetic patients. Methods: Electronic databases including
PubMed, EMBASE and Cochrane Library for studies investigating clinical
outcomes of OFF-CABG versus ON-CABG in diabetic patients were searched,
collecting data from inception until June 2016. We pooled the odds ratios
from individual studies and performed heterogeneity, quality assessment
and publication bias analysis. Results: A total of 543,220 diabetic
patients in 10 studies were included. The overall mortality (OR, 0.87; 95%
CI, 0.58-1.31; p = 0.50) was comparable between the OFF-CABG and ON-CABG.
OFF-CABG was associated with significantly fewer cerebrovascular accidents
(OR, 0.45; 95% CI, 0.31-0.65; p < 0.0001), bleeding complications (OR,
0.59; 95% CI, 0.43-0.80; p < 0.001) and pulmonary complications. However,
no differences in myocardial infarction (OR, 0.76; 95% CI, 0.52-1.12; p =
0.16), renal failure (OR, 0.74; 95% CI, 0.50-1.11; p = 0.14) and other
postoperative morbidity outcomes were found. Conclusions: OFF-CABG
significantly reduces the incidence of postoperative cerebrovascular
accidents and bleeding complications compared with ON-CABG in diabetic
patients. No differences were found regarding mortality, myocardial
infarction and renal failure between these two techniques. Our study
suggests that OFF-CABG may be an optimal strategy for diabetic patients
although adequately powered randomized trials are needed to further verify
the finding. Copyright &#xa9; 2016, Springer-Verlag Italia.

<7>
Accession Number
613456820
Author
Landes U.; Barsheshet A.; Finkelstein A.; Guetta V.; Assali A.; Halkin A.;
Vaknin-Assa H.; Segev A.; Bental T.; Ben-Shoshan J.; Barbash I.M.;
Kornowski R.
Institution
(Landes, Barsheshet, Assali, Vaknin-Assa, Bental, Kornowski) Department of
Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
(Finkelstein, Halkin, Ben-Shoshan) Department of Cardiology, Tel Aviv
Medical Center, Israel
(Guetta, Segev, Barbash) Leviev Heart Center, Sheba Medical Center, Ramat
Gan, Israel
(Guetta, Segev, Barbash) Sackler Faculty of Medicine, Tel Aviv University,
Israel
Title
Temporal trends in transcatheter aortic valve implantation, 2008-2014:
patient characteristics, procedural issues, and clinical outcome.
Source
Clinical Cardiology. 40 (2) (pp 82-88), 2017. Date of Publication: 01 Feb
2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: About a decade past the first transcatheter aortic valve
implantation (TAVI), data are limited regarding temporal trends
accompanying its evolution from novel technology to mainstream therapy. We
evaluated these trends in a large multicenter TAVI registry. Hypothesis:
TAVI is changing and improving with time. Methods: Patients who underwent
TAVI between January 2008 and December 2014 at 3 high-volume Israeli
centers were divided into 5 time quintiles according to procedure date.
Outcomes were analyzed and reported according to Valve Academic Research
Consortium-2. Results: A total of 1285 patients were studied (43% male;
mean age, 83 +/- 3 years; mean Society of Thoracic Surgeons [STS] score,
5.5 +/- 3.6). Over time, there was a shift toward treating patients at
lower STS score, increased use of conscious sedation and transfemoral
approach, and decreased use of balloon predilatation. The
balloon-expandable to self-expandable valve utilization ratio decreased,
the valve-in-valve experience increased from 4% to 17% of all TAVI volume,
and length of hospital stay was halved (P = 0.006). Kaplan-Meier survival
curves showed gradual decrease in mortality risk (P = 0.031), but there
was no significant 1-year mortality decrease by multivariable analysis.
Each year increment was associated with an adjusted 20%, 15%, and 12%
decrease in new pacemaker obligation (P = 0.004), new pacemaker obligation
or left bundle branch block (P = 0.008), and in-hospital infections (P =
0.082), respectively. Conclusions: Temporal trends accompanying TAVI
evolution include its utilization in lower-risk patients, procedural
simplification, improved overall survival, decreased pacemaker obligation,
and shorter hospital stay. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<8>
Accession Number
614006996
Author
Mastropietro C.W.; Cashen K.; Grimaldi L.M.; Narayana Gowda K.M.; Piggott
K.D.; Wilhelm M.; Gradidge E.; Moser E.A.S.; Benneyworth B.D.; Costello
J.M.
Institution
(Mastropietro, Benneyworth) Department of Pediatrics, Division of Critical
Care, Indiana University School of Medicine, Riley Hospital for Children,
Indianapolis, IN, United States
(Cashen) Division of Critical Care, Department of Pediatrics, Wayne State
University School of Medicine, Children's Hospital of Michigan, Detroit,
MI, United States
(Grimaldi) Division of Cardiovascular Intensive Care, Phoenix Children's
Hospital, Department of Child Health, University of Arizona, College of
Medicine - Phoenix, Phoenix, AZ, United States
(Narayana Gowda) Division of Pediatric Critical Care Medicine, Department
of Pediatrics, Cleveland Clinic, Cleveland, OH, United States
(Piggott) The Heart Center at Arnold Palmer Hospital for Children,
Division of Pediatric Cardiac Intensive Care, Department of Pediatrics,
University of Central Florida College of Medicine, Orlando, FL, United
States
(Wilhelm) Division of Pediatric Cardiac Intensive Care, Department of
Pediatrics, University of Wisconsin, Madison, WI, United States
(Gradidge) Division of Critical Care at Phoenix Children's Hospital,
Department of Child Health, University of Arizona, College of Medicine -
Phoenix, Phoenix, AZ, United States
(Moser) Department of Biostatistics, Indiana University School of Medicine
& Richard M. Fairbanks School of Public Health, Indianapolis, IN, United
States
(Costello) Divisions of Cardiology & Critical Care Medicine, Department of
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago,
Northwestern University Feinberg School of Medicine, Chicago, IL, United
States
Title
Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis.
Source
Journal of Pediatrics. 182 (pp 190-196.e4), 2017. Date of Publication: 01
Mar 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To describe the epidemiology of extubation failure and identify
risk factors for its occurrence in a multicenter population of neonates
undergoing surgery for congenital heart disease. Study design We conducted
a prospective observational study of neonates <30 days of age who
underwent cardiac surgery at 7 centers within the US in 2015. Extubation
failure was defined as reintubation within 72 hours of the first planned
extubation. Risk factors were identified with the use of multivariable
logistic regression analysis and reported as OR with 95% CIs.
Multivariable logistic regression analysis was conducted to examine the
relationship between extubation failure and worse clinical outcome,
defined as hospital length of stay in the upper 25% or operative
mortality. Results We enrolled 283 neonates, of whom 35 (12%) failed their
first extubation at a median time of 7.5 hours (range 1-70 hours). In a
multivariable model, use of uncuffed endotracheal tubes (OR 4.6; 95% CI
1.8-11.6) and open sternotomy of 4 days or more (OR 4.8; 95% CI 1.3-17.1)
were associated independently with extubation failure. Accordingly,
extubation failure was determined to be an independent risk factor for
worse clinical outcome (OR 5.1; 95% CI 2-13). Conclusions In this
multicenter cohort of neonates who underwent surgery for congenital heart
disease, extubation failure occurred in 12% of cases and was associated
independently with worse clinical outcome. Use of uncuffed endotracheal
tubes and prolonged open sternotomy were identified as independent and
potentially modifiable risk factors for the occurrence of this precarious
complication. Copyright &#xa9; 2016 Elsevier Inc.

<9>
Accession Number
611708709
Author
Lu Y.; Wang L.; Liu N.; Dong T.; Li R.
Institution
(Lu, Wang, Liu, Dong, Li) Department of Anesthesiology, Affiliated
Hospital of Chengde Medical College, No. 36 NanYingzi Road, Chengde,
Heibei 067000, China
Title
Sevoflurane preconditioning in on-pump coronary artery bypass grafting: a
meta-analysis of randomized controlled trials.
Source
Journal of Anesthesia. 30 (6) (pp 977-986), 2016. Date of Publication: 01
Dec 2016.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: Sevoflurane preconditioning (SevoPreC) has been proved to prevent
organ ischemia/reperfusion (I/R) injury in various animal models and
preclinical studies. Clinical trials on cardioprotection by SevoPreC for
adult patients undergoing coronary artery bypass graft (CABG) revealed
mixed results. The aim of this meta-analysis was to evaluate the cardiac
effect of SevoPreC in on-pump CABG. Methods: Randomized controlled trials
(RCT) comparing the cardiac effect of SevoPreC (compared with control) in
adult patients undergoing CABG were searched from PubMed, Embase, and the
Cochrane Library (up to November 2015). The primary endpoints were
postoperative troponin levels. Additional endpoints were CK-MB levels,
mechanic ventilation (MV) duration, intensive care unit (ICU) stay, and
hospital length of stay (LOS). Results: Six trials with eight comparisons
enrolling a total of 384 study patients reporting postoperative troponin
levels were identified. Compared with controls, SevoPreC decreased
postoperative myocardial troponin levels [standardized mean difference
(SMD) = -0.38; 95 % CI, -0.74 to -0.03; P = 0.04; I² = 63.9 %].
However, no significant differences were observed in postoperative CK-MB
levels [weighted mean difference (WMD) = -1.71; P = 0.37; I² =
37.7 %], MV duration (WMD = -0.53; P = 0.47; I² = 0.0 %), ICU
stay (WMD = -0.91; P = 0.39; I² = 0.9 %), and hospital LOS (WMD
= 0.08; P = 0.86; I² = 8.0 %). Conclusion: Available evidence
from the present systematic review and meta-analysis suggests that
sevoflurane preconditioning may reduce troponin levels in on-pump CABG.
Future high-quality, large-scale clinical trials should focus on the early
and long-term clinical effect of SevoPreC in on-pump CABG. Copyright
&#xa9; 2016, Japanese Society of Anesthesiologists.

<10>
Accession Number
610357764
Author
Vogkou C.T.; Vlachogiannis N.I.; Palaiodimos L.; Kousoulis A.A.
Institution
(Vogkou, Vlachogiannis, Palaiodimos, Kousoulis) Society of Junior Doctors,
Athens, Greece
(Vogkou, Vlachogiannis) School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
(Palaiodimos) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
(Kousoulis) Faculty of Epidemiology and Population Health, London School
of Hygiene and Tropical Medicine, London, United Kingdom
Title
The causative agents in infective endocarditis: a systematic review
comprising 33,214 cases.
Source
European Journal of Clinical Microbiology and Infectious Diseases. (pp
1-19), 2016. Date of Publication: 11 May 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Infective endocarditis (IE) incidence remains high with considerable
fatality rates; guidelines for prophylaxis against IE are currently under
review in some settings which highlights the importance of maintaining
up-to-date epidemiological estimates about the most common microbial
causes. The objective of this systematic review, following PRISMA
guidelines, was to identify the most common microbial causes of IE in
recent years. Medline was searched from January 1, 2003 to March 31, 2013
for all articles containing the term "infective endocarditis". All
relevant studies reporting diagnostic results were included. Special
patient subpopulations were assessed separately. A total of 105 studies
were included, from 36 countries, with available data on a total of 33,214
cases. Staphylococcus aureus was found to be the most common
microorganism, being the most frequent in 54.3 % of studies (N = 57) (and
in 55.4 % of studies using Duke's criteria for diagnosis [N = 51]).
Viridans group streptococci (VGS), coagulase-negative staphylococci
(CoNS), Enterococcus spp and Streptococcus bovis were among the most
common causes. S. aureus was the most common pathogen in almost all
population subgroups; however, this was not the case in patients with
implantable devices, prosthetic valves, or immunocompromised non-HIV, as
well as in the sub-group from Asia, emphasizing that a global
one-size-fits-all approach to the management of suspected IE is not
appropriate. This review provides an evidence-based map of the most common
causative agents of IE, highlighting S. aureus as the leading cause in the
21st century. The changing epidemiology of IE in some patient sub-groups
in the last decade and the very high number of microbiologically
undiagnosed cases (26.6 %) suggest the need to revisit IE prophylaxis and
diagnostic strategies. Copyright &#xa9; 2016 Springer-Verlag Berlin
Heidelberg

<11>
Accession Number
614673728
Author
Amendola S.; McElhinney D.; Bhatla P.; Flamini V.
Institution
(Amendola, Flamini) New York University, Tandon School of Engineering,
Brooklyn, NY, United States
(McElhinney) Stanford University Medical Center, Stanford, CA, United
States
(Bhatla) New York University, Langone Medical Center, New York, NY, United
States
Title
Personalized simulations of pre-TPVR angioplasty coronary compression
using finite element analyses.
Source
Annals of Biomedical Engineering. Conference: 2016 BMES/FDA Frontiers in
Medical Devices Conference. United States. Conference Start: 20160523.
Conference End: 20160525. 44 (12) (pp 3727-3730), 2016. Date of
Publication: December 2016.
Publisher
Springer New York LLC
Abstract
INTRODUCTION Melody transcatheter pulmonary valve (TPV) implantation is
frequently considered in patients with Right Ventricle Outflow Tract
(RVOT) conduit obstruction, as a minimally invasive alternative to
open-heart surgery.1 However, TPV implantation is associated to a risk of
coronary artery (CA) compression.2 In this work, an innovative Finite
Element (FE) balloon dilatation model has been built to predict CA
compression in order to avoid patient exposure to unnecessary risks. In
this study four patients, who underwent MRI or CT in anticipation to
receive TPV, were considered. Images were segmented to generate 3D models.
A balloon dilatation FE simulation was implemented for each of the models.
The balloon was represented as a deformable 3D cylinder positioned at the
center of mass at the narrowest point of the conduit lumen. Then, radial
displacement was applied uniformly until the balloon reached the dimension
of a fully inflated balloon. A linear elastic constitutive model was
chosen to describe all the vasculature, and parameters for it were
retrieved from literature. A frictionless contact algorithm was
implemented between the balloon and the conduit and between the conduit
and the surrounding structures. The results of the simulations allowed
analysis of important parameters that could play an active role in the
determination of the angioplasty procedure outcome in terms of CA
compression. MATERIALS AND METHODS Patient-Specific Models Patients who
were candidates for Transcatheter Pulmonary Valve Replacement (TPVR) were
included (n = 4). The investigators from Tandon School of Engineering were
blinded to the results of the procedure. Each patient underwent
pre-catheterization Magnetic Resonance Imaging (MRI) or Computerized
Tomography scan (CT scan) and patient-specific models were created from
these images using Mimics (Materialize, Belgium), Meshmixer (Autodesk,
California) and Cubit (C Sim Software, Utah) software. Each model was
constituted by the components of the cardiovascular system affected by the
angioplasty procedure, the pulmonary artery (PA), the aorta and the
coronary arteries (CA). A 60 mm long segment of PA was selected from the
right ventricle outflow tract (RVOT) to the PA bifurcation so that the
conduit was included. Similarly, a 60 mm long segment of aorta was
selected from the aortic root to the aortic arch. Finally, left and right
CAs were selected where visible. Our protocol required the CA branches to
be at least 20 mm in length to be included in the study. The model thus
obtained, was manipulated using 3D CAD tools available in Meshmixer to
smooth the model and to generate a 3D hollow geometry from a model
representing only the blood pool. The hollowing procedure required the
definition of the thickness of the arterial wall, which was chosen to be 2
mm for the aorta and the RVOT conduit, and 1 mm for the CA branches,3 see
Fig. 1A-D. Finally, the model was meshed using Cubit. The PA model was
divided in three parts: a 30 mm long central section that defined the
contact surfaces, internally with the balloon and externally with the
aorta and CAs; and the two remaining parts, each 15 mm long, extending
before and after the contact area. Tetrahedral elements where used for
meshing the models, and in average, the number of elements used was 14,406
+/- 5875. The model thus obtained was then exported in ABAQUS (Dassault
Systemes, RI) for the finite element simulations. Balloon Models In this
study, two separate approaches were used to model the angioplasty balloon.
In one case an analytical rigid surface is used to simulate the balloon,
and the results of this approach are compared with a deformable balloon
model. * Rigid Balloon In order to replicate folding of the angioplasty
balloon into a catheter, the rigid balloon model was composed by 5
analytical rigid surfaces made in such a way that, after the applied
radial displacement, the shells were forming a cylinder with a diameter
matching that of an inflated angioplasty balloon, see Fig. 1E. *
Deformable Balloon The deformable balloon model was created in ABAQUS. In
this case, the balloon was modeled as a deformable 3D cylinder of 20 mm
length, 1 mm of external diameter and 0.2 mm thickness.1 A mesh of 63
quadrilateral elements was generated and solved by employing reduced
integration algorithms and large-strain formulation, see Fig. 1F. Material
Models Human arterial tissue was modeled as a linear-elastic isotropic
material with Young's modulus of 2.7 MPa and Poisson ratio of
0.49.4Duetothe lack of data on thematerialproperties of the conduit after
implantation, the material properties of the conduit were assumed to be
similar to those of the arterial tissue. Based on literature, the balloon
was modeled as an isotropic, linear-elastic material, with a Young's
modulus of 900 MPa and Poisson's ratio of 0.3.5-6 Contact Definition Each
model surface was defined and surface-to-surface frictionless hard contact
was imposed between the external surface of the balloon model and the
internal surface of the conduit. Surface to surface frictionless hard
contact was also imposed between the external pulmonary artery surface
external surface of the aorta and the CA. The contact model used assumed
that: (1) the surfaces transmit no contact pressure unless the nodes of
the slave-surface contact the master-surface; (2) no penetration is
allowed at each surface; (3) there is no limit to the magnitude of contact
pressure that can be transmitted when the surfaces are in contact. The
direct method was chosen as contact constraint enforcement method. Surface
to surface contact was used such that the master role was given to the
surface with the coarser mesh and/or larger area. For the analyses with
analytical rigid surfaces, the master role was always given to the rigid
shell. Boundary Conditions All the extremities of the conduit and of the
aorta are constrained through an encastre. The extremity at the end of the
CA is constrained as well through an encastre. Displacement Protocol The
angioplasty intervention was simulated by displacing the balloon to the
diameter used during the intervention. Although the TPVR standard
protocol, states that the angioplasty balloon can be inflated to 110% of
the original conduit diameter or 24 mm,1,2 whichever is greater, this
protocol could be applied only to patient 2, see Fig. 1G. RESULTS For all
the simulations, the balloon expanded under the imposed displacement
conditions causing the conduit to deform. As the balloon displacement was
increased, the central part of the conduit also expanded. It was also
noticeable that once the balloon had reached its nominal diameter, the
maximum stress value was localized in the portion of the conduit with the
highest curvature for all four models. Rigid Balloon vs Deformable Balloon
By comparing the two different approaches to model angioplasty, it was
found that more stable results were obtained using the meshed cylinder
balloon model rather than the one made of analytically rigid surfaces.
However, it was possible to compare the results of the two models for
deformations up to the 80% of the complete final angioplasty balloon
diameter. Results on the conduit in terms of stress and deformation were
strongly comparable. In fact, the average Von Mises stress varied by
0.76%, while the average displacement varied by 0.3%. In both cases the
values obtained in the deformable model were smaller than the ones
obtained in the rigid one. Angioplasty Outcomes For all the
patient-specific models we evaluated whether CA compression could be
modeled with this approach. The results show that in two cases the CA
deforms, but there is no contact with the conduit. In these cases, we
defined the CA to be distorted and not compressed as it deforms as a
consequence of compression at the level of the aortic root, see Fig. 2A-D.
DISCUSSION Segmentation of the patient geometries generated regular
models, which made possible to complete the computational analysis.
Overall, 50% of the sample population analyzed showed the risk of coronary
deformation as a result of the angioplasty balloon expansion.
Computational methods, such as the finite element method, represent an
interesting alternative to the state-of-art catheterization lab
evaluation, which have been found to have a low prediction value. The
results of the four expansion simulations presented similar values of the
maximum Von Mises stresses on the pulmonary arteries, while they present
different results in terms of displacement and stresses in the coronary
arteries, showing that coronary compression is strictly dependent on the
specific geometry on the specific patient. CONCLUSIONS In this study, the
effect of the balloon expansion during pre- TPV Angioplasty procedure was
investigated by means of the FE method. Data of four patients who
underwent attempted MelodyTM valve implantation were used. A deformable
cylindrical balloon model was developed and compared with a balloon model
constituted by analytical rigid shells to evaluate whether the choice of a
different balloon model can be significant in terms of displacement
results in the artery. The developed models allowed analysis of important
parameters that could play a role in the determination on the angioplasty
procedure outcome in terms of coronary compression. Finally, this work
successfully identified a method to simulate a pre-TPVR procedure. Future
work includes the analysis of a pressure based balloon expansion. This
approach would be closer to the actual procedure and make possible the
realization of a folded balloon model obtained by applying a negative
pressure from a cylindrical configuration.(Table Presented).

<12>
Accession Number
614672750
Author
Cheng Z.
Institution
(Cheng) Fujian Provincial Hospital, Fujian Province, China
Title
Perioperative acute normovolemic hemodilution in PBM during cardiac
surgery.
Source
Vascular. Conference: 2016 VEITH Symposium and ISVS Associate Faculty
Global Podium Presentations. United States. Conference Start: 20161115.
Conference End: 20161119. 24 (1 Supplement 1) (pp 102-103), 2016. Date of
Publication: 2016.
Publisher
SAGE Publications Ltd
Abstract
Acute Normovolemic Hemodilution (ANH) also called Intra-operative
Autologous Donation is a technique that removes whole blood while
maintaining euvolemia immediately before the operation. The blood
withdrawn is simultaneously replaced by an appropriate volume of
crystalloid or colloid fluids (alone or in combination) to maintain
normovolemia. In our institution ANH is performed after induction of the
anesthesia. The blood is withdrawn (60 to 80 mL/min) from a central vein
by gravity into citrate-phosphate-dextrose collection bags that are placed
on a rocking platform of a precision scale. In parallel, crystalloid or
colloid fluids are infused through a 16-gauge peripheral catheter on the
opposite arm. At the end of the CPB, protamine is administered to
neutralize circulating heparin, and the whole autologous blood volume is
re-transfused shortly after weaning from CPB. ANH is performed to avoid or
reduce allogeneic blood transfusions. However its use reminds
controversial. This is confirmed by a number of experts' consensus,
clinical trials and metaanalysis as follow: * The Perioperative Blood
Transfusion and Blood Conservation in Cardiac Surgery clinical practices
guidelines from the Society of Thoracic Surgeons and the Society of
Cardiovascular Anaesthesiologists published in 2007, and the updated 2011
version of the same guidelines (Ann Thorac Surge 2011;91:944-82) of Level
evidence B, * Some prospective randomized trials published in Ann Thorac
Surg 1996,61:900-3, or in in J of Cardiothoracic and Vascular Anesthesia,
2002, * A meta-analysis of all RCT on ANH published in Transfusion in
2004. This literature supports only modest benefits from ANH alone, which
usefulness is not well established, and the safety is not completely
addressed. So a widespread adoption of ANH cannot be encouraged, and
combinations of ANH with other blood conservations strategies such as the
use of synthetic fluorocarbons or haemoglobin based oxygen carrier
products may be beneficial. But the use of ANH alone is not recommended.

<13>
Accession Number
614672746
Author
Wozniak M.; Qureshi S.; Sullo N.; Dott W.; Cardigan R.; Morris T.; Nath
M.; Bittar N.; Budhia S.; Patel N.; Kumar T.; Murphy G.
Institution
(Wozniak, Qureshi, Sullo, Dott, Morris, Nath, Bittar, Kumar, Murphy)
University of Leicester, United Kingdom
(Cardigan) NHS Blood and Transplant, United Kingdom
(Budhia) University Hospitals Coventry, Warwickshire NHS Trust, United
Kingdom
(Patel) Imperial College London, United Kingdom
Title
Red cell washing for the prevention of transfusion associated organ injury
in cardiac surgery: The REDWASH trial.
Source
Transfusion Medicine. Conference: Annual Scientific Meeting of the British
Blood Transfusion Society 2016. United Kingdom. Conference Start:
20160921. Conference End: 20160923. 26 (pp 56), 2016. Date of Publication:
September 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Background: This study assessed whether the removal of pro-inflammatory
substances that accumulate in stored donor red cells by mechanical cell
washing would attenuate platelet and leucocyte activation, inflammation
and organ injury post cardiac surgery. Methods and Results: Fifty six
adult (>16 years) cardiac surgery patients at one of three UK cardiac
centres were randomly allocated in a 1:1 ratio to either mechanical
washing of allogeneic red cells transfused within 48 hours of surgery or
standard care red cells. Post-surgery there was no difference between the
groups with respect to biomarkers of inflammation, myocardial, lung or
kidney injury. Complementary experimental studies demonstrated that red
cell derived microparticles (MP) that accumulated in stored units directly
activate monocytes and platelets in vitro. Washing removed these MP and
reduced platelet and leucocyte activation in the lungs and kidneys of
transfused swine invivo. Washing also resulted in accelerated release of
cell free haemoglobin (Hgb) that directly activated vascular endothelium
resulting in VLA5 expression and fenestration in vitro, and renal and
pulmonary injury in vivo. These experimental findings were not replicated
in REDWASH trial patients where there was no difference between the groups
with respect to platelet and leucocyte activation, plasma cell free Hgb,
or endothelial activation. Conclusions: Washing alters components of the
storage lesion in red cell units. These changes have direct effects on
platelet, leucocyte and endothelial activation and organ injury in
experimental models but do not have similar effects in cardiac surgery
patients.

<14>
Accession Number
614674670
Author
Moayedifar R.; Zimpfer D.; Riebandt J.; Dimitrov K.; Schloglhofer T.;
Aliabadi A.; Haberl T.; Osorio E.; Freystatter K.; Uyanik-Unal K.; Laufer
G.; Zuckermann A.
Institution
(Moayedifar, Zimpfer, Riebandt, Dimitrov, Aliabadi, Haberl, Osorio,
Freystatter, Uyanik-Unal, Laufer, Zuckermann) Medical University Vienna,
Cardiac Surgery, Vienna, Austria
(Schloglhofer) Medical University Vienna, Center for Medical Physics and
Biomedical Engineering, Vienna, Austria
Title
Outcome of HVAD bridged to transplantation patients after heart
transplantation-a single center experience.
Source
Transplant International. Conference: 2nd European Cardio Thoracic
Transplant Association Meeting. Spain. Conference Start: 20161028.
Conference End: 20161029. 29 (pp 13-14), 2016. Date of Publication:
October 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Objectives: In recent years, the number of heart-transplant patients
bridged to transplantation by Left Ventricular Assist Devices has
increased to 37% (ISHLT registry 2015). This is despite data that suggests
mechanically supported recipients suffer inferior mortality rates after
transplantation. While studies have been published reporting the
differences between the outcomes of pulsatile and continuous flow devices,
including specifically the HeartMate II, no data has been reported on the
outcome of HeartWare HVAD devices. We report our experience with the
HeartWare HVAD LVAD in bridged to transplantation recipients after heart
transplantation. Methods: We retrospectively reviewed the data of 50
patients who have been bridged to transplantation with the HeartWare LVAD,
and afterwards underwent heart transplantation between April 2007 and
March 2016 at Vienna Cardiac Transplant Center. Study endpoints were
recipient and donor demographics, operative outcome, long-term survival
and incidence of adverse events, defined as rejection, infection and graft
vasculopathy. Results: Mean patient age was 50 +/- 14 years, 38 were male
and underlying disease was of dilatative origin in 62%. 30% of the
recipients were listed primary as high-urgency (HU) and median duration of
HVAD-support was 563 +/- 392 days (range 3-2279). We observed nine (18%)
cases of graft rejection requiring treatment over the course of this
study, seven (78%) of which occurred in the first six months after
transplantation and three (33%) having resulted in death. High panel
reactive antibody activity (PRA >10%) prior to transplantation was
observed in only two (4%) patients (PRA 97% and 37% respectively). Two
(4%) recipients were diagnosed with graft vasculopathy and therefore
required percutaneous coronary intervention (PCI) at 539 and 629 days
after heart transplantation respectively. Four (8%) patients experienced
fatal infection resulting in death at 58, 213, 222 and 613 days
posttransplant. 30-day and in-hospital mortality rates were 0% and 4%
respectively. One-year survival was 92%. Conclusion: As the first
transplant center reporting on the long-term outcomes of patients having
received the Heartware HVAD as a bridge to transplantation device, our
findings indicate that it is a feasible and safe alternative to other
continuous-flow devices. While our findings do include a substantially
lower post-transplant mortality rate in comparison to other studies, a
multi-center study is still desirable in order to confirm these results.

<15>
Accession Number
614674580
Author
Sabatino M.; Vitale G.; Masetti M.; Manfredini V.; Clemenza F.; Grigioni
F.; Potena L.
Institution
(Sabatino, Masetti, Manfredini, Grigioni, Potena) S.Orsola-Malpighi
University Hospital, Department of Specialist, Diagnostic and Experimental
Medicine, Bologna, Italy
(Vitale, Clemenza) ISMETT, Department of Cardiac Transplantation, Palermo,
Italy
Title
Donor-recipient size mismatch and risk of early graft dysfunction in
patients with pulmonary hypertension: Potential role of matching based on
predicted heart mass.
Source
Transplant International. Conference: 2nd European Cardio Thoracic
Transplant Association Meeting. Spain. Conference Start: 20161028.
Conference End: 20161029. 29 (pp 13), 2016. Date of Publication: October
2016.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Pulmonary hypertension (PH) is a known risk factor for early
graft dysfunction (EGF) after heart transplantation (HT). Current practice
advocates matching with oversized donor in order to reduce the risk of
EGF. We explore the hypothesis that donor-recipient matching based on
predicted heart mass (pHM) would be superior to matching based on weight
or body mass index (BMI) in predicting the risk of EGF. Methods: This
study is based on a registry including all consecutive isolated HT
performed at two Centers between 1999 and 2013. pHM for both donor and
recipient was calculated according to previously described equations
(1,2). Study population was divided in quartiles according to percentage
difference in pHM, body weight and BMI. We classified recipients according
to the presence of PH, defined as pulmonary vascular resistance (PVR) >3
WU. Study endpoint was the occurence of EGF, defined as need for
mechanical circulatory support within 24 hours from surgery. In-hospital
mortality was recorded as well. Results: Study population includes 518 HT
recipients (age 52 +/- 12 y, 81% male), 121 of whom had PH. Size mismatch
based on pHM, weight and BMI quartiles did not predict EGF and in-hospital
mortality in general population nor in patients without PH. In the PH
subgroup, difference in pHM was related to increased incidence of EGF.
While no differences were recorded among the first three quartiles,
patients in the most undersized one (median pHM difference 19%,
[8.3-37.8%]) experienced higher incidence of EGF (34% vs 10% OR 4.5 [95%
CI 1.57-12.9, P = 0.005]) and had a non-significant higher in-hospital
mortality (23% vs 12%, P = 0.2). pHM remained a significant predictor of
EGF also after correction for gender mismatch. The most undersized
quartile according to body weight (P = 0.051) had a less robust
statistical association with the same results, while stratification based
on BMI was not related to different outcomes. Conclusions: Size mismatch
amplifies the risk of early graft dysfunction after heart transplantation
in recipients with pulmonary hypertension. Size matching using predicted
heart mass better stratifies the risk of EGF than weight and BMI-based
methods.

<16>
Accession Number
614626303
Author
Dureau P.; Bougle A.; Tanguy A.; Arbelot C.; Ait H.N.; Ben H.K.;
Charfeddine A.; Granger B.; Amour J.
Institution
(Dureau, Amour) Service D'Anesthesie et De Reanimation, Institut De
Cardiologie, Pitie Salpetriere Hospital, Paris, France
(Bougle, Ait, Ben, Charfeddine) Service D'Anesthesie et De Reanimation,
Institut De Cardiologie, Pitie-Salpetriere Hospital, Paris, France
(Tanguy, Granger) Departement De Biostatistiques, Sante Publique et
Information Medicale, Pitie-Salpetriere Hospital, Paris, France
(Arbelot) Reanimation Chirurgicale Polyvalente, Hopital De La
Pitie-Salpetriere, Paris, France
Title
Lung ultrasound for early diagnosis of pneumonia after cardiac surgery.
Source
Annals of Intensive Care. Conference: French Intensive Care Society,
International Congress - Reanimation 2017. France. Conference Start:
20170111. Conference End: 20170113. 7 (1 Supplement 1) (pp 101), 2017.
Date of Publication: January 2017.
Publisher
Springer Verlag
Abstract
Introduction Pneumonia is a frequent and severe complication of major
cardiac surgery, contributing to postoperative morbidity and death [1].
Diagnosis of pneumonia remains a challenge in ventilated patients, notably
after cardiac surgery, and the diagnostic performance of Clinical
Pulmonary Infection Score (CPIS) remains controversial. Lung ultrasound
(LUS) has been successfully used for the diagnosis and the management of
community acquired pneumonia and ventilator-associated pneumonia (VAP)
[2], but LUS usefulness and reliability was never investigated in the
specific ICU patients after cardiac surgery with cardiopulmonary bypass
(CPB). This pilot observational study investigated the clinical relevance
of lung ultrasonography (LUS) for diagnosis of pneumonia in cardiac
postoperative patients with acute respiratory failure (ARF). Patients and
methods Adult patients were prospectively enrolled from January through
May 2015 in presence of acute respiratory failure (ARF) less than 3 days
after a cardiac surgery with CPB. Lung ultrasound examination was
performed as follows: subpleural consolidation, lobar consolidation,
dynamic and static air bronchogram, and intrapulmonary shunt. We compared
this ultrasound approach to the post hoc diagnosis of pneumonia
established from clinical, radiologic, and biologic data by three blinded
experts. Then, we compared the diagnostic performances of CPIS, ultrasound
criteria and a lung ultrasound based CPIS, LUS-CPIS, with or without
radiology criteria. The study was approved by the Comite de Protection des
Personnes Ile de France III; IRB 2015-A00127-42 Ref. S.C. 3275. Results
Fifty-one patients (age 65 +/- 12 years, male sex 72.6%) with ARF were
included in the study, and pneumonia was diagnosed in 26 of them. No
difference was observed between patients with or without pneumonia among
demographic data, type of surgery, CPB length. In case of pneumonia, the
most frequently identified pathogens were Enterobacteriaceae (37%),
Pseudomonas aeruginosa (15%) and Haemophilus influenza (8%). Multivaried
analysis showed that intrapulmonary shunt was the best predictive criteria
of pneumonia (odds-ratio 1.92; 95% CI [1.00; 5.43]). The ultrasound
diagnosis was more accurate than the simplified CPIS for the diagnosis of
pneumonia, area under the curve (AUC) respectively 0.75 (95% CI [0.62;
0.87] vs 0.59 (95% CI [0.47; 0.71]). Receiver operating characteristic
curves analysis showed that the most accurate score for diagnosis of
pneumonia was LUS-CPIS without radiology (AUC, 0.80 [0.69; 0.91]), with a
sensitivity of 92% (95% CI [0.85; 0.99]) and a specificity of 68% (95% CI
[0.55; 0.81]), a positive predictive value of 75% (95% CI [0.64; 0.88])
and a negative predictive value of (95% CI [0.63; 0.87]) (Fig. 30).
Furthermore, our results suggest the use of ultrasound data may
consistently reduce misuse of antibiotics of 70%. Discussion A new score,
combination of simplified CPIS and a simple ultrasound parameter,
intra-pulmonary shunt, predicts efficiently the presence of pneumonia
after cardiac surgery with CPB. Two LUS parameters, presence of a shunt
and a bronchogram aeric within a consolidation, are crucial for discerning
pneumonia from another etiology. This approach has the advantage to make
an early diagnosis of pneumonia in ARF patients with an inexpensive,
non-invasive and convenient at bedside technology. Conclusion This
prospective observational study is the first one showing that LUS combined
with a clinical score can be a reliable tool for early diagnosis of
pneumonia in a cardiac ICU population after cardiac surgery with CPB.
(Figure Presented) .

<17>
Accession Number
614617486
Author
Wovkulich M.; Kersten B.
Institution
(Wovkulich, Kersten) Buffalo General Medical Center, 100 High Street,
Buffalo, NY 14203, United States
Title
Post-CABG patient satisfaction with pharmacist-led medication education.
Source
Journal of Pharmacy Practice. Conference: 54th New York State Council of
Health-system Pharmacists Annual Assembly. United States. Conference
Start: 20150424. Conference End: 20150426. 28 (3) (pp 312), 2015. Date of
Publication: June 2015.
Publisher
SAGE Publications Inc.
Abstract
Background: Quality outcomes associated with coronary artery bypass graft
(CABG) surgery are of interest because the procedure is often associated
with complications such as heart failure, new onset atrial fibrillation,
and recurrent myocardial infarction. As a part of post-operative
management, current standards of care recommend patients receive aspirin
and/or clopidogrel, a statin, a beta blocker, and an angiotensin
converting enzyme inhibitor or angiotensin II receptor blocker to help
prevent these complications. For patients who were not on complex
medication regimens previously, the sudden addition of several new
medications may be confusing and overwhelming. Patients who receive
inadequate discharge medication education may not fully understand why
they have been initiated on multiple medications as well as the importance
of medication compliance. Pharmacists possess a unique skill-set to
improve patient understanding of their discharge medications and may
enhance overall satisfaction. Methods: This is a prospective, randomized,
single-blinded study evaluating patient satisfaction and comprehension of
medication counseling. The study has been approved by the University at
Buffalo IRB. Patients >18 years of age who presented to Buffalo General
Medical Center for CABG surgery or CABG and valve surgery between February
2015 through December 2015 will be prospectively randomized to two groups:
pharmacist or nurse-led education in a one to one ratio. Patients who were
less than 18 years of age, pregnant, reliant on home caregivers/unable to
perform activities of daily living, unable to provide consent, discharged
to a facility other than home, and those previously admitted for CABG
surgery were excluded. Objectives: The primary objective of this study is
to evaluate patient satisfaction and comprehension with pharmacist-led
medication counseling compared to the current standard of care, nurse-led
medication education. Secondary outcomes include 30-day all-cause
readmission rates and number of changes in medications from initial
admission to initial discharge. Results: The results of this study will
provide valuable information regarding a pharmacist's impact on patient
satisfaction and understanding of their discharge medication.

<18>
Accession Number
613862643
Author
Azzalini L.; Dautov R.; Brilakis E.S.; Ojeda S.; Benincasa S.; Bellini B.;
Karatasakis A.; Chavarria J.; Rangan B.V.; Pan M.; Carlino M.; Colombo A.;
Rinfret S.
Institution
(Azzalini, Benincasa, Bellini, Carlino, Colombo) Interventional
Cardiology, San Raffaele Scientific Institute, Milan, Italy
(Dautov, Rinfret) Interventional Cardiology, McGill University Health
Centre, Montreal, QC, Canada
(Dautov, Rinfret) Interventional Cardiology, Quebec Heart and Lung
Institute, Laval University, Quebec City, QC, Canada
(Karatasakis, Rangan) VA North Texas Healthcare System and University of
Texas Southwestern Medical Center at Dallas, Dallas, TX, United States
(Ojeda, Chavarria, Pan) Interventional Cardiology, Reina Sofia Hospital,
University of Cordoba (IMIBIC), Cordoba, Spain
(Brilakis) Interventional Cardiology, Minneapolis Heart Institute,
Minneapolis, MN, United States
Title
Procedural and longer-term outcomes of wire- versus device-based antegrade
dissection and re-entry techniques for the percutaneous revascularization
of coronary chronic total occlusions.
Source
International Journal of Cardiology. 231 (pp 78-83), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background There are few data regarding the procedural and follow-up
outcomes of different antegrade dissection/re-entry (ADR) techniques for
chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods We compiled a multicenter registry of consecutive patients
undergoing ADR-based CTO PCI at four high-volume specialized institutions.
Patients were divided according to the specific ADR technique used:
subintimal tracking and re-entry (STAR), limited antegrade subintimal
tracking (LAST), or device-based with the CrossBoss/Stingray system
(Boston Scientific, Marlborough, MA). Major adverse cardiac events (MACE:
cardiac death, target-vessel myocardial infarction and target-vessel
revascularization) on follow-up were the main outcome of this study.
Independent predictors of MACE were sought with Cox regression analysis.
Results A total of 223 patients were included (STAR n = 39, LAST n = 68,
CrossBoss/Stingray n = 116). Baseline characteristics were similar across
groups. Technical and procedural success was lower with STAR (59% and
59%), as compared with LAST (96% and 96%) and CrossBoss/Stingray (89% and
87%; p < 0.001 for both). At 24-month follow-up, MACE rates were higher in
STAR (15.4%) and LAST (17.5%), as compared with device-based ADR with
CrossBoss/Stingray (4.3%, p = 0.02), driven by TVR (7.7% vs. 15.5% vs.
3.1%, respectively; p = 0.02). Multivariable Cox regression analysis
identified wire-based ADR (STAR and LAST) and total stent length as
independent predictors of MACE. Conclusions In this multicenter cohort of
patients undergoing CTO PCI with ADR techniques, STAR had lower success
rates, as compared with the CrossBoss/Stingray system and LAST. The
CrossBoss/Stingray system was independently associated with lower risk of
MACE on follow-up, as compared with wire-based ADR techniques. Copyright
&#xa9; 2016 Elsevier Ireland Ltd

<19>
Accession Number
613976416
Author
Dennis M.; McCanny P.; D'Souza M.; Forrest P.; Burns B.; Lowe D.A.; Gattas
D.; Scott S.; Bannon P.; Granger E.; Pye R.; Totaro R.
Institution
(Dennis, Forrest, Burns, Gattas, Bannon, Totaro) Sydney Medical School,
University of Sydney, Sydney, Australia
(Dennis) Department of Cardiology, Royal Prince Alfred Hospital, Sydney,
Australia
(McCanny, Lowe, Pye) Department of Intensive Care, St Vincent's Hospital,
Sydney, Australia
(D'Souza) Sydney Local Health District, Clinical Research Centre,
Australia
(Burns) Greater Sydney Area Helicopter Emergency Medical Service, New
South Wales Ambulance Service, Australia
(Forrest) Department of Cardiothoracic Anaesthesia, Royal Prince Alfred
Hospital, Sydney, Australia
(Gattas, Totaro) Department of Intensive Care, Royal Prince Alfred
Hospital, Sydney, Australia
(Scott) Department of Emergency Medicine, St Vincent's Hospital, Sydney,
Australia
(Bannon) Institute of Academic Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
(Granger) Department of Cardiothoracic Surgery, St Vincent's Hospital,
Sydney, Australia
Title
Extracorporeal cardiopulmonary resuscitation for refractory cardiac
arrest: A multicentre experience.
Source
International Journal of Cardiology. 231 (pp 131-136), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Aim To describe the ECPR experience of two Australian ECMO centres, with
regards to survival and neurological outcome, their predictors and
complications. Methods Retrospective observational study of prospectively
collected data on all patients who underwent extracorporeal
cardiopulmonary resuscitation (ECPR) at two academic ECMO referral centres
in Sydney, Australia. Measurements and main results Thirty-seven patients
underwent ECPR, 25 (68%) were for in-hospital cardiac arrests. Median age
was 54 (IQR 47-58), 27 (73%) were male. Initial rhythm was ventricular
fibrillation or pulseless ventricular tachycardia in 20 patients (54%),
pulseless electrical activity (n = 14, 38%), and asystole (n = 3, 8%). 27
(73%) arrests were witnessed and 30 (81%) patients received bystander CPR.
Median time from arrest to initiation of ECMO flow was 45 min (IQR 30-70),
and the median time on ECMO was 3 days (IQR 1-6). Angiography was
performed in 54% of patients, and 27% required subsequent coronary
intervention (stenting or balloon angioplasty 24%). A total of 13 patients
(35%) survived to hospital discharge (IHCA 33% vs. OHCA 37%). All
survivors were discharged with favourable neurological outcome (Cerebral
Performance Category 1 or 2). Pre-ECMO lactate level was predictive of
mortality OR 1.35 (1.06-1.73, p = 0.016). Conclusions In selected patients
with refractory cardiac arrest, ECPR may provide temporary support as a
bridge to intervention or recovery. We report favourable survival and
neurological outcomes in one third of patients and pre-ECMO lactate levels
predictive of mortality. Further studies are required to determine optimum
selection criteria for ECPR. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<20>
[Use Link to view the full text]
Accession Number
613247648
Author
Reynolds J.C.; Grunau B.E.; Rittenberger J.C.; Sawyer K.N.; Kurz M.C.;
Callaway C.W.
Institution
(Reynolds) Department of Emergency Medicine, Michigan State University
College of Human Medicine, 15 Michigan St NE, Ste 420, Grand Rapids, MI
49503, United States
(Grunau) Department of Emergency Medicine, University of British Columbia,
Vancouver, BC, Canada
(Rittenberger) Department of Emergency Medicine, University of Pittsburgh,
Pittsburgh, PA, United States
(Sawyer) Department of Emergency Medicine, Beaumont Health System, Royal
Oak, MI, United States
(Kurz) Department of Emergency Medicine, University of Alabama School of
Medicine, Birmingham, United States
Title
Association between Duration of Resuscitation and Favorable Outcome after
Out-of-Hospital Cardiac Arrest: Implications for Prolonging or Terminating
Resuscitation.
Source
Circulation. 134 (25) (pp 2084-2094), 2016. Date of Publication: 20 Dec
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Little evidence guides the appropriate duration of
resuscitation in out-of-hospital cardiac arrest, and case features
justifying longer or shorter durations are ill defined. We estimated the
impact of resuscitation duration on the probability of favorable
functional outcome in out-of-hospital cardiac arrest using a large,
multicenter cohort. Methods: This was a secondary analysis of a North
American, single-blind, multicenter, cluster-randomized, clinical trial
(ROC-PRIMED [Resuscitation Outcomes Consortium Prehospital Resuscitation
Using an Impedance Valve and Early Versus Delayed]) of consecutive adults
with nontraumatic, emergency medical services-treated out-of-hospital
cardiac arrest. Primary exposure was duration of resuscitation in minutes
(onset of professional resuscitation to return of spontaneous circulation
[ROSC] or termination of resuscitation). Primary outcome was survival to
hospital discharge with favorable outcome (modified Rankin scale [mRS]
score of 0-3). Subjects were additionally classified as survival with
unfavorable outcome (mRS score of 4-5), ROSC without survival (mRS score
of 6), or without ROSC. Subject accrual was plotted as a function of
resuscitation duration, and the dynamic probability of favorable outcome
at discharge was estimated for the whole cohort and subgroups. Adjusted
logistic regression models tested the association between resuscitation
duration and survival with favorable outcome. Results: The primary cohort
included 11 368 subjects (median age, 69 years [interquartile range, 56-81
years]; 7121 men [62.6%]). Of these, 4023 (35.4%) achieved ROSC, 1232
(10.8%) survived to hospital discharge, and 905 (8.0%) had an mRS score of
0 to 3 at discharge. Distribution of cardiopulmonary resuscitation
duration differed by outcome (P<0.00001). For cardiopulmonary
resuscitation duration up to 37.0 minutes (95% confidence interval,
34.9-40.9 minutes), 99% with an eventual mRS score of 0 to 3 at discharge
achieved ROSC. The dynamic probability of an mRS score of 0 to 3 at
discharge declined over elapsed resuscitation duration, but subjects with
initial shockable cardiac rhythm, witnessed cardiac arrest, and bystander
cardiopulmonary resuscitation were more likely to survive with favorable
outcome after prolonged efforts (30-40 minutes). After adjustment for
prehospital (odds ratio, 0.93; 95% confidence interval, 0.92-0.95) and
inpatient (odds ratio, 0.97; 95% confidence interval, 0.95-0.99)
covariates, resuscitation duration was associated with survival to
discharge with an mRS score of 0 to 3. Conclusions: Shorter resuscitation
duration was associated with likelihood of favorable outcome at hospital
discharge. Subjects with favorable case features were more likely to
survive prolonged resuscitation up to 47 minutes. Clinical Trial
Registration: URL: http://clinicaltrials.gov. Unique identifier:
NCT00394706. Copyright &#xa9; 2016 American Heart Association, Inc.

<21>
Accession Number
613834989
Author
Boehne M.; Sasse M.; Karch A.; Dziuba F.; Horke A.; Kaussen T.;
Mikolajczyk R.; Beerbaum P.; Jack T.
Institution
(Boehne, Sasse, Dziuba, Kaussen, Beerbaum, Jack) Department of Pediatric
Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover,
Germany
(Karch, Mikolajczyk) Department of Epidemiology, Helmholtz Centre for
Infection Research, Braunschweig, Germany
(Horke) Department of Cardiothoracic, Transplantation and Vascular
Surgery, Hannover Medical School, Hannover, Germany
Title
Systemic inflammatory response syndrome after pediatric congenital heart
surgery: Incidence, risk factors, and clinical outcome.
Source
Journal of Cardiac Surgery. 32 (2) (pp 116-125), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Systemic inflammatory response syndrome (SIRS) is frequent
after cardiac surgery, but data on its incidence and perioperative risk
factors are scarce for children with congenital heart disease. METHODS:
SIRS incidence within 72 hours following cardiac surgery was evaluated in
a secondary analysis of children enrolled to a treatment-free control
group of a randomized controlled trial. Intraoperative parameters were
investigated for their association with SIRS using multivariable
fractional polynomial logistic regression models. Effects of SIRS on
various organ functions and length of stay were evaluated using
time-varying Cox regression models. RESULTS: In 116 children after cardiac
surgery (median age [range]: 7.4 month [1 day-16.2 years]) SIRS occurred
in n = 39/102 with and n = 1/14 without cardiopulmonary bypass (CPB).
Duration of CPB (hazard ratio [HR]: 2.28 per hour; 95% confidence interval
[CI] 1.17; 4.42) and amount of fresh frozen plasma (HR: 1.23 per 10 mL/kg;
95%CI 1.06; 1.42) were identified as predictors for SIRS; neonates seemed
to be less susceptible for SIRS development (HR: 0.86; 95%CI 0.79; 0.95).
SIRS was associated with organ dysfunction (HR: 2.69; 95%CI 1.41; 5.12)
and extended stay in the pediatric intensive care unit (PICU) (median: 168
vs. 96 hours; p = 0.007). CONCLUSIONS: SIRS is a frequent complication
after pediatric congenital heart surgery; it affects nearly one third of
children and prolongs PICU stay significantly. Duration of CPB and amount
of fresh frozen plasma were identified as important risk factors. Neonates
seem to be less susceptible to SIRS development. Copyright &#xa9; 2016
Wiley Periodicals, Inc.

<22>
Accession Number
612864761
Author
Buia A.; Stockhausen F.; Filmann N.; Hanisch E.
Institution
(Buia) Department of General and Visceral Surgery, St.
Elisabethen-Krankenhaus, Academic Teaching Hospital Goethe-University
Frankfurt, Ginnheimer Str. 3, Frankfurt 60487, Germany
(Stockhausen) Department of General and Visceral Surgery, St.
Elisabethen-Krankenhaus, Academic Teaching Hospital Goethe-University
Frankfurt, Frankfurt, Germany
(Filmann) Department of Medicine, Institute of Biostatistics and
Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
(Hanisch) Department of Visceral and Thoracic Surgery, Asklepios Klinik
Langen, Academic Teaching Hospital, Goethe-University Frankfurt, Langen,
Germany
Title
3D vs. 2D imaging in laparoscopic surgery-an advantage? Results of
standardised black box training in laparoscopic surgery.
Source
Langenbeck's Archives of Surgery. 402 (1) (pp 167-171), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: 3D imaging is an upcoming technology in laparoscopic surgery, and
recent studies have shown that the modern 3D technique is superior in an
experimental setting. Methods: All 14 members of the Asklepios Klinik
Langen Department of Visceral and Thoracic Surgery, as well as two
gynaecologists, were asked to undertake 2D vs. 3D laparoscopic black box
skill training. The black box training was adapted to the "fundamentals of
laparoscopic surgery" programme provided by the Society of American
Gastrointestinal and Endoscopic Surgeons (SAGES). First, the participants
categorised themselves as beginner, advanced or expert in laparoscopic
surgery. Then, they were randomised in terms of whether the black box
training commenced with 2D or 3D vision. The exercises included peg
transfer with the dominant hand and the non-dominant hand (with and
without transfer between the graspers), needle capping and cutting a
sutured knot. The time taken to complete these exercises was measured.
After the training, each participant was asked to describe his/her
personal impression of the imaging systems employed. Results: Overall, for
the participants in all groups, the time required for all exercises showed
a significant advantage for 3D imaging (3D vs. 2D; Wilcoxon matched pair
test; mean 68.0 +/- 94.9 s (3D) vs. 90.1 +/- 69.4 s (2D); p = 0.002).
Regarding the subgroups, the experts significantly improved their time in
completing the exercises in 3D vs. 2D by a margin of 25.8 % (mean 30.8 +/-
20.1 s (3D) vs. 41.5 +/- 25.0 s (2D); p = 0.010). In the group of advanced
surgeons, the results were similar, showing an improvement of 23.6 % for
3D, but without significance (mean 61.5 +/- 41.1 s (3D) vs. 80.4 +/- 72.8
s (2D); p = 0.123). The results for the beginner group also showed an
improvement in the 3D exercises of 24.8 %; here, the result also showed a
trend towards 3D but did not reach significance (mean 93.9 +/- 90.7 s (3D)
vs. 124.8 +/- 118.72 (2D); p = 0.062). Conclusion: In our opinion, 3D
imaging could be an advantage in laparoscopic surgery, especially in the
surgical education of upcoming surgical generations. To determine whether
these ex vivo results can be transferred to the clinical situation, our
group has initiated a randomised controlled study. Copyright &#xa9; 2016,
Springer-Verlag Berlin Heidelberg.

<23>
Accession Number
614013185
Author
Neefs J.; van den Berg N.W.E.; Limpens J.; Berger W.R.; Boekholdt S.M.;
Sanders P.; de Groot J.R.
Institution
(Neefs, van den Berg, Limpens, Berger, Boekholdt, de Groot) Department of
Cardiology, Heart Center, and Medical Library, Academic Medical Center,
Amsterdam, Netherlands
(Sanders) Centre for Heart Rhythm Disorders (CHRD), South Australian
Health and Medical Research Institute (SAHMRI), University of Adelaide and
Royal Adelaide Hospital, Adelaide, Australia
Title
Aldosterone Pathway Blockade to Prevent Atrial Fibrillation: A Systematic
Review and Meta-Analysis.
Source
International Journal of Cardiology. 231 (pp 155-161), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite advances in therapeutic interventions AF remains a
progressive and symptomatic disease. Therefore, novel therapeutic
interventions targeting the underlying arrhythmogenic substrate for AF is
needed. Atrial fibrosis is an important component of the arrhythmogenic
substrate of AF and may be initiated by aldosterone binding to the
mineralocorticoid receptor. We hypothesized that aldosterone pathway
blockade with mineralocorticoid receptor antagonists (MRA) reduces atrial
fibrosis, and thus AF. Methods We searched OVID MEDLINE, OVID EMBASE and
the Cochrane Central Register of Controlled Trials from inception to June
10th, 2016 for randomized controlled trials (RCT) and observational
studies addressing MRA and providing information on AF occurrence. Two
independent reviewers selected and appraised the data. We performed
random-effects meta-analyses. Summary odds ratios (OR) with 95% confidence
intervals (CI) were calculated. Results We included 14 studies, 5 RCT and
9 observational cohorts, with a cumulative number of 5332 patients (male:
74.9%, age: 65.3 years); 2397 (45.0%) received an MRA (spironolactone or
eplerenone). During follow-up, 204 (8.5%) patients treated with MRAs,
developed AF, compared to 547 (18.6%) patients, without MRA treatment.
Meta-analyses showed a significant overall reduction of AF risk in MRA
treated patients (OR: 0.48 CI: 0.38-0.60 p < 0.001), including a reduction
of new-onset AF (OR: 0.52 CI: 0.37-0.74 p < 0.001) and recurrent AF (OR:
0.37 CI: 0.24-0.57 p < 0.001), but not post-operative AF (POAF) (OR: 0.60
CI: 0.33-1.09 p = 0.09). Conclusions MRAs significantly reduce new-onset
AF and recurrent AF, but not POAF. MRA treatment can be considered an
additive therapeutic strategy in AF. Copyright &#xa9; 2017 The Authors

<24>
Accession Number
614009009
Author
Gryka R.J.; Buckley L.F.; Anderson S.M.
Institution
(Gryka) Pharmaceutical Sciences Department, School of Pharmacy, Cedarville
University, 251 North Main Street, Cedarville, OH 45314, United States
(Buckley) Department of Pharmacotherapy and Outcomes Science, School of
Pharmacy, Virginia Commonwealth University, Cedarville, OH, United States
(Anderson) Center for Pharmacy Care, Duquesne University, Pittsburgh, PA,
United States
Title
Vorapaxar: The Current Role and Future Directions of a Novel
Protease-Activated Receptor Antagonist for Risk Reduction in
Atherosclerotic Disease.
Source
Drugs in R and D. 17 (1) (pp 65-72), 2017. Date of Publication: 01 Mar
2017.
Publisher
Springer International Publishing
Abstract
Introduction: Despite the current standard of care, patients with
cardiovascular disease remain at a high risk for recurrent events.
Inhibition of thrombin-mediated platelet activation through
protease-activated receptor-1 antagonism may provide reductions in
atherosclerotic disease beyond those achievable with the current standard
of care. Objective: Our primary objective is to evaluate the clinical
literature regarding the role of vorapaxar (ZontivityTM) in the reduction
of cardiovascular events in patients with a history of myocardial
infarction and peripheral artery disease. In particular, we focus on the
potential future directions for protease-activating receptor antagonists
in the treatment of a broad range of atherosclerotic diseases. Data
Sources: A literature search of PubMed and EBSCO was conducted to identify
randomized clinical trials from August 2005 to June 2016 using the search
terms: 'vorapaxar', 'SCH 530348', 'protease-activated receptor-1
antagonist', and 'ZontivityTM'. Bibliographies were searched and
additional resources were obtained. Results: Vorapaxar is a
first-in-class, protease-activated receptor-1 antagonist. The Thrombin
Receptor Antagonist for Clinical Event Reduction (TRACER) trial did not
demonstrate a significant reduction in a broad primary composite endpoint.
However, the Thrombin-Receptor Antagonist in Secondary Prevention of
Atherothrombotic Ischemic Events (TRA 2degreeP-TIMI 50) trial examined a
more traditional composite endpoint and found a significant benefit with
vorapaxar. Vorapaxar significantly increased bleeding compared with
standard care. Ongoing trials will help define the role of vorapaxar in
patients with peripheral arterial disease, patients with diabetes
mellitus, and other important subgroups. The use of multivariate modeling
may enable the identification of subgroups with maximal benefit and
minimal harm from vorapaxar. Conclusion: Vorapaxar provides clinicians
with a novel mechanism of action to further reduce the burden of ischemic
heart disease. Identification of patients with a high ischemic risk and
low bleeding risk would enable clinicians to maximize the utility of this
unique agent. Copyright &#xa9; 2017, The Author(s).

<25>
Accession Number
612732470
Author
Gueret P.; Combe S.; Krezel C.; Fuseau E.; van Giersbergen P.L.M.; Petitou
M.; Neuhart E.
Institution
(Gueret) Haemostasis Department, University Hospital Pontchaillou, 2 rue
Henri Le Guilloux, Rennes Cedex 35033, France
(Combe) University Hospital Cochin, Paris, France
(Krezel, Petitou, Neuhart) Endotis Pharma, Romainville, Paris, France
(Fuseau) EMF Consulting, Aix en Provence, France
(van Giersbergen) Van Giersbergen Consulting, Wuenheim, France
(Gueret) GETBO EA 3878, Brest, France
Title
Neutralization of EP217609, a new dual-action FIIa/FXa anticoagulant, by
its specific antidote avidin: a phase I study.
Source
European Journal of Clinical Pharmacology. 73 (1) (pp 15-28), 2017. Date
of Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Introduction: EP217609 is a representative of a new class of synthetic
parenteral anticoagulants with a dual mechanism of action. It combines in
a single molecule a direct thrombin inhibitor and an indirect factor Xa
inhibitor. EP217609 can be neutralized by a specific antidote avidin,
which binds to the biotin moiety of EP217609. Purpose: The primary
objective was to assess the neutralization of EP217609 by avidin in
healthy subjects. Secondary objectives were to define the optimal avidin
monomer/EP217609 molar ratio to achieve an adequate neutralization of
EP217609 and to assess the safety and tolerability of EP217609 and avidin.
Methods: Healthy subjects (n = 36) were randomized to a 3 by 3 replicated
Latin square design between 3 EP217609 doses (4, 8, 12 mg) and 3 avidin
monomer/EP217609 molar ratios (1:1; 2:1; 3:1). EP217609 was administered
as a single intravenous bolus, and avidin as a 30-min intravenous
infusion, starting 90 min after EP217609 administration. Results: Overall,
EP217609 and avidin were well tolerated. One subject experienced a benign
and transient typical pseudo-allergic reaction. The administration of
EP217609 resulted in dose-dependent increases in pharmacodynamic markers.
Avidin triggered a rapid and irreversible neutralization of EP217609
without rebound effect. Adequate neutralization of the anticoagulant
activity was achieved with both 2:1 and 3:1 avidin monomer/EP217609 molar
ratios. All safety parameters did not show any treatment-emergent
clinically relevant changes or abnormalities in any dose group.
Conclusions: These results will allow further investigation in patients
requiring a neutralizable anticoagulant as those undergoing cardiac
surgery. Study registration: EudraCT number 2010-020216-10. Copyright
&#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<26>
Accession Number
614334786
Author
Rogers J.G.; Pagani F.D.; Tatooles A.J.; Bhat G.; Slaughter M.S.; Birks
E.J.; Boyce S.W.; Najjar S.S.; Jeevanandam V.; Anderson A.S.; Gregoric
I.D.; Mallidi H.; Leadley K.; Aaronson K.D.; Frazier O.H.; Milano C.A.
Institution
(Rogers, Milano) Division of Cardiovascular Medicine, Duke Clinical
Research Institute, Duke University Medical Center, Box 3034 DUMC, Durham,
NC 27710, United States
(Pagani, Aaronson) University of Michigan, Ann Arbor, IL, United States
(Tatooles, Bhat) Advocate Christ Medical Center, Oak Lawn, IL, United
States
(Jeevanandam) University of Chicago Medicine, Chicago, IL, United States
(Anderson) Northwestern Memorial Hospital, Chicago, IL, United States
(Slaughter, Birks) University of Louisville, Louisville, KY, United States
(Boyce, Najjar) MedStar Heart Institute, Washington, DC, United States
(Gregoric) University of Texas Health Science Center, Houston, United
States
(Mallidi, Frazier) Texas Heart Institute, Houston, United States
(Leadley) HeartWare, Framingham, MA, United States
Title
Intrapericardial left ventricular assist device for advanced heart
failure.
Source
New England Journal of Medicine. 376 (5) (pp 451-460), 2017. Date of
Publication: 02 Feb 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Mechanical circulatory support with a left ventricular assist
device (LVAD) is an established treatment for patients with advanced heart
failure. We compared a newer LVAD design (a small intrapericardial
centrifugal-flow device) against existing technology (a commercially
available axial-flow device) in patients with advanced heart failure who
were ineligible for heart transplantation. METHODS: We conducted a
multicenter randomized trial involving 446 patients who were assigned, in
a 2:1 ratio, to the study (centrifugal-flow) device or the control
(axial-flow) device. Adults who met contemporary criteria for LVAD
implantation for permanent use were eligible to participate in the trial.
The primary end point was survival at 2 years free from disabling stroke
or device removal for malfunction or failure. The trial was powered to
show noninferiority with a margin of 15 percentage points. RESULTS: The
intention-to treat-population included 297 participants assigned to the
study device and 148 participants assigned to the control device. The
primary end point was achieved in 164 patients in the study group and 85
patients in the control group. The analysis of the primary end point
showed noninferiority of the study device relative to the control device
(estimated success rates, 55.4% and 59.1%, respectively, calculated by the
Weibull model; absolute difference, 3.7 percentage points; 95% upper
confidence limit, 12.56 percentage points; P = 0.01 for noninferiority).
More patients in the control group than in the study group had device
malfunction or device failure requiring replacement (16.2% vs. 8.8%), and
more patients in the study group had strokes (29.7% vs. 12.1%). Quality of
life and functional capacity improved to a similar degree in the two
groups. CONCLUSIONS: In this trial involving patients with advanced heart
failure who were ineligible for heart transplantation, a small,
intrapericardial, centrifugal-flow LVAD was found to be noninferior to an
axial-flow LVAD with respect to survival free from disabling stroke or
device removal for malfunction or failure. Copyright &#xa9; 2017
Massachusetts Medical Society.

<27>
Accession Number
614581999
Author
Mehrpooya M.; Larti F.; Nozari Y.; Sattarzadeh-Badkoobeh R.; Parsa A.F.Z.;
Zebardast J.; Tavoosi A.; Shahbazi F.
Institution
(Mehrpooya, Larti, Sattarzadeh-Badkoobeh, Parsa, Tavoosi) Department of
Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Nozari) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Zebardast) Department of Electronic Learning in Medical Education, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Shahbazi) Department of Biology, Payame Noor University, Tehran, Iran,
Islamic Republic of
Title
Study of serum uric acid levels in myocardial infarction and its
association with killip class.
Source
Acta Medica Iranica. 55 (2) (pp 97-102), 2017. Date of Publication: 2017.
Publisher
Medical Sciences University of Teheran
Abstract
The present study aimed to compare the serum level of uric acid in
patients with and without heart failure and also to determine the
association between uric acid level and clinical status by Killip class in
patients with STEMI. This case-control study was conducted on 50
consecutives as control group and 50 patients with acute heart failure,
(20 patients had acute STEMI), who documented by both clinical conditions
and echocardiography assessment. The mean plasma level of uric acid in the
case group was 7.6+/-1.6 milligrams/deciliter (mg/dL) and in the control
group was 4.5+/-1.5 respectively (P<0.001). These values in patients with
STEMI was about 9.2+/-0.86, but in patients with acute heart failure in
absence of STEMI was 6.5+/-1.04 (P<0.001). Moreover, there was significant
difference among the level of uric acid and Killip classes (P<0.001). Also
there was significant difference for uric acid level between HFrEF (HF
with reduced EF) and severe LV systolic dysfunction (0.049). In STEMI
patients with culprit LAD, mean uric acid was significantly higher than
cases with culprit LCX [(9.7+/-0.98 versus 8.6+/-0.52 respectively)
P=0.012]. Regarding treatment plan in patients with STEMI, mean level of
uric acid in those considered for CABG was significantly higher than who
were considered for PCI, 9.9+/-0.82 versus 8.9+/-0.76 respectively,
P=0.029. In STEMI patients with higher killip class, higher level of uric
acid was seen. Also, the severity of LV systolic dysfunction was
associated with higher level of uric acid. Copyright &#xa9; 2017 Tehran
University of Medical Sciences. All rights reserved.

<28>
Accession Number
614107348
Author
Hart E.A.; Jansen R.; Meijs T.A.; Bouma B.J.; Riezebos R.K.; Tanis W.; van
Boven W.J.P.; Hindori V.; Wiersma N.; Dessing T.; Westerink J.; Chamuleau
S.A.J.
Institution
(Hart, Jansen, Meijs, Dessing, Westerink, Chamuleau) University Medical
Center Utrecht, Utrecht, Netherlands
(Bouma, van Boven) Academic Medical Center, Amsterdam, Netherlands
(Riezebos, Hindori) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Tanis) Haga Ziekenhuis, The Hague, Netherlands
(Wiersma) Thrombosis Center Saltro, Utrecht, Netherlands
Title
Anticoagulant bridging in left-sided mechanical heart valve patients.
Source
International Journal of Cardiology. 232 (pp 121-126), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background In preparation for an invasive procedure with a high bleeding
risk, patients with a mechanical heart valve temporarily have to
discontinue their anticoagulant therapy and are usually bridged with
either intravenous unfractionated heparin (UFH) or subcutaneous
low-molecular-weight heparin (LMWH). In this study we retrospectively
analyzed the safety of UFH versus LMWH as bridging strategy in left-sided
mechanical heart valve patients. Methods We performed a retrospective
multicenter study in four surgical centers in The Netherlands. Patients
with a mechanical heart valve implantation bridged from January 2010 until
January 2015 were included. The cumulative incidence of adverse events in
the 30 days following the procedure was recorded. Main outcomes were major
bleeding according to International Society on Thrombosis and Haemostasis
(ISTH) criteria, symptomatic thromboembolism, and mortality. Results In
total, 238 (174 aortic, 42 mitral, 22 aortic + mitral) bridging episodes
were included. The incidence of major bleeding was 16 (19%) events in the
UFH group versus 29 (19%) events in the LMWH group (p = 0.97). Incidences
of thromboembolism were 2 (2.4%) versus 1 (0.6%). The incidence of death
was 1 (1.2%) patient in the UFH group versus 3 (1.9%) patients in the LMWH
group. More than 50% of all bleeding complications were categorized as a
major bleeding. Conclusions Bridging anticoagulation in patients with
aortic and mitral mechanical valves is associated with considerable risk,
but no difference was apparent between UFH and LMWH strategy. The rate of
thromboembolism and death was low with either strategy and the vast
majority of adverse events were bleedings. Copyright &#xa9; 2017 Elsevier
B.V.

<29>
Accession Number
614158733
Author
Schafer U.; Deuschl F.; Schofer N.; Frerker C.; Schmidt T.; Kuck K.H.;
Kreidel F.; Schirmer J.; Mizote I.; Reichenspurner H.; Blankenberg S.;
Treede H.; Conradi L.
Institution
(Schafer, Deuschl, Schofer, Mizote, Blankenberg) Department for General
and Interventional Cardiology, University Heart Center, University
Hospital Hamburg-Eppendorf, Germany
(Schirmer, Reichenspurner, Treede, Conradi) Department of Cardiovascular
Surgery, University Heart Center, University Hospital Hamburg-Eppendorf,
Germany
(Frerker, Schmidt, Kuck, Kreidel) Department of Cardiology, Asklepios
Clinic St. Georg, Hamburg, Germany
Title
Safety and efficacy of the percutaneous transaxillary access for
transcatheter aortic valve implantation using various transcatheter heart
valves in 100 consecutive patients.
Source
International Journal of Cardiology. 232 (pp 247-254), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives Transcatheter Aortic Valve Implantation (TAVI) can be performed
via the transaxillary approach, but data about complications and
procedural outcome is limited. Introduction TAVI is an established
treatment option for patients at high risk for conventional aortic valve
replacement. Nowadays, the transfemoral approach is the most commonly used
access for TAVI. Nevertheless, the transfemoral access is not suitable in
many patients necessitating alternative approaches. Methods We analyzed
the outcome of 100 consecutive cases receiving percutaneous transaxillary
TAVI at two different hospitals. Data were retrospectively analyzed by
means of procedural, hemodynamic and clinical outcome. In addition, 1st
versus 2nd generation devices were analyzed. Results Mean age was 78.2 +/-
2.1 years and the logEuroSCORE I was 24.6 +/- 13.9%. Transaxillary TAVI
was performed in 85% via the left and in 15% via the right axillary
artery. Device success was achieved in 95%. In general, there was a clear
learning curve with this approach. No patient experienced a major and 11%
a minor access site complication. There was one procedural death (annular
rupture) and one peri-procedural TIA. 23% of the patients received a new
pacemaker. At discharge, effective orifice area was 1.94 +/- 0.16
cm² and the mean aortic gradient was 6.8 +/- 2.1 mm Hg.
Moderate aortic regurgitation/paravalvular leakage was documented in two
patients. Mortality rates at 30 days and one year were 6% and 14.8%. Last
but not least, 2nd generation devices showed improved procedural outcomes.
Conclusions The percutaneous transaxillary access for TAVI is technically
feasible and safe thereby yielding excellent clinical results. Condensed
abstract We investigated In 100 consecutive patients undergoing
percutaneous transaxillary transcatheter aortic valve implantation thereby
demonstrating that this approach is technically feasible and safe with
acceptable numbers of minor vascular complications. Copyright &#xa9; 2017
Elsevier B.V.

<30>
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

<31>
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

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

<33>
Accession Number
614117344
Author
Schulz E.; Jabs A.; Tamm A.; Herz P.; Schulz A.; Gori T.; von Bardeleben
S.; Kasper-Konig W.; Hink U.; Vahl C.-F.; Munzel T.
Institution
(Schulz, Jabs, Tamm, Herz, Schulz, Gori, von Bardeleben, Hink, Munzel)
Department of Cardiology 1, Universitatsmedizin Mainz, Germany
(Kasper-Konig, Vahl) Department of Cardiovascular and Thoracic Surgery,
Universitatsmedizin Mainz, Germany
(Jabs, Hink) Department of Cardiology, Klinikum Frankfurt Hochst,
Frankfurt am Main, Germany
Title
Comparison of transcatheter aortic valve implantation with the
newest-generation Sapien 3 vs. Direct Flow Medical valve in a single
center cohort.
Source
International Journal of Cardiology. 232 (pp 186-191), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The latest generation transcatheter heart valves including
Edwards Sapien 3 (ES3) and Direct Flow Medical (DFM) were designed to
allow precise implantation at the intended position and to minimize
prosthesis dysfunction as well as procedural complications. Our aim was to
compare short-term functional and clinical outcomes of these 2
transcatheter aortic valve systems. Methods Of 174 patients undergoing
transfemoral transcatheter aortic valve implantation (TAVI) at our
institution between August 2013 and June 2015, 113 were treated with ES3
and 61 with DFM. Device success, residual aortic regurgitation and early
safety endpoints were defined according to the updated VARC-2 criteria and
prespecified as primary endpoints. Results Patients treated with ES3 had a
significantly higher rate of procedural success (ES3 94% vs. DFM 79%, p =
0.005), mainly driven by lower postprocedural gradients (ES3 8.6 +/- 0.5
mm Hg vs. DFM 14.6 +/- 1.4 mm Hg by invasive recordings; p = 0.00012) and
no incidence of more than mild aortic regurgitation. The occurrence of
safety endpoints at 30 days was low and comparable in the DFM vs. ES3
group (ES3 88% vs. DFM 95% of patients without endpoints, p = 0.26). No
significant differences were observed in 30 day mortality, stroke or the
incidence of new permanent pacemaker implantation. Conclusions These
single-center experience data show a higher rate of device success for ES3
treated patients, while 30 day safety outcome was similar in both groups.
Long-term follow-up and larger scale multicenter experience will have to
assess possible effects of these observations on long-term clinical
outcomes. Copyright &#xa9; 2017 Elsevier B.V.

<34>
Accession Number
614478721
Author
Daoulah A.; Lotfi A.; Al-Murayeh M.; Al-Kaabi S.; Al-Faifi S.M.; Elkhateeb
O.E.; Alama M.N.; Hersi A.S.; Dixon C.M.; Ahmed W.; Al-Shehri M.; Youssef
A.; Elimam A.M.; Abougalambou A.S.; Murad W.; Alsheikh-Ali A.A.
Institution
(Daoulah) Section of Adult Cardiology, Cardiovascular Department, King
Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
(Lotfi) Division of Cardiology, Baystate Medical Center, Tufts University
School of Medicine, Springfield, MA, United States
(Al-Murayeh, Al-Shehri) Cardiovascular Department, Armed Forces Hospital,
Southern Region, Khamis Mushayt, Saudi Arabia
(Al-Kaabi, Murad) Cardiovascular Department, Zayed Military Hospital, Abu
Dhabi, United Arab Emirates
(Al-Faifi) Section of Pulmonology, Internal Medicine Department, King
Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
(Elkhateeb, Abougalambou) Cardiac Center, King Abdullah Medical City in
Holy Capital, Makkah, Saudi Arabia
(Alama, Elimam) Cardiovascular Department, King Abdulaziz University
Hospital, Jeddah, Saudi Arabia
(Hersi) Cardiovascular Department, College of Medicine, King Saud
University, Riyadh, Saudi Arabia
(Dixon) Emergency Department, King Faisal Specialist Hospital and Research
Center, Riyadh, Saudi Arabia
(Ahmed) Section of Infectious Disease, Internal Medicine Department, King
Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
(Youssef) Cardiovascular Department, Suez Canal University, Ismailia,
Egypt
(Alsheikh-Ali) College of Medicine, Mohammed Bin Rashid University of
Medicine and Health Sciences, Dubai, United Arab Emirates
(Alsheikh-Ali) Institute of Cardiac Sciences, Sheikh Khalifa Medical City,
Abu Dhabi, United Arab Emirates
Title
Polygamy & risk of coronary artery disease in men undergoing angiography:
An observational study.
Source
International Journal of Vascular Medicine. 2017 (no pagination), 2017.
Article Number: 1925176. Date of Publication: 2017.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Epidemiologic evidence suggests a link between psychosocial risk factors
such as marital status and coronary artery disease (CAD). Polygamy
(multiple concurrent wives) is a distinct marital status practiced in many
countries in Asia and the Middle East, but its association with CAD is not
well defined. We conducted a multicenter, observational study of
consecutive patients undergoing coronary angiography during the period
from April 1, 2013, to March 30, 2014. Of 1,068 enrolled patients, 687
were married men. Polygamy was reported in 32% of married men (1 wife:
68%, 2 wives: 19%, 3 wives: 10%, and 4 wives: 3%). When stratified by
number of wives, significant baseline differences were observed in age,
type of community (rural versus urban), prior coronary artery bypass
grafting (CABG), and household income. After adjusting for baseline
differences, there was a significant association between polygamy and CAD
(adjusted OR 4.6 [95% CI 2.5, 8.3]), multivessel disease (MVD) (adjusted
OR 2.6 [95% CI 1.8, 3.7]), and left main disease (LMD) (adjusted OR 3.5
[95% CI 2.1, 5.9]). Findings were consistent when the number of wives was
analyzed as a continuous variable. In conclusion, among married men
undergoing coronary angiography for clinical indications, polygamy is
associated with the presence of significant CAD, MVD, and LMD. Copyright
&#xa9; 2017 Amin Daoulah et al.

<35>
Accession Number
614157379
Author
Hojskov I.E.; Moons P.; Hansen N.V.; La Cour So.; Olsen P.S.; Gluud C.;
Winkel P.; Lindschou J.; Thygesen L.C.; Egerod I.; Berg S.K.
Institution
(Hojskov, Olsen, Berg) Department of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Moons) KU Leuven Department of Public Health and Primary Care, KU Leuven,
Leuven, Belgium
(Moons) Institute of Health and Care Sciences, University of Gothenburg,
Gothenburg, Sweden
(Hansen) Interacting Minds Center, Aarhus University, Aarhus, Denmark
(La Cour) Centre for Research in Existence and Society, University of
Copenhagen, Copenhagen, Denmark
(Gluud, Winkel, Lindschou) Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
(Thygesen) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Egerod) Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
Title
SheppHeartCABG trial-comprehensive early rehabilitation after coronary
artery bypass grafting: A protocol for a randomised clinical trial.
Source
BMJ Open. 7 (1) (no pagination), 2017. Article Number: e013038. Date of
Publication: 01 Jan 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Patients undergoing coronary artery bypass graft surgery
often experience a range of symptoms. Studies indicate that
non-pharmacological interventions such as exercise training and
psychoeducation have a positive physiological and psychological effect in
early outpatient rehabilitation. The SheppHeartCABG trial will investigate
the effect of early comprehensive rehabilitation in early phase
rehabilitation versus usual care. The aim of this paper is to present the
protocol for the SheppHeartCABG trial. Methods/analysis SheppHeartCABG is
an investigator-initiated randomised clinical superiority trial with
blinded outcome assessment, employing 1:1 central randomisation to
rehabilitation plus usual care versus usual care alone. On the basis of a
sample size calculation, 326 patients undergoing coronary artery bypass
grafting will be included from two clinical sites. All patients receive
usual care and patients allocated to the experimental intervention follow
4weeks rehabilitation consisting of an exercise programme,
psycho-educative consultations and a compact mindfulness programme. The
primary outcome is physical function measured by the 6-min walk test. The
secondary outcomes are mental health and physical activity measured by the
Medical Outcome Study Short Form (SF-12), anxiety and depression measured
by the Hospital Anxiety and Depression Scale questionnaire, physical,
emotional and global scores by the HeartQoL questionnaire, sleep measured
by the Pittsburgh Sleep Quality Index, pain measured by the Orebro
Musculoskeletal Screening Questionnaire and muscle endurance measured by
the sit-to-stand test. A number of explorative analyses will also be
conducted. Ethics and dissemination SheppHeartCABG is approved by the
regional ethics committee (no. H-4-2014-109) and the Danish Data
Protection Agency (no. 30-1309) and is performed in accordance with good
clinical practice and the Declaration of Helsinki in its latest form.
Positive, neutral and negative results of the trial will be submitted to
international peer-reviewed journals. Furthermore, results will be
presented at national and international conferences relevant to the
subject fields. Copyright &#xa9; Published by the BMJ Publishing Group
Limited.

<36>
Accession Number
614394388
Author
Perez S.B.; Rodriguez-Fanjul J.; Garcia I.J.; Hernando J.M.; Sanz M.I.
Institution
(Perez) Pediatric Intensive Care Unit Service, Hospital de Sant Joan de
Deu, University of Barcelona, Barcelona, Spain
(Rodriguez-Fanjul, Hernando, Sanz) Neonatal Intensive Care Unit Service,
Hospital de Sant Joan de Deu Maternal, Fetal and Neonatology Center
Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
(Garcia) Pediatric Intensive Care Unit, Sant Joan de Deu Hospital,
Paediatric Infectious Diseases Research Group, Institut Recerca Hospital
Sant Joan de Deu, CIBERESP, Barcelona, Spain
Title
Procalcitonin is a better biomarker than C-reactive protein in newborns
undergoing cardiac surgery: The PROKINECA study.
Source
Biomarker Insights. 11 (pp 123-129), 2016. Date of Publication: 03 Nov
2016.
Publisher
Libertas Academica Ltd. (PO Box 300-874, Albany 0751, Mairangi Bay,
Auckland 0751, New Zealand)
Abstract
Objectives: To assess the kinetics of procalcitonin (PCT) and C-reactive
protein (CRP) in newborns after cardiothoracic surgery (CS), with and
without cardiopulmonary bypass, and to assess whether PCT was better than
CRP in identifying sepsis in the first 72 hours after CS.Patients and
methods: This is a prospective study of newborns admitted to the neonatal
intensive care unit after CS.Interventioions: PCT and CRP were
sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72
hours after surgery.Results: A total of 65 patients were recruited, of
which 14 were excluded because of complications. We compared the kinetics
of PCT and CRP after CS in bypass and non-bypass groups without sepsis;
there were no differences in the PCT values at any time (24 hours, P =
0.564; 48 hours, P = 0.117; 72 hours, P = 0.076). Thirty-five patients
needed bypass, of whom four were septic (11.4%). Significant differences
were detected in the PCT values on comparing the septic group to the
nonseptic group at 48 hours after cardiopulmonary bypass (P = 0.018). No
differences were detected in the CRP values in these groups. A suitable
cutoff for sepsis diagnosis at 48 hours following bypass would be 5 ng/mL,
with optimal area under the curve of 0.867 (confidence interval
0.709-0.958), P<0.0001, and sensitivity and specificity of 87.5%
(29.6-99.7) and 72.6% (53.5-86.4), respectively.CoConclusioion: This is a
preliminary study but PCT seems to be a good biomarker in newborns after
CS. Values over 5 ng/mL at 48 hours after CS should alert physicians to
the high risk of sepsis in these patients. Copyright &#xa9; the authors,
publisher and licensee Libertas Academica Limited.

<37>
Accession Number
613219415
Author
Quevedo H.C.; Alonso A.
Institution
(Quevedo, Alonso) Tulane University Heart and Vascular Institute, Tulane
University School of Medicine, New Orleans, LA, United States
Title
Endovascular therapy for ascending aorta pseudoaneurysm.
Source
Cardiovascular Revascularization Medicine. 17 (8) (pp 586-588), 2016. Date
of Publication: 01 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Ascending Aortic pseudoaneurysms (AAP) are often formed as a result of
prior thoracic surgery. In patients with large AAP, surgical correction is
the established therapy. However, a group of patients are not suitable
surgical candidates because of advanced age or multiple comorbidities.
Instead, endovascular approach represents a viable option in this
population. Here, we review the literature of the surgical and
trans-catheter therapy for AAP. Additionally, we complement the review
with a case presentation of a prohibitive surgical risk case that was
treated with endovascular options including an unsuccessful septal
occluder deployment, but final excellent angiographic AAP exclusion with
coil embolization. Copyright &#xa9; 2016 Elsevier Inc.

<38>
Accession Number
613216126
Author
Verma D.R.; Pershad Y.; Pershad A.; Fang K.; Gellert G.; Morris M.F.
Institution
(Verma, Pershad, Fang, Gellert, Morris) Cardiovascular Institute, Banner
University Medical Center, Phoenix, United States
(Verma, Pershad) Division of Interventional Cardiology, Banner University
Medical Center, Phoenix, United States
(Pershad, Morris) Department of Radiology, Banner University Medical
Center, Phoenix, United States
(Fang) Division of Cardiothoracic Surgery, Banner University Medical
Center, Phoenix, United States
(Gellert) Department of Anesthesiology, Banner University Medical Center,
Phoenix, United States
Title
Impact of institutional volume and experience with CT interpretation on
sizing of transcatheter aortic valves: A multicenter retrospective study.
Source
Cardiovascular Revascularization Medicine. 17 (8) (pp 566-570), 2016. Date
of Publication: 01 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Computed tomography (CT) has become the standard imaging
modality for pre-procedural aortic annular sizing prior to transcatheter
aortic valve replacement (TAVR). We hypothesized that the accuracy of CT
derived annular measurements would be greater at sites with higher TAVR
procedural volume. Methods Within a large integrated health system, TAVR
was performed at low (<40 cases), intermediate (40-75 cases), and
high-volume sites (>75 cases). 181 patients underwent TAVR with a Sapien
XT transcatheter heart valve (THV). Two blinded experienced readers
independently remeasured the annulus on CT and compared their measurements
to site reported measurements. Hypothetical THV sizes were chosen based on
measurements from site CT reports and independent readers' measurements,
and compared to the implanted THV size. Results Correlation between site
reported measurements and independent readers measurements of mean annulus
size varied between low-volume (r = 0.31, p = 0.18), intermediate-volume
(r = 0.34, p = 0.01), and high-volume sites (r = 0.96, p < 0.01). On
multivariate analysis, interpretation of >20 CT scans (OR 0.29; 95% CI
0.03-0.81; p 0.02) and high-volume site (OR 0.16; 95% CI 0.10-0.82; p
0.02) were associated with reduced mismatch between the site predicted THV
size and independent readers predicted THV size. Mismatch between site
predicted THV size and implanted THV size was associated with a worse
30-day composite of mortality, dialysis-dependent renal failure,
cerebrovascular accident, new permanent pacemaker, and hospital
readmission (55.3 vs. 38.7%; p = 0.05). Conclusions Accuracy of CT aortic
annular sizing is improved with higher individual experience and site TAVR
volume. These findings should be confirmed in larger, prospective studies.
Copyright &#xa9; 2016 Elsevier Inc.

<39>
Accession Number
608113798
Author
Mookhoek A.; Korteland N.M.; Arabkhani B.; Di Centa I.; Lansac E.; Bekkers
J.A.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Mookhoek, Korteland, Arabkhani, Bekkers, Bogers, Takkenberg) Erasmus
University Medical Center, Department of Cardiothoracic Surgery, PO Box
2040, Rotterdam 3000 CA, Netherlands
(Di Centa) Hopital Foch, Suresnes, France
(Lansac) Institut Mutualiste Montsouris, Paris, France
Title
Bentall Procedure: A Systematic Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1684-1690), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background The Bentall procedure is considered the gold standard in the
treatment of patients requiring aortic root replacement. An up-to-date
overview of outcomes after the Bentall procedure is lacking. Methods We
conducted a systematic review and meta-analysis of characteristics of and
long-term outcome after the Bentall procedure with a mechanical valve
prosthesis. Pooling was performed using the inverse variance method within
a random-effects model. Outcome events are reported as linearized
occurrence rates (percentage per patient year) with 95% confidence
intervals. Results In total, 46 studies with 7,629 patients (mean age, 50
years; 76% men) were selected. Pooled early mortality was 6% (422
patients). During a mean follow-up of 6 years (49,175 patient-years), the
annual linearized occurrence rate for late mortality was 2.02% (1.77%-
2.31%; 892 patients), for aortic root reoperation it was 0.46%
(0.36%-0.59%), for hemorrhage it was 0.64% (0.47%-0.87%), for
thromboemboli it was 0.77% (0.60%-1.00%), for endocarditis it was 0.39%
(0.33%-0.46%), and for major adverse valve-related events it was 2.66%
(2.17%-3.24%). Operations performed in more recent years were associated
with lower rates of aortic root reoperation (beta = -0.452; p = 0.015).
Conclusions This systematic review illustrates that rates of aortic root
reoperation after the Bentall procedure have decreased over the years.
However, late mortality, major bleeding, and thromboembolic complications
remain a concern. This report may be used to benchmark the potential
therapeutic benefit of novel surgical approaches, such as valve-sparing
aortic root replacement. Copyright &#xa9; 2016 The Society of Thoracic
Surgeons.

<40>
Accession Number
613647878
Author
Lipinski M.J.; Lee R.C.; Gaglia M.A.; Torguson R.; Garcia-Garcia H.M.;
Pichard A.D.; Satler L.F.; Waksman R.
Institution
(Lipinski, Lee, Gaglia, Torguson, Garcia-Garcia, Pichard, Satler, Waksman)
Section of Interventional Cardiology, MedStar Washington Hospital Center,
Washington, DC, United States
Title
Comparison of heparin, bivalirudin, and different glycoprotein IIb/IIIa
inhibitor regimens for anticoagulation during percutaneous coronary
intervention: A network meta-analysis.
Source
Cardiovascular Revascularization Medicine. 17 (8) (pp 535-545), 2016. Date
of Publication: 01 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background/purpose Numerous GPIs are available for PCI. Although they were
tested in randomized controlled trials, a comparison between the different
GPI strategies is lacking. Thus, we performed a Bayesian network
meta-analysis to compare different glycoprotein IIb/IIIa inhibitor (GPI)
strategies with heparin and bivalirudin for percutaneous coronary
intervention (PCI). Methods MEDLINE, Cochrane CENTRAL, and
ClinicalTrials.gov were searched by two independent reviewers for
randomized controlled trials comparing high-dose bolus tirofiban,
abciximab, eptifibatide, heparin with provisional glycoprotein IIb/IIIa
inhibitors, and bivalirudin with provisional GPI that reported clinical
outcomes. Mixed treatment comparison model generation was performed to
directly and indirectly compare between different anticoagulation
strategies for all-cause mortality, myocardial infarction, major adverse
cardiovascular events, major bleeding, minor bleeding, need for
transfusion, and thrombocytopenia. Results A total of 41 randomized
controlled trials with 38,645 patients were included in the analysis,
among which 2654 were randomized to high-dose bolus tirofiban, 6752 to
abciximab, 1669 to eptifibatide, 16,500 to heparin, and 11,070 to
bivalirudin. Mean age was 64 +/- 11 years, 75% were male, 91% were treated
with stenting, 71% with clopidogrel, and 74% for acute coronary syndrome.
High-dose bolus tirofiban was associated with a significant reduction in
all-cause mortality compared with heparin (OR 0.57 [credible intervals
0.37, 0.9]) and eptifibatide (OR 0.44 [credible intervals 0.19, 1.0]). GPI
regimens had less myocardial infarction and major adverse cardiovascular
events but greater bleeding compared with heparin and bivalirudin. There
was no difference among the GPI therapies for other outcomes, including
myocardial infarction, major adverse cardiovascular events, and major
bleeding. Conclusions Our network meta-analysis of 38,645 patients
demonstrated that GPI regimens were associated with a reduction in
recurrent myocardial infarction or major adverse cardiovascular events for
PCI, while bivalirudin was associated with the lowest risk of bleeding.
Copyright &#xa9; 2016

<41>
Accession Number
613716507
Author
Liebenberg J.J.; Dold C.J.; Olivier L.R.
Institution
(Liebenberg) Worcester Hospital, Worcester, South Africa
(Dold) Hanover Park Day Hospital, Cape Town, South Africa
(Olivier) Medi-Clinic Hospital, Durbanville, South Africa
Title
A prospective investigation into the effect of colchicine on tuberculous
pericarditis.
Source
Cardiovascular Journal of Africa. 27 (6) (pp 350-355), 2016. Date of
Publication: November-December 2016.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Introduction: Tuberculous (TB) pericarditis carries significant mortality
and morbidity rates, not only during the primary infection, but also as
part of the granulomatous scar-forming fibrocalcific constrictive
pericarditis so commonly associated with this disease. Numerous therapies
have previously been investigated as adjuvant strategies in the prevention
of pericardial constriction. Colchicine is well described in the treatment
of various aetiologies of pericarditis. The aim of this research was to
investigate the merit for the use of colchicine in the management of
tuberculous pericarditis, specifically to prevent constrictive
pericarditis. Methods: This pilot study was designed as a prospective,
double-blinded, randomised, control cohort study and was conducted at a
secondary level hospital in the Northern Cape of South Africa between
August 2013 and December 2015. Patients with a probable or definite
diagnosis of TB pericarditis were included (n = 33). Study participants
with pericardial effusions amenable to pericardiocentesis underwent
aspiration until dryness. All patients were treated with standard TB
treatment and corticosteroids in accordance with the South African
Tuberculosis Treatment Guidelines. Patients were randomised to an
intervention and control group using a webbased computer system that
ensured assignment concealment. The intervention group received colchicine
1.0 mg per day for six weeks and the control group received a placebo for
the same period. Patients were followed up with serial echocardiography
for 16 weeks. The primary outcome assessed was the development of
pericardial constriction. Upon completion of the research period, the
blinding was unveiled and data were presented for statistical analysis.
Results: TB pericarditis was found exclusively in HIV-positive
individuals. The incidence of pericardial constriction in our cohort was
23.8%. No demonstrable benefit with the use of colchicine was found in
terms of prevention of pericardial constriction (p = 0.88, relative risk
1.07, 95% CI: 0.46-2.46). Interestingly, pericardiocentesis appeared to
decrease the incidence of pericardial constriction. Conclusion: Based on
this research, the use of colchicine in TB pericarditis cannot be advised.
Adjuvant therapy in the prevention of pericardial constriction is still
being investigated and routine pericardiocentesis may prove to be
beneficial in this regard.

<42>
Accession Number
613716503
Author
Ozel E.; Tastan A.; Ozturk A.; Ozcan E.E.; Kilicaslan B.; Ozdogan O.
Institution
(Ozel, Kilicaslan, Ozdogan) Cardiology Department, Tepecik Training and
Research Hospital, Izmir, Turkey
(Tastan, Ozturk) Cardiology Department, Sifa University, Izmir, Turkey
(Ozcan) Cardiology Department, Dokuz Eylul University, Izmir, Turkey
Title
Procedural and one-year clinical outcomes of bioresorbable vascular
scaffolds for the treatment of chronic total occlusions: A single-centre
experience.
Source
Cardiovascular Journal of Africa. 27 (6) (pp 345-349), 2016. Date of
Publication: November-December 2016.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Introduction: The bioresorbable vascular scaffold system (BVS) is the
latest fully absorbable vascular therapy system that is used to treat
coronary artery disease. The BVS has been used in different coronary
lesion subsets, such as acute thrombotic lesions, bifurcation lesions,
ostial lesions and lesions originating from bypass grafts. However, data
about the use of BVS in chronic total occlusions (CTO) are limited. We
report our BVS experience for the treatment of CTOs in terms of procedural
features and one-year clinical follow-up results. Methods: An analysis was
made of 41 consecutive patients with CTO lesions who were referred to our
clinic between January 2013 and December 2014. A total of 52 BVS were
implanted. An analysis was made of patient characteristics, procedural
features [target vessel, BVS diameter, BVS length, post-dilatation rate,
type of post-dilatation balloon, procedure time, fluoroscopy time,
contrast volume, postprocedure reference vessel diameter (RVD),
post-procedure minimal lesion diameter (MLD), type of CTO technique and
rate of microcatheter use] and one-year clinical follow-up results [death,
myocardial infarction, angina, coronary artery bypass graft (CABG),
target-lesion revascularisation (TLR) and target-vessel revascularisation
(TVR)]. Descriptive and frequency statistics were used for statistical
analysis. Results: The mean age of the patient group was 61.9 +/- 9.7
years, 85.4% were male, and 51.2 % had diabetes. Prior myocardial
infarction incidence was 65.9%, 56.1% of the patients had percutaneous
coronary intervention and 17.1% had a previous history of CABG. The
procedure was performed via the radial route in 24.3% of the patients. The
target vessel was the right coronary artery in 48.7% of the patients.
Post-dilatation was performed on the implanted BVS in 97.5% of the
patients, mainly by non-compliant balloon; 87.8% of the BVS were implanted
by the antegrade CTO technique. Mean procedure time was 92 +/- 35.6
minutes. Mean contrast volume was 146.6 +/- 26.7 ml. At one year, there
were no deaths. One patient had lesionrelated myocardial infarction and
needed revascularisation because of early cessation of dual anti-platelet
therapy. Eleven patients had angina and five of them needed target-vessel
revascularisation. Conclusions: BVS implantation appeared to be effective
and safe in CTO lesions but randomised studies with a larger number of
patients and with longer follow-up times are needed.

<43>
Accession Number
611876030
Author
Park Y.; Franchi F.; Rollini F.; Angiolillo D.J.
Institution
(Park, Franchi, Rollini, Angiolillo) Division of Cardiology, University of
Florida College of Medicine - Jacksonville, Jacksonville, FL, United
States
(Park) Department of Internal Medicine, Gyeongsang National University
School of Medicine and Gyeongsang National University Hospital, Jinju,
South Korea
Title
Dual antiplatelet therapy after coronary stenting.
Source
Expert Opinion on Pharmacotherapy. 17 (13) (pp 1775-1787), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Introduction: Dual antiplatelet therapy (DAPT) with aspirin and a
P2Y<inf>12</inf> receptor inhibitor represents the mainstay of
pharmacotherapy in patients undergoing coronary stenting. Currently, three
P2Y<inf>12</inf> receptor inhibitors are approved for clinical use,
including clopidogrel, prasugrel, and ticagrelor, with the latter two
being preferred in patients presenting with an acute coronary syndrome.
The introduction into clinical practice of newer-generation drug-eluting
stent (DES) with safer profiles (i.e. less stent thrombosis) compared with
earlier platforms have led recent guideline updates to re-evaluate the
optimal duration of DAPT therapy, which are now based on evidence of a
multitude of randomized clinical trials, registries, and meta-analysis and
take into consideration the ischemic and bleeding risk profile of the
patients. Areas covered: Most recent updates on DAPT duration from
professional societies in the United States and Europe are discussed.
Moreover, an assessment of clinical trials, registries, and meta-analysis
leading to changes on practice guidelines analyzed. Expert opinion: The
widespread introduction into clinical practice of newer-generation DES
allows for shortening DAPT duration as also endorsed by practice
guidelines. However, the optimal duration of DAPT therapy varies according
to the individuals' risk of ischemic and bleeding complications, with
longer or shorter durations of treatment, respectively, that may be
considered. Copyright &#xa9; 2016 Informa UK Limited, trading as Taylor &
Francis Group.

<44>
Accession Number
607761524
Author
Lima E.G.; Hueb W.; Gersh B.J.; Rezende P.C.; Garzillo C.L.; Favarato D.;
Hueb A.C.; Rahmi Garcia R.M.; Franchini Ramires J.A.; Filho R.K.
Institution
(Lima, Hueb, Rezende, Garzillo, Favarato, Hueb, Rahmi Garcia, Franchini
Ramires, Filho) Department of Clinical Cardiology, Heart Institute
(InCor), University of Sao Paulo, Av Dr Eneas de Carvalho Aguiar 44, Sao
Paulo 05403-000, Brazil
(Gersh) Mayo Clinic Foundation, Rochester, MN, United States
Title
Impact of Chronic Kidney Disease on Long-Term Outcomes in Type 2 Diabetic
Patients with Coronary Artery Disease on Surgical, Angioplasty, or Medical
Treatment.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1735-1744), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background Coronary artery disease (CAD) among patients with diabetes and
chronic kidney disease (CKD) is not well studied, and the best treatment
for this condition is not established. Our aim was to compare three
therapeutic strategies for CAD in diabetic patients stratified by renal
function. Methods Patients with multivessel CAD that underwent coronary
artery bypass graft (CABG), angioplasty (percutaneous coronary
intervention [PCI]), or medical therapy alone (MT) were included. Data
were analyzed according to glomerular filtration rate in three strata:
normal (>90 mL/min), mild CKD (60 to 89 mL/min), and moderate CKD (30 to
59 mL/min). End points comprised overall rate of mortality, acute
myocardial infarction, and need for additional revascularization. Results
Among patients with normal renal function (n = 270), 122 underwent CABG,
72 PCI, and 76 MT; among patients with mild CKD (n = 367), 167 underwent
CABG, 92 PCI, and 108 MT; and among patients with moderate CKD (n = 126),
46 underwent CABG, 40 PCI, and 40 MT. Event-free survival was 80.4%,
75.7%, 67.5% for strata 1, 2, and 3, respectively (p = 0.037). Survival
rates among patients with no, mild, and moderate CKD are 91.1%, 89.6%, and
76.2%, respectively (p = 0.001) (hazard ratio 0.69; 95% confidence
interval 0.51 to 0.95; p = 0.024 for stratum 1 versus 3). We found no
differences for overall number of deaths or acute myocardial infarctions
irrespective of strata. The need of new revascularization was different in
all strata, favoring CABG (p < 0.001, p < 0.001, and p = 0.029 for no,
mild, and moderate CKD, respectively). Conclusions Mortality rates were
higher in patients with mild and moderate CKD. Higher event-free survival
was observed in the CABG group among patients with no and mild CKD.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<45>
Accession Number
611358837
Author
Tastan A.; Ozturk A.; Senarslan O.; Ozel E.; Uyar S.; Ozcan E.E.; Kozan O.
Institution
(Tastan, Ozturk, Senarslan, Ozel, Uyar, Ozcan) Department of Cardiology,
Sifa University Faculty of Medicine, Izmir, Turkey
(Kozan) Department of Cardiology, Dokuz Eylul University Faculty of
Medicine, Izmir, Turkey
Title
Comparison of two different techniques for balloon sizing in percutaneous
mitral balloon valvuloplasty: Which is preferable?.
Source
Cardiovascular Journal of Africa. 27 (3) (pp 147-151), 2016. Date of
Publication: May-June 2016.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Background: Percutaneous balloon mitral valvuloplasty (BMV) is an
important option for the treatment of mitral valve stenosis. The crux of
this process is choosing the appropriate Inoue balloon size. There are two
methods to do this. One is an empirical formula based on the patient's
height, and other is to choose according to the maximal inter-commissural
distance of the mitral valve provided by echocardiography. Methods: The
study, performed between January 2006 and December 2011, included 128
patients who had moderate to severe mitral stenosis and whose valve
morphology was suitable for BMV. Patients were randomised into two groups.
One group was allocated to conventional height-based balloon reference
sizing (the HBRS group) and the other was allocated to balloons sized by
the echocardiographic measurement of the diastolic inter-commissural
diameter (the EBRS group). Results: BMV was assessed as successful in 60
(92.3%) patients in the HBRS group and in 61 (96.8%) in the EBRS group (p
= 0.03). The mean of the calculated balloon reference sizes was
significantly higher in the HBRS than in the EBRS group [26.3 ?} 1.2 mm,
95% confidence interval (CI): 26.1-26.6 vs 25.2 ?} 1.1, 95% CI: 25.0-25.4,
respectively; p = 0.007). Final mitral valve areas (MVA) were larger and
mitral regurgitation (MR) > 2+ was less in the EBRS group (p = 0.02 and p
= 0.05, respectively). Conclusions: EBRS is a method that is independent
of body structure. Choosing Inoue balloon size by measuring maximal
diastolic annulus diameter by echocardiography for BMV may be an
acceptable method for appropriate final MVA and to avoid risk of
significant MR.

<46>
Accession Number
612344918
Author
Karakisi S.O.; Kunt A.G.; Bozok A.; Cankaya D.; Kocakulak M.; Muabak U.;
Sargon M.F.; Ergene A.; Lhan G.; Karamustafa H.; Tufekci N.; Ener E.
Institution
(Karakisi, Bozok, Ergene, Lhan, Karamustafa, Tufekci) Department of
Cardiovascular Surgery, Faculty of Medicine, Recep Tayyip Erdogan
University, Training and Research Hospital, Rize, Turkey
(Kunt, Ener) Department of Cardiovascular Surgery, Faculty of Medicine,
Yldrm Beyazd University, Ataturk Training and Research Hospital, Ankara,
Turkey
(Cankaya, Kocakulak) Department of Biomedical Engineering, Baskent
University, Ankara, Turkey
(Muabak) Department of Immunology, Gulhane Military Medical Academy and
School of Medicine, Ankara, Turkey
(Sargon) Department of Anatomy, Faculty of Medicine, Hacettepe University,
Ankara, Turkey
Title
Humoral immune response and coated or uncoated oxygenators during
cardiopulmonary bypass surgery.
Source
Cardiovascular Journal of Africa. 27 (4) (pp 242-245), 2016. Date of
Publication: July-August 2016.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Aim: To investigate and compare uncoated and phosphorylcholine-coated
oxygenators in terms of induction of humoral immune response during
coronary artery bypass surgery. Methods: A total of 20 consecutive
patients who underwent coronary artery bypass surgery were randomly
distributed into two groups according to the type of oxygenator used
during surgery. Group 1 consisted of 10 patients who were operated on
using phosphorylcholine-coated oxygenators. Group 2 contained 10 patients
who underwent surgery using uncoated oxygenators. Blood and oxygenator
fibre samples were obtained and compared in terms of immunoglobulins (IgG,
IgM), complements (C3c, C4), serum total protein and albumin levels using
electron microscopy and flow cytometry. Results: In group 1, levels of
IgM, IgG, total protein and serum albumin were significantly increased at
the end of cardiopulmonary bypass (CPB) compared to those at the beginning
of CPB. In group 2, C3c and C4 levels at the beginning of CPB were found
to be significantly higher than at the end. Electron microscopic
examination of oxygenator fibres demonstrated that
phosphorylcholine-coated fibres were less likely to be adsorbed by serum
proteins and complements than the uncoated fibres. Conclusion: Our results
indicate that phosphorylcholine-coated oxygenators seemed to induce
humoral immune response to a lesser extent than uncoated oxygenators
during coronary artery bypass procedures.

<47>
Accession Number
610227093
Author
Clavijo L.C.; Cortes G.A.; Jolly A.; Tun H.; Mehra A.; Gaglia M.A.;
Shavelle D.; Matthews R.V.
Institution
(Clavijo, Cortes, Jolly, Tun, Mehra, Gaglia, Shavelle, Matthews)
University of Southern California, Los Angeles, CA, United States
Title
Same-day discharge after coronary stenting and femoral artery device
closure: A randomized study in stable and low-risk acute coronary syndrome
patients.
Source
Cardiovascular Revascularization Medicine. 17 (3) (pp 155-161), 2016. Date
of Publication: 01 Apr 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To compare same-day (SD) vs. delayed hospital discharge (DD)
after single and multivessel coronary stenting facilitated by femoral
closure device in patients with stable angina and low-risk acute coronary
syndrome (ACS). Methods: University of Southern California patients were
screened and coronary stenting was performed in 2480 patients. Four
hundred ninety-three patients met screening criteria and consented. Four
hours after percutaneous coronary intervention, 100 were randomized to SD
(n = 50) or DD (n = 50). Patients were followed for one year; outcomes-,
patient satisfaction-, and cost analyses were performed. Results: Groups
were well distributed, with similar baseline demographic and angiographic
characteristics. Mean age was 58.1 +/- 8.8 years and 86% were male.
Non-ST-elevation myocardial infarction and unstable angina were the
clinical presentations in 30% and 44% of the SD and DD groups,
respectively (p = 0.2). Multivessel stenting was performed in 36% and 30%
of SD and DD groups, respectively (p = 0.14). At one year, two patients
from each group (4%) required unplanned revascularization and one patient
in the SD group had a gastrointestinal bleed that required a blood
transfusion. Six SD and four DD patients required repeat hospitalization
(p = 0.74). There were no femoral artery vascular complications in either
group. Patient satisfaction scores were equivalent. SD discharge was
associated with $1200 savings per patient. Conclusions: SD discharge after
uncomplicated single and multivessel coronary stenting of patients with
stable, low-risk ACS, via the femoral approach facilitated by a closure
device, is associated with similar clinical outcomes, patient
satisfaction, and cost savings compared to overnight (DD) hospital stay.
Copyright &#xa9; 2016 Elsevier Inc.

<48>
Accession Number
613413273
Author
Aronow W.S.
Institution
(Aronow) Department of Medicine, Division of Cardiology, Westchester
Medical Center/New York Medical College, Macy Pavilion, Room 141,
Valhalla, NY 10595, United States
Title
Current treatment of heart failure with reduction of left ventricular
ejection fraction.
Source
Expert Review of Clinical Pharmacology. 9 (12) (pp 1619-1631), 2016. Date
of Publication: 01 Dec 2016.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Heart failure is the commonest cause of hospitalization and
of rehospitalization This review paper is a comprehensive review of
current treatment of heart failure in 2016. The target of this review is
all health care professionals who treat patients with heart failure. Areas
covered: This article discusses stages of heart failure, treatment of
heart failure with general measures, and drug therapy with diuretics,
angiotensin-converting enzyme inhibitors, angiotensin receptor blockers,
beta blockers, aldosterone antagonists, isosorbide dinitrate plus
hydralazine, digoxin, other neurohormonal antagonists,
sacubitril/valsartan, calcium channel blockers, and ivabradine. This
article also discusses treatment of heart failure with use of cardiac
resynchronization therapy, implantable cardioverter-defibrillators, and
surgical therapy, and management of end-stage heart failure. This paper
was written after an extensive Medline search reviewing articles written
from 1970 through May, 2016. Expert commentary: Our approach as physicians
must emphasize prevention of heart failure as well as treating it. Risk
factors for developing heart failure, especially hypertension, must be
better controlled starting in childhood. I concur with the current heart
failure treatment guidelines (Tables 1 and 2 in this paper). Copyright
&#xa9; 2016 Informa UK Limited, trading as Taylor & Francis Group.

<49>
Accession Number
614171075
Author
Unverzagt S.; Wachsmuth L.; Hirsch K.; Thiele H.; Buerke M.; Haerting J.;
Werdan K.; Prondzinsky R.
Institution
(Unverzagt, Hirsch, Haerting) Institute of Medical Epidemiology,
Biostatistics and Informatics, Martin Luther University Halle-Wittenberg,
Halle/Saale, Germany
(Wachsmuth, Prondzinsky) Cardiology/Intensive Care Medicine, Carl von
Basedow Klinikum Merseburg, Merseburg, Germany
(Thiele) Heart Center, University of Leipzig, Leipzig, Germany
(Buerke, Werdan) Internal Medicine III, Martin Luther University
Halle-Wittenberg, Halle, Saale, Germany
Title
Inotropic agents and vasodilator strategies for acute myocardial
infarction complicated by cardiogenic shock or low cardiac output
syndrome.
Source
Cochrane Database of Systematic Reviews. 2014 (1) (pp 1-70), 2014. Date of
Publication: 2014.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background The recently published German-Austrian S3 Guideline for the
treatment of infarct related cardiogenic shock (CS) revealed a lack of
evidence for all recommended therapeutic measures. Objectives To determine
the effects in terms of efficacy, efficiency and safety of cardiac care
with inotropic agents and vasodilator strategies versus placebo or against
each other for haemodynamic stabilisation following surgical treatment,
interventional therapy (angioplasty, stent implantation) and conservative
treatment (that is no revascularization) on mortality and morbidity in
patients with acute myocardial infarction (AMI) complicated by CS or low
cardiac output syndrome (LCOS). Search methods We searched CENTRAL,
MEDLINE (Ovid), EMBASE (Ovid) and ISIWeb of Science, registers of ongoing
trials and proceedings of conferences in January 2013. Reference lists
were scanned and experts in the field were contacted to obtain further
information. No language restrictions were applied. Selection criteria
Randomised controlled trials in patients with AMI complicated by CS or
LCOS. Data collection and analysis Data collection and analysis were
performed according to the published protocol. All trials were analysed
individually. Hazard ratios (HRs) and odds ratios with 95% confidence
intervals (CI) were extracted but not pooled because of high heterogeneity
between the control group interventions. Main results Four eligible, very
small studies were identified from a total of 4065 references. Three
trials with high overall risk of bias compared levosimendan to standard
treatment (enoximone or dobutamine) or placebo. Data from a total of 63
participants were included in our comparisons, 31 were treated with
levosimendan and 32 served as controls. Levosimendan showed an imprecise
survival benefit in comparison with enoximone based on a very small trial
with 32 participants (HR 0.33; 95% CI 0.11 to 0.97). Results from the
other similarly small trials were too imprecise to provide any meaningful
information about the effect of levosimendan in comparison with dobutamine
or placebo. Only small differences in haemodynamics, length of hospital
stay and the frequency of major adverse cardiac events or adverse events
overall were found between study groups. Only one small randomised
controlled trial with three participants was found for vasodilator
strategies (nitric oxide gas versus placebo) in AMI complicated by CS or
LCOS. This study was too small to draw any conclusions on the effects on
our key outcomes. Authors' conclusions At present there are no robust and
convincing data to support a distinct inotropic or vasodilator drug based
therapy as a superior solution to reduce mortality in haemodynamically
unstable patients with CS or low cardiac output complicating AMI.
Copyright &#xa9; 2014 The Cochrane Collaboration.

<50>
Accession Number
613131351
Author
Reichert M.; Hecker M.; Witte B.; Bodner J.; Padberg W.; Weigand M.A.;
Hecker A.
Institution
(Reichert, Witte, Padberg, Hecker) Department of General and Thoracic
Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7,
Giessen 35392, Germany
(Hecker) Department of Pulmonology and Intensive Care Medicine, Medical
Clinic II, University Hospital of Giessen, Giessen 35392, Germany
(Bodner) Department of Thoracic Surgery, Klinikum Bogenhausen,
Englschalkinger Strasse 77, Munich 81925, Germany
(Bodner) Department of Visceral, Transplant and Thoracic Surgery, Center
of Operative Medicine, Innsbruck Medical University, Innsbruck 6020,
Austria
(Weigand) Department of Anesthesiology, University Hospital of Heidelberg,
Heidelberg 69120, Germany
Title
Stage-directed therapy of pleural empyema.
Source
Langenbeck's Archives of Surgery. 402 (1) (pp 15-26), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Intensivists and surgeons are often confronted with critically
ill patients suffering from pleural empyema. Due to it' s multifactorial
pathogenesis and etiology, medicals should be sensitized to recognize the
different stages of the disease. Besides a whole bundle of different
established classification systems, the progress of pleural effusions can
be subdivided into the early exudative, the intermediate fibropurulent and
the late organized phase according to the classification of the American
Thoracic Society. Results: Rapid diagnosis of pleura empyema is essential
for patients' survival. Due to the importance of stage-adapted therapeutic
decisions, different classification systems were established. Depending on
the stage of pleural empyema, both antimicrobial and interventional
approaches are indicated. For organized empyema, minimally invasive and
open thoracic surgery are gold standard. Surgery is based on the three
therapeutic columns: removal of pleural fluid, debridement and
decortication. In general, therapy must be intended stage-directed
following multidisciplinary concepts including surgeons, intensivists,
anesthesiologists, physiotherapists and antibiotic stewards. Despite an
established therapeutic algorithm is presented in this review, there is
still a lack of randomized, prospective studies to evaluate potential
benefits of minimally invasive (versus open) surgery for end-stage empyema
or of catheter-directed intrathoracic fibrinolysis (versus minimally
invasive surgery) for intermediate-stage pleural empyema. Any delay in
adequate therapy results in an increased morbidity and mortality.
Conclusion: The aim of this article is to review current treatment
standards for different phases of adult thoracic empyema from an
interdisciplinary point of view. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<51>
Accession Number
614272322
Author
Tang L.H.; Kikkenborg Berg S.; Christensen J.; Lawaetz J.; Doherty P.;
Taylor R.S.; Langberg H.; Zwisler A.-D.
Institution
(Tang, Kikkenborg Berg, Lawaetz) Department of Cardiology, The Heart
Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Tang, Christensen, Lawaetz, Langberg) CopenRehab, Section of Social
Medicine, Department of Public Health, University of Copenhagen, Denmark
(Tang, Lawaetz) Bachelor's Degree Program in Physiotherapy, Dept. of
Rehabilitation and Nutrition, Faculty of Health and Technology,
Metropolitan University College, Copenhagen, Denmark
(Christensen) Department of Occupational Therapy and Physiotherapy,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Doherty) Department of Health Sciences, University of York, England,
United Kingdom
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, England, United Kingdom
(Taylor) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Taylor, Zwisler) National Centre for Rehabilitation and Palliative Care,
University of Southern Denmark, Denmark
(Taylor, Zwisler) Odense University Hospital, Denmark
Title
Patients' preference for exercise setting and its influence on the health
benefits gained from exercise-based cardiac rehabilitation.
Source
International Journal of Cardiology. 232 (pp 33-39), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To assess patient preference for exercise setting and examine if
choice of setting influences the long-term health benefit of
exercise-based cardiac rehabilitation. Methods Patients participating in a
randomised controlled trial following either heart valve surgery, or
radiofrequency ablation for atrial fibrillation were given the choice to
perform a 12-week exercise programme in either a supervised centre-based,
or a self-management home-based setting. Exercise capacity and physical
and mental health outcomes were assessed for up to 24 months after
hospital discharge. Outcomes between settings were compared using a time x
setting interaction using a mixed effects regression model. Results Across
the 158 included patients, an equivalent proportion preferred to undertake
exercise rehabilitation in a centre-based setting (55%, 95% CI: 45% to
63%) compared to a home-based setting (45%, 95% CI: 37% to 53%, p =
0.233). At baseline, those who preferred a home-based setting reported
better physical health (mean difference in physical component score: 5.0,
95% CI 2.3 to 7.4; p = 0.001) and higher exercise capacity (mean between
group difference 15.9 watts, 95% CI 3.7 to 28.1; p = 0.011). With the
exception of the depression score in the Hospital Anxiety and Depression
Score (F(3.65), p = 0.004), there was no evidence of a significant
difference in outcomes between settings. Conclusion The preference of
patients to participate in home-based and centre-based exercise programmes
appears to be equivalent and provides similar health benefits. Whilst
these findings support that patients should be given the choice between
exercise-settings when initiating cardiac rehabilitation, further
confirmatory evidence is needed. Copyright &#xa9; 2017

<52>
Accession Number
609469433
Author
Newland R.F.; Baker R.A.; Mazzone A.L.; Quinn S.S.; Chew D.P.
Institution
(Newland, Baker, Mazzone, Chew) Flinders Medical Centre, Cardiac Surgery
Research and Perfusion, Flinders University, 1 Flinders Dr, Bedford-Park,
SA 5042, Australia
(Newland, Baker, Quinn, Chew) Flinders University, Bedford-Park, SA,
Australia
Title
Rewarming Temperature during Cardiopulmonary Bypass and Acute Kidney
Injury: A Multicenter Analysis Presented at the Tenth Annual Perfusion
Downunder Meeting, Queenstown, New Zealand, Aug 6-9, 2014.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1655-1662), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is
associated with a requirement for dialysis, a longer stay in the intensive
care unit, a longer hospital length of stay, and mortality. An oxygenator
arterial outlet temperature greater than 37degreeC has been reported to be
associated with AKI; however, the influence of other rewarming
temperatures is unclear. Using multicenter registry data, this study aimed
to evaluate the role of CPB rewarming temperatures on AKI. Methods Data
from 8,407 adult patients undergoing coronary artery bypass grafting
(CABG) or valve repair or replacement, or a combination, were collected
using the Perfusion Downunder Collaborative Database. Primary variables of
interest were rewarming temperatures, defined as cumulative time the
oxygenator arterial outlet temperature was greater than 36degreeC, greater
than 36.5degreeC, or greater than 37degreeC. Propensity scores were
calculated to determine the predicted probability of hyperthermic
perfusion (rewarming temperature >37degreeC). The influence of temperature
on AKI was determined using separate multivariate models adjusting for
propensity score in the entire cohort (n = 6,904) and in
propensity-matched patients (n = 2,044). Results Overall, 11.8% of
patients acquired AKI. The duration of rewarming temperature greater than
36degreeC or 36.5degreeC was not associated with AKI. The duration of
rewarming temperature greater than 37degreeC (hyperthermic perfusion) was
independently associated with RIFLE (Risk, Injury, Failure, Loss,
End-stage renal disease) risk classification or greater (odds ratio [OR],
1.42; 95% confidence interval [CI], 1.09-1.77; p = 0.012) and injury
classification or greater AKI (OR, 1.52; 95% CI, 1.09-1.97; p = 0.016) in
the entire cohort, and injury classification or greater AKI (OR, 1.51; 95%
CI, 1.15-1.90; p = 0.006) in propensity-matched patients. Conclusions The
duration of hyperthermic perfusion - rewarming temperature greater than
37degreeC - was an independent predictor of AKI. Avoidance of hyperthermic
perfusion may be more beneficial in reducing AKI than avoidance of
rewarming. Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<53>
Accession Number
609465226
Author
Brown C.H.; Laflam A.; Max L.; Lymar D.; Neufeld K.J.; Tian J.; Shah A.S.;
Whitman G.J.; Hogue C.W.
Institution
(Brown, Laflam, Max, Lymar, Hogue) Department of Anesthesiology and
Critical Care Medicine, Johns Hopkins University, School of Medicine, 1800
Orleans, Baltimore, MD 21287, United States
(Neufeld) Department of Psychiatry and Behavioral Sciences, Johns Hopkins
University, School of Medicine, Baltimore, United States
(Whitman) Division of Cardiac Surgery, Johns Hopkins University, School of
Medicine, Baltimore, United States
(Tian) Department of Biostatistics, Johns Hopkins Bloomberg, School of
Public Health, Baltimore, MD, United States
(Shah) Department of Surgery, Vanderbilt University Medical Center,
Nashville, TN, United States
Title
The Impact of Delirium after Cardiac Surgical Procedures on Postoperative
Resource Use.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1663-1669), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background Delirium is a common complication after cardiac surgical
procedures and is associated with increased morbidity and mortality.
However, whether rigorously assessed postoperative delirium is associated
with an increased length of stay in the intensive care unit (LOS-ICU),
length of stay (LOS), and hospital charges is not clear. Methods Patients
(n = 66) undergoing coronary artery bypass or valve operations, or both,
were enrolled in a nested cohort study. Rigorous delirium assessments were
conducted using the Confusion Assessment Method. LOS-ICU and LOS were
obtained from the medical record, and hospital charges were obtained from
administrative data reported to the state. Because of the skewed
distribution of outcome variables, outcomes were compared using rank-sum
tests, as well as median regression incorporating propensity scores.
Results Patients who developed delirium (56%) versus no delirium (43%) had
increased median LOS-ICU (75.6 hours [interquartile range (IQR): 43.6 to
136.8] vs. 29.7 hours [IQR: 21.7 to 46.0]; p = 0.002), increased median
LOS (9 days [IQR: 6 to 16] vs. 7 days [IQR: 5 to 8]; p = 0.006), and
increased median hospital charges ($51,805 [IQR: $44,041 to $80,238] vs.
$41,576 [IQR: $35,748 to $43,660]; p = 0.002). In propensity score models
adjusted for patient-related and surgical characteristics and
complications, the results for LOS-ICU and cost remained highly
significant, although the results for LOS were attenuated on the basis of
the specific statistical model. Increased severity of delirium was
associated with both increased LOS-ICU and increased charges in a
dose-response manner. Conclusions Delirium after cardiac surgical
procedures is independently associated with both increased LOS-ICU and
higher hospital charges. Because delirium is potentially preventable,
targeted delirium-prevention protocols for high-risk patients may
represent an important strategy for quality improvement. Copyright &#xa9;
2016 The Society of Thoracic Surgeons.

<54>
Accession Number
611990361
Author
Kayvanpour E.; Sedaghat-Hamedani F.; Amr A.; Lai A.; Haas J.; Holzer D.B.;
Frese K.S.; Keller A.; Jensen K.; Katus H.A.; Meder B.
Institution
(Kayvanpour, Sedaghat-Hamedani, Amr, Lai, Haas, Holzer, Frese, Katus,
Meder) Department of Medicine III, University of Heidelberg, INF 410,
Heidelberg 69120, Germany
(Kayvanpour, Sedaghat-Hamedani, Amr, Haas, Frese, Katus, Meder) DZHK
(German Centre for Cardiovascular Research), Berlin, Germany
(Keller) Clinical Bioinformatics, Saarland University, Saarbrucken,
Germany
(Jensen) Institute of Medical Biometry and Informatics, University of
Heidelberg, Heidelberg, Germany
Title
Genotype-phenotype associations in dilated cardiomyopathy: meta-analysis
on more than 8000 individuals.
Source
Clinical Research in Cardiology. 106 (2) (pp 127-139), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Aims: Routine genetic testing in Dilated Cardiomyopathy (DCM) has recently
become reality using Next-Generation Sequencing. Several studies have
explored the relationship between genotypes and clinical phenotypes to
support risk estimation and therapeutic decisions, however, most studies
are small or restricted to a few genes. This study provides to our
knowledge the first systematic meta-analysis on genotype-phenotype
associations in DCM. Methods and results: We retrieved PubMed/Medline
literature on genotype-phenotype associations in patients with DCM and
mutations in LMNA, PLN, RBM20, MYBPC3, MYH7, TNNT2 and TNNI3. We
summarized and extensively reviewed all studies that passed selection
criteria and performed a meta-analysis on key phenotypic parameters.
Together, 48 studies with 8097 patients were included. Furthermore, we
reviewed recent studies investigating genotype-phenotype associations in
DCM patients with TTN mutations. The average frequency of mutations in the
investigated genes was between 1 and 5 %. The mean age of DCM onset was
the beginning of the fifth decade for all genes. Heart transplantation
(HTx) rate was highest in LMNA mutation carriers (27 %), while RBM20
mutation carriers were transplanted at a markedly younger age (mean 28.5
years). While 73 % of DCM patients with LMNA mutations showed cardiac
conduction diseases, low voltage was the reported ECG hallmark in PLN
mutation carriers. The frequency of ventricular arrhythmia in DCM patients
with LMNA (50 %) and PLN (43 %) mutations was significantly higher. The
penetrance of DCM phenotype in subjects with TTN truncating variants
increased with age and reached 100 % by age of 70. Conclusion: A pooled
analysis of available genotype-phenotype data shows a higher prevalence of
sudden cardiac death (SCD), cardiac transplantation, or ventricular
arrhythmias in LMNA and PLN mutation carriers compared to sarcomeric gene
mutations. This study will further support the clinical interpretation of
genetic findings. Copyright &#xa9; 2016, Springer-Verlag Berlin
Heidelberg.

<55>
Accession Number
612098253
Author
Harle T.; Zeymer U.; Hochadel M.; Zahn R.; Kerber S.; Zrenner B.;
Schachinger V.; Lauer B.; Runde T.; Elsasser A.
Institution
(Harle, Elsasser) Klinik fur Kardiologie, Klinikum Oldenburg gGmbH,
European Medical School Oldenburg-Groningen, Carl von Ossietzky
Universitat Oldenburg, Rahel-Straus-Str. 10, Oldenburg 26133, Germany
(Zeymer, Zahn) Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen,
Germany
(Zeymer, Hochadel) Stiftung Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Kerber) Klinik fur Kardiologie, Herz- und Gefas-Klinik GmbH, Bad Neustadt
a. d., Haale, Germany
(Zrenner) Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Landshut,
Germany
(Schachinger) Klinikum Fulda, Medizinische Klinik I, Fulda, Germany
(Lauer) Klinik fur Kardiologie, Zentralklinik Bad Berka, Bad Berka,
Germany
(Runde) Klinikum Wetzlar, Medizinische Klinik I, Wetzlar, Germany
Title
Real-world use of fractional flow reserve in Germany: results of the
prospective ALKK coronary angiography and PCI registry.
Source
Clinical Research in Cardiology. 106 (2) (pp 140-150), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: There is growing evidence for beneficial prognostic and
economic effects of FFR-guided treatment of stable coronary artery
disease. We sought to evaluate the real-world use of FFR measurements in
patients undergoing elective coronary angiography. Methods and results: We
analyzed the data of the prospective ALKK coronary angiography and PCI
registry including data of 38 hospitals from January 2010 to December
2013. A total of 100,977 patients undergoing coronary angiography were
included. In 3240 patients (3.2 %) intracoronary pressure measurement was
performed. There was a wide range of use of FFR measurement in the
different analyzed ALKK hospitals from 0.1 to 8.8 % in elective patients
with suspected or known coronary artery disease (median 2.7 %, quartiles
0.9 and 5.3 %), with a successive increase of use over time during the
study period. Overall, it was performed in 3.2 % of coronary
angiographies. Use in patients with three-vessel disease (2.5 %) and
recommendation for bypass surgery (1.6 %) was less frequent. In procedures
without PCI, dose area product was higher in the FFR group (2641 cGy x
cm² vs. 2368 cGy x cm², p < 0.001), while it was
lower in procedures with ad hoc PCI (4676 cGy x cm² vs. 5143
cGy x cm², p < 0.001). The performing center turned out to be
the strongest predictor. Conclusions: The use of FFR measurement was very
heterogeneous between different hospitals and in general relatively low,
in particular in patients with multivessel disease or recommendation for
bypass surgery, but there was a positive trend during the study period.
Technically, FFR measurement was not associated with an increased
periprocedural complication rate. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<56>
[Use Link to view the full text]
Accession Number
614188499
Author
Yu Y.; Song Z.; Xu Z.; Ye X.; Xue C.; Li J.; Bi H.
Institution
(Yu, Song, Xu) Department of Cardiac Surgery, Second Military Medical
University, Shanghai 200433, China
(Ye) Department of Statistics, Faculty of Medical Services, Second
Military Medical University, Shanghai 200433, China
(Xue, Li, Bi) Department of Plastic Surgery, Changhai Hospital, Second
Military Medical University, 168 Changhai Road, Shanghai 200433, China
Title
Bilayered negative-pressure wound therapy preventing leg incision
morbidity in coronary artery bypass graft patients A randomized controlled
trial.
Source
Medicine (United States). 96 (3) (no pagination), 2017. Article Number:
e5925. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Backgrounds: The harvesting of great saphenous veins for coronary artery
bypass graft (CABG) patients may result in significant complications,
including lymphorrhagia, lymphoedema, incision infection, wound
dehiscence, and skin flap necrosis. We investigated the function of a
self-designed bilayered negative pressure wound therapy (b-NPWT) for
reducing the above-mentioned complications using a clinical randomized
controlled trial. Methods: A single-center, pilot randomized controlled
trial was conducted. From December 2013 to March 2014, a total of 72
coronary heart disease patients (48 men and 24 women) received CABG
therapy, with great saphenous veins were selected as grafts. Patients were
equally randomized into a treatment and a control group. After the
harvesting of the great saphenous veins and direct closure of the wound
with sutures, b-NPWT was used for the thigh incision in the treatment
group for 5 days (treatment thigh). Traditional surgical pads were applied
to both the shank incisions of the treatment group patients (treatment
shank) and the entire incisions of the control group (control thigh,
control shank). Postoperative complications were recorded and
statistically analyzed based on outcomes of thigh treatment, shank
treatment, thigh control, and shank control groups. Results: The incidence
rates of early complications, such as lymphorrhagia, lymphoedema,
infection, wound dehiscence, and skin flap necrosis, of the vascular donor
site in the thigh treatment group was significantly lower than those in
the 3 other groups. Conclusions: The self-designed b-NPWT can effectively
reduce postoperative complications, such as lymphedema, incision
infection, wound dehiscence, and skin flap necrosis, in CABG patients who
underwent great saphenous veins harvesting. Trial registration:
ClinicalTrials.gov. The unique registration number is NCT02010996.
Abbreviations: b-NPWT = bilayered negative pressure wound therapy, CABG =
coronary artery bypass graft, C-shank = control shank, C-thigh = control
thigh, mmHg = millimetre(s) of mercury, RCT = randomized controlled trial,
SAS = statistic analysis system, T-shank = treatment shank, T-thigh =
treatment thigh. &#xa9; Copyright 2017 the Author(s).

<57>
Accession Number
614519720
Author
Kane T.; Pugh M.A.
Institution
(Kane) Texas Wesleyan Graduate Programs of Nurse Anesthesia, Fort Worth,
TX, United States
(Pugh) Texas Wesleyan University, Fort Worth, TX, United States
Title
Usefulness of cerebral oximetry in preventing postoperative cognitive
dysfunction in patients undergoing coronary artery bypass grafting.
Source
AANA Journal. 85 (1) (pp 49-54), 2017. Date of Publication: 2017.
Publisher
AANA Publishing Inc. (E-mail: llacey@aana.com )
Abstract
Postoperative cognitive dysfunction (POCD) following coronary artery
bypass grafting has a negative impact on patients physically and
psychologically. Of increasing interest is the role that cerebral
autoregulation plays in postoperative neurologic outcomes. We sought
evidence examining the usefulness of cerebral oximetry data in preventing
POCD. Three hundred eighty potential evidence sources were located. Twelve
evidence sources (8 randomized controlled trials, 2 retrospective reviews,
and 2 prospective cohort studies with a retrospective cohort control) met
inclusion criteria. Although the neurologic assessment tools, desaturation
definitions, and interventional protocols varied, strong statistical
significance links the use of cerebral oximetry information to the
prevention of POCD.

<58>
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).

<59>
Accession Number
614471648
Author
Hammoudeh A.J.; Tabbalat R.; Alhaddad I.A.; Khader Y.; Jarrah M.; Izraiq
M.; Al-Mousa E.
Institution
(Hammoudeh, Al-Mousa) Cardiology Department, Istishari Hospital, 44 Kindi
Street, Amman 11954, Jordan
(Tabbalat) Cardiology Department, Khalidi Medical Center, Amman, Jordan
(Alhaddad) Cardiology Department, Jordan Hospital, Amman, Jordan
(Khader) Allied Medical Sciences School, Jordan University of Science and
Technology, Irbid, Jordan
(Jarrah) Cardiology Section, Internal Medicine Department, King Abdullah
University Hospital, Irbid, Jordan
(Izraiq) Cardiology Department, Specialty Hospital, Amman, Jordan
Title
Short- and long-term outcomes in Middle Eastern diabetic patients after
percutaneous coronary intervention: results from The First Jordanian PCI
Registry (JoPCR1).
Source
Diabetology International. 8 (1) (pp 30-38), 2017. Date of Publication: 01
Mar 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Introduction: Diabetes mellitus (DM) is highly prevalent among Middle
Eastern patients admitted with acute coronary syndrome (ACS) or who
undergo percutaneous coronary intervention (PCI). This study used data
from the First Jordanian PCI Registry (JoPCR1) to determine the short- and
long-term outcomes in a subgroup of diabetic patients within a large PCI
population. Methods: JoPCR1, a prospective, multicenter study of
consecutive patients who underwent PCI from January 2013 to February 2014,
assessed the incidence of major cardiovascular events (cardiac mortality,
stent thrombosis, major bleeding events and coronary revascularization) in
diabetic compared with nondiabetic patients from the index hospitalization
to 1 year of follow-up. Results: Of 2426 patients enrolled, 1300 (53.6 %)
were diabetics. Compared with nondiabetic patients, diabetic patients were
older, more likely to be female and to have hypertension,
hypercholesterolemia and chronic renal disease. Diabetic patients had
higher prevalences of multivessel coronary artery disease and PCI than
nondiabetic patients. Although both groups had similar proportions of
patients undergoing PCI for ACS (76.3 vs. 78.4 %; p = 0.237), fewer
diabetic patients had PCI for ST-segment elevation myocardial infarction
than nondiabetics (27.5 vs. 33.7 %; p = 0.0002). Both groups had similar
incidences of stent thrombosis (ST) during hospitalization (0.46 vs. 0.27
%; p = 0.665) and at 1 year (2.36 vs. 1.53 %; p = 0.196). Similarly, major
bleeding events were not different between diabetic and nondiabetic
patients during hospitalization (1.31 vs. 0.53 %; p = 0.077) and at 1 year
(1.47 vs. 0.98 %; p = 0.377). Compared with nondiabetic patients, diabetic
patients had a higher incidence of readmission for ACS and coronary
revascularization at 1 year. Diabetic patients had higher incidences of
cardiac mortality than nondiabetic patients during the index
hospitalization (1.23 vs. 0.27 %; p = 0.015) and at 1 year (2.58 vs. 0.81
%; p = 0.002). In multivariate analysis, diabetic patients were four times
more likely to die in the hospital compared to nondiabetic patients (odds
ratio = 4.2; 95 % CI 1.2-14.8, p = 0.025). Conclusions: Diabetic patients,
who accounted for more than half of this Middle Eastern PCI population,
had a higher risk of cardiac mortality, readmission for ACS and coronary
revascularization at 1 year compared with nondiabetic patients. Copyright
&#xa9; 2016, The Japan Diabetes Society.

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

<61>
Accession Number
613784579
Author
Luo Z.; Li X.; Zhu M.; Tang J.; Li Z.; Zhou X.; Song G.; Liu Z.; Zhou H.;
Zhang W.
Institution
(Luo, Li, Tang, Li, Liu, Zhou, Zhang) Department of Clinical Pharmacology,
Xiangya Hospital, Central South University, Changsha, China
(Luo, Tang, Li, Liu, Zhou, Zhang) Hunan Key Laboratory of
Pharmacogenetics, Institute of Clinical Pharmacology, Central South
University, Changsha, China
(Zhu) School of Mathematics and Statistics, Central South University,
Changsha, China
(Zhou, Song) Department of Cardio-Thoracic Surgery, the Second Xiangya
Hospital Hospital of Central South University, Changsha, China
Title
Identification of novel variants associated with warfarin stable dosage by
use of a two-stage extreme phenotype strategy.
Source
Journal of Thrombosis and Haemostasis. 15 (1) (pp 28-37), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials Required warfarin doses for mechanical heart valves vary
greatly. A two-stage extreme phenotype design was used to identify novel
warfarin dose associated mutation. We identified a group of variants
significantly associated with extreme warfarin dose. Four novel identified
mutations account for 2.2% of warfarin dose discrepancies. Summary:
Background The variation among patients in warfarin response complicates
the management of warfarin therapy, and an improper therapeutic dose
usually results in serious adverse events. Objective To use a two-stage
extreme phenotype strategy in order to discover novel warfarin
dose-associated mutations in heart valve replacement patients.
Patients/method A total of 1617 stable-dose patients were enrolled and
divided randomly into two cohorts. Stage I patients were genotyped into
three groups on the basis of VKORC1-1639G>A and CYP2C9*3 polymorphisms;
only patients with the therapeutic dose at the upper or lower 5% of each
genotype group were selected as extreme-dose patients for resequencing of
the targeted regions. Evaluation of the accuracy of the sequence data and
the potential value of the stage I-identified significant mutations were
conducted in a validation cohort of 420 subjects. Results A group of
mutations were found to be significantly associated with the extreme
warfarin dose. The validation work finally identified four novel
mutations, i.e. DNMT3A rs2304429 (24.74%), CYP1A1 rs3826041 (47.35%),
STX1B rs72800847 (7.01%), and NQO1 rs10517 (36.11%), which independently
and significantly contributed to the overall variability in the warfarin
dose. After addition of these four mutations, the estimated regression
equation was able to account for 56.2% (R² <inf>Adj</inf> =
0.562) of the overall variability in the warfarin maintenance dose, with a
predictive accuracy of 62.4%. Conclusion Our study provides evidence
linking genetic variations in STX1B, DNMT3A and CYP1A1 to warfarin
maintenance dose. The newly identified mutations together account for 2.2%
of warfarin dose discrepancy. Copyright &#xa9; 2016 The Authors. Journal
of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on
behalf of International Society on Thrombosis and Haemostasis.

<62>
Accession Number
611708010
Author
Mangiacapra F.; Colaiori I.; Ricottini E.; Balducci F.; Creta A.;
Demartini C.; Minotti G.; Di Sciascio G.
Institution
(Mangiacapra, Colaiori, Ricottini, Balducci, Creta, Demartini, Di
Sciascio) Unit of Cardiovascular Science, Department of Medicine, Campus
Bio-Medico University, Via Alvaro del Portillo, 200, Rome 00128, Italy
(Minotti) Unit of Drug Science, Department of Medicine, Campus Bio-Medico
University, Rome, Italy
Title
Heart Rate reduction by IVabradine for improvement of ENDothELial function
in patients with coronary artery disease: the RIVENDEL study.
Source
Clinical Research in Cardiology. 106 (1) (pp 69-75), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Aims: Data from experimental studies suggest that the <inf>f</inf>
current-inhibitor ivabradine may reduce oxidative stress and improve
endothelial function. We aimed to evaluate the effect of ivabradine on
endothelial function in patients with coronary artery disease (CAD) after
complete revascularization with percutaneous coronary angioplasty (PCI).
Methods and results: At least 30 days after PCI, 70 patients were
randomized (T0) to receive ivabradine 5 mg twice daily (ivabradine group,
n = 36) or to continue with standard medical therapy (control group, n =
34). After 4 weeks (T1), ivabradine dose was adjusted up to 7.5 mg twice
daily in patients with heart rate (HR) at rest >60 bpm, and thereafter
continued for additional 4 weeks (T2). At all timings, brachial artery
reactivity was assessed by flow-mediated dilatation (FMD) and
nitroglycerin-mediated dilatation (NMD). No significant differences were
observed at T0 between ivabradine and control groups in terms of HR (68.0
+/- 6.4 vs. 67.6 +/- 6.4 bpm; p = 0.803), FMD (8.7 +/- 4.9 vs. 8.0 +/- 5.5
%; p = 0.577) and NMD (12.7 +/- 6.7 vs. 13.3 +/- 6.2 %; p = 0.715). Over
the study period, a significant reduction of HR (65.2 +/- 5.9 bpm at T1,
62.2 +/- 5.7 bpm at T2; p < 0.001), and improvement of FMD (12.2 +/- 6.2 %
at T1, 15.0 +/- 7.7 % at T2; p < 0.001) and NMD (16.6 +/- 10.4 % at T1,
17.7 +/- 10.8 at T2; p < 0.001) were observed in the ivabradine group,
while no significant changes were observed in the control group. In the
ivabradine group, a moderate negative correlation was observed between the
HR variation and FMD variation from T1 to T3 (r = -0.448; p = 0.006).
Conclusions: In patients with CAD undergoing complete revascularization
with PCI, addition of ivabradine to the standard medical therapy produces
a significant improvement in endothelial function. This effect seems to be
related to HR reduction. ClinicalTrials.gov number, NCT02681978. Copyright
&#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<63>
Accession Number
614248560
Author
Mariathas M.; Olechowski B.; Mahmoudi M.; Curzen N.
Institution
(Mariathas, Olechowski, Mahmoudi, Curzen) Coronary Research Group,
University Hospital Southampton NHS Foundation Trust, Southampton, United
Kingdom
(Mariathas, Olechowski, Mahmoudi, Curzen) Faculty of Medicine, University
of Southampton, Southampton, United Kingdom
Title
Does the evidence really suggest that we should completely revascularise
bystander disease in patients with ST elevation myocardial infarction
undergoing primary angioplasty? Why we still need more definitive trial
data to change routine practice.
Source
Expert Review of Cardiovascular Therapy. 15 (2) (pp 75-81), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: There remains considerable heterogeneity in the management
of significant lesions in non culprit coronary arteries in STEMI patients
undergoing primary percutaneous coronary intervention (PPCI). Three recent
randomised trials have shown clinical outcome benefit in a complete
revascularisation approach when compared to PPCI of the culprit artery
alone. By contrast, observational data suggest that an aggressive complete
revascularisation may not confer clinical benefit and may, in some cases,
be harmful. Areas covered: In this review we discuss the three recent
randomised trials that have advocated a complete revasculariation approach
in addition to data available from registries. Expert commentary: An
adequately powered, randomised controlled trial is required to answer the
question of whether complete revascularisation in STEMI patients is
beneficial and, if so, whether it should be ischaemia directed and whether
it should be at the index procedure or staged. Copyright &#xa9; 2016
Informa UK Limited, trading as Taylor & Francis Group.

<64>
Accession Number
613767533
Author
Giannini F.; Aurelio A.; Jabbour R.J.; Ferri L.; Colombo A.; Latib A.
Institution
(Giannini, Aurelio, Jabbour, Ferri, Colombo, Latib) Interventional
Cardiology Unit, San Raffaele Hospital, Milan, Italy
(Giannini, Jabbour, Colombo, Latib) Interventional Cardiology Unit,
EMO-GVM Centro Cuore Columbus, Milan, Italy
(Aurelio) Cardiovascular Department, Casa di Cura Villa Verde, Taranto,
Italy
(Ferri) Cardiovascular Department, Ospedale A. Manzoni, Lecco, Italy
Title
The coronary sinus reducer: clinical evidence and technical aspects.
Source
Expert Review of Cardiovascular Therapy. 15 (1) (pp 47-58), 2017. Date of
Publication: 02 Jan 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Chronic refractory angina is often a disabling condition,
predominantly due to severe obstructive coronary artery disease, that is
inadequately controlled by optimal medical therapy and not amenable to
further percutaneous or surgical revascularization. mortality rates
associated with this condition are relatively low in clinically stable
patients. however, it is associated with a high hospitalization rate and a
reduction in both exercise capacity and quality of life. due to the
paucity of available treatment options, there is an unmet need for new
therapies for these patients and for a reduction in the associated
economic healthcare burden. Areas covered: This review is focusing on the
clinical evidence and technical aspects of this new therapeutic modality
in refractory angina patients unsuitable for revascularization. Expert
commentary: The Coronary Sinus Reducer (Neovasc Inc. Richmond B.C.,
Canada) is a new percutaneous device designed to achieve a controlled
narrowing of the coronary sinus that may alleviate myocardial ischemia,
possibly by redistributing blood from the less ischemic sub-epicardium to
the more ischemic sub-endocardium, or by neoangiogenesis. Recently, a
randomized, double-blind, multi-center clinical trial demonstrated a
benefit in improving symptoms in 104 refractory angina patients, when
compared to placebo. Copyright &#xa9; 2016 Informa UK Limited, trading as
Taylor & Francis Group.

<65>
Accession Number
613767531
Author
Furiasse N.; Kobashigawa J.A.
Institution
(Furiasse, Kobashigawa) Cedars Sinai Medical Center, Department of
Cardiology, Cedars Sinai Heart Institute, Los Angeles, CA, United States
Title
Immunosuppression and adult heart transplantation: emerging therapies and
opportunities.
Source
Expert Review of Cardiovascular Therapy. 15 (1) (pp 59-69), 2017. Date of
Publication: 02 Jan 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Immunosuppression following heart transplantation has
improved graft longevity through the reduction of cellular and antibody
mediated rejection. The attempt to limit the unintended consequences of
immunosuppressive therapies and address sensitized patients has led to a
revolution in immunosuppression. Areas covered: This review will focus on
the current emerging immunosuppressive therapies in heart transplantation
while reviewing the effective contemporary treatments, and explore the
potential development of new immunomodulatory therapies. An exhaustive
review of the PubMed database and abstract data from national meetings was
performed to compile the data for the manuscript. Expert commentary: The
timing and targets of immunosuppressive therapies are evolving to provide
adjunctive therapies to the established treatments. Recent advances will
allow for further tailoring of immunomodulatory therapies to the
individual patient. Copyright &#xa9; 2016 Informa UK Limited, trading as
Taylor & Francis Group.

<66>
Accession Number
613767530
Author
Nagendran J.; Catrip J.; Losenno K.L.; Adams C.; Kiaii B.; Chu M.W.A.
Institution
(Nagendran) Division of Cardiac Surgery, Department of Surgery,
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton,
Canada
(Catrip) Department of Cardiovascular Surgery, Instituto Nacional de
Cardiologia Ignacio Chavez, Mexico City, Mexico
(Losenno, Kiaii, Chu) Division of Cardiac Surgery, Department of Surgery,
Lawson Health Research Institute, Western University, London, Canada
(Adams) Division of Cardiac Surgery, Department of Surgery, Health Science
Center, Memorial University, St. John's, Canada
Title
Minimally invasive mitral repair surgery: why does controversy still
persist?.
Source
Expert Review of Cardiovascular Therapy. 15 (1) (pp 15-24), 2017. Date of
Publication: 02 Jan 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Surgical treatment for mitral valve disease has evolved and
remains a rapidly expanding field. Minimally invasive mitral valve repair
(MI-MVR) is a well-known alternative to conventional sternotomy mitral
valve repair (cMVR). However, controversy as to the efficacy of MI-MVR
persists, hindering the adoption and potential benefits of this less
invasive approach. Areas covered: In this review, we provide an updated
summary evaluation of the latest evidence, including observational
studies, clinical trials and meta-analyses, regarding MI-MVR in comparison
to cMVR. Expert commentary: The controversy that persists around the
widespread adoption of MI-MVR procedures is addressed with the wealth of
evidence published establishing similarly excellent outcomes between
MI-MVR and cMVR. Copyright &#xa9; 2016 Informa UK Limited, trading as
Taylor & Francis Group.

<67>
Accession Number
614358759
Author
Cruz-Gonzalez I.; Rama-Merchan J.C.; Rodriguez-Collado J.; Martin-Moreiras
J.; Diego-Nieto A.; Barreiro-Perez M.; Sanchez P.L.
Institution
(Cruz-Gonzalez, Rama-Merchan, Rodriguez-Collado, Martin-Moreiras,
Diego-Nieto, Barreiro-Perez, Sanchez) Cardiology Department, University
Hospital of Salamanca, IBSAL, Salamanca, Spain
(Rama-Merchan) Cardiology Department, Hospital of Merida, Badajoz, Spain
Title
Transcatheter closure of paravalvular leaks: State of the art.
Source
Netherlands Heart Journal. 25 (2) (pp 116-124), 2017. Date of Publication:
February 2017.
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Paravalvular leak (PVL) is a serious complication after surgical valve
replacement or after transcatheter aortic valve replacement. Approximately
1-5% of PVLs can lead to serious clinical consequences, including
congestive heart failure and/or haemolytic anaemia. For years, surgical
reintervention has been considered the treatment of choice for symptomatic
patients with PVLs. However, surgical reintervention is associated with a
high risk of morbidity and mortality. Transcatheter PVL (TPVL) closure is
a less invasive alternative to surgical re-intervention. The safety and
feasibility of TPVL closure has been confirmed in several registries and a
meta-analysis. In this review, we discuss the clinical implications and
diagnosis of PVLs, technical considerations for TPVL, execution of the
procedure and assessment of the results. Copyright &#xa9; The Author(s)
2016.

<68>
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).

<69>
Accession Number
613355207
Author
Roncada G.
Institution
(Roncada) Jessa Hospital, Heart Centre Hasselt, Stadsomvaart 11, Hasselt
3500, Belgium
(Roncada) Commission for Osteopathic Research, Practice and Promotion,
Mechelen, Belgium
Title
Effects of osteopathic treatment on pulmonary function and chronic
thoracic pain after coronary artery bypass graft surgery (OstinCaRe):
Study protocol for a randomised controlled trial.
Source
BMC Complementary and Alternative Medicine. 16 (1) (no pagination), 2016.
Article Number: 482. Date of Publication: 25 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Coronary artery bypass graft surgery (CABG) is an effective
and widespread coronary revascularisation technique, nevertheless there
are a number of long-term postoperative complications from which patients
can suffer. One year after CABG surgery pulmonary function is decreased by
12% and 30% of the patients suffer from chronic thoracic pain. To date and
to our knowledge there are no effective treatments for these conditions.
The aim of the present clinical trial is to explore the effectiveness of
osteopathic treatment on these conditions. Methods: The study is designed
as a randomised controlled trial with two parallel groups. Group A will
receive a standard cardiac rehabilitation programme during 12 weeks and
group B will receive the same standard cardiac rehabilitation programme
supplemented with four osteopathic treatments (OT). OT will be performed
at week 4, 5, 8 and 12 after surgery. Three hundred and eight patients
(Group A: n = 154, Group B: n = 154) will be enrolled from the
cardiothoracic surgery department of the Jessa Hospital Hasselt. Blinding
will be assured for the staff of the cardiac rehabilitation centre and
outcome assessors. Primary outcome measure will be the mean difference in
change from baseline in slow vital capacity (SVC) at 12 weeks after
surgery between groups. Secondary outcome measures will be the change from
baseline in quality of life, pain, thoracic stiffness and maximal aerobic
capacity at 12 weeks after surgery. A follow-up is planned 52 weeks after
surgery for SVC, quality of life, pain and thoracic stiffness. Intention
to treat analysis will be executed. Discussion: The OstinCare study has
been designed to explore the potential long-term added value of
osteopathic treatment in the management of decreased pulmonary function,
chronic thoracic pain and diminished thoracic mobility after CABG surgery.
Trial registration: The protocol has been retrospectively registered on
ClinicalTrials.gov (NCT01714791). Copyright &#xa9; 2016 The Author(s).

<70>
Accession Number
610390105
Author
Chen H.; Guo K.; Yang H.; Wu D.; Yuan F.
Institution
(Chen, Yang) Department of Orthopedics, First Hospital Affiliated to
Soochow University, Suzhou, Jiangsu, China
(Chen, Guo, Wu, Yuan) Department of Orthopedics, The Affiliated Hospital
of Xuzhou Medical College, Xuzhou, Jiangsu, China
Title
Thoracic pedicle screw placement guide plate produced by three-dimensional
(3-D) laser printing.
Source
Medical Science Monitor. 22 (pp 1682-1686), 2016. Date of Publication: 19
May 2016.
Publisher
International Scientific Literature Inc. (E-mail: msi@medscimonit.com)
Abstract
Background: The aim of this study was to evaluate the accuracy and
feasibility of an individualized thoracic pedicle screw placement guide
plate produced by 3-D laser printing. Material/Methods: Thoracic pedicle
samples of 3 adult cadavers were randomly assigned for 3-D CT scans. The
3-D thoracic models were established by using medical Mimics software, and
a screw path was designed with scanned data. Then the individualized
thoracic pedicle screw placement guide plate models, matched to the
backside of thoracic vertebral plates, were produced with a 3-D laser
printer. Screws were placed with assistance of a guide plate. Then, the
placement was assessed. Results: With the data provided by CT scans, 27
individualized guide plates were produced by 3-D printing. There was no
significant difference in sex and relevant parameters of left and right
sides among individuals (P>0.05). Screws were placed with assistance of
guide plates, and all screws were in the correct positions without
penetration of pedicles, under direct observation and anatomic evaluation
post-operatively. Conclusions: A thoracic pedicle screw placement guide
plate can be produced by 3-D printing. With a high accuracy in placement
and convenient operation, it provides a new method for accurate placement
of thoracic pedicle screws. Copyright &#xa9; Med Sci Monit, 2016.

<71>
Accession Number
612270079
Author
Thadani U.
Institution
(Thadani) Department of Medicine, Cardiovascular Section, University of
Oklahoma HSC and VA Medical Center, OU Health Sciences Center, 920 Stanton
L Young Boulevard, Room WP3010, Oklahoma City, OK 73104, United States
Title
Management of Stable Angina - Current Guidelines: A Critical Appraisal.
Source
Cardiovascular Drugs and Therapy. 30 (4) (pp 419-426), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Guidelines provide recommendations to improve patient outcomes, but many
of the recommendations made for treating patients with stable angina are
opinion based rather than evidence based. Risk stratification to predict
patients at an increased risk of myocardial infarction (MI) and sudden
ischemic death, and selection of patients for possible revascularization,
is based on expert opinion. Randomized trials have compared optimal
medical therapy to revascularization, after the coronary anatomy was
known, and yet routine coronary angiography to exclude left main disease
is not recommended. What exactly is optimal antianginal treatment varies
considerably from one country's guideline recommendations to another. None
of the antianginal drugs reduce mortality or MI and these drugs are
equally effective in treating angina pectoris; and yet beta-blockers and
calcium channel blockers are recommended as first line therapy. Double and
triple therapy with different classes of antianginal drugs is also expert
opinion based rather than evidence based. Recommendations to reduce the
incidence of MI and sudden death are appropriate; however the use of a
potent, high dose statin, is recommended by AHA/ACC and NICE guidelines
for all patients with ischemic heart disease, while the European
guidelines recommend a target LDL goal in patients with coronary artery
disease (CAD). Management of patients with stable angina pectoris with
normal coronary arteries remains ambiguous. This short review critically
appraises the recommendations for managing patients with stable angina
pectoris. Copyright &#xa9; 2016, Springer Science+Business Media New York.

<72>
Accession Number
607903742
Author
Katz M.G.; Fargnoli A.S.; Kendle A.P.; Hajjar R.J.; Bridges C.R.
Institution
(Katz, Fargnoli, Kendle, Bridges) Sanger Heart and Vascular Institute,
1001 Blythe Blvd, Ste 300, Charlotte, NC 28203, United States
(Katz, Fargnoli, Hajjar) Mount Sinai School of Medicine, New York, NY,
United States
Title
Gene Therapy in Cardiac Surgery: Clinical Trials, Challenges, and
Perspectives.
Source
Annals of Thoracic Surgery. 101 (6) (pp 2407-2416), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Elsevier USA
Abstract
The concept of gene therapy was introduced in the 1970s after the
development of recombinant DNA technology. Despite the initial great
expectations, this field experienced early setbacks. Recent years have
seen a revival of clinical programs of gene therapy in different fields of
medicine. There are many promising targets for genetic therapy as an
adjunct to cardiac surgery. The first positive long-term results were
published for adenoviral administration of vascular endothelial growth
factor with coronary artery bypass grafting. In this review we analyze the
past, present, and future of gene therapy in cardiac surgery. The articles
discussed were collected through PubMed and from author experience. The
clinical trials referenced were found through the Wiley clinical trial
database (http://www.Wiley.com/legacy/Wileychi/genmed/clinical/) as well
as the National Institutes of Health clinical trial database
(Clinicaltrials.gov). Copyright &#xa9; 2016 The Society of Thoracic
Surgeons.

<73>
Accession Number
612347697
Author
Magri D.; Re F.; Limongelli G.; Agostoni P.; Zachara E.; Correale M.;
Mastromarino V.; Santolamazza C.; Casenghi M.; Pacileo G.; Valente F.;
Morosin M.; Musumeci B.; Pagannone E.; Maruotti A.; Uguccioni M.; Volpe
M.; Autore C.
Institution
(Magri, Mastromarino, Santolamazza, Casenghi, Musumeci, Pagannone, Volpe,
Autore) Department of Clinical and Molecular Medicine, University of Rome
"La Sapienza", Rome, Italy
(Re, Zachara, Uguccioni) Cardiology Division, Cardiac Arrhythmia Center
and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy
(Limongelli, Pacileo, Valente) Cardiology SUN, Monaldi Hospital, II
University of Naples, Naples, Italy
(Agostoni, Morosin) "Monzino" Cardiologic Center, IRCCS, Milan, Italy
(Agostoni) Department of Clinical Sciences and Community Health,
University of Milan, Milan, Italy
(Correale) Department of Cardiology, University of Foggia, Foggia, Italy
(Morosin) Cardiovascular Department, "Ospedali Riuniti" Trieste and
Postgraduate School Cardiovascular Sciences, University of Trieste,
Tieste, Italy
(Maruotti) Department of Economic, Political Sciences and Modern Languages
"Libera Universita-SS Maria Assunta", Rome, Italy
(Maruotti) Centre for Innovation and Leadership in Health Sciences,
University of Southampton, Southampton, United Kingdom
(Volpe) IRCCS-Neuromed, Pozzilli, IS, Italy
Title
Heart failure progression in hypertrophic cardiomyopathy - Possible
insights from cardiopulmonary exercise testing.
Source
Circulation Journal. 80 (10) (pp 2204-2211), 2016. Date of Publication:
2016.
Publisher
Japanese Circulation Society
Abstract
Background: Heart failure (HF) progression and its complications represent
major emergent concerns in hypertrophic cardiomyopathy (HCM). We
investigated the possible adjunctive role of cardiopulmonary exercise
testing (CPET) in predicting HF-related events. An exercise-derived risk
model, the HYPertrophic Exercise-derived Risk HF (HYPER<inf>HF</inf>), has
been developed. Methods and Results: A multicenter cohort of 620
consecutive HCM outpatients was recruited and followed (2007 to 2015). The
endpoint was death from HF, cardiac transplantation, NYHA III-IV class
progression, severe functional deterioration leading to hospitalization
for septal reduction, and hospitalization for HF worsening. During a
median follow-up of 3.8 years (25-75th centile: 2.3-5.3 years), 84
patients reached the endpoint. Peak circulatory power (peak oxygen
consumption * peak systolic blood pressure), ventilatory efficiency and
left atrial diameter were independently associated with the endpoint and,
accordingly, integrated into the HYPER<inf>HF</inf> model (C index: 0.849;
best cutoff value equal to 15%). Conclusions: CPET is useful in the
evaluation of HCM patients. In this context, the HYPER<inf>HF</inf> score
might allow early identification of those patients at high risk of HF
progression and its complications. Copyright &#xa9; 2016, Japanese
Circulation Society. All rights reserved.

<74>
[Use Link to view the full text]
Accession Number
613375878
Author
Zong Z.J.; Shen Q.Y.; Lu Y.; Li Y.H.
Institution
(Zong, Shen, Lu, Li) Department of Anesthesiology, First Affiliated
Hospital of Anhui Medical University, Hefei, Anhui Province 230022, China
Title
A simple blind placement of the left-sided double-lumen tubes.
Source
Medicine (United States). 95 (45) (no pagination), 2016. Article Number:
e5376. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
One-lung ventilation (OLV) has been commonly provided by using a
double-lumen tube (DLT). Previous reports have indicated the high
incidence of inappropriate DLT positioning in conventional maneuvers.
After obtaining approval from the medical ethics committee of First
Affiliated Hospital of Anhui Medical University and written consent from
patients, 88 adult patients belonging to American society of
anesthesiologists (ASA) physical status grade I or II, and undergoing
elective thoracic surgery requiring a left-side DLT for OLV were enrolled
in this prospective, single-blind, randomized controlled study. Patients
were randomly allocated to 1 of 2 groups: simple maneuver group or
conventional maneuver group. The simple maneuver is a method that relies
on partially inflating the bronchial balloon and recreating the effect of
a carinal hook on the DLTs to give an idea of orientation and depth. After
the induction of anesthesia the patients were intubated with a left-sided
Robertshaw DLT using one of the 2 intubation techniques. After intubation
of each DLT, an anesthesiologist used flexible bronchoscopy to evaluate
the patient while the patient lay in a supine position. The number of
optimal position and the time required to place DLT in correct position
were recorded. Time for the intubation of DLT took 100+/-16.2seconds
(mean+/-SD) in simple maneuver group and 95.1+/-20.8seconds in
conventional maneuver group. The difference was not statistically
significant (P=0.221). Time for fiberoptic bronchoscope (FOB) took
22+/-4.8seconds in simple maneuver group and was statistically faster than
that in conventional maneuver group (43.6+/-23.7seconds, P<0.001). Nearly
98% of the 44 intubations in simple maneuver group were considered as in
optimal position while only 52% of the 44 intubations in conventional
maneuver group were in optimal position, and the difference was
statistically significant (P<0.001). This simple maneuver is more rapid
and more accurate to position left-sided DLTs, it may be substituted for
FOB during positioning of a left-sided DLT in condition that FOB is
unavailable or inapplicable. Copyright &#xa9; 2016 the Author(s).
Published by Wolters Kluwer Health, Inc. All rights reserved.

<75>
[Use Link to view the full text]
Accession Number
610763065
Author
Skoloudik D.; Hurtikova E.; Brat R.; Herzig R.
Institution
(Skoloudik, Hurtikova, Brat) Department of Neurology, Comprehensive Stroke
Center, University Hospital Ostrava, Ostrava-Poruba CZ-708 52, Czech
Republic
(Skoloudik) Faculty of Health Sciences, Palacky University, Olomouc, Czech
Republic
(Herzig) Department of Cardiac Surgery, University Hospital Ostrava,
Ostrava, Czech Republic
(Brat) Department of Neurosurgery and Neurooncology, Comprehensive Stroke
Center, Military University Hospital, Prague, Czech Republic
Title
Sonolysis in Prevention of Brain Infarction during Cardiac Surgery
(SONORESCUE).
Source
Medicine (United States). 95 (20) (no pagination), 2016. Article Number:
e3615. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Here, we examined whether intraoperative sonolysis can alter the risk of
new ischemic lesions in the insonated brain artery territory during
coronary artery bypass grafting (CABG) or valve surgery. Silent brain
ischemic lesions could be detected in as many as two-Thirds of patients
after CABG or valve surgery. Patients indicated for CABG or valve surgery
were allocated randomly to sonolysis (60 patients, 37 males; mean age,
65.3 years) of the right middle cerebral artery (MCA) during cardiac
surgery and control group (60 patients, 37 males; mean age, 65.3 years).
Neurologic examination, cognitive function tests, and brain magnetic
resonance imaging (MRI) were conducted before intervention as well as 24
to 72hours and 30 days after surgery. New ischemic lesions on control
diffusion-weighted MRI in the insonated MCA territory >0.5mL were
significantly less frequent in the sonolysis group than in the control
group (13.3% vs 26.7%, P=0.109). The sonolysis group exhibited
significantly reduced median volume of new brain ischemic lesions
(P=0.026). Stenosis of the internal carotid artery >50% and smoking were
independent predictors of new brain ischemic lesions >0.5mL (odds
ratio=5.685 [1.272-25.409], P=0.023 and 4.698 [1.092-20.208], P=0.038,
respectively). Stroke or transient ischemic attack occurred only in 2
control patients (P=0.496). No significant differences were found in
scores for postintervention cognitive tests (P>0.05). This study provides
class-II evidence that sonolysis during CABG or valve surgery reduces the
risk of larger, new ischemic lesions in the brain. www.clinicaltrials.gov
(NCT01591018). Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All
rights reserved.

<76>
Accession Number
609905531
Author
Williams M.C.; Hunter A.; Shah A.S.V.; Assi V.; Lewis S.; Smith J.; Berry
C.; Boon N.A.; Clark E.; Flather M.; Forbes J.; McLean S.; Roditi G.; Van
Beek E.J.R.; Timmis A.D.; Newby D.E.
Institution
(Williams, Hunter, Shah, Boon, Clark, Van Beek, Newby) British Heart
Foundation Centre for Cardiovascular Science, University of Edinburgh,
Chancellor's Building, Room SU314, 49 Little France Crescent, Edinburgh
EH16 4SA, United Kingdom
(Assi, Lewis) Centre for Population Health Sciences, University of
Edinburgh, Edinburgh, United Kingdom
(Smith) Health Economics Research Centre, University of Oxford, Oxford,
United Kingdom
(Berry, Roditi) Institute for Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Forbes) Health Research Institute, University of Limerick, Limerick,
Ireland
(McLean) National Health Service, Fife, United Kingdom
(Timmis) William Harvey Research Institute, Queen Mary University of
London, London, United Kingdom
Title
Use of Coronary Computed Tomographic Angiography to Guide Management of
Patients with Coronary Disease.
Source
Journal of the American College of Cardiology. 67 (15) (pp 1759-1768),
2016. Date of Publication: 19 Apr 2016.
Publisher
Elsevier USA
Abstract
Background In a prospective, multicenter, randomized controlled trial,
4,146 patients were randomized to receive standard care or standard care
plus coronary computed tomography angiography (CCTA). Objectives The
purpose of this study was to explore the consequences of CCTA-assisted
diagnosis on invasive coronary angiography, preventive treatments, and
clinical outcomes. Methods In post hoc analyses, we assessed changes in
invasive coronary angiography, preventive treatments, and clinical
outcomes using national electronic health records. Results Despite similar
overall rates (409 vs. 401; p = 0.451), invasive angiography was less
likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios
[HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but
more likely to show obstructive coronary artery disease (283 vs. 230; HR:
1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More
preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p <
0.001) were initiated after CCTA, with each drug commencing at a median of
48 to 52 days after clinic attendance. From the median time for preventive
therapy initiation (50 days), fatal and nonfatal myocardial infarction was
halved in patients allocated to CCTA compared with those assigned to
standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020).
Cumulative 6-month costs were slightly higher with CCTA: difference $462
(95% CI: $303 to $621). Conclusions In patients with suspected angina due
to coronary heart disease, CCTA leads to more appropriate use of invasive
angiography and alterations in preventive therapies that were associated
with a halving of fatal and non-fatal myocardial infarction. (Scottish
COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).
Copyright &#xa9; 2016 American College of Cardiology Foundation.

<77>
Accession Number
611028981
Author
Doenst T.; Struning C.; Moschovas A.; Gonzalez-Lopez D.; Essa Y.; Kirov
H.; Diab M.; Faerber G.
Institution
(Doenst, Struning, Moschovas, Gonzalez-Lopez, Essa, Kirov, Diab, Faerber)
Department of Cardiothoracic Surgery, Friedrich-Schiller-University of
Jena, Erlanger Allee 101, Jena 07747, Germany
Title
Cardiac surgery 2015 reviewed.
Source
Clinical Research in Cardiology. 105 (10) (pp 801-814), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
For the year 2015, almost 19,000 published references can be found in
PubMed when entering the search term "cardiac surgery". The last year has
been again characterized by lively discussions in the fields where classic
cardiac surgery and modern interventional techniques overlap. Lacking
evidence in the field of coronary revascularization with either
percutaneous coronary intervention or bypass surgery has been added. As in
the years before, CABG remains the gold standard for the revascularization
of complex stable triple-vessel disease. Plenty of new information has
been presented comparing the conventional to transcatheter aortic valve
implantation (TAVI) demonstrating similar short- and mid-term outcomes at
high and low risk, but even a survival advantage with transfemoral TAVI at
intermediate risk. In addition, there were many relevant and interesting
other contributions from the purely operative arena. This review article
will summarize the most pertinent publications in the fields of coronary
revascularization, surgical treatment of valve disease, heart failure
(i.e., transplantation and ventricular assist devices), and aortic
surgery. While the article does not have the expectation of being complete
and cannot be free of individual interpretation, it provides a condensed
summary that is intended to give the reader "solid ground" for up-to-date
decision-making in cardiac surgery. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<78>
Accession Number
610043935
Author
Colditz G.A.; Stoll C.R.T.
Institution
(Colditz, Stoll) Division of Public Health Sciences, Department of
Surgery, Washington University, School of Medicine, 660 S Euclid Ave, St.
Louis, MO 63110, United States
Title
Reporting Standards for Randomized Trials Published in the Annals of
Thoracic Surgery.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1639-1640), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA

<79>
Accession Number
614252762
Author
Tarricone R.; Callea G.; Ogorevc M.; Prevolnik Rupel V.
Institution
(Tarricone) Department of Policy Analysis and Public Management, Bocconi
University, Milan, Italy
(Tarricone, Callea) Centre for Research on Health and Social Care
Management (CERGAS), Bocconi University, Milan, Italy
(Ogorevc, Prevolnik Rupel) Institute for Economic Research, Ljubljana,
Slovenia
Title
Improving the Methods for the Economic Evaluation of Medical Devices.
Source
Health Economics (United Kingdom). 26 (pp 70-92), 2017. Date of
Publication: 01 Feb 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Medical devices (MDs) have distinctive features, such as incremental
innovation, dynamic pricing, the learning curve and organisational impact,
that need to be considered when they are evaluated. This paper
investigates how MDs have been assessed in practice, in order to identify
methodological gaps that need to be addressed to improve the
decision-making process for their adoption. We used the Consolidated
Health Economic Evaluation Reporting Standards (CHEERS) checklist
supplemented by some additional categories to assess the quality of
reporting and consideration of the distinctive features of MDs. Two case
studies were considered: transcatheter aortic valve implantation (TAVI)
representing an emerging technology and implantable cardioverter
defibrillators (ICDs) representing a mature technology. Economic
evaluation studies published as journal articles or within Health
Technology Assessment reports were identified through a systematic
literature review. A total of 19 studies on TAVI and 41 studies on ICDs
were analysed. Learning curve was considered in only 16% of studies on
TAVI. Incremental innovation was more frequently mentioned in the studies
of ICDs, but its impact was considered in only 34% of the cases. Dynamic
pricing was the most recognised feature but was empirically tested in less
than half of studies of TAVI and only 32% of studies on ICDs. Finally,
organisational impact was considered in only one study of ICDs and in
almost all studies on TAVI, but none of them estimated its impact. By
their very nature, most of the distinctive features of MDs cannot be fully
assessed at market entry. However, their potential impact could be
modelled, based on the experience with previous MDs, in order to make a
preliminary recommendation. Then, well-designed post-market studies could
help in reducing uncertainties and make policymakers more confident to
achieve conclusive recommendations. &#xa9; 2017 The Authors. Health
Economics published by John Wiley & Sons, Ltd. Copyright &#xa9; 2017 The
Authors. Health Economics published by John Wiley & Sons, Ltd.

<80>
[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.

<81>
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

<82>
[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.

<83>
Accession Number
613768398
Author
Erden I.; Golcuk E.; Bozyel S.; Erden E.C.; Balaban Y.; Yalin K.; Turan B.
Institution
(Erden, Erden, Balaban) Department of Cardiology, VM Medicalpark Kocaeli
Hospital, Kocaeli, Turkey
(Golcuk, Bozyel, Turan) Department of Cardiology, Kocaeli Derince Training
and Research Hospital, Kocaeli, Turkey
(Yalin) Department of Cardiology, Bayrampasa Kolan Hospital, Istanbul,
Turkey
Title
Effectiveness of Handmade "Jacky-Like Catheter" As a Single Multipurpose
Catheter in Transradial Coronary Angiography: A Randomized Comparison With
Conventional Two-Catheter Strategy.
Source
Journal of Interventional Cardiology. 30 (1) (pp 24-32), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To investigate safety and efficacy of specialized hand-modified
"Jacky-Like" catheter (JLC) as a single dual-purpose catheter in
transradial coronary angiography. Methods: Patients over 18 years
undergoing diagnostic CAG through right radial artery (RRA) were
prospectively enrolled. Procedures were performed with a single JLC
modified from a left Judkins (JL) 3.5 catheter or by using 2-catheter
approach (2C). Procedures with coronary artery bypass grafts or
ventricular angiographies were excluded from the study. Three hundred and
eighty-seven transradial procedures were performed successfully. One
hundred and ninety-four procedures were performed with 2C and 193
procedures with a JLC. Inability to use intended catheters, total
fluoroscopic time in minutes, the consumption of contrast medium in
milliliter, development of radial artery spasm (RAS), and radial artery
occlusion (RAO) were evaluated. Results: In the 2C group, angiography was
successfully performed on the RCA of 191 patients (98.9%) and on LCA in
192 patients (99.4%). In the JLC group, angiography was successfully
performed on the RCA and LCA of 193 (99.4%) and 174 (89.6%) patients,
respectively. Utilization of supplemental catheters was significantly
greater in the JLC group (21; 10.8%) versus the 2C group (3; 1.5% P =
0.001). Mean fluoroscopy time was shorter in the JLC group (2.0 +/- 2.3
min vs. 2.3 +/- 1.5 min; P = 0.043). Mean procedure time was also
decreased with JLC but did not reach statistical significance (5.7 +/- 3.1
min vs. 6.2 +/- 2.5 min; P = 0.081). When additional time for reshaping
the JLC was not taken into account, mean procedure time was significantly
decreased in the JLC group (5.6 +/- 2.9 min vs. 6.2 +/- 2.4 min; P =
0.031). There was a trend toward lower incidence of consumption of
contrast medium in the 2C group (49 +/- 13 mL vs. 52 +/- 18 mL; P =
0.061). RAS was observed more frequently in the 2C group (11.3% vs. 21.7%,
P = 0.005). There was a trend toward high incidence of RAO in the 2C group
(4.1 vs. 8.3% P = 0.064). Conclusion: In transradial procedures from RRA,
a JLC catheter can be very effective when dedicated dual-purpose catheter
is not available. Copyright &#xa9; 2016, Wiley Periodicals, Inc.

<84>
[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.

<85>
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.

<86>
Accession Number
614517188
Author
Elgendy I.Y.; Mahmoud A.N.; Kumbhani D.J.; Bhatt D.L.; Bavry A.A.
Institution
(Elgendy, Mahmoud, Bavry) Department of Medicine, University of Florida,
Gainesville, Florida, United States
(Kumbhani) Department of Medicine, University of Texas Southwestern
Medical Center, Dallas, Texas, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, Massachusetts, United States
(Bavry) North Florida/South Georgia Veterans Health Systems, Gainesville,
Florida, United States
Title
Complete or Culprit-Only Revascularization for Patients With Multivessel
Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A
Pairwise and Network Meta-Analysis of Randomized Trials.
Source
JACC: Cardiovascular Interventions. 10 (4) (pp 315-324), 2017. Date of
Publication: 27 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to compare the effectiveness of the
different revascularization strategies in ST-segment elevation myocardial
infarction (STEMI) patients with multivessel coronary artery disease
undergoing primary percutaneous coronary intervention (PCI). Background
Recent randomized trials have suggested that multivessel complete
revascularization at the time of primary percutaneous coronary
intervention (PCI) is associated with better outcomes, however; the
optimum timing for nonculprit PCI is unknown. Methods Trials that
randomized STEMI patients with multivessel disease to any combination of
the 4 different revascularization strategies (i.e., complete
revascularization at the index procedure, staged procedure during the
hospitalization, staged procedure after discharge or culprit-only
revascularization) were included. Random effect risk ratios (RRs) were
conducted. Network meta-analysis was constructed using mixed treatment
comparison models, and the 4 revascularization strategies were compared.
Results A total of 10 trials with 2,285 patients were included. In the
pairwise meta-analysis, complete revascularization (i.e., at the index
procedure or as a staged procedure) was associated with a lower risk of
major adverse cardiac events (MACE) (RR: 0.57; 95% confidence interval
[CI]: 0.42 to 0.77), due to lower risk of urgent revascularization (RR:
0.44; 95% CI: 0.30 to 0.66). The risk of all-cause mortality (RR: 0.76;
95% CI: 0.52 to 1.12), and spontaneous reinfarction (RR: 0.54; 95% CI:
0.23 to 1.27) was similar. The reduction in the risk of MACE was observed
irrespective of the timing of nonculprit artery revascularization in the
mixed treatment model. Conclusions Current evidence from randomized trials
suggests that the risk of all-cause mortality and spontaneous reinfarction
is not different among the various revascularization strategies for
multivessel disease. Complete revascularization at the index procedure or
as a staged procedure (either during the hospitalization or after
discharge) was associated with a reduction of MACE due to reduction in
urgent revascularization with no difference between these 3 strategies.
Future trials are needed to determine the impact of complete
revascularization on the risk of all-cause mortality and spontaneous
reinfarction. Copyright &#xa9; 2017 American College of Cardiology
Foundation

<87>
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

<88>
Accession Number
614512958
Author
Ruan V.; Czer L.S.C.; Awad M.; Kittleson M.; Patel J.; Arabia F.;
Esmailian F.; Ramzy D.; Chung J.; De Robertis M.; Trento A.; Kobashigawa
J.A.
Institution
(Ruan, Czer, Awad, Kittleson, Patel, Kobashigawa) Division of Cardiology,
Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles,
California, United States
(Arabia, Esmailian, Ramzy, Chung, De Robertis, Trento) Division of
Cardiothoracic Surgery, Cedars-Sinai Medical Center, Cedars-Sinai Heart
Institute, Los Angeles, California, United States
Title
Use of Anti-Thymocyte Globulin for Induction Therapy in Cardiac
Transplantation: A Review.
Source
Transplantation Proceedings. 49 (2) (pp 253-259), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier USA
Abstract
The most common causes of death after heart transplantation (HTx) include
acute rejection and multi-organ failure in the early period and malignancy
and cardiac allograft vasculopathy (CAV) in the late period. Polyclonal
antibody preparations such as rabbit anti-thymocyte globulin (ATG) may
reduce early acute rejection and the later occurrence of CAV after HTx.
ATG therapy depletes T cells, modulates adhesion and cell-signaling
molecules, interferes with dendritic cell function, and induces B-cell
apoptosis and regulatory and natural killer T-cell expansion. Evidence
from animal studies and from retrospective clinical studies in humans
indicates that ATG can be used to delay calcineurin inhibitor (CNI)
exposure after HTx, thus benefiting renal function, and to reduce the
incidence of CAV and ischemia-reperfusion injury in the transplanted
heart. ATG may reduce de novo antibody production after HTx. ATG does not
appear to increase cytomegalovirus infection rates with longer prophylaxis
(6-12 months). In addition, ATG may reduce the risk of lymphoproliferative
disease and does not appear to confer an additive effect on acquiring
lymphoma after HTx. Randomized, controlled trials may provide stronger
evidence of ATG association with patient survival, graft rejection, renal
protection through delayed CNI initiation, as well as other benefits. It
can also help establish optimal dosing and patient criteria to maximize
treatment benefits. Copyright &#xa9; 2016 Elsevier Inc.

<89>
Accession Number
607899783
Author
Ihmsen H.; Rohde D.; Schuttler J.; Jeleazcov C.
Institution
(Ihmsen, Rohde, Schuttler, Jeleazcov) Anasthesiologische Klinik,
Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat
Erlangen-Nurnberg, Krankenhausstrasse 12, Erlangen 91054, Germany
Title
External Validation of a Recently Developed Population Pharmacokinetic
Model for Hydromorphone During Postoperative Pain Therapy.
Source
European Journal of Drug Metabolism and Pharmacokinetics. 42 (1) (pp
17-28), 2017. Date of Publication: 01 Feb 2017.
Publisher
Springer-Verlag France (22, Rue de Palestro, Paris 75002, France. E-mail:
york@springer-paris.fr)
Abstract
Background and Objective: We recently developed a new population
pharmacokinetic model for hydromorphone in patients including age and
bodyweight as covariates. The aim of the present study was to evaluate
prospectively the predictive performance of this new model during
postoperative pain therapy. Methods: This was a prospective,
single-blinded, randomized, single-center study with two parallel arms.
Fifty patients aged 40-85 years undergoing cardiac surgery involving
thoracotomy were enrolled. Hydromorphone was administered postoperatively
on the intensive care unit as target controlled infusion (TCI) for patient
controlled analgesia (TCI-PCA) using the new pharmacokinetic model, or as
conventional patient controlled analgesia (PCA). Arterial blood samples
were taken for measurement of the hydromorphone plasma concentration. The
predictive performance of the pharmacokinetic model was assessed by the
median performance error (MDPE), the median absolute performance error
(MDAPE), wobble and divergence. For comparison, the performance indices
were also determined for three older models from the literature. Results:
903 plasma concentrations of 41 patients were analyzed. The mean values
(95 % CI) of MDPE, MDAPE, wobble and divergence for the new
pharmacokinetic model were 11.2 % (3.9 to 18.7 %), 28.5 % (23.9 to 33.0
%), 21.4 % (18.0 to 24.9 %) and -1.6 %/h (-2.3 to -0.8 %/h). When compared
with older models from the literature, performance was better with less
overshoot after bolus doses. Conclusion: The new pharmacokinetic model of
hydromorphone showed a good precision and a better performance than older
models. It is therefore suitable for TCI with hydromorphone during
postoperative pain therapy. Trial Registration: EudraCT 2013-002875-16,
Clinical Trials NCT02035709. Copyright &#xa9; 2016, Springer International
Publishing Switzerland.

<90>
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

<91>
Accession Number
614590696
Author
Caruba T.; Hourton D.; Sabatier B.; Rousseau D.; Tibi A.; Hoffart-Jourdain
C.; Souag A.; Freitas N.; Yjjou M.; Almeida C.; Gomes N.; Aucouturier P.;
Djadi-Prat J.; Menasche P.; Chatellier G.; Cholley B.
Institution
(Caruba) Department of Pharmacy, Hopital Europeen Georges Pompidou, AP-HP,
Paris, France
(Hourton) Clinical Trial Unit and INSERM CIC-141, Hopital Europeen Georges
Pompidou, AP-HP, Paris, France
(Sabatier) Department of Pharmacy, Hopital Europeen Georges Pompidou,
AP-HP, Paris, France
(Sabatier) INSERM Centre de Recherche des Cordeliers UMR S 872 eq 22
Universite Paris Descartes, Paris, France
(Rousseau) Department of Pharmacy, Hopital Europeen Georges Pompidou,
AP-HP, Paris, France
(Tibi) Agence Generale des Equipements et des Produits de Sante (AGEPS),
AP-HP, Paris, France
(Hoffart-Jourdain) Departement de la Recherche Clinique et du
Developpement (DRCD), Hopital Saint-Louis, (AP-HP), Paris, France
(Souag) Departement de la Recherche Clinique et du Developpement (DRCD),
Hopital Saint-Louis, (AP-HP), Paris, France
(Freitas) Clinical Trial Unit and INSERM CIC-141, Hopital Europeen Georges
Pompidou, AP-HP, Paris, France
(Yjjou) Clinical Trial Unit and INSERM CIC-141, Hopital Europeen Georges
Pompidou, AP-HP, Paris, France
(Almeida) Clinical Trial Unit and INSERM CIC-141, Hopital Europeen Georges
Pompidou, AP-HP, Paris, France
(Gomes) Clinical Trial Unit and INSERM CIC-141, Hopital Europeen Georges
Pompidou, AP-HP, Paris, France
(Aucouturier) Clinical Trial Unit and INSERM CIC-141, Hopital Europeen
Georges Pompidou, AP-HP, Paris, France
(Djadi-Prat) Clinical Trial Unit and INSERM CIC-141, Hopital Europeen
Georges Pompidou, AP-HP, Paris, France
(Menasche) Department of Cardiovascular Surgery, Hopital Europeen Georges
Pompidou, AP-HP, Paris, France
(Menasche) Universite Paris Descartes, Sorbonne Paris Cite, Paris, France
(Chatellier) Clinical Trial Unit and INSERM CIC-141, Hopital Europeen
Georges Pompidou, AP-HP, Paris, France
(Chatellier) Universite Paris Descartes, Sorbonne Paris Cite, Paris,
France
(Cholley) Department of Anaesthesiology and Intensive Care, Hopital
Europeen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.
(Cholley) Universite Paris Descartes, Sorbonne Paris Cite, Paris, France.
Title
Rationale and design of the multicenter randomized trial investigating the
effects of levosimendan pretreatment in patients with low ejection
fraction (<40 %) undergoing CABG with cardiopulmonary bypass (LICORN
study).
Source
Journal of cardiothoracic surgery. 11 (1) (pp 127), 2016. Date of
Publication: 05 Aug 2016.
Abstract
TRIAL REGISTRATION NUMBER: NCT02184819 (ClinicalTrials.gov).
BACKGROUND: Patients with a left ventricular ejection fraction (LVEF) of
less than 40 % are at high risk of developing postoperative low cardiac
output syndrome (LCOS). Despite actual treatments (inotropic agents and/or
mechanical assist devices), the mortality rate of such patients remains
very high (13 to 24 %). The LICORN trial aims at assessing the efficacy of
a preoperative infusion of levosimendan in reducing postoperative LCOS in
patients with poor LVEF undergoing coronary artery bypass grafting (CABG).
METHODS/DESIGN: LICORN study is a multicenter, randomized double-blind,
placebo-controlled trial in parallel groups. 340 patients with LVEF <40 %,
undergoing CABG will be recruited from 13 French hospitals. The study drug
will be started after anaesthesia induction and infused over 24 h (0.1
mug/kg/min). The primary outcome (postoperative LCOS) is evaluated using a
composite criterion composed of: 1) need for inotropic agents beyond 24 h
following discontinuation of the study drug; 2) need for post-operative
mechanical assist devices or failure to wean from these techniques when
inserted pre-operatively; 3) need for renal replacement therapy. Secondary
outcomes include: 1) mortality at Day 28 and Day 180; 2) each item of the
composite criterion of the primary outcome; 3) the number of
"ventilator-free" days and "out of intensive care unit" days at Day 28.
DISCUSSION: The usefulness of levosimendan in the perioperative period has
not yet been documented with a high level of evidence. The LICORN study is
the first randomized controlled trial evaluating the clinical value of
preoperative levosimendan in high risk cardiac surgical patients
undergoing CABG.

<92>
Accession Number
614591015
Author
Shang X.K.; Zhong L.; Lu R.; Zhang G.C.; Liu M.; Shen Q.S.; Zhou X.; Qin
C.Y.; Zhou H.M.
Institution
(Shang, Zhong, Lu, Zhang, Liu, Shen, Zhou, Qin, Zhou) National Heart
Centre, Singapore
Title
Comparison of Outcomes of Transcatheter and Surgical Procedure in
Perimembranous Ventricular Septal Defect Patients with Tricuspid
Regurgitation.
Source
Annals of the Academy of Medicine, Singapore. 45 (7) (pp 322-325), 2016.
Date of Publication: 01 Jul 2016.

<93>
Accession Number
614605954
Author
Zhou A.-G.; Wang X.-X.; Pan D.-B.; Chen A.-J.; Zhang X.-F.; Deng H.-W.
Institution
(Zhou, Wang, Pan, Chen, Zhang, Deng) Department of Anesthesiology, First
People's Hospital of Changde City, Changde, Hunan, China
Title
Preoperative Antihypertensive Medication in Relation to Postoperative
Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A
Meta-Analysis.
Source
BioMed Research International. 2017 (no pagination), 2017. Article Number:
1203538. Date of Publication: 2017.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. We undertake a systematic review and meta-analysis to evaluate
the effect of preoperative hypertension and preoperative antihypertensive
medication to postoperative atrial fibrillation (POAF) in patients
undergoing cardiac surgery. Methods. We searched PubMed, Embase, and
Cochrane Library (from inception to March 2016) for eligible studies. The
outcomes were the effects of preoperative hypertension, preoperative
calcium antagonists regimen, preoperative ACE inhibitors regimen, and
preoperative beta blocking agents regimen with POAF. We calculated pooled
risk ratios (OR) and 95% CIs using random- or fixed-effects models.
Results. Twenty-five trials involving 130087 patients were listed.
Meta-analysis showed that the number of preoperative hypertension patients
in POAF group was significantly higher (P < 0.05), while we found that
there are no significant differences between two groups in Asia patients
by subgroup analysis, which is in contrast to other outcomes. Compared
with the Non-POAF group, the number of patients who used calcium
antagonists and ACE inhibitors preoperatively in POAF group was
significantly higher (P < 0.05). And we found that there were no
significant differences between two groups of preoperative beta blocking
agents used (P = 0.08). Conclusions. Preoperative hypertension and
preoperative antihypertensive medication in patients undergoing cardiac
operations seem to be associated with higher risk of POAF. Copyright
&#xa9; 2017 Ai-Guo Zhou et al.

<94>
Accession Number
614635135
Author
Tutic-Horn M.; Gambazzi F.; Rocco G.; Mosimann M.; Schneiter D.; Opitz I.;
Martucci N.; Hillinger S.; Weder W.; Jungraithmayr W.
Institution
(Tutic-Horn, Schneiter, Opitz, Hillinger, Weder, Jungraithmayr) Department
of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
(Gambazzi, Mosimann) Division of Thoracic Surgery, Cantonal Hospital
Aarau, Aarau, Switzerland
(Rocco, Martucci) Division of Thoracic Surgery, University Hospital
Naples, Naples, Italy
(Jungraithmayr) Department of Thoracic Surgery, Medical University
Brandenburg, Germany
Title
Curative resection for lung cancer in octogenarians is justified.
Source
Journal of Thoracic Disease. 9 (2) (pp 296-302), 2017. Date of
Publication: 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Due to an increased life expectancy in a healthy aging
population and a progressive incidence of lung cancer, curative pulmonary
resections can be performed even in octogenarians. The present study aims
to investigate whether surgery is justified in patients reaching the age
of 80 years and older who undergo resection for non-small cell lung cancer
(NSCLC). Methods: In this retrospective multi-centre analysis, the
morbidity, mortality and long-term survival of 88 patients (24 females)
aged =80 who underwent complete resection for lung cancer between 2000 and
2013 were analysed. Only fit patients with few comorbidities, low
cardiopulmonary risk, good quality of life and a life expectancy of at
least 5 years were included. Results: Curative resections from three
thoracic surgery centres included 61 lobectomies, 9 bilobectomies, 6
pneumonectomies and 12 segmentectomies or wide wedge resections with
additional systematic mediastinal lymphadenectomy in all cases. Final
histology revealed squamous cell carcinoma [33], adenocarcinoma [41],
large cell carcinoma [5] or other histological types [9]. Lung cancer
stage distribution was 0 [1], I [53], II [17] and IIIA [14]. The overall
90-day mortality was 1.1%. The median hospitalisation and chest drainage
times were 10 days (range, 5-27 days) and 5 days (range, 0-17 days),
respectively. Thirty-six patients were complication-free (41%). In
particular, pulmonary complications occurred in 25 patients (28%). In
addition, 23 patients (26%) developed cardiovascular complications
requiring medical intervention, while 24 patients (27%) had
cerebrovascular complications, urinary tract infection and others. The
median survival time was 51 months (range, 1-110 months), and the 5-year
overall survival reached 45% without significance between tumour stages.
Conclusions: Curative lung resections in selected octogenarians can be
safely performed up to pneumonectomy for all tumour stages with a
perioperative mortality, morbidity, and 5-year survival rate comparable to
younger cohorts. Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<95>
Accession Number
614522168
Author
Agus M.S.D.; Wypij D.; Hirshberg E.L.; Srinivasan V.; Faustino E.V.;
Luckett P.M.; Alexander J.L.; Asaro L.A.; Curley M.A.Q.; Steil G.M.;
Nadkarni V.M.
Institution
(Agus, Alexander, Steil) Division of Medicine Critical Care, Boston
Children's Hospital, Harvard Medical School, Boston, MA 02115, United
States
(Wypij, Asaro) Department of Cardiology, Boston Children's Hospital,
Harvard Medical School, Boston, UT, United States
(Hirshberg) Division of Pediatric Critical Care, University of Utah
Medical School, Primary Children's Hospital, Salt Lake City, UT, United
States
(Srinivasan, Nadkarni) Children's Hospital of Philadelphia, University of
Pennsylvania, PA, United States
(Srinivasan, Curley, Nadkarni) Perelman School of Medicine, University of
Pennsylvania, PA, United States
(Curley) School of Nursing, University of Pennsylvania, PA, United States
(Faustino) Yale School of Medicine, New Haven, CT, United States
(Luckett) Children's Medical Center Dallas, University of Texas
Southwestern Medical School, Dallas, United States
Title
Tight glycemic control in critically Ill children.
Source
New England Journal of Medicine. 376 (8) (pp 729-741), 2017. Date of
Publication: 23 Feb 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In multicenter studies, tight glycemic control targeting a
normal blood glucose level has not been shown to improve outcomes in
critically ill adults or children after cardiac surgery. Studies involving
critically ill children who have not undergone cardiac surgery are
lacking. METHODS In a 35-center trial, we randomly assigned critically ill
children with confirmed hyperglycemia (excluding patients who had
undergone cardiac surgery) to one of two ranges of glycemic control: 80 to
110 mg per deciliter (4.4 to 6.1 mmol per liter; lower-Target group) or
150 to 180 mg per deciliter (8.3 to 10.0 mmol per liter; higher-Target
group). Clinicians were guided by continuous glucose monitoring and
explicit methods for insulin adjustment. The primary outcome was the
number of intensive care unit (ICU)-free days to day 28. RESULTS The trial
was stopped early, on the recommendation of the data and safety monitoring
board, owing to a low likelihood of benefit and evidence of the
possibility of harm. Of 713 patients, 360 were randomly assigned to the
lower-Target group and 353 to the higher-Target group. In the
intention-To-Treat analysis, the median number of ICU-free days did not
differ significantly between the lower-Target group and the higher-Target
group (19.4 days [interquartile range {IQR}, 0 to 24.2] and 19.4 days
[IQR, 6.7 to 23.9], respectively; P = 0.58). In per-protocol analyses, the
median time-weighted average glucose level was significantly lower in the
lower-Target group (109 mg per deciliter [IQR, 102 to 118]; 6.1 mmol per
liter [IQR, 5.7 to 6.6]) than in the higher-Target group (123 mg per
deciliter [IQR, 108 to 142]; 6.8 mmol per liter [IQR, 6.0 to 7.9];
P<0.001). Patients in the lower-Target group also had higher rates of
health care-Associated infections than those in the highertarget group (12
of 349 patients [3.4%] vs. 4 of 349 [1.1%], P = 0.04), as well as higher
rates of severe hypoglycemia, defined as a blood glucose level below 40 mg
per deciliter (2.2 mmol per liter) (18 patients [5.2%] vs. 7 [2.0%], P =
0.03). No significant differences were observed in mortality, severity of
organ dysfunction, or the number of ventilator-free days. CONCLUSIONS
Critically ill children with hyperglycemia did not benefit from tight
glycemic control targeted to a blood glucose level of 80 to 110 mg per
deciliter, as compared with a level of 150 to 180 mg per deciliter.
Copyright &#xa9; 2017 Massachusetts Medical Society.

<96>
Accession Number
614559101
Author
Yamato Y.; Matsuyama Y.; Hasegawa K.; Aota Y.; Akazawa T.; Iida T.; Ueyama
K.; Uno K.; Kanemura T.; Kawakami N.; Kotani T.; Takaso M.; Takahashi J.;
Tanaka M.; Taneichi H.; Tsuji T.; Hosoe H.; Mochida J.; Shimizu T.;
Yonezawa I.; Watanabe K.; Matsumoto M.
Institution
(Yamato, Matsuyama) Department of Orthopaedic Surgery, Hamamatsu
University School of Medicine, Handayama 1-20-1, Higashi-ku,
Hamamatsu-shi, Shizuoka 431-3192, Japan
(Hasegawa) Niigata Spine Surgery Center, Nishimachi 2-5-22, Konan-ku,
Niigata-shi 950-0165, Japan
(Aota) Department of Spinal Surgery, Yokohama Brain and Spine Center,
Takigashira 1-2-1, Isogo-ku, Yokohama-shi 235-0012, Japan
(Akazawa, Kotani) Department of Orthopaedic Surgery, Seirei Sakura Citizen
Hospital, Ebaradai 2-36-2, Sakura-shi 285-8765, Japan
(Iida) Department of Orthopaedic Surgery, Dokkyo Medical University
Koshigaya Hospital, Minamikoshigaya 2-1-50, Koshigaya-shi 343-8555, Japan
(Ueyama) Department of Orthopaedic Surgery, Hirosaki Memorial Hospital,
Sakaizekinishita 59-1, Hirosaki-shi 036-8076, Japan
(Uno) Department of Orthopaedic Surgery, National Hospital Organization
Kobe Medical Center, Nishiochiai 3-1-1, Suma-ku, Kobe-shi 654-0155, Japan
(Kanemura) Department of Orthopaedic Surgery, Konan Kosei Hospital,
Takayacho Omatsubara 137, Konan-shi 483-8704, Japan
(Kawakami, Tsuji) Department of Orthopaedic Surgery, Meijo Hospital,
Sannomaru 1-3-1, Naka-ku, Nagoya-shi 460-0001, Japan
(Takaso) Department of Orthopaedic Surgery, Kitasato University School of
Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara-shi 252-0375, Japan
(Takahashi) Department of Orthopaedic Surgery, Shinshu University, Asahi
3-1-1, Matsumoto-shi 390-8621, Japan
(Tanaka) Department of Orthopaedic Surgery, Okayama University Hospital,
Shikatacho 2-5-1, Okayama-shi 700-8558, Japan
(Taneichi) Department of Orthopaedic Surgery, Dokkyo Medical University,
Kitakobayashi 880, Mibumachi, Shimotsuga-gun 321-0207, Japan
(Hosoe) Department of Orthopaedic Surgery, Gifu Prefectural General
Medical Center, Noisshiki 4-6-1, Gifu-shi 500-8717, Japan
(Mochida) Department of Orthopaedic Surgery, Tokai University School of
Medicine, Shimokasuya 143, Isehara-shi 259-1193, Japan
(Shimizu) Department of Orthopaedic Surgery, Gunma Spine Center,
Kamitoyookamachi 828-1, Takasaki-shi 370-0871, Japan
(Yonezawa) Department of Orthopaedic Surgery, Juntendo University School
of Medicine, Hongo 3-1-3, Bunkyou-ku, Tokyo 113-8431, Japan
(Watanabe, Matsumoto) Department of Orthopaedic Surgery, Keio University,
Shinanomachi 35, Shinjuku-ku 160-8582, Japan
Title
A Japanese nationwide multicenter survey on perioperative complications of
corrective fusion for elderly patients with adult spinal deformity.
Source
Journal of Orthopaedic Science. 22 (2) (pp 237-242), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier (E-mail: orders@springer.jp)
Abstract
Background Recently, corrective fusion surgery for patients with adult
spinal deformity (ASD) has become common in Japan. This study aimed to
clarify the status of surgeries for ASD in Japan, focusing on
perioperative complications. A nationwide multicenter survey gathering
information on surgically treated ASD patients was conducted by the
committee for Adult Spinal Deformity of the Japanese Scoliosis Society.
Methods This study was a review of retrospectively collected data from 18
spine scoliosis centers belonging to the Japanese Scoliosis Society.
Patients who underwent corrective fusion surgery for ASD between 2011 and
2013 were included. Demographics, comorbidities, surgical data, and
complications were investigated. Results A total of 1192 patients (mean
age, 57.7 years) were included in this study. Of these, 611 patients were
aged less than 65 years and 581 patients were aged 65 years or greater.
The age distribution had two peaks, in the third and eighth decades.
Deformities caused by degeneration represented 67% of the pathology in
patients aged over 65 years; however, non-degenerative disease such as
adult idiopathic scoliosis and syndromic or congenital deformity
represented over 60% of pathology in patients aged less than 65 years. The
iatrogenic deformity and reoperation rates were both less than 3%. The
mean operation time and estimated blood loss were 370 min and 1642 ml,
respectively. Major perioperative complications occurred in 160 patients
(14.5%). The incidence of complications was significantly higher in
patients aged over 65 years, including neurological deficits, hemorrhagic
shock, hematoma, heart failure, and surgical site infection (p < 0.05).
Conclusions Older (aged over 65 years) ASD patients showed greater rates
of deformity due to the occurrence of degeneration and vertebral
fractures, as well as a higher incidence of peri-and postoperative
complications. Efforts to reduce perioperative complications are therefore
imperative, especially for elderly ASD patients in our aging society.
Copyright &#xa9; 2016 The Japanese Orthopaedic Association

<97>
Accession Number
614514320
Author
Shadvar K.; Sanaie S.; Mahmoodpoor A.; Safarpoor M.; Nagipour B.
Institution
(Shadvar) Fellowship of Critical Care Medicine, Cardiovascular Research
Center, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Sanaie) Lung Disease and Tuberculosis Research Center, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Mahmoodpoor) Fellowship of Critical Care Medicine, Department of
Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
(Safarpoor) Student Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Nagipour) Fellowship of Cardiac Anesthesia, Department of Anesthesiology,
Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of
Title
The effect of bilateral intrapleural infusion of lidocaine with fentanyl
versus only lidocaine in relieving pain after coronary artery bypasses
surgery.
Source
Pakistan Journal of Medical Sciences. 33 (1) (pp 177-181), 2017. Date of
Publication: January-February 2017.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Background and Objective: Pain control during surgery in order to cause
analgesia and reduce the somatic and autonomic response may decrease the
morbidity. Intrapleural catheter embedding during surgery under direct
vision of surgeon is safe and easy and without potential risk of thoracic
epidural block. The aim of this study was to investigate the effect of
bilateral intrapleural infusion of lidocaine with fentanyl versus only
lidocaine in relieving pain after coronary artery bypass surgery. Methods:
In this prospective randomized double blind clinical trial,130 adult
patients undergoing elective CABG with age range of 20 to 60 years were
divided into two groups receiving either lidocaine and fentanyl (group A)
or lidocaine (group B). The analgesia was evaluated every two hours in all
intubated and non-intubated patients using Visual analog scale (VAS) and
data were analyzed using SPSS software package. Results: Of all patients,
67 (51.5%) were males and 63 (48.5%) were females. The average age of
subjects was 53.49 +/- 5.099 years. Mean pain score six hours after the
surgery was statistically different between the groups at all times.
Conclusion: The pain in patients receiving combination of lidocaine and
fentanyl is less than patients receiving only lidocaine. Copyright &#xa9;
2017, Professional Medical Publications. All rights reserved.

<98>
[Use Link to view the full text]
Accession Number
614578013
Author
Auyong D.B.; Hostetter L.; Yuan S.C.; Slee A.E.; Hanson N.A.
Institution
(Auyong, Hostetter, Yuan, Hanson) Department of Anesthesiology, Virginia
Mason Medical Center, 1100 9th Ave, Seattle, WA 98101, United States
(Slee) Axio Research, Seattle, WA, United States
Title
Evaluation of ultrasound-assisted thoracic epidural placement in patients
undergoing upper abdominal and thoracic surgery a randomized, double-blind
study.
Source
Regional Anesthesia and Pain Medicine. 42 (2) (pp 204-209), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background andObjectives: The placement of thoracic epidurals can be
technically challenging and requires a thorough understanding of neuraxial
anatomy. Although ultrasound imaging of the thoracic spine has been
described, no outcome studies on the use of this imaging have been
performed. We evaluated whether preprocedural ultrasound of the thoracic
spine would facilitate the process of epidural catheterization. Methods:
Subjects undergoing thoracic or upper abdominal surgery with planned
thoracic epidural placement at T10 or higher were enrolled in this
randomized double-blind study. Subjects were allocated into 1 of 2 groups
for preoperative epidural placement: ultrasound guidance (group US) or
palpation (group Palp). Subjects randomized to group US had a
preprocedural ultrasound examination to identify pertinent spinal anatomy
and make appropriate marks on the skin identifying midline and
interlaminar spaces for targeted Tuohy needle insertion. Subjects in group
Palp had a skin marking performed by palpation alone. Using the skin
markings, all epidurals were performed using a loss of resistance to
saline technique. Block levels were assessed with ice and pain scores
obtained by a blinded nurse in the postanesthesia care unit. The primary
outcome was procedural time from needle insertion to loss of resistance in
the epidural space. Results: Seventy subjects were recruited and completed
the study protocol. Themedian time for epidural needle placement to
achieve loss of resistance in group US and group Palp was 188.5 seconds
(interquartile range [IQR], 79.0-515.0) and 242.0 seconds (IQR,
87.0-627.0), respectively (P = 0.188). Using ultrasound to mark the skin
overlying the targeted epidural space took a median time of 85 seconds
(IQR, 69-113) for group US and 35 seconds (IQR, 27-51) for group Palp (P <
0.001). The number of needle passes was not significantly different
between the 2 groups (P = 0.31). The use of ultrasound assistance resulted
in a decreased number of needle skin punctures to achieve loss of
resistance (P = 0.005).Mean pain scores after surgery were lower in group
US compared to group Palp: 3.0 versus 4.7, respectively (P = 0.015).
Conclusions: This is the first randomized study to evaluate the efficacy
of preprocedural ultrasound marking for placement of thoracic epidural
catheters. We observed that preprocedural ultrasound did not significantly
reduce the time required to identify the thoracic epidural space via loss
of resistance. Clinical Trials Registration: NCT02785055
(https://clinicaltrials.gov/). Copyright &#xa9; 2017 American Society of
Regional Anesthesia and Pain Medicine.

<99>
Accession Number
614666953
Author
Ferguson M.K.; Bennett C.
Institution
(Ferguson) Department of Surgery, University of Chicago, Chicago, Illinois
(Ferguson) Comprehensive Cancer Center, University of Chicago, Chicago,
Illinois
(Bennett) Centre for Technology Enabled Health Research, Coventry
University, Coventry, United Kingdom
Title
Identification of Essential Components of Thoracoscopic Lobectomy and
Targets for Simulation.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Fewer than 50% of lobectomies for lung cancer are performed
using thoracoscopic (video-assisted thoracic surgery [VATS]) techniques.
This situation could be mitigated through the use of simulation training.
Using a Delphi process, this study identified essential components of VATS
right upper lobectomy most amenable to focused simulation. Methods:
Experienced VATS surgeons were randomly selected for participation. A
custom Internet interface permitted anonymous voting, commenting, and the
ability to modify and propose new components. A component was declared
essential when 80% or more of the study participants agreed or strongly
agreed on this designation. Participants rated each component for
difficulty and then voted for components that were most appropriate for
simulation. Results: Thirty-five surgeons initially agreed to participate,
and 30 completed the study. Twenty-four components were identified after
three votes, and 21 of these components were considered essential.
Procedural components that scored the highest for overall difficulty and
that were deemed most appropriate for focused simulation included division
of the truncus anterior, division of the posterior segmental artery,
division of the upper lobe vein, and division of the upper lobe bronchus.
Conclusions: A Delphi approach enabled surgeons of disparate training
backgrounds and experience to agree on essential components of a VATS
lobectomy. There was agreement on the components that are most appropriate
for simulation. These findings can be used to design simulation exercises
for VATS lobectomy by using targeted anatomy. Copyright &#xa9; 2017 The
Society of Thoracic Surgeons.

<100>
Accession Number
614664038
Author
Qian C.; Feng H.; Cao J.; Wei B.; Wang Y.
Institution
(Qian, Feng, Cao, Wei, Wang) Department of Cardiology, Zhongnan Hospital
of Wuhan University, Wuhan University, Wuhan, China
(Wang) Medical Research Institute of Wuhan University, Wuhan University,
Wuhan, China
Title
Meta-Analysis of Randomized Control Trials Comparing Drug-Eluting Stents
Versus Coronary Artery Bypass Grafting for Significant Left Main Coronary
Narrowing.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: November 26, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Previous meta-analyses showed that drug-eluting stent (DES) implantation
may serve as an alternative to coronary artery bypass grafting (CABG) for
unprotected left main coronary artery (ULMCA) stenosis, largely driven by
data from registries. Hence, we performed a meta-analysis of randomized
controlled trials (RCTs) to overcome this limitation. PubMed, the Cochrane
Library, and Scopus were systematically searched through October 2016 to
identify eligible RCTs. The primary outcomes were major adverse cardiac
and cerebrovascular events (MACCE) at 1-year and long-term (>3 years)
follow-ups. This meta-analysis included 5 RCTs, totaling 4,595 patients
with ULMCA disease. Compared with CABG, DES showed similar 1-year rates of
MACCE (risk ratio [RR] 1.14, 95% confidence interval [CI] 0.91-1.42),
all-cause death, and myocardial infarction, with a higher incidence of
revascularization (RR 1.68, 95% CI 1.24-2.27) and lower incidence of stoke
(RR 0.43, 95% CI 0.23-0.78). At long-term follow-up, DES placement was
inferior to CABG in terms of MACCE (RR 1.27, 95% CI 1.13-1.43) and
revascularization (RR 1.70, 95% CI 1.43-2.01). There was no difference in
long-term risk of other outcomes between these 2 strategies. In
conclusion, DES stenting and CABG for ULMCA disease yield comparable rates
of MACCE at 1-year follow-up; however, CABG is associated with a decreased
risk of long-term MACCE compared with DES, exclusively driven by the
considerable reduction in revascularization events. Copyright &#xa9; 2017
Elsevier Inc.

<101>
Accession Number
614641345
Author
Benneyworth B.D.; Mastropietro C.W.; Graham E.M.; Klugman D.; Costello
J.M.; Zhang W.; Gaies M.
Institution
(Benneyworth, Mastropietro) Section of Critical Care Medicine, Department
of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind
(Benneyworth) Children's Health Services Research, Department of
Pediatrics, Indiana University School of Medicine, Indianapolis, Ind
(Graham) Division of Cardiology, Department of Pediatrics, Medical
University of South Carolina, Charleston, SC
(Klugman) Division of Cardiac Critical Care Medicine and Cardiology,
Children's National Health System, Washington, DC
(Costello) Division of Cardiology, Department of Pediatrics, Northwestern
University Feinberg School of Medicine, Ann and Robert H. Lurie Children's
Hospital of Chicago, Chicago, Ill
(Zhang, Gaies) Division of Cardiology, Department of Pediatrics and
Communicable Diseases, C.S. Mott Children's Hospital and University of
Michigan Medical School, Ann Arbor, Mich
Title
Variation in extubation failure rates after neonatal congenital heart
surgery across Pediatric Cardiac Critical Care Consortium hospitals.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: June 30, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: In a multicenter cohort of neonates recovering from cardiac
surgery, we sought to describe the epidemiology of extubation failure and
its variability across centers, identify risk factors, and determine its
impact on outcomes. Methods: We analyzed prospectively collected clinical
registry data on all neonates undergoing cardiac surgery in the Pediatric
Cardiac Critical Care Consortium database from October 2013 to July 2015.
Extubation failure was defined as reintubation less than 72 hours after
the first planned extubation. Risk factors were identified using
multivariable logistic regression with generalized estimating equations to
account for within-center correlation. Results: The cohort included 899
neonates from 14 Pediatric Cardiac Critical Care Consortium centers; 14%
were premature, 20% had genetic abnormalities, 18% had major extracardiac
anomalies, and 74% underwent surgery with cardiopulmonary bypass.
Extubation failure occurred in 103 neonates (11%), within 24 hours in 61%.
Unadjusted rates of extubation failure ranged from 5% to 22% across
centers; this variability was unchanged after adjusting for procedural
complexity and airway anomaly. After multivariable analysis, only airway
anomaly was identified as an independent risk factor for extubation
failure (odds ratio, 3.1; 95% confidence interval, 1.4-6.7; P = .01).
Neonates who failed extubation had a greater median postoperative length
of stay (33 vs 23 days, P < .001) and in-hospital mortality (8% vs 2%, P =
.002). Conclusions: This multicenter study showed that 11% of neonates
recovering from cardiac surgery fail initial postoperative extubation.
Only congenital airway anomaly was independently associated with
extubation failure. We observed a 4-fold variation in extubation failure
rates across hospitals, suggesting a role for collaborative quality
improvement to optimize outcomes. Copyright &#xa9; 2017 The American
Association for Thoracic Surgery.

<102>
Accession Number
614646627
Author
Chen H.-L.; Shen W.-Q.; Liu P.; Liu K.
Institution
(Chen, Shen, Liu) School of Nursing Nantong University Nantong PR China
(Liu) Department of Cardiothoracic Surgery Affiliated Hospital of Nantong
University Nantong PR China
Title
Length of surgery and pressure ulcers risk in cardiovascular surgical
patients: A dose-response meta-analysis.
Source
International Wound Journal. (no pagination), 2017. Date of Publication:
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
The aim of this study was to assess the relationship between length of
surgery (LOS) and pressure ulcer (PU) risk in cardiovascular surgery
patients. PubMed and Web of Science were systematically searched. We
compared LOS difference between PU (+) group and PU (-) group. We also
examined the dose-response effect of this relationship. The mean LOS in
the PU(+) groups ranged from 252.5 to 335.7 minutes, compared with 233.0
to 298.3 minutes in PU(-) groups. The LOS was higher in PU(+) groups
compared with PU(-) groups [weighted mean difference (WMD) = 36.081
minutes; 95% CI: 21.640-50.522 minutes; Z=4.90, P=0.000]. The funnel plot
showed no publication bias. A significant dose-response association was
also found between the LOS and the risk of surgery-related pressure ulcers
(SRPU, model chi²=9.29, P=0.000). In the linear model, the PU
OR was 1.296 (95% CI 1.097-1.531) for a 60-minute increase in the LOS
intervals and 13.344 (95% CI 2.521-70.636) for a 600-minute increase. In a
spline model, the OR of PU increased almost linearly along with the LOS.
Our meta-analysis indicated that LOS was an important risk factor for
pressure ulcers in cardiovascular surgical patients. Copyright &#xa9; 2017
John Wiley & Sons Ltd and Medicalhelplines.com Inc.

<103>
Accession Number
614608021
Author
Bail D.H.L.
Institution
(Bail) Karl-Olga-HospitalStuttgartGermany
Title
Treatment of functional mitral regurgitation by percutaneous annuloplasty
using the Carillon Mitral Contour System-Currently available data state.
Source
Journal of Interventional Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
OBJECTIVE: The purpose of this study is to provide a systematic review of
currently available data about the percutaneous trans-coronary-venous
mitral annuloplasty with the Carillon Mitral Contour System. METHOD: A
systematic literature search was conducted using the common medical and
scientific databases. The documented parameters included among others
grade of mitral regurgitation (MR), vena contracta (VC), effective
regurgitant orifice area (EROA), 6 minute-walk-test (6MWT),
NYHA-classification, and Quality of Life (QoL) at baseline, 30 days and in
the long-term follow-up. RESULTS: The exact total number of successfully
implantations with available data remains unclear because so many
publications are either of the same institution or study group, or they
present overlapping results. Reduction of functional mitral regurgitation
(FMR) was associated with significant inverse left-ventricular (LV))
remodeling, improvement in 6MWT, QoL and NYHA-class during the 12-month
follow-up. In almost half of the enrolled patients, the Carillon System
could not be implanted or had to be removed due to coronary compromission.
Adverse advent rate (AE) ranged between 2.8-39%. CONCLUSIONS: Results with
regard to reduction of MR and inverse LV remodeling have been remarkable.
Indication and selection criteria for suitable patients, the expected
complications, and the long-term results with regard to survival and
quality of life still remain unclear. The available results do not
establish superiority of the Carillon Mitral Contour System and support
the lack of a clear benefit. The approach with the Carillon Mitral Contour
System should be limited to participants of prospective and randomized
trials. Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<104>
Accession Number
614607940
Author
Jorgensen T.H.; Thyregod H.G.H.; Tarp J.B.; Svendsen J.H.; Sondergaard L.
Institution
(Jorgensen, Tarp, Svendsen, Sondergaard) Department of Cardiology, The
Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100
Copenhagen, Denmark
(Thyregod) Department of Cardiothoracic Surgery, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
(Svendsen, Sondergaard) Department of Clinical Medicine, University of
Copenhagen, 2100 Copenhagen, Denmark
(Svendsen) Danish Arrhythmia Research Centre, University of Copenhagen,
2100 Copenhagen, Denmark
Title
Temporal changes of new-onset atrial fibrillation in patients randomized
to surgical or transcatheter aortic valve replacement.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: July 12, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Temporal development of new-onset atrial fibrillation (NOAF)
after aortic valve replacement is unclear, and opportunistic screening has
limited diagnostic accuracy. This is the first study to investigate the
incidence and temporal development of NOAF detected by implantable loop
recorder (ILR) in patients with aortic stenosis, randomized to surgical
aortic valve replacement (SAVR) or transcatheter aortic valve replacement
(TAVR). Method: An ILR was implanted in a subgroup of patients without
pre-procedural atrial fibrillation (AF), randomized to SAVR or TAVR in the
NOTION trial. Data from the ILR were transmitted in intervals of 2. weeks
for 12. weeks post-procedurally and analyzed. Results: The study included
25 and 27 patients who underwent SAVR and TAVR, respectively. The
cumulative rate of NOAF was 100% and 81.5% for patients undergoing SAVR
and TAVR, respectively (P = 0.06). TAVR patients without NOAF 6. weeks
post-procedurally remained free from NOAF. The prevalence of AF after SAVR
decreased significantly after 8. weeks when compared with the first 2.
weeks (50.0% vs. 84.0%, respectively; P <. 0.05). The prevalence of AF
after TAVR did not change significantly during follow-up. The median AF
burden (percentage of time with AF) was 2.8% and 0.04% during the first 2.
weeks after SAVR and TAVR, respectively (P = 0.01) and it decreased
significantly over time after SAVR but not after TAVR. Conclusion: NOAF
subsided 6. weeks after TAVR. AF prevalence and burden decreased
significantly over time after SAVR, but remained stable after TAVR. These
findings may be considered for post-procedural anti-coagulation strategy.
Copyright &#xa9; 2017 Elsevier Ireland Ltd.

<105>
Accession Number
614599511
Author
Wang J.; Yu W.; Jin Q.; Li Y.; Liu N.; Hou X.; Yu Y.
Institution
(Wang, Yu, Yu) Department of Cardiac Surgery, Beijing An Zhen Hospital
Capital Medical University, Beijing, China
(Wang, Jin, Li, Liu, Hou) Center for Cardiac Intensive Care, Beijing An
Zhen Hospital Capital Medical University, Beijing, China
Title
Risk Factors for Post-TAVI Bleeding According to the VARC-2 Bleeding
Definition and Effect of the Bleeding on Short-Term Mortality: A
Meta-analysis.
Source
Canadian Journal of Cardiology. (no pagination), 2016. Date of
Publication: August 17, 2016.
Publisher
Pulsus Group Inc.
Abstract
Background: In this study we investigated the effect of post-transcatheter
aortic valve implantation (TAVI) bleeding (per Valve Academic Research
Consortium-2 [VARC-2] bleeding criteria) on 30-day postoperative mortality
and examined the correlation between pre- or intraoperative variables and
bleeding. Methods: Multiple electronic literature databases were searched
using predefined criteria, with bleeding defined per Valve Academic
Research Consortium-2 criteria. A total of 10 eligible articles with 3602
patients were included in the meta-analysis. Results: The meta-analysis
revealed that post-TAVI bleeding was associated with a 323% increase in
30-day postoperative mortality (odds risk [OR]; 4.23, 95% confidence
interval [CI], 2.80-6.40; P < 0.0001) without significant study
heterogeneity or publication bias. In subgroup analysis we found that
patients with major bleeding/life-threatening bleeding showed a 410%
increase in mortality compared with patients without bleeding (OR, 5.10;
95% CI, 3.17-8.19; P < 0.0001). Transapical access was associated with an
83% increase in the incidence of bleeding compared with transfemoral
access (OR, 1.83; 95% CI, 1.43-2.33; P < 0.0001). Multiple logistic
regression analysis revealed that atrial fibrillation (AF) was
independently correlated with TAVI-associated bleeding (OR, 2.63; 95% CI,
1.33-5.21; P = 0.005). Meta-regression showed that potential modifiers
like the Society of Thoracic Surgeons (STS) score, mortality, the logistic
European System for Cardiac Operative Risk Evaluation (EuroSCORE), aortic
valve area, mean pressure gradient, left ventricular ejection fraction,
preoperative hemoglobin and platelet levels, and study design had no
significant effects on the results of the meta-analysis. Conclusions:
Post-TAVI bleeding, in particular, major bleeding/life-threatening
bleeding, increased 30-day postoperative mortality. Transapical access was
a significant bleeding risk factor. Preexisting AF independently
correlated with TAVI-associated bleeding, likely because of AF-related
anticoagulation. Recognition of the importance and determinants of
post-TAVI bleeding should lead to strategies to improve outcomes.
Copyright &#xa9; 2016 Canadian Cardiovascular Society.

<106>
Accession Number
614582599
Author
Gaudiani V.; Deeb G.M.; Popma J.J.; Adams D.H.; Gleason T.G.; Conte J.V.;
Zorn G.L.; Hermiller J.B.; Chetcuti S.; Mumtaz M.; Yakubov S.J.; Kleiman
N.S.; Huang J.; Reardon M.J.
Institution
(Gaudiani) Department of Thoracic and Cardiac Surgery, El Camino Hospital,
Mountain View, Calif
(Deeb) Department of Cardiovascular Surgery, University of Michigan
Hospitals, Ann Arbor, Mich
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, Mass
(Adams, Chetcuti) Department of Cardiovascular Surgery, Mount Sinai Health
System, New York, NY
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh,
Pittsburgh, Pa
(Conte) Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Md
(Zorn) Cardiovascular Research Institute, University of Kansas, Kansas
City, Kan
(Hermiller) Interventional Cardiology, St Vincent Medical Center,
Indianapolis, Ind
(Mumtaz) Department of Cardiovascular Surgery, Pinnacle Health,
Harrisburg, Pa
(Yakubov) Interventional Cardiology, Riverside Methodist Hospital,
Columbus, Ohio
(Kleiman, Reardon) Department of Cardiothoracic Surgery, Houston Methodist
DeBakey Heart and Vascular Center, Houston, Tex
(Huang) Biostatistical Services, Medtronic, Minneapolis, Minn
Title
Causes of death from the randomized CoreValve US Pivotal High-Risk Trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: May 25, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Explore causes and timing of death from the CoreValve US
Pivotal High-Risk Trial. Methods: An independent clinical events committee
adjudicated causes of death, followed by post hoc hierarchical
classification. Baseline characteristics, early outcomes and causes of
death were evaluated for 3 time periods (selected based on threshold of
surgical 30-day mortality and on the differences in the continuous hazard
between the 2 groups): early (0-30 days), recovery (31-120 days), and late
(121-365 days). Results: Differences in the rate of death were evident
only during the recovery period (31-120 days), whereas 15 patients
undergoing transcatheter aortic valve replacement (TAVR) (4.0%) and 27
surgical aortic valve replacement (SAVR) patients (7.9%) died (P = .025).
This mortality difference was largely driven by higher rates of technical
failure, surgical complications, and lack of recovery following surgery.
From 0 to 30 days, the causes of death were more technical failures in the
TAVR group and lack of recovery in the SAVR group. Mortality in the late
period (121-365 days) in both arms was most commonly ascribed to other
circumstances, comprising death from medical complications from comorbid
disease. Conclusions: Mortality at 1 year in the CoreValve US Pivotal
High-Risk Trial favored TAVR over SAVR. The major contributor was that
more SAVR patients died during the recovery period (31-121 days), likely
affected by the overall influence of physical stress associated with
surgery. Similar rates of technical failure and complications were
observed between the 2 groups. This suggests that early TAVR results can
improve with technical refinements and that high-risk surgical patients
will benefit from reducing complications. Copyright &#xa9; 2017 The
American Association for Thoracic Surgery.