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<1>
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, Copenhagen
2100, Denmark
(Thyregod) Department of Cardiothoracic Surgery, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
(Svendsen, Sondergaard) Department of Clinical Medicine, University of
Copenhagen, Copenhagen 2100, Denmark
(Svendsen) Danish Arrhythmia Research Centre, University of Copenhagen,
Copenhagen 2100, Denmark
Title
Temporal changes of new-onset atrial fibrillation in patients randomized
to surgical or transcatheter aortic valve replacement.
Source
International Journal of Cardiology. 234 (pp 16-21), 2017. Date of
Publication: 01 May 2017.
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 B.V.

<2>
Accession Number
612365074
Author
Cavalcante R.; Sotomi Y.; Zeng Y.; Lee C.W.; Ahn J.-M.; Collet C.;
Tenekecioglu E.; Suwannasom P.; Onuma Y.; Park S.-J.; Serruys P.W.
Institution
(Cavalcante, Zeng, Tenekecioglu, Suwannasom, Onuma) Erasmus University
Medical Center, Rotterdam, Netherlands
(Cavalcante) Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Sotomi, Collet, Suwannasom) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Lee, Ahn, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Serruys) International Center for Circulatory Health, Imperial College
London, London, United Kingdom
Title
Coronary bypass surgery versus stenting in multivessel disease involving
the proximal left anterior descending coronary artery.
Source
Heart. 103 (6) (pp 428-433), 2017. Date of Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective In patients with multivessel disease and proximal left anterior
descending artery (LAD) involvement, the best revascularisation strategy
is still unclear. We assess outcomes after coronary artery bypass graft
surgery (CABG) and percutaneous coronary intervention (PCI) with
drug-eluting stents in a pooled analysis of individual patient-level data
of the SYNTAX and BEST randomised trials. Design Proximal LAD involvement
was defined by any lesion > 50% diameter stenosis in the arterial segment
starting from the left-main bifurcation up to (and including) the origin
of the first major septal branch. The primary endpoint was the composite
of all-cause death, myocardial infarction (MI) or stroke at 5 years of
follow-up. Results The present study population comprises 1166 patients of
which 577 were randomised to PCI and 589 to CABG. Baseline characteristics
were well balanced across study arms. The primary endpoint occurred in 94
(16.3%) patients in the PCI arm and in 68 (11.5%) patients in the CABG arm
(HR 1.43; 95%CI 1.05 to 1.95; p=0.026). CABG was also associated with a
significantly lower rate of cardiac death (p=0.007), MI (p<0.001),
all-cause revascularisation (p<0.001) and major adverse cardiovascular and
cerebrovascular events (all-cause death, MI, stroke, revascularisation)
(p<0.001). The rates of all-cause mortality (p=0.06) and stroke (p=0.09)
were not statistically different between the two groups. The overall study
results for the primary outcome were consistent across several subgroups.
Conclusions In patients with multivessel disease with proximal LAD
involvement, CABG is associated with lower rates of the safety composite
endpoint of death, MI or stroke as compared with PCI with drug-eluting
stents at 5 years of follow-up (number needed to treat=21). Copyright
&#xa9; Published by the BMJ Publishing Group Limited.

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

<4>
Accession Number
611879776
Author
Hioki H.; Watanabe Y.; Kozuma K.; Nara Y.; Kawashima H.; Kataoka A.;
Yamamoto M.; Takagi K.; Araki M.; Tada N.; Shirai S.; Yamanaka F.;
Hayashida K.
Institution
(Hioki, Watanabe, Kozuma, Nara, Kawashima, Kataoka) Division of
Cardiology, Department of Internal Medicine, Teikyo University Hospital,
2-11-1 Kaga, Itabashi-ku, Tokyo 173-0003, Japan
(Yamamoto) Division of Cardiovascular Medicine, Toyohashi Heart Center,
Aichi, Japan
(Takagi) Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
(Araki) Department of Cardiovascular Medicine, Yokohama City Eastern
Hospital, Kanagawa, Japan
(Tada) Department of Cardiovascular Center, Sendai Kosei Hospital, Miyagi,
Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
Japan
(Yamanaka) Department of Cardiovascular Medicine, Shonan Kamakura General
Hospital, Kanagawa, Japan
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Title
Pre-procedural dual antiplatelet therapy in patients undergoing
transcatheter aortic valve implantation increases risk of bleeding.
Source
Heart. 103 (5) (pp 361-367), 2017. Date of Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate the clinical benefit of pre-procedural antiplatelet
therapy in patients undergoing transfemoral (TF) transcatheter aortic
valve implantation (TAVI). Methods OCEAN (Optimized transCathEter vAlvular
interveNtion)-TAVI is a prospective, multicentre, observational cohort
registry, enrolling 749 patients who underwent TAVI from October 2013 to
August 2015 in Japan. We identified 540 patients (median age 85 years,
68.1% female) undergoing TF-TAVI; of these, 80 had no pre-procedural
antiplatelet therapy and 460 had antiplatelet therapy. The endpoints were
any bleeding (life-threatening, major, and minor bleeding) and thrombotic
events (stroke, myocardial infarction, and valve thrombosis) during
hospitalisation. Results Patients with dual antiplatelet therapy (DAPT)
had a significantly higher incidence of any bleeding than those with
single antiplatelet therapy (SAPT) (36.5% vs 27.5%, p=0.049) and no
antiplatelet therapy (36.5% vs 21.3%, p=0.010). Patients without
pre-procedural antiplatelet therapy did not experience an increased risk
of thrombotic events. In multivariable logistic regression analysis, DAPT
before TF-TAVI significantly increased any bleeding compared with SAPT (OR
2.05, 95% CI 1.16 to 3.65) and no antiplatelet therapy (OR 2.30, 95% CI
1.08 to 4.90). Conclusions The current study demonstrated that DAPT before
TF-TAVI increased the risk of bleeding compared with single or no
antiplatelet therapy. Lower intensity antiplatelet therapy was not
associated with thrombotic events. In modern practice, it might be
reasonable to perform TAVI using single or no pre-procedural antiplatelet
therapy with an expectation of no increase of adverse events. Copyright
&#xa9; Published by the BMJ Publishing Group Limited.

<5>
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Accession Number
612361864
Author
Phan K.; Haswell J.M.; Xu J.; Assem Y.; Mick S.L.; Kapadia S.R.; Cheung
A.; Ling F.S.; Yan T.D.; Tchantchaleishvili V.
Institution
(Phan, Yan, Tchantchaleishvili) Collaborative Research (CORE) Group,
Macquarie University, Sydney, NSW, Australia
(Phan, Xu) Faculty of Medicine, University of Sydney, Sydney, NSW,
Australia
(Phan, Assem) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Haswell, Ling) Division of Cardiovascular Diseases, University of
Rochester Medical Center, Rochester, NY, United States
(Mick) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(Kapadia) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Cheung) Division of Cardiothoracic Surgery, St. Paul's Hospital,
University of British Columbia, Vancouver, BC, Canada
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, NSW, Australia
(Tchantchaleishvili) Division of Cardiac Surgery, University of Rochester
Medical Center, Rochester, NY, United States
(Tchantchaleishvili) Division of Cardiac Surgery, Mayo Clinic, 200 First
Street, Rochester, MN, United States
Title
Percutaneous Transcatheter Interventions for Aortic Insufficiency in
Continuous-Flow Left Ventricular Assist Device Patients: A Systematic
Review and Meta-Analysis.
Source
ASAIO Journal. 63 (2) (pp 117-122), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
De novo progressive aortic insufficiency (AI) is a side effect frequently
related to prolonged support with continuous-flow left ventricular assist
devices (CF-LVAD). Its progression can result in recurrent clinical heart
failure symptoms and significantly increased mortality. Recently,
percutaneous intervention methods, such as transcatheter aortic valve
replacement (TAVR) and percutaneous occluder devices, have emerged.
However, given the very scarce global experience with these approaches,
evidence in the literature is lacking. We sought to assess the outcomes of
CF-LVAD patients who had undergone percutaneous intervention for AI. A
systematic search of six databases from inception to April 2016 was
performed by two independent reviewers. Eligible studies were those that
included series or cases where patients had percutaneous transcatheter
interventions for AI in CF-LVAD patients. Data were extracted and
meta-analyzed from the identified studies. A total of 29 patients from 15
published studies and 3 unpublished records were included in the analysis.
Mean patient age was 56.6 +/- 13.7 years, and 72.4% were male. The
etiology of heart failure resulting in LVAD placement was ischemic
cardiomyopathy in 17.2%. The two intervention groups were TAVR (27.6%) and
occluder devices (72.4%). A transfemoral approach (69%), apical approach
(10%), brachial approach (7%), subclavian approach (3%), and
mini-sternotomy (3%) were used. The preintervention AI grade was severe
with a median grade of 4 (interquartile range, 4-4). Postoperatively, the
AI grade improved significantly to a median grade of 0 (0-2). At long-term
follow-up AI grade was still trivial with a median AI grade of 1 (0-1).
Subgrouping the treatments into the occluder device and TAVR, it was found
that both interventional techniques were similarly effective in reducing
the AI grade from severe to trivial. In terms of complications, from the
occluder group, two patients were complicated with device migration and
another two with transient hemolysis. In the TAVR cohort, two patients
experienced device migration and another had significant postimplant
perivalvular leakage. Our results indicate that percutaneous interventions
for AI in CF-LVAD patients with TAVR, and closure devices demonstrate
similar efficacy in significantly reducing severe AI. Current results are
encouraging, potentiating viability as a treatment option, particularly in
nonsurgical candidates. Future research with larger patient cohorts and
comparative controls is required to sufficiently evaluate the efficacy of
this technique and promote its widespread acceptance as a mainstay
treatment. Copyright &#xa9; 2016 by the ASAIO.

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

<7>
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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.

<8>
Accession Number
614166133
Author
Elmorsy A.; Abdel-Wahab A.; Sabry M.; Wahby E.
Institution
(Elmorsy, Abdel-Wahab, Sabry, Wahby) Cardiothoracic Surgery Dept, Tanta
University, Tanta, Egypt
Title
Bone wax versus oxidized regenerated cellulose in preventing sternal
intramedullary bleeding in cardiac surgery.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 24 (4) (pp
302-307), 2016. Date of Publication: 01 Dec 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Bone wax (BW) or oxidized regenerated cellulose (ORC)
concomitant with electrocoagulation is one of the preventive strategies in
controlling sternal intramedullary bleeding post cardiac surgery. The aim
of this study is to compare the difference between these two strategies in
our patients. Methods: 50 of our patients who underwent conventional open
heart surgery in our department were recruited in this study and were
randomized into 2 groups; group I (25 patients) bone wax and concomitant
electrocauterization were used, and group II (25 patients) oxidized
regenerated cellulose and concomitant electrocauterization were used. The
following parameters were compared: the amount of postoperative hemorrhage
in the first 24 h, numbers of units of blood and its products used, rates
of reexploration for hemorrhage, wound complications in first 3 months
follow-up and the difference in cost-effective ratio. Results: Patient's
Demographics and intraoperativevariables were comparable in both groups.
There was no statistically significant difference between the amounts of
postoperative hemorrhage in both groups; however, there was only one case
of superficial wound infection and one case with sternal dehiscence in the
short term follow-up in group I. Bone wax is significantly cheaper than
ORC. Conclusion: BW concomitant with electrocauterization is effective as
ORC concomitant with electrocauterization in preventing sternal
intramedullary bleeding in cardiac surgery and is much cheaper. Copyright
&#xa9; 2016, The Egyptian Society of Cardio-thoracic Surgery.

<9>
Accession Number
614524760
Author
Barbero C.; Ricci D.; Stura E.C.; Pellegrini A.; Marchetto G.; Qarra S.E.;
Boffini M.; Passera R.; Valentini M.C.; Rinaldi M.
Institution
(Barbero, Ricci, Stura, Pellegrini, Marchetto, Qarra, Boffini, Rinaldi)
Department of Cardiovascular and Thoracic Surgery, University of Turin,
Corso Bramante 88, Turin 10126, Italy
(Passera) Department of Nuclear Medicine, University of Turin, Turin,
Italy
(Valentini) Department of Neuroradiology, University of Turin, Turin,
Italy
Title
Magnetic resonance imaging for cerebral lesions during minimal invasive
mitral valve surgery: Study protocol for a randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 76. Date of
Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recent data have highlighted a higher rate of neurological
injuries in minimal invasive mitral valve surgery (MIMVS) compared with
the standard sternotomy approach; therefore, the role of specific clamping
techniques and perfusion strategies on the occurrence of this complication
is a matter of discussion in the medical literature. The purpose of this
trial is to prospectively evaluate major, minor and silent neurological
events in patients undergoing right mini-thoracotomy mitral valve surgery
using retrograde perfusion and an endoaortic clamp or a transthoracic
clamp. Methods/design: A prospective, blinded, randomized controlled study
on the rate of neurological embolizations during MIMVS started at the
University of Turin in June 2014. Major, minor and silent neurological
events are being investigated through standard neurological evaluation and
magnetic resonance imaging assessment. The magnetic resonance imaging
protocol includes conventional sequences for the morphological and
quantitative assessment and nonconventional sequences for the white matter
microstructural evaluation. Imaging studies are performed before surgery
as baseline assessment and on the third postoperative day and, in patients
who develop postoperative ischemic lesions, after 6 months. Discussion:
Despite recent concerns raised about the endoaortic setting with
retrograde perfusion, we expect to show equivalence in terms of
neurological events of this technique compared with the transthoracic
clamp in a selected cohort of patients. With the first results expected in
December 2016 the findings would be of help in confirming the efficacy and
safety of MIMVS. Trial registration: ClinicalTrials.gov, Identifier:
NCT02818166. Registered on 8 February 2016 - trial retrospectively
registered. Copyright &#xa9; The Author(s).

<10>
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Accession Number
614677615
Author
Gadre A.; Stoller J.K.
Institution
(Gadre, Stoller) Medicine Institute, Respiratory Institute, and Education
Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195,
United States
Title
Tranexamic Acid for Hemoptysis: A review.
Source
Clinical Pulmonary Medicine. 24 (2) (pp 69-74), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Tranexamic acid (TXA) is an antifibrinolytic agent used to promote
hemostasis. TXA is widely used to arrest bleeding in trauma,
perioperatively after cardiac surgery, for menorrhagia, and in hemophilia.
Less attention has been given to using TXA to lessen hemoptysis, which is
the subject of this systematic review. Three small, underpowered
randomized controlled trials have examined the efficacy of TXA in
hemoptysis. Two of these assessed intravenous TXA, one of which showed
significant reduction in the severity and duration of hemoptysis. The
third trial examined oral TXA for controlling hemoptysis and failed to
show a significant reduction in the amount or duration of hemoptysis.
Although inhaled TXA has been described in several case reports and small
series, no trial has examined the efficacy of inhaled TXA. The weight of
evidence suggests that systemic administration of TXA is safe and does not
increase the risk for thrombosis; no adverse effects have been described
in the few available reports of inhaled TXA. Overall, TXA is an
underrecognized treatment that may have temporizing value in managing
patients with nonmassive hemoptysis. In the context that the available
literature is sparse, large, well-designed clinical trials are needed to
advance understanding of the role of TXA in hemoptysis. Copyright &#xa9;
2017 Wolters Kluwer Health, Inc.

<11>
Accession Number
614689608
Author
Rodriguez A.E.; Santaera O.; Larribau M.; Sarmiento R.; Haiek C.; Delpozo
J.F.; Pavlovsky H.; Rodriguez-Granillo A.M.
Institution
(Rodriguez, Delpozo, Pavlovsky) Otamendi Hospital, Buenos Aires, Argentina
(Santaera) Las Lomas Hospital, San Isidro, Argentina
(Larribau) Spanish Hospital of Mendoza, Mendoza, Argentina
(Sarmiento) El Cruce Hospital, Lomas de Zamora, Argentina
(Haiek) Trinidad Hospital, Quilmes, Argentina
(Rodriguez-Granillo) Interventional Cardiology Research Center, Buenos
Aires, Argentina
Title
Second vs. first-generation drug-eluting stents in complex lesions
subsets: 3 years' follow-up of ERACIIV study.
Source
Minerva Cardioangiologica. 65 (1) (pp 81-90), 2017. Date of Publication:
February 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Although percutaneous coronary intervention (PCI) with
first-generation drug-eluting stents (DES-1) did not show a benefit in
terms of death rate and myocardial infarction (MI) compared to bypass
surgery (coronary artery bypass graft [CABG]), DES platforms have seen a
remarkable improvement in the last few years, and a significant increase
in their safety and efficacy was observed in randomized controlled trials
and observational studies in comparison with DES-1 in patients with
coronary artery disease (CAD). One-year results from the ERACIIV registry
using a second-generation DES (DES-2) demonstrated significantly greater
efficacy and safety in patients with multiple vessel CAD, including
diabetics, compared to DES-1. Long-term results are yet unknown. METHODS:
The ERACIIV registry was a multicenter, prospective and controlled
open-label study conducted in 9 sites in Argentina during 2013 and 2014,
which evaluated a DES-2 for the treatment of patients with multiple vessel
CADincluding unprotected left main disease (ULMD) and diabetes. The
primary endpoint was to compare the composite of death of any cause, MIand
cerebrovascular accident (CVA) as hard endpoints with ERACIIIIDES-1 arm.
Secondary endpoints included each component of the primary endpoint and
target vessel revascularization (TVR) as major adverse cardiovascular
events (MACCE) and stent thrombosis. We include a modified Syntax Score
(SS) taking in account functional revascularization, treating lesions >70%
in vessels > 2.00 mm, whereas severe lesions in vessels < 2.0 mm and
intermediate lesions were not rated. RESULTS: Baseline characteristics
were similar between groups, with higher numbers of diabetics and
3-vessel/ULMD(P=0.02 and P=0.003, respectively) in ERACIIV. At 34.7
months' follow-up, the incidence of the composite of death/MI/CVA between
ERACI IV and ERACI III (4.9% vs. 13.7%, P<0.001); unplanned new
revascularization (5.3% vs. 14.2%, P<0.001) and MACCE (9.3% vs. 22.7%,
P<0.001), were significantly lower in ERACI IV DES-2. MACCE rate was
similar in diabetics, (5.8%) and nondiabetics (7.0%). After performing a
matched propensity score, MACCE remain significantly lower in ERACI IV (P
= 0.005). Incidence of stent thrombosis was lower although not
significantly between groups, (0.9% vs. 3.1% in ERACI IV and III,
respectively; P=0.13). CONCLUSIONS: The use of DES-2 in patients with
complex lesions subsets together with a functional PCIstrategy were
associated with a remarkable low incidence of adverse events at 3 years'
follow-up and the benefit was also seen in in diabetic population. Late
outcome of this study strongly validated our lesion PCI scoring and
assessment. Copyright &#xa9; 2016 Edizioni Minerva Medica.

<12>
Accession Number
614689606
Author
Pancholy S.B.; Patel G.; Nanavaty S.P.; Pancholy M.S.
Institution
(Pancholy) Commonwealth Medical College, Scranton, PA, United States
(Pancholy, Patel, Nanavaty) Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Pancholy) Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA, United States
Title
Cardiogenic shock and access site choice.
Source
Minerva Cardioangiologica. 65 (1) (pp 74-80), 2017. Date of Publication:
February 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Transradial access (TRA) has increased in utilization, although operators
have been reluctant to use TRAin patients presenting with cardiogenic
shock (CS). Experienced TRAoperators have started using TRAin CS patients,
although the literature is scant. Several datasets have included CS
patients in their study population, while others have systematically
excluded CS patients when comparing outcomes with TRAto transfemoral
access (TFA). In this review, we have compiled the existing literature
describing outcomes of patients presenting with CS who underwent PCIusing
TRAversus TFA. Each dataset has been described in detail and its study
population, methodology and conclusions have been critically examined
after obtaining all published and most non-published details pertaining to
CS patients in these datasets. The contemporary literature consists of
observational data comparing access-site related outcomes in CS patients
undergoing PCI. Although the composite outcome appears to favor TRAover
TFA, the high likelihood of selection bias, with the sickest CS patients
getting triaged to TFA, makes an aggressive interpretation of the existing
results rather difficult. Despite the operating biases, a few high-quality
adjusted analyses clearly report better outcomes in CS patients undergoing
PCIvia TRA, highlighting an immediate necessity to perform an
appropriately powered randomized evaluation of this important question.
Copyright &#xa9; 2016 Edizioni Minerva Medica.

<13>
Accession Number
614689453
Author
Salimi A.; Sharifi G.; Bahrani H.; Mohajerani S.A.; Jafari A.; Safari F.;
Jalessi M.; Mirkheshti A.; Mottaghi K.
Institution
(Salimi, Bahrani, Mohajerani, Safari, Mottaghi) Department of
Anesthesiology, Loghman Hakim Hospital, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Sharifi) Department of Neurosurgery, Shahid Beheshti University of
Medical Sciences, Loghman Hospital, ehran, Iran, Islamic Republic of
(Jafari) Department of Anesthesiology, Shahid Beheshti University of
Medical Sciences, Labbafinejad Hospital, Tehran, Iran, Islamic Republic of
(Jalessi) Endoscopic Pituitary and Skull Base Unit, ENT-Head and Neck
Surgery Research Center and Department, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Mirkheshti) Department of Anesthesiology, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Dexmedetomidine could enhance surgical satisfaction in Trans-sphenoidal
resection of pituitary adenoma.
Source
Journal of Neurosurgical Sciences. 61 (1) (pp 46-52), 2017. Date of
Publication: February 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Excessive bleeding is an unwanted complication of
trans-sphenoidal resection of pituitary adenoma due to increases in
intracranial pressure (ICP) and hemodynamic instability. Dexmedetomidine
(Dex) analpha2-agonists is the drug of choice in intensive care units
(ICU) and cardiac surgeries to control abrupt changes in hemodynamic.
Severe cardiovascular responses occur during trans-sphenoidal resection
(TSR) of the pituitary adenoma despite adequate depth of anesthesia. The
aim of this paper was to determine the effect of Dexmedetomidine on
bleeding as primary outcome, and surgeon's satisfaction and hemodynamic
stability as secondary outcomes in patients undergoing trans-sphenoidal
resection of pituitary adenoma. METHODS: Total numbers of 60 patients
between 18-65 years old and candidate for elective trans-sphenoidal
resection of pituitary adenoma were randomLy allocated to two groups;
Dexmedetomidine infusion (0.6mug/kg/hour) or normal saline infusion. Mean
arterial pressure (MAP), heart rate (HR), dose of hypnotics and narcotics
during surgery, bleeding, and surgeon's satisfaction were recorded.
RESULTS: Propofol maintenance dose (mug/kg/min) and total Fentanyl use
(mug) were significantly lower in Dex group compare to control group
(P=0.01 and 0.003, respectively). Total bleeding amount during operation
in Dex group was significantly lower than control group (P=0.012).
Surgeon's satisfaction was significantly higher in Dex group at the end of
surgery. MAP and heart rate throughout surgery were significantly lower in
Dex group compare to control group (P=0.001). CONCLUSIONS: Dexmedetomidine
infusion (0.6mug/kg/hour) could reduce bleeding and provide surgeon's
satisfaction during trans-sphenoidal resection of pituitary adenoma.
Copyright &#xa9; 2015 Edizioni Minerva Medica.

<14>
Accession Number
614605669
Author
Zhang F.; Yu X.; Xiao H.
Institution
(Zhang, Yu, Xiao) Department of Anesthesiology, Guizhou Provincial
People's Hospital, Guiyang, China
Title
Cardioprotection of electroacupuncture for enhanced recovery after surgery
on patients undergoing heart valve replacement with cardiopulmonary
bypass: A randomized control clinical trial.
Source
Evidence-based Complementary and Alternative Medicine. 2017 (no
pagination), 2017. Article Number: 6243630. Date of Publication: 2017.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
We attempted to investigate cardioprotection of electroacupuncture (EA)
for enhanced recovery after surgery on patients undergoing heart valve
replacement with cardiopulmonary bypass. Forty-four patients with acquired
heart valve replacement were randomly allocated to the EA group or the
control group. Patients in the EA group received EA stimulus at bilateral
Neiguan (PC6), Ximen (PC4), Shenting (GV24), and Baihui (GV20) acupoints
twenty minutes before anesthesia induction to the end of surgery. The
primary end point was cardioprotection effect of electroacupuncture
postoperatively and the secondary endpoints were quality of recovery and
cognitive functioning postoperatively. The present study demonstrated that
electroacupuncture reduced the occurrence of complications and played a
role of cardioprotective effect on patients after heart valve replacement
surgery with cardiopulmonary bypass, and it benefits patients more
comfortable and contributes to recovery after surgery. This trial is
registered with ChiCTR-IOC-16009123. Copyright &#xa9; 2017 Fangxiang Zhang
et al.

<15>
Accession Number
614406620
Author
Wu J.H.Y.; Marchioli R.; Silletta M.G.; Macchia A.; Songm X.; Siscovick
D.S.; Harris W.S.; Masson S.; Latini R.; Albert C.; Brown N.J.; Lamarra
M.; Favaloro R.R.; Mozaffarian D.
Institution
(Wu, Mozaffarian) Department of Epidemiology, Harvard School of Public
Health, Boston, MA, United States
(Mozaffarian) Department of Nutrition, Harvard School of Public Health,
Boston, MA, United States
(Mozaffarian) Harvard School of Public Health, Boston, MA, United States
(Marchioli, Silletta) Laboratory of Clinical Epidemiology of
Cardiovascular Disease, Consorzio Mario Negri Sud, Santa Maria Imbaro,
Italy
(Macchia) GESICA Foundation, Buenos Aires, Argentina
(Songm) Public Health Sciences Division, Fred Hutchinson Cancer Research
Center, Seattle, WA, United States
(Siscovick) Cardiovascular Health Research Unit, Department of Medicine,
University of Washington, Seattle, WA, United States
(Siscovick) Department of Epidemiology, University of Washington, Seattle,
WA, United States
(Harris) Health Diagnostic Laboratory, Inc, Richmond, VA, United States
(Masson, Latini) Department of Cardiovascular Research, Istituto di
Ricerche Farmacologiche 'Mario Negri'-IRCCS, Milan, Italy
(Albert) Center for Arrhythmia Prevention, Division of Preventive Medicine
and Cardiovascular Division, Brigham and Women's Hospital, Boston, MA,
United States
(Brown) Department of Medicine, Vanderbilt University School of Medicine,
Nashville, TN, United States
(Lamarra) Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
(Favaloro) Hospital Universitario de la Fundacion Favaloro, Favaloro
University, Buenos Aires, Argentina
(Mozaffarian) Division of Cardiovascular Medicine and Channing Division of
Network Medicine, Department of Medicine, Brigham and Women's Hospital and
Harvard Medical School, Boston, MA, United States
Title
Plasma phospholipid omega-3 fatty acids and incidence of postoperative
atrial fibrillation in the OPERA trial.
Source
Journal of the American Heart Association. 2 (5) (no pagination), 2013.
Article Number: e000397. Date of Publication: 2013.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Long-chain polyunsaturated omega-3 fatty acids (n-3 PUFA)
demonstrated antiarrhythmic potential in experimental studies. In a large
multinational randomized trial (OPERA), perioperative fish oil
supplementation did not reduce the risk of postoperative atrial
fibrillation (PoAF) in cardiac surgery patients. However, whether
presupplementation habitual plasma phospholipid n-3 PUFA, or achieved or
change in n-3 PUFA level postsupplementation are associated with lower
risk of PoAF is unknown. Methods and Results--In 564 subjects undergoing
cardiac surgery between August 2010 and June 2012 in 28 centers across 3
countries, plasma phospholipid levels of eicosapentaenoic acid (EPA),
docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) were measured
at enrollment and again on the morning of cardiac surgery following fish
oil or placebo supplementation (10 g over 3 to 5 days, or 8 g over 2
days). The primary endpoint was incident PoAF lasting >30 seconds,
centrally adjudicated, and confirmed by rhythm strip or ECG. Secondary
endpoints included sustained (>1 hour), symptomatic, or treated PoAF; the
time to first PoAF; and the number of PoAF episodes per patient. PoAF
outcomes were assessed until hospital discharge or postoperative day 10,
whichever occurred first. Relative to the baseline, fish oil
supplementation increased phospholipid concentrations of EPA (+142%), DPA
(+13%), and DHA (+22%) (P < 0.001 each). Substantial interindividual
variability was observed for change in total n-3 PUFA (range=-0.7% to 7.5%
after 5 days of supplementation). Neither individual nor total circulating
n-3 PUFA levels at enrollment, morning of surgery, or change between these
time points were associated with risk of PoAF. The multivariable-adjusted
OR (95% CI) across increasing quartiles of total n-3 PUFA at enrollment
were 1.0, 1.06 (0.60 to 1.90), 1.35 (0.76 to 2.38), and 1.19 (0.64 to
2.20); and for changes in n-3 PUFA between enrollment and the morning of
surgery were 1.0, 0.78 (0.44 to 1.39), 0.89 (0.51 to 1.55), and 1.01 (0.58
to 1.75). In stratified analysis, demographic, medication, and cardiac
parameters did not significantly modify these associations. Findings were
similar for secondary PoAF endpoints. Conclusions--Among patients
undergoing cardiac surgery, neither higher habitual circulating n-3 PUFA
levels, nor achieved levels or changes following short-term fish oil
supplementation are associated with risk of PoAF. Copyright &#xa9; 2013
The Authors.

<16>
[Use Link to view the full text]
Accession Number
613828654
Author
Michael T.T.; Badhey N.; Banerjee S.; Brilakis M.S.
Institution
(Michael, Badhey, Banerjee, Brilakis) VA North Texas Health Care System,
University of Texas Southwestern Medical Center at Dallas, Division of
Cardiology (111A), 4500 S Lancaster d, Dallas, TX 75216, United States
Title
Comparison of Characteristics and Outcomes of Patients Undergoing
Saphenous Vein Graft Stenting Who Were or Were Not nrolled in the Stenting
of Saphenous Vein Grafts andomized Controlled Trial.
Source
Journal of Investigative Medicine. 59 (2) (pp 259-266), 2011. Date of
Publication: 2011.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective We sought to compare the characteristics and outcomes of
patients who were enrolled versus those who were not enrolled in the
Stenting of Saphenous Vein Grafts (SOS) randomized controlled trial.
Methods and esults We identified all patients who underwent saphenous vein
graft stenting during the SOS Trial enrollment period (May 2005 and
October 2007) at our institution. Baseline characteristics and clinical
outcomes were compared between patients who were versus those who were not
enrolled in SOS. Of the 97 patients who underwent saphenous vein graft
stenting during the study period, 62 patients (64%) were enrolled in SOS.
In the enrolled group, 62 patients with 91 lesions were randomized to a
bare metal stent (BMS) (n = 39) or paclitaxel-eluting stent (n = 41). In
the nonenrolled group, 35 patients with 44 lesions received a drug-eluting
stent (DS) (n = 27) or BMS (n = 8). During a median follow-up period of
2.66 years, nonenrolled patients had higher mortality (31.4% vs 14.5%, P =
0.039), but lower rates of myocardial infarction (5.7% vs 32.3%, P =
0.005) and target vessel failure (37% vs 61.3%, P = 0.023). Overall,
patients who received DS had lower incidence of myocardial infarction,
target lesion revascularization, target vessel failure and major adverse
cardiac events, and similar mortality compared with the BMS group.
Conclusions Compared with nonenrolled patients, those who were enrolled in
SOS had lower mortality. Patients receiving DS had better outcomes than
those receiving BMS in both groups. Copyright &#xa9; 2011 American
Federation for Medical Research.

<17>
Accession Number
614346906
Author
Soleimani M.; Masoumi N.; Nooraei N.; Lashay A.; Safarinejad M.R.
Institution
(Soleimani, Masoumi, Lashay) Department of Urology, Shahid Modarress
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Nooraei) Department of Anesthesiology, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Safarinejad) Clinical Center for Urological Disease Diagnosis, Private
Clinic Specializing in Urological and Andrological Genetics, Tehran, Iran,
Islamic Republic of
Title
The effect of fibrinogen concentrate on perioperative bleeding in
transurethral resection of the prostate: a double-blind placebo-controlled
and randomized study.
Source
Journal of Thrombosis and Haemostasis. 15 (2) (pp 255-262), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials Perioperative bleeding during prostate surgery is still a
common morbidity. Anticoagulant and antiplatelet medications contribute to
the risk of hemorrhage and prolonged hospital stay. Multiple
pharmacological agents have been proposed, but none of them have been
widely accepted. It is crucial to find a safe and effective modality to
reduce hemorrhage. Summary: Background Hemorrhage during transurethral
resection of the prostate (TUR-P) has always been a concern. Several
studies have shown preoperative administration of fibrinogen concentrate
to have promising results in reducing hemorrhage in cardiac surgery.
Objectives To investigate the hemostatic effect of fibrinogen concentrate
administration on reducing the amount of bleeding during TUR-P in patients
with benign prostatic hyperplasia. Methods Sixty men with benign prostatic
hyperplasia, who were chosen to undergo TUR-P, entered this prospective
randomized double-blind placebo-controlled study. The participants were
randomly assigned to two groups: treatment (n = 31) and placebo (n = 29).
They received an infusion of 2 g of fibrinogen concentrate (treatment
group) or normal saline (placebo group) before surgery. Data regarding the
amount of bleeding, the operation and complications were recorded and
analyzed. Results No difference was observed in bleeding between the
fibrinogen and placebo groups during (521 mL versus 557 mL, respectively)
and after (291 mL versus 341 mL, respectively) surgery. This lack of
difference was also seen in operation time (43 min versus 42 min),
irrigating fluid volume used during (17 L versus 19 L) and after (29 L
versus 28 L) surgery, and resected adenoma volume (19 g versus 19 g). The
mean blood pressure was also similar in both groups as a confounding
factor for the amount of bleeding. Conclusion Preoperative administration
of fibrinogen concentrate had no significant influence on intraoperative
and postoperative bleeding in TUR-P surgery. Copyright &#xa9; 2016
International Society on Thrombosis and Haemostasis

<18>
Accession Number
614346087
Author
Hare J.M.; DiFede D.L.; Rieger A.C.; Florea V.; Landin A.M.; El-Khorazaty
J.; Khan A.; Mushtaq M.; Lowery M.H.; Byrnes J.J.; Hendel R.C.; Cohen
M.G.; Alfonso C.E.; Valasaki K.; Pujol M.V.; Golpanian S.; Ghersin E.;
Fishman J.E.; Pattany P.; Gomes S.A.; Delgado C.; Miki R.; Abuzeid F.;
Vidro-Casiano M.; Premer C.; Medina A.; Porras V.; Hatzistergos K.E.;
Anderson E.; Mendizabal A.; Mitrani R.; Heldman A.W.
Institution
(Hare, DiFede, Rieger, Florea, Landin, Khan, Valasaki, Pujol, Gomes,
Delgado, Abuzeid, Vidro-Casiano, Premer, Medina, Porras, Hatzistergos)
Interdisciplinary Stem Cell Institute, University of Miami Miller School
of Medicine, Miami, Florida, United States
(Hare, Mushtaq, Lowery, Byrnes, Hendel, Cohen, Alfonso, Miki, Mitrani,
Heldman) Department of Medicine, University of Miami Miller School of
Medicine, Miami, Florida, United States
(El-Khorazaty, Anderson, Mendizabal) The Emmes Corporation, Rockville,
Maryland, United States
(Golpanian) Department of Surgery, University of Miami Miller School of
Medicine, Miami, Florida, United States
(Ghersin, Fishman, Pattany) Department of Radiology, University of Miami
Miller School of Medicine, Miami, Florida, United States
Title
Randomized Comparison of Allogeneic Versus Autologous Mesenchymal Stem
Cells for Nonischemic Dilated Cardiomyopathy: POSEIDON-DCM Trial.
Source
Journal of the American College of Cardiology. 69 (5) (pp 526-537), 2017.
Date of Publication: 07 Feb 2017.
Publisher
Elsevier USA
Abstract
Background Although human mesenchymal stem cells (hMSCs) have been tested
in ischemic cardiomyopathy, few studies exist in chronic nonischemic
dilated cardiomyopathy (NIDCM). Objectives The authors conducted a
randomized comparison of safety and efficacy of autologous (auto) versus
allogeneic (allo) bone marrow-derived hMSCs in NIDCM. Methods Thirty-seven
patients were randomized to either allo- or auto-hMSCs in a 1:1 ratio.
Patients were recruited between December 2011 and July 2015 at the
University of Miami Hospital. Patients received hMSCs (100 million) by
transendocardial stem cell injection in 10 left ventricular sites. Treated
patients were evaluated at baseline, 30 days, and 3-, 6-, and 12-months
for safety (serious adverse events [SAE]), and efficacy endpoints:
ejection fraction, Minnesota Living with Heart Failure Questionnaire,
6-min walk test, major adverse cardiac events, and immune biomarkers.
Results There were no 30-day treatment-emergent SAEs. Twelve-month SAE
incidence was 28.2% with allo-hMSCs versus 63.5% with auto-hMSCs (p =
0.1004 for the comparison). One allo-hMSC patient developed an elevated
(>80) donor-specific calculated panel reactive antibody level. The
ejection fraction increased in allo-hMSC patients by 8.0 percentage points
(p = 0.004) compared with 5.4 with auto-hMSCs (p = 0.116; allo vs. auto p
= 0.4887). The 6-min walk test increased with allo-hMSCs by 37.0 m (p =
0.04), but not auto-hMSCs at 7.3 m (p = 0.71; auto vs. allo p = 0.0168).
MLHFQ score decreased in allo-hMSC (p = 0.0022) and auto-hMSC patients (p
= 0.463; auto vs. allo p = 0.172). The major adverse cardiac event rate
was lower, too, in the allo group (p = 0.0186 vs. auto). Tumor necrosis
factor-alpha decreased (p = 0.0001 for each), to a greater extent with
allo-hMSCs versus auto-hMSCs at 6 months (p = 0.05). Conclusions These
findings demonstrated safety and clinically meaningful efficacy of
allo-hMSC versus auto-hMSC in NIDCM patients. Pivotal trials of allo-hMSCs
are warranted based on these results. (Percutaneous Stem Cell Injection
Delivery Effects on Neomyogenesis in Dilated Cardiomyopathy [PoseidonDCM];
NCT01392625) Copyright &#xa9; 2017 The Authors

<19>
Accession Number
614346078
Author
Greenbaum A.B.; Babaliaros V.C.; Chen M.Y.; Stine A.M.; Rogers T.; O'Neill
W.W.; Paone G.; Thourani V.H.; Muhammad K.I.; Leonardi R.A.; Ramee S.;
Troendle J.F.; Lederman R.J.
Institution
(Greenbaum, O'Neill, Paone) Henry Ford Hospital, Detroit, Michigan, United
States
(Babaliaros, Thourani) Emory University, Atlanta, Georgia
(Chen, Stine, Rogers, Troendle, Lederman) National Heart, Lung, and Blood
Institute, National Institutes of Health, Bethesda, Maryland, United
States
(Muhammad) Oklahoma Heart Institute, Tulsa, Oklahoma, United States
(Leonardi) Lexington Medical Center, West Columbia, South Carolina, United
States
(Ramee) Ochsner Medical Center, New Orleans, Louisiana, United States
Title
Transcaval Access and Closure for Transcatheter Aortic Valve Replacement:
A Prospective Investigation.
Source
Journal of the American College of Cardiology. 69 (5) (pp 511-521), 2017.
Date of Publication: 07 Feb 2017.
Publisher
Elsevier USA
Abstract
Background Transcaval access may enable fully percutaneous transcatheter
aortic valve replacement (TAVR) without the hazards and discomfort of
transthoracic (transapical or transaortic) access. Objectives The authors
performed a prospective, independently adjudicated, multicenter,
single-arm trial of transcaval access for TAVR in patients who were
ineligible for femoral artery access and had high or prohibitive risk of
complications from transthoracic access. Methods A total of 100 patients
underwent attempted percutaneous transcaval access to the abdominal aorta
by electrifying a caval guidewire and advancing it into a pre-positioned
aortic snare. After exchanging for a rigid guidewire, conventional TAVR
was performed through transcaval introducer sheaths. Transcaval access
ports were closed with nitinol cardiac occluders. A core laboratory
analyzed pre-discharge and 30-day abdominal computed tomograms. The
Society of Thoracic Surgeons predicted risk of mortality was 9.6 +/- 6.3%.
Results Transcaval access was successful in 99 of 100 patients. Device
success (access and closure with a nitinol cardiac occluder without death
or emergency surgical rescue) occurred 98 of 99 patients; 1 subject had
closure with a covered stent. Inpatient survival was 96%, and 30-day
survival was 92%. Second Valve Academic Research Consortium (VARC-2)
life-threatening bleeding and modified VARC-2 major vascular complications
possibly related to transcaval access were 7% and 13%, respectively.
Median length of stay was 4 days (range 2 to 6 days). There were no
vascular complications after discharge. Conclusions Transcaval access
enabled TAVR in patients who were not good candidates for transthoracic
access. Bleeding and vascular complications, using permeable nitinol
cardiac occluders to close the access ports, were common but acceptable in
this high-risk cohort. Transcaval access should be investigated in
patients who are eligible for transthoracic access. Purpose-built closure
devices are in development that may simplify the procedure and reduce
bleeding. (Transcaval Access for Transcatheter Aortic Valve Replacement in
People With No Good Options for Aortic Access; NCT02280824) Copyright
&#xa9; 2017

<20>
Accession Number
611451770
Author
Huisman J.; van der Heijden L.C.; Kok M.M.; Louwerenburg J.H.W.; Danse
P.W.; Jessurun G.A.J.; de Man F.H.A.F.; Lowik M.M.; Linssen G.C.M.;
IJzerman M.J.; Doggen C.J.M.; von Birgelen C.
Institution
(Huisman, van der Heijden, Kok, Louwerenburg, de Man, Lowik, von Birgelen)
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente,
Enschede, Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Jessurun) Department of Cardiology, Treant Zorggroep, Emmen, Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo and
Hengelo, Netherlands
(IJzerman, Doggen, von Birgelen) Health Technology and Services Research,
MIRA - Institute for Biomedical Technology, and Technical Medicine,
University of Twente, Enschede, Netherlands
Title
Two-year outcome after treatment of severely calcified lesions with
newer-generation drug-eluting stents in acute coronary syndromes: A
patient-level pooled analysis from TWENTE and DUTCH PEERS.
Source
Journal of Cardiology. 69 (4) (pp 660-665), 2017. Date of Publication: 01
Apr 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Data on medium-term outcome of patients with acute coronary
syndrome (ACS), treated with newer-generation durable polymer drug-eluting
stents (DES) in severely calcified coronary lesions, are scarce. We aimed
to assess the impact of severe coronary lesion calcification on clinical
outcome of patients with ACS, treated with newer-generation DES. Methods
The TWENTE and DUTCH PEERS randomized trials comprise 1779 ACS patients,
who were categorized into patients with versus without severe target
lesion calcification. We performed a patient-level pooled analysis to
assess 2-year outcome, including target vessel failure (TVF), a composite
of cardiac death, target vessel-related myocardial infarction (MI), or
target vessel revascularization (TVR). Results Patients with severe target
lesion calcification (n = 340, 19.1%) were older (66.8 +/- 10.6 years vs.
62.8 +/- 11.5 years, p < 0.001) and had more often diabetes (22.1% vs.
16.8%, p = 0.02) and hypercholesterolemia (51.5% vs. 42.9%, p = 0.005)
than other patients (n = 1439, 79.9%). In addition they showed a higher
TVF rate (12.4% vs.7.0%, p = 0.001), mainly related to a difference in TVR
(6.8% vs. 3.3%, p = 0.003). There was a borderline significant
between-group difference in cardiac death (3.6% vs. 1.8%, p = 0.05), but
not in target vessel MI (3.8% vs.2.6%, p = 0.23) and definite stent
thrombosis (0.9% vs. 0.6%, p = 0.71). Multivariate analysis demonstrated
that severe lesion calcification was an independent risk factor of TVF
(adjusted HR; 1.58, 95% CI: 1.23-2.03; p < 0.001). Conclusions In patients
with ACS, treatment of severely calcified lesions with newer-generation
DES was associated with an overall higher clinical event risk - related in
particular to a higher TVR rate, while the risk of MI was low. Copyright
&#xa9; 2016 Japanese College of Cardiology

<21>
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.

<22>
Accession Number
614585786
Author
Zhao Y.; Liu S.; Mao Q.; Tian W.; Zhang H.; Chen J.; Song J.
Institution
(Zhao, Liu, Mao, Tian, Zhang, Chen, Song) Department of Anesthesia, Daping
Hospital, Third Military Medical University, Chongqing 400042, China
Title
Effect of venous sampling methods and sites on thromboelastography for
patients underwent thoracic surgery.
Source
International Journal of Clinical and Experimental Medicine. 10 (2) (pp
3629-3633), 2017. Article Number: IJCEM0037983. Date of Publication: 28
Feb 2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
This study was assigned to assess the influence of different blood
collection methods and sites on the results of thromboelastography (TEG)
in patients underwent thoracic surgery. Forty patients, who underwent
lobectomy or esophagectomy in our hospital from May 2014 to March 2015,
were randomly divided into two groups (group A and group B; n = 20 in each
group). In group A, blood was collected from femoral vein and internal
jugular vein by direct venipuncture. In group B, femoral vein blood was
sampled by direct venipuncture, and then blood from internal jugular vein
was drawn via a deep venous catheter. Kaolin-activated TEG analyses were
performed, and clotting time (R), clot kinetics (K), alpha angle and
maximal amplitude (MA) were compared using paired t-test. All tested
parameters were within the normal range. In group A, no significant
differences in R, K, alpha angle and MA values were found between samples
obtained by direct venipuncture from femoral and jugular vein (P > 0.05).
In group B, however, the R value of blood sample collected by femoral vein
puncture was significantly lower than that of sample captured via an
indwelling internal jugular vein catheter (P < 0.05), while differences in
K, alpha angle and MA values did not reach statistical significant (P >
0.05). In summary, all of these sampling routes were acceptable for
thromboelastographic analysis. Howbeit, to avoid bias, the sampling method
and site should be the same when conducting clinical dynamic observation.
Copyright &#xa9; 2017, E-Century Publishing Corporation. All rights
reserved.

<23>
Accession Number
614585738
Author
Wang T.; Fan W.; Liu M.; Wang G.; Li Z.
Institution
(Wang) Department of Anesthesia, Honggang Hospital, Dongying 257000, China
(Fan) Shengli Oilfield Central Hospital, Dongyi 257000, China
(Liu) Department of Anesthesia, Fuwai Hospital of Cardiovascular Disease,
Chinese Academy of Medical Sciences, Beijing 100000, China
(Wang) Department of Anesthesiology, Weifang Medical University, Weifang
261000, China
(Li) Department of Information Center, The Third People's Hospital of
Hefei, Hefei 230022, China
Title
Effects of preoperative magnesium sulphate infusion on the hemodynamics in
patients with off-pump coronary artery bypass grafting surgery.
Source
International Journal of Clinical and Experimental Medicine. 10 (2) (pp
3719-3724), 2017. Article Number: IJCEM0039496. Date of Publication: 28
Feb 2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Background: Off-pump coronary artery bypass grafting (OPCABG) is an
effective method for coronary artery revascularization, but it may lead to
unstable hemodynamics. Purpose: To evaluate the effects of preoperative
magnesium sulphate infusion on the hemodynamics in patients with OPCABG
surgery. Methods: Sixty patients undergoing routine OPCABG surgery were
randomly divided into control group (C) and magnesium sulfate group (M),
30 patients in each group. All patients were performed with routine
operation preparation and induced anesthesia, followed by OPCABG surgery.
Before surgery, M group was intravenously infused with magnesium sulfate
(10 mg/ kg), and C group was intravenously infused with 0.9% normal saline
with the same volume. The preoperative and intraoperative hemodynamics
indexes and intraoperative vasoactive drug use in two groups were recorded
and compared. Results: There was no significant differences in gender,
age, weight, preoperative hear rate (HR), systolic blood pressure (SBP),
diastolic blood pressure (DBP), pulse pressure or mean arterial pressure
between two groups (P > 0.05), with no significant differences in surgery
time, intraoperative blood loss or central venous pressure (P > 0.05). The
intraoperative max SBP, max DBP, SBP fluctuation and DBP fluctuation in M
group were significantly lower than C group, respectively (P < 0.05). The
intraoperative min HR in M group was significantly higher than C group (P
< 0.05), and the HR fluctuation in M group was significantly lower than C
group (P < 0.05). The percentage of patients intraoperatively using
vasoactive drugs in M group was significantly lower than C group (P <
0.05). Conclusion: Preoperative magnesium sulphate infusion can
effectively reduce the hemodynamic fluctuation in patients with OPCABG.
Copyright &#xa9; 2017, E-Century Publishing Corporation. All rights
reserved.

<24>
[Use Link to view the full text]
Accession Number
614644444
Author
Meneveau N.; Ecarnot F.
Institution
(Meneveau, Ecarnot) Department of Cardiology, University Hospital Jean
Minjoz, and EA3920, University of Burgundy - Franche-Comte, Besancon,
France
Title
Response by Meneveau and Ecarnot to Letter Regarding Article, "optical
Coherence Tomography to Optimize Results of Percutaneous Coronary
Intervention in Patients with Non-ST-Elevation Acute Coronary Syndrome:
Results of the Multicenter, Randomized DOCTORS Study (Does Optical
Coherence Tomography Optimize Results of Stenting)".
Source
Circulation. 135 (9) (pp e142-e143), 2017. Date of Publication: 28 Feb
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<25>
[Use Link to view the full text]
Accession Number
614644441
Author
Nadir M.A.
Institution
(Nadir) University Hospital Birmingham, United Kingdom
Title
Letter by Nadir Regarding Article, "optical Coherence Tomography to
Optimize Results of Percutaneous Coronary Intervention in Patients with
Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter,
Randomized DOCTORS Study (Does Optical Coherence Tomography Optimize
Results of Stenting)".
Source
Circulation. 135 (9) (pp e138-e139), 2017. Date of Publication: 28 Feb
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<26>
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.

<27>
Accession Number
614343138
Author
Smith L.E.; Smith D.K.; Blume J.D.; Siew E.D.; Billings F.T.
Institution
(Smith, Billings) Department of Anesthesiology, Vanderbilt University
Medical Center, 1211 21st Avenue South, Nashville, TN 37205, United States
(Smith, Blume) Department of Biostatistics, Vanderbilt University Medical
Center, Nashville, TN, United States
(Siew, Billings) Department of Medicine, Vanderbilt University Medical
Center, Nashville, TN, United States
(Siew) Division of Nephrology and Hypertension, Vanderbilt Center for
Kidney Disease and Integrated Program for AKI Research, Vanderbilt
University Medical Center, Nashville, TN, United States
Title
Latent variable modeling improves AKI risk factor identification and AKI
prediction compared to traditional methods.
Source
BMC Nephrology. 18 (1) (no pagination), 2017. Article Number: 55. Date of
Publication: 08 Feb 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) is diagnosed based on postoperative
serum creatinine change, but AKI models have not consistently performed
well, in part due to the omission of clinically important but practically
unmeasurable variables that affect creatinine. We hypothesized that a
latent variable mixture model of postoperative serum creatinine change
would partially account for these unmeasured factors and therefore
increase power to identify risk factors of AKI and improve predictive
accuracy. Methods: We constructed a two-component latent variable mixture
model and a linear model using data from a prospective, 653-subject
randomized clinical trial of AKI following cardiac surgery (NCT00791648)
and included established AKI risk factors and covariates known to affect
serum creatinine. We compared model fit, discrimination, power to detect
AKI risk factors, and ability to predict AKI between the latent variable
mixture model and the linear model. Results: The latent variable mixture
model demonstrated superior fit (likelihood ratio of 6.68 x 1071) and
enhanced discrimination (permutation test of Spearman's correlation
coefficients, p < 0.001) compared to the linear model. The latent variable
mixture model was 94% (-13 to 1132%) more powerful (median [range]) at
identifying risk factors than the linear model, and demonstrated increased
ability to predict change in serum creatinine (relative mean square error
reduction of 6.8%). Conclusions: A latent variable mixture model better
fit a clinical cohort of cardiac surgery patients than a linear model,
thus providing better assessment of the associations between risk factors
of AKI and serum creatinine change and more accurate prediction of AKI.
Incorporation of latent variable mixture modeling into AKI research will
allow clinicians and investigators to account for clinically meaningful
patient heterogeneity resulting from unmeasured variables, and therefore
provide improved ability to examine risk factors, measure mechanisms and
mediators of kidney injury, and more accurately predict AKI in clinical
cohorts. Copyright &#xa9; 2017 The Author(s).

<28>
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

<29>
[Use Link to view the full text]
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.

<30>
Accession Number
614679380
Author
Beckmann S.; Nikolic N.; Denhaerynck K.; Binet I.; Koller M.; Boely E.; De
Geest S.; Berben L.; Burkhalter H.; Claes V.; Helmy R.; Kirsch M.; Leppla
L.; Mauthner O.; Struker M.; Boehler A.; Gerull S.; Huynh-Do U.; Catana
E.; Simcox A.; Seiler A.; Klaghofer R.; Kunzler-Heule P.; Achermann R.;
Amico P.; Aubert J.-D.; Banz V.; Beldi G.; Benden C.; Berger C.; Bochud
P.-Y.; Bucher H.; Buhler L.; Carell T.; Chalandon Y.; de Rougemont O.;
Dickenmann M.; Duchosal M.; Elkrief L.; Fehr T.; Ferrari-Lacraz S.;
Garzoni C.; Soccal P.G.; Gaudet C.; Giostra E.; Golshayan D.; Hadaya K.;
Halter J.; Heim D.; Hess C.; Hillinger S.; Hirsch H.H.; Hofbauer G.; Immer
F.; Laesser B.; Lehmann R.; Lovis C.; Manuel O.; Marti H.-P.; Martin P.Y.;
Meylan P.; Mohacsi P.; Morel P.; Mueller U.; Mueller N.J.; Mueller-McKenna
H.; Muller A.; Muller T.; Mullhaupt B.; Nadal D.; Pascual M.; Passweg J.;
Rick J.; Roosnek E.; Rosselet A.; Rothlin S.; Ruschitzka F.; Schanz U.;
Schaub S.; Schnyder A.; Seiler C.; Stampf S.; Steiger J.; Stirnimann G.;
Toso C.; Van Delden C.; Venetz J.-P.; Villard J.; Wick M.; Wilhelm M.;
Yerly P.
Institution
(Beckmann, Denhaerynck, De Geest) Institute of Nursing Science, University
of Basel, Basel, Switzerland
(Beckmann) Department of Abdomen-Metabolism, University Hospital Zurich,
Zurich, Switzerland
(Nikolic) Department of Neurosurgery, University Hospital Zurich, Zurich,
Switzerland
(Binet) Nephrology and Transplantation Medicine, Cantonal Hospital St
Gallen, St Gallen, Switzerland
(Koller) Transplantation Immunology and Nephrology, University Hospital
Basel, Basel, Switzerland
(Boely) University Hospital of Geneva, Geneva, Switzerland
(De Geest) Department of Public Health and Primary Care, Academic Center
for Nursing and Midwifery, KU Leuven, Leuven, Belgium
Title
Evolution of body weight parameters up to 3 years after solid organ
transplantation: The prospective Swiss Transplant Cohort Study.
Source
Clinical Transplantation. 31 (3) (no pagination), 2017. Article Number:
e12896. Date of Publication: 01 Mar 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Obesity and weight gain are serious concerns after solid organ
transplantation (Tx); however, no unbiased comparison regarding body
weight parameter evolution across organ groups has yet been performed.
Using data from the prospective nationwide Swiss Transplant Cohort Study,
we compared the evolution of weight parameters up to 3 years post-Tx in
1359 adult kidney (58.3%), liver (21.7%), lung (11.6%), and heart (8.4%)
recipients transplanted between May 2008 and May 2012. Changes in mean
weight and body mass index (BMI) category were compared to reference
values from 6 months post-Tx. At 3 years post-Tx, compared to other organ
groups, liver Tx recipients showed the greatest weight gain (mean
4.8+/-10.4 kg), 57.4% gained >5% body weight, and they had the highest
incidence of obesity (38.1%). After 3 years, based on their BMI categories
at 6 months, normal weight and obese liver Tx patients, as well as
underweight kidney, lung and heart Tx patients had the highest weight
gains. Judged against international Tx patient data, the majority of our
Swiss Tx recipients' experienced lower post-Tx weight gain. However, our
findings show weight gain pattern differences, both within and across
organ Tx groups that call for preventive measures. Copyright &#xa9; 2016
John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<31>
Accession Number
614690784
Author
Mielniczuk L.M.; Toth G.G.; Xie J.X.; De Bruyne B.; Shaw L.J.; Beanlands
R.S.
Institution
(Mielniczuk, Beanlands) Division of Cardiology, Department of Medicine,
University of Ottawa Heart Institute, Ottawa, Canada
(Toth) University Heart Centre Graz, Graz, Austria
(Xie, Shaw) Cardiovascular Center Aalst, Aalst, Belgium
(De Bruyne) Division of Cardiology, Emory University School of Medicine
Atlanta, Georgia
Title
Can Functional Testing for Ischemia and Viability Guide
Revascularization?.
Source
JACC: Cardiovascular Imaging. 10 (3) (pp 354-364), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cardiac imaging procedures are a cornerstone of the diagnosis and
management of patients with cardiac disease. The optimal management of the
patient with stable ischemic heart disease or ischemic heart failure often
rests on the totality of symptom burden, patient risk, and disease
severity, whether assessed anatomically or functionally. Recent trials
have demonstrated the power of flow measurements to direct
revascularization as well as the strengths and limitations of ischemia and
viability/hibernation imaging as markers of risk to direct interventions.
They have also highlighted the challenges in evaluating imaging or
functional testing to direct therapies, because imaging does not directly
affect outcome itself, rather it affects the management decisions that may
result in a positive outcome. Ongoing studies with randomized designs,
such as FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel
Evaluation), ISCHEMIA (International Study of Comparative Health
Effectiveness with Medical and Invasive Approaches), and AIMI-HF
(Alternative Imaging Modalities in Ischemic Heart Failure) (IMAGE-HF
[Imaging Modalities to Assist with Guiding Therapy in The Evaluation of
Patients with Heart Failure]), will provide the highest level of evidence
to support practice changes that may further clarify the role of cardiac
imaging in the evaluation of these patients and result in improved patient
outcomes. Copyright &#xa9; 2017 American College of Cardiology Foundation

<32>
Accession Number
614690771
Author
Shaw L.J.; Phillips L.M.; Nagel E.; Newby D.E.; Narula J.; Douglas P.S.
Institution
(Shaw) Emory University School of Medicine, Atlanta, Georgia
(Phillips) New York University Langone Medical Center, New York City, New
York, United States
(Nagel) Institute for Experimental and Translational Cardiovascular
Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital
Frankfurt, Frankfurt am Main, Germany
(Newby) University of Edinburgh, Edinburgh, United Kingdom
(Narula) Mount Sinai School of Medicine, New York City, New York, United
States
(Douglas) Duke Clinical Research Institute, Durham, North Carolina, United
States
Title
Comparative Effectiveness Trials of Imaging-Guided Strategies in Stable
Ischemic Heart Disease.
Source
JACC: Cardiovascular Imaging. 10 (3) (pp 321-334), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The evaluation of patients with suspected stable ischemic heart disease is
among the most common diagnostic evaluations with nearly 20 million
imaging and exercise stress tests performed annually in the United States.
Over the past decade, there has been an evolution in imaging research with
an ever-increasing focus on larger registries and randomized trials
comparing the effectiveness of varying diagnostic algorithms. The current
review highlights recent randomized trial evidence with a particular focus
comparing the effectiveness of cardiac imaging procedures within the
stable ischemic heart disease evaluation for coronary artery disease
detection, angina, and other quality of life measures, and major clinical
outcomes. Also highlighted are secondary analyses from these trials on the
economic findings related to comparative cost differences across
diagnostic testing strategies. Copyright &#xa9; 2017 American College of
Cardiology Foundation

<33>
Accession Number
614690762
Author
Leipsic J.; Bax J.J.; Webb J.G.; Martin R.; Blanke P.
Institution
(Leipsic, Webb, Blanke) Department of Radiology and Cardiology, Centre for
Heart Valve Innovation, University of British Columbia, Vancouver, British
Columbia, Canada
(Bax) Leiden University Medical Center, Leiden, Netherlands
(Martin) Piedmont Medical Center, Atlanta, Georgia
Title
Trials Testing the Value of Imaging Use in Valve Disease and in
Transcatheter Valvular Interventions.
Source
JACC: Cardiovascular Imaging. 10 (3) (pp 286-295), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The role of imaging in the diagnosis of valvular heart disease is well
established through years of investigation and validation. However, the
role of imaging in guiding the treatment decision-making for valvular
heart disease is less well established, and there is a striking paucity of
randomized trial data to help inform these decisions. Given this relative
absence of randomized trial data, the present article highlights some of
the most important knowledge gaps and defines meaningful opportunities for
the field to help advance the care of patients with valvular heart disease
in a cost-effective fashion. (The PARTNER 3-Trial: The Safety and
Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk
Patients With Aortic Stenosis [P3]; NCT02675114; Medtronic Transcatheter
Aortic Valve Replacement in Low Risk Patients; NCT02701283) Copyright
&#xa9; 2017 American College of Cardiology Foundation

<34>
Accession Number
614690751
Author
Sun J.; Zhao X.-Q.; Balu N.; Neradilek M.B.; Isquith D.A.; Yamada K.;
Canton G.; Crouse J.R.; Anderson T.J.; Huston J.; O'Brien K.; Hippe D.S.;
Polissar N.L.; Yuan C.; Hatsukami T.S.
Institution
(Sun, Balu, Yamada, Hippe, Yuan) Department of Radiology, University of
Washington, Seattle, Washington, United States
(Zhao, Isquith, O'Brien) Department of Medicine, University of Washington,
Seattle, Washington, United States
(Neradilek, Polissar) The Mountain-Whisper-Light Statistics, Seattle,
Washington, United States
(Canton) Department of Mechanical Engineering, University of Washington,
Seattle, Washington, United States
(Crouse) Department of Medicine, Wake Forest University, Winston-Salem,
North Carolina, United States
(Anderson) Libin Cardiovascular Institute of Alberta and Cumming School of
Medicine, Calgary, Alberta, Canada
(Huston) Department of Radiology, Mayo Clinic, Rochester, Minnesota,
United States
(Hatsukami) Department of Surgery, University of Washington, Seattle,
Washington, United States
Title
Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV
Outcomes: The MRI Substudy in AIM-HIGH.
Source
JACC: Cardiovascular Imaging. 10 (3) (pp 241-249), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to investigate whether and what
carotid plaque characteristics predict systemic cardiovascular outcomes in
patients with clinically established atherosclerotic disease. Background
Advancements in atherosclerosis imaging have allowed assessment of various
plaque characteristics, some of which are more directly linked to the
pathogenesis of acute cardiovascular events compared to plaque burden.
Methods As part of the event-driven clinical trial AIM-HIGH
(Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High
Triglycerides: Impact on Global Health Outcomes), subjects with clinically
established atherosclerotic disease underwent multicontrast carotid
magnetic resonance imaging (MRI) to detect plaque tissue composition and
high-risk features. Prospective associations between MRI measurements and
the AIM-HIGH primary endpoint (fatal and nonfatal myocardial infarction,
ischemic stroke, hospitalization for acute coronary syndrome, and
symptom-driven revascularization) were analyzed using Cox proportional
hazards survival models. Results Of the 232 subjects recruited, 214
(92.2%) with diagnostic image quality constituted the study population
(82% male, mean age 61 +/- 9 years, 94% statin use). During median
follow-up of 35.1 months, 18 subjects (8.4%) reached the AIM-HIGH
endpoint. High lipid content (hazard ratio [HR] per 1 SD increase in
percent lipid core volume: 1.57; p = 0.002) and thin/ruptured fibrous cap
(HR: 4.31; p = 0.003) in carotid plaques were strongly associated with the
AIM-HIGH endpoint. Intraplaque hemorrhage had a low prevalence (8%) and
was marginally associated with the AIM-HIGH endpoint (HR: 3.00; p =
0.053). High calcification content (HR per 1 SD increase in percent
calcification volume: 0.66; p = 0.20), plaque burden metrics, and clinical
risk factors were not significantly associated with the AIM-HIGH endpoint.
The associations between carotid plaque characteristics and the AIM-HIGH
endpoint changed little after adjusting for clinical risk factors, plaque
burden, or AIM-HIGH randomized treatment assignment. Conclusions Among
patients with clinically established atherosclerotic disease, carotid
plaque lipid content and fibrous cap status were strongly associated with
systemic cardiovascular outcomes. Markers of carotid plaque vulnerability
may serve as novel surrogate markers for systemic atherothrombotic risk.
Copyright &#xa9; 2017 American College of Cardiology Foundation

<35>
Accession Number
614638989
Author
Menting T.P.; Wever K.E.; Ozdemir-van Brunschot D.M.; Van der Vliet
D.J.A.; Rovers M.M.; Warle M.C.
Institution
(Menting, Wever, Ozdemir-van Brunschot, Van der Vliet, Warle) Radboud
University Nijmegen Medical Centre, Department of Surgery, Geert
Grooteplein Zuid 10, Nijmegen, Gelderland 6525 GA, Netherlands
(Rovers) Radboud University Nijmegen Medical Centre, Department of
Operating Rooms, Hp 630, route 631, PO Box 9101, Nijmegen 6500 HB,
Netherlands
Title
Ischaemic preconditioning for the reduction of renal ischaemia reperfusion
injury.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD010777. Date of Publication: 04 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Ischaemia reperfusion injury can lead to kidney dysfunction or
failure. Ischaemic preconditioning is a short period of deprivation of
blood supply to particular organs or tissue, followed by a period of
reperfusion. It has the potential to protect kidneys from ischaemia
reperfusion injury. Objectives: This review aimed to look at the benefits
and harms of local and remote ischaemic preconditioning to reduce
ischaemia and reperfusion injury among people with renal ischaemia
reperfusion injury. Search methods: We searched Cochrane Kidney and
Transplant's Specialised Register to 5 August 2016 through contact with
the Information Specialist using search terms relevant to this review.
Selection criteria: We included all randomised controlled trials measuring
kidney function and the role of ischaemic preconditioning in patients
undergoing a surgical intervention that induces kidney injury. Kidney
transplantation studies were excluded. Data collection and analysis:
Studies were assessed for eligibility and quality; data were extracted by
two independent authors. We collected basic study characteristics: type of
surgery, remote ischaemic preconditioning protocol, type of anaesthesia.
We collected primary outcome measurements: serum creatinine and adverse
effects to remote ischaemic preconditioning and secondary outcome
measurements: acute kidney injury, need for dialysis, neutrophil
gelatinase-associated lipocalin, hospital stay and mortality. Summary
estimates of effect were obtained using a random-effects model, and
results were expressed as risk ratios (RR) and their 95% confidence
intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95%
CI for continuous outcomes. Main results: We included 28 studies which
randomised a total of 6851 patients. Risk of bias assessment indicated
unclear to low risk of bias for most studies. For consistency regarding
the direction of effects, continuous outcomes with negative values, and
dichotomous outcomes with values less than one favour remote ischaemic
preconditioning. Based on high quality evidence, remote ischaemic
preconditioning made little or no difference to the reduction of serum
creatinine levels at postoperative days one (14 studies, 1022
participants: MD -0.02 mg/dL, 95% CI -0.05 to 0.02; I² = 21%),
two (9 studies, 770 participants: MD -0.04 mg/dL, 95% CI -0.09 to 0.02;
I² = 31%), and three (6 studies, 417 participants: MD -0.05
mg/dL, 95% CI -0.19 to 0.10; I² = 68%) compared to control.
Serious adverse events occurred in four patients receiving remote
ischaemic preconditioning by iliac clamping. It is uncertain whether
remote ischaemic preconditioning by cuff inflation leads to increased
adverse effects compared to control because the certainty of the evidence
is low (15 studies, 3993 participants: RR 3.47, 95% CI 0.55 to 21.76;
I² = 0%); only two of 15 studies reported any adverse effects
(6/1999 in the remote ischaemic preconditioning group and 1/1994 in the
control group), the remaining 13 studies stated no adverse effects were
observed in either group. Compared to control, remote ischaemic
preconditioning made little or no difference to the need for dialysis (13
studies, 2417 participants: RR 0.85, 95% CI 0.37 to 1.94; I² =
60%; moderate quality evidence), length of hospital stay (8 studies, 920
participants: MD 0.17 days, 95% CI -0.46 to 0.80; I² = 49%,
high quality evidence), or all-cause mortality (24 studies, 4931
participants: RR 0.86, 95% CI 0.54 to 1.37; I² = 0%, high
quality evidence). Remote ischaemic preconditioning may have slightly
improved the incidence of acute kidney injury using either the AKIN (8
studies, 2364 participants: RR 0.76, 95% CI 0.57 to 1.00; I² =
61%, high quality evidence) or RIFLE criteria (3 studies, 1586
participants: RR 0.91, 95% CI 0.75 to 1.12; I² = 0%, moderate
quality evidence). Authors' conclusions: Remote ischaemic preconditioning
by cuff inflation appears to be a safe method, and probably leads to
little or no difference in serum creatinine, adverse effects, need for
dialysis, length of hospital stay, death and in the incidence of acute
kidney injury. Overall we had moderate-high certainty evidence however the
available data does not confirm the efficacy of remote ischaemic
preconditioning in reducing renal ischaemia reperfusion injury in patients
undergoing major cardiac and vascular surgery in which renal ischaemia
reperfusion injury may occur. Copyright &#xa9; 2017 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<36>
Accession Number
613668721
Author
Lamy A.; Devereaux P.J.; Prabhakaran D.; Taggart D.P.; Hu S.; Straka Z.;
Piegas L.S.; Avezum A.; Akar A.R.; Zanetti F.L.; Jain A.R.; Noiseux N.;
Padmanabhan C.; Bahamondes J.C.; Novick R.J.; Tao L.; Olavegogeascoechea
P.A.; Airan B.; Sulling T.A.; Whitlock R.P.; Ou Y.; Gao P.; Pettit S.;
Yusuf S.
Institution
(Lamy, Devereaux, Pettit, Yusuf) Population Health Research Institute,
Hamilton Health Sciences, McMaster University, Hamilton, ON, New Zealand
(Noiseux) Centre Hospitalier de l'Universite de Montral, Montreal, Canada
(Novick) University of Calgary, Calgary, AB, Canada
(Prabhakaran, Airan) Center for Chronic Disease Control, Gurgaon, India
(Taggart, Jain) SAL Hospital, Ahmedabad, India
(Hu, Padmanabhan) G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
(Tao, Airan) All India Institute of Medical Sciences, New Delhi, India
(Taggart, Straka) University of Oxford, Oxford, United Kingdom
(Hu, Piegas, Avezum) Fu Wai Cardiovascular Hospital, Xicheng
District,Beijing, China
(Akar) Wuhan Asia Heart Hospital, Wuhan, China
(Zanetti, Bahamondes) Third Faculty of Medicine Charles University,
University Hospital Kralovske Vinohrady, Prague, Czech Republic
(Olavegogeascoechea) Instituto Dante Pazzanese de Cardiologia, Sao Paulo,
Brazil
(Sulling) Ankara University School of Medicine, Ankara, Turkey
(Whitlock) Hospital Regional de Temuco and Universidad de la Frontera,
Temuco, Chile
(Ou) Fundacion Medica de Rio Negro y Neuquen, Rio Negro, Argentina
(Gao) North Estonia Medical Center, Tallinn, Estonia
Title
Five-year outcomes after off-pump or on-pump coronary-artery bypass
grafting.
Source
New England Journal of Medicine. 375 (24) (pp 2359-2368), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND We previously reported that there was no significant difference
at 30 days or at 1 year in the rate of the composite outcome of death,
stroke, myocardial infarction, or renal failure between patients who
underwent coronary-artery bypass grafting (CABG) performed with a
beating-heart technique (off-pump) and those who underwent CABG performed
with cardiopulmonary bypass (on-pump). We now report the results at 5
years (the end of the trial). METHODS A total of 4752 patients (from 19
countries) who had coronary artery disease were randomly assigned to
undergo off-pump or on-pump CABG. For this report, we analyzed a composite
outcome of death, stroke, myocardial infarction, renal failure, or repeat
coronary revascularization (either CABG or percutaneous coronary
intervention). The mean follow-up period was 4.8 years. RESULTS There were
no significant differences between the off-pump group and the onpump group
in the rate of the composite outcome (23.1% and 23.6%, respectively;
hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87
to 1.10; P = 0.72) or in the rates of the components of the outcome,
including repeat coronary revascularization, which was performed in 2.8%
of the patients in the offpump group and in 2.3% of the patients in the
on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P = 0.29). The
secondary outcome for the overall period of the trial - The mean cost in
U.S. dollars per patient - Also did not differ significantly between the
off-pump group and the on-pump group ($15,107 and $14,992, respectively;
between-group difference, $115; 95% CI, -$697 to $927). There were no
significant between-group differences in quality-of-life measures.
CONCLUSIONS In our trial, the rate of the composite outcome of death,
stroke, myocardial infarction, renal failure, or repeat revascularization
at 5 years of follow-up was similar among patients who underwent off-pump
CABG and those who underwent onpump CABG. (Funded by the Canadian
Institutes of Health Research; CORONARY ClinicalTrials.gov number,
NCT00463294.). Copyright &#xa9; 2016 Massachusetts Medical Society. All
rights reserved.

<37>
Accession Number
614673136
Author
Gallego I.; Beaumont J.; Lopez B.; Ravassa S.; Gomez-Doblas J.J.; Moreno
M.U.; Valencia F.; de Teresa E.; Diez J.; Gonzalez A.
Institution
(Gallego, Beaumont, Lopez, Ravassa, Moreno, Diez, Gonzalez) Program of
Cardiovascular Diseases, Centre for Applied Medical Research, University
of Navarra, Pamplona 31008, Spain
(Gallego, Beaumont, Lopez, Ravassa, Moreno, Diez, Gonzalez) IdiSNA,
Navarra Institute for Health Research, Pamplona 31008, Spain
(Gomez-Doblas, Valencia, de Teresa) Division of Cardiology, Virgen de la
Victoria University Hospital, Malaga 29010, Spain
(Diez) Department of Cardiology and Cardiac Surgery, University Clinic,
University of Navarra, Pamplona 31008, Spain
Title
Potential role of microRNA-10b down-regulation in cardiomyocyte apoptosis
in aortic stenosis patients.
Source
Clinical Science. 130 (23) (pp 2139-2149), 2016. Date of Publication:
2016.
Publisher
Portland Press Ltd
Abstract
MicroRNAs have been associated with cardiomyocyte apoptosis, a process
involved in myocardial remodelling in aortic valve (Av) stenosis (AS). Our
aim was to analyse whether the dysregulation of myocardial microRNAs was
related to cardiomyocyte apoptosis in AS patients. Endomyocardial biopsies
were obtained from 28 patients with severe AS (based on pressure gradients
and Av area) referred for Av replacement and from necropsies of 10
cardiovascular disease-free control subjects. AS patients showed an
increased (P<0.001) cardiomyocyte apoptotic index (CMAI) compared with
controls. Two clusters of patients were identified according to the CMAI:
group 1 (CMAI > 0.08 %; n = 16) and group 2 (CMAI > 0.08 %; n = 12). Group
2 patients presented lower cardiomyocyte density (P < 0.001) and ejection
fraction (P<0.05), and higher troponin T levels (P<0.05), prevalence of
heart failure (HF; P < 0.05) and NT-proBNP levels (P<0.05) than those from
group 1. miRNA expression profile analysed in 5 patients randomly selected
from each group showed 64 microRNAs down-regulated and 6 up-regulated
(P<0.05) in group 2 compared with group 1. Those microRNAs with the
highest fold-change were validated in the full two groups corroborating
that miR-10b, miR-125b-2* and miR-338-3p were down-regulated (P<0.05) in
group 2 compared with group 1 and control subjects. These three microRNAs
were inversely correlated (P<0.05) with the CMAI. Inhibition of miR-10b
induced an increase (P < 0.05) of apoptosis and increased expression
(P<0.05) of apoptosis protease-activating factor-1 (Apaf-1) in HL-1
cardiomyocytes. In conclusion, myocardial down-regulation of miR-10b may
be involved in increased cardiomyocyte apoptosis in AS patients, probably
through Apaf-1 up-regulation, contributing to cardiomyocyte damage and to
the development of HF. Copyright &#xa9; 2016 The Author(s).

<38>
Accession Number
609154347
Author
Liang F.; Song B.; Liu R.; Yang L.; Tang H.; Li Y.
Institution
(Liang, Song, Liu, Tang, Li) First Clinical College, Lanzhou University,
No. 1, DongGang Xi Road, Chengguan District, Lanzhou City, Gansu Province,
China
(Liang, Song, Liu, Yang, Tang, Li) Department of Cardiovascular Surgery,
First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
Title
Optimal timing for early surgery in infective endocarditis: A
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (3) (pp 336-345),
2016. Date of Publication: 01 Mar 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
To systematically review early surgery and the optimal timing of surgery
in patients with infective endocarditis (IE), a search for foreign and
domestic articles on cohort studies about the association between early
surgery and infective endocarditis published from inception to January
2015 was conducted in the PubMed, EMBASE, Chinese Biomedical Literature
(CBM), Wanfang and Chinese National Knowledge Infrastructure (CNKI)
databases. The studies were screened according to the inclusion and
exclusion criteria, the data were extracted and the quality of the method
of the included studies was assessed. Then, the meta-analysis was
performed using the Stata 12.0 software. Sixteen cohort studies, including
8141 participants were finally included. The results of the meta-analysis
revealed that, compared with non-early surgery, early surgery in IE lowers
the incidence of in-hospital mortality [odds ratio (OR) = 0.57, 95%
confidence interval (CI) (0.42, 0.77); P = 0.000, I² = 73.1%]
and long-term mortality [OR = 0.57, 95% CI (0.43, 0.77); P = 0.001,
I² = 67.4%]. Further, performing operation within 2 weeks had a
more favourable effect on long-term mortality [OR = 0.63, 95% CI (0.41,
0.97); P = 0.192, I² = 39.4%] than non-early surgery. In
different kinds of IE, we found that early surgery for native valve
endocarditis (NVE) had a lower in-hospital [OR = 0.46, 95% CI (0.31,
0.69); P = 0.001, I² = 73.0%] and long-term [OR = 0.57, 95% CI
(0.40, 0.81); P = 0.001, I² = 68.9%] mortality than the
non-early surgery group. However, for prosthetic valve endocarditis (PVE),
in-hospital mortality did not differ significantly [OR = 0.83, 95% CI
(0.65, 1.06); P = 0.413, I² = 0.0%] between early and non-early
surgery. We concluded that early surgery was associated with lower
in-hospital and long-term mortality compared with non-early surgical
treatment for IE, especially in NVE. However, the optimal timing of
surgery remains unclear. Additional larger prospective clinical trials
will be required to clarify the optimal timing for surgical intervention
and determine its efficacy in PVE. Copyright &#xa9; 2015 The Author.

<39>
Accession Number
609154262
Author
Rodham P.; Batty J.A.; McElnay P.J.; Immanuel A.
Institution
(Rodham) Medical School, Newcastle University, Newcastle-upon-Tyne, United
Kingdom
(Batty) Department of Colorectal Surgery, Newcastle Upon Tyne Hospitals
NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
(McElnay, Immanuel) Department of Upper Gastrointestinal Surgery,
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
NE1 4LP, United Kingdom
Title
Does minimally invasive oesophagectomy provide a benefit in hospital
length of stay when compared with open oesophagectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (3) (pp 360-367),
2016. Date of Publication: 01 Mar 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: 'in patients undergoing
oesophagectomy, does a minimally invasive approach convey a benefit in
hospital length of stay (LOS), when compared to an open approach?' A total
of 647 papers were identified, using an a priori defined search strategy;
24 papers represented the best evidence to answer the clinical question.
The authors, journal, date, country of publication, patient group, study
type, relevant outcomes and key results are tabulated. Of the studies
identified, data from two randomized controlled trials were available. The
first randomized study compared the use of open thoracotomy and laparotomy
versus thoracoscopy and laparoscopy. Those undergoing minimally invasive
oesophagectomy (MIO) left hospital on average 3 days earlier than those
treated with the open oesophagectomy (OO) technique (P = 0.044). The other
randomized trial, which compared thoracotomy with thoracoscopy and
laparoscopy, demonstrated a reduction of 1.8 days in the LOS when
employing the MIO technique (P < 0.001). With the addition of the
remaining 22 non-randomized studies, comprising 3 prospective and 19
retrospective cohort studies, which are heterogeneous with regard to their
design, study populations and outcomes; data are available representing
3173 MIO and 25 691 OO procedures. In total, 13 studies (including the
randomized trials) demonstrate a significant reduction in hospital LOS
associated with MIO; 10 suggest no significant difference between
techniques; and only 1 suggests a significantly greater length of stay
associated with MIO. The only two randomized trials comparing MIO and OO
demonstrated a reduction in length of stay in the MIO group, without
compromising survival or increasing complication rates. All bar one of the
non-randomized studies demonstrated either a significant reduction in
length of stay with MIO or no difference. The benefit in reduced length of
stay was not at the cost of worsened survival or increased complications,
and conversion rates in all studies were low. Copyright &#xa9; 2015 The
Author.

<40>
Accession Number
609154242
Author
MacHerey S.; Doerr F.; Heldwein M.; Hekmat K.
Institution
(MacHerey) School of Medicine, University of Cologne, Cologne, Germany
(Doerr, Heldwein, Hekmat) Department of Cardiothoracic Surgery, University
of Cologne, Kerpener Strasse 62, Cologne 50931, Germany
Title
Is manual palpation of the lung necessary in patients undergoing pulmonary
metastasectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (3) (pp 351-359),
2016. Date of Publication: 01 Mar 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether manual palpation
of the lung is necessary in patients undergoing pulmonary metastasectomy.
In total, 56 articles were found using the described search strategy.
After screening these articles and their references, 18 publications
represented the best evidence to answer the clinical question. No
randomized controlled trial addressing the three-part question was
available. The authors, journal, date and country of publication, patient
group, study type, relevant outcomes and results of these papers were
tabulated. The studies reported on 1472 patients with different primary
cancers. The patients underwent more than 1630 pulmonary metastasectomies
between 1990 and 2014 after the treatment of primary cancer. Almost three
quarters of patients underwent open procedures like thoracotomy or
sternotomy. Most frequently, helical CT with a slice thickness ranging
between 1 and 10 mm was used for preoperative imaging. The sensitivity in
detecting pulmonary nodules ranged from 34 to 97%. The corresponding
sensitivity rates for PET-CT were 66-67.5 and 75% for high-resolution CT.
The positive predictive value for lesions detected by helical CT varied
from 47 to 96%. Helical CT reached a specificity between 54 and 93% in
detecting pulmonary nodules. The surgeons identified more nodules by
meticulous palpation than helical CT. It is noteworthy that up to 48.5% of
these palpated nodules were benign lesions (false-positive). Patients with
smaller imaged nodules, multiple imaged nodules or primary mesenchymal
tumour are more likely to have occult pulmonary nodules. We conclude that
not all palpable pulmonary nodules can be imaged preoperatively.
Thoracotomy allows the manual palpation of the ipsilateral hemithorax and
might be superior to video-assisted thoracic surgery regarding radical
resection. However, not all palpable nodules are malignant, and the impact
of non-resected pulmonary metastases on patient survival is not clearly
evaluated. Copyright &#xa9; 2015 The Author.

<41>
Accession Number
609839508
Author
Akintoye E.; Wu J.H.Y.; Hou T.; Song X.; Yang J.; Hammock B.; Mozaffarian
D.
Institution
(Akintoye) Department of Internal Medicine, Wayne State University School
of Medicine, Detroit, MI, United States
(Wu) George Institute for Global Health, University of Sydney, Sydney,
NSW, Australia
(Hou) Harvard University School of Public Health, Boston, MA, United
States
(Song) Division of Public Health Sciences, Fred Hutchinson Cancer Research
Center, Seattle, WA, United States
(Yang, Hammock) Department of Entomology and Nematology, University of
California Davis, Davis, CA, United States
(Yang, Hammock) UC Davis Comprehensive Cancer Center, University of
California Davis, Davis, CA, United States
(Mozaffarian) Tufts Friedman School of Nutrition Science and Policy,
Boston, MA, United States
Title
Effect of fi sh oil on monoepoxides derived from fatty acids during
cardiac surgery.
Source
Journal of Lipid Research. 57 (3) (pp 492-498), 2016. Date of Publication:
March 2016.
Publisher
American Society for Biochemistry and Molecular Biology Inc. (9650
Rockville Pike, Bethesda MD 20814, United States)
Abstract
Our objective was to assess the dynamics of monoepoxides derived from
polyunsaturated fatty acids (MEFAs), and their response to n-3 PUFA
supplementation, in the setting of acute tissue injury and infl ammation
(cardiac surgery) in humans. Patients (479) undergoing cardiac surgery in
three countries were randomized to perioperative fi sh oil (EPA + DHA;
8-10 g over 2-5 days preoperatively, then 2 g/day postoperatively) or
placebo (olive oil). Plasma MEFAs derived from n-3 and n-6 PUFAs were
measured 2 days postoperatively. Based on serial measures in a subset of
the placebo group, levels of all MEFAs declined substantially following
surgery (at postoperative day 2), with declines ranging from 37% to 63% (
P < 0.05 each). Compared with placebo at postoperative day 2, levels of
EPA-and DHA-derived MEFAs were 40% and 18% higher, respectively ( P <
0.004). The n-3 PUFA supplementation did not signifi cantly alter the
decline in n-6 PUFA-derived MEFAs. Both enrollment level and changes in
plasma phospholipid EPA and DHA were associated with their respective
MEFAs at postoperative day 2 ( P < 0.001). Under the acute stress of
cardiac surgery, n^-3 PUFA supplementation signifi cantly
ameliorated the reduction in postoperative n^-3 MEFAs, but not
n^-6 MEFAs, and the degree of increase in n^-3 MEFAs
related positively to the circulating level of their n^-3 PUFA
precursors. Copyright &#xa9; 2016 by the American Society for Biochemistry
and Molecular Biology, Inc.

<42>
[Use Link to view the full text]
Accession Number
607795151
Author
Yan S.; Chen Q.; Xu M.; Sun J.; Liebeskind D.S.; Lou M.
Institution
(Yan, Chen, Xu, Sun, Lou) Department of Neurology, 2nd Affiliated
Hospital, Zhejiang University, No. 88 Jiefang Rd, Hangzhou, China
(Liebeskind) Department of Neurology, University of California, Los
Angeles Stroke Center, United States
Title
Thrombus Length Estimation on Delayed Gadolinium-Enhanced T1.
Source
Stroke. 47 (3) (pp 756-761), 2016. Date of Publication: 01 Mar 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose-Previous studies revealed a close relationship
between thrombus length and recanalization rate after intravenous
thrombolysis (IVT). As a novel approach, we prospectively adjusted the
order of sequence acquisition to obtain delayed gadolinium-enhanced T1
(dGE-T1) and thereby assess thrombus length on dGE-T1 to evaluate its
predictive value for recanalization after IVT. Methods-We reviewed
prospectively collected clinical and imaging data from acute ischemic
stroke patients with middle cerebral artery occlusion who underwent
multimodal magnetic resonance imaging before and 24 hours after IVT.
Perfusion-weighted imaging was performed followed by conventional T1. We
measured thrombus length on dGE-T1 and examined its association with
middle cerebral artery recanalization. Results-Of the included 74
patients, the median age was 66 years and 28 (37.8%) were women. Thrombus
length was 8.18+/-4.56 mm on dGE-T1, which was an acceptable predictor for
no recanalization (odds ratio, 1.196; 95% confidence interval,
1.015-1.409; P=0.033), with a receiver-operator characteristic of 0.732
(95% confidence interval, 0.619-0.845; P=0.001). The optimal cut-off point
was identified at 6.77 mm, which yielded a sensitivity of 77.8%, a
specificity of 57.9%, and an odds ratio of 4.81 (95% confidence interval,
1.742-13.292; P=0.002). Moreover, no one achieved recanalization after IVT
when length of thrombus exceeded 14 mm on dGE-T1. Conclusions-The dGE-T1,
obtained by simply adjusting scanning order in multimodal magnetic
resonance imaging protocol, is a useful tool for thrombus length
estimation and middle cerebral artery recanalization prediction after IVT.
Copyright &#xa9; 2015 American Heart Association, Inc.

<43>
Accession Number
614599173
Author
Jarrah M.I.; Hammoudeh A.J.; Al-Natour D.B.; Khader Y.S.; Tabbalat R.A.;
Alhaddad I.A.; Kullab S.M.
Institution
(Jarrah, Kullab) Department of Internal Medicine, Faculty of Medicine,
Jordan University of Science and Technology, Irbid, Jordan
(Khader) Department of Public Health, Faculty of Medicine, Jordan
University of Science and Technology, Irbid, Jordan
(Hammoudeh) Department of Cardiology, Jordan Hospital, Amman, Jordan
(Tabbalat) Istishari Hospital, Jordan Hospital, Amman, Jordan
(Alhaddad) Al Khalidi Medical Center, Jordan Hospital, Amman, Jordan
(Al-Natour) Jordan Hospital Medical Center, Pharmaceutical Department,
Jordan Hospital, Amman, Jordan
Title
Gender differences in risk profile and outcome of Middle Eastern patients
undergoing percutaneous coronary intervention.
Source
Saudi Medical Journal. 38 (2) (pp 149-155), 2017. Date of Publication:
February 2017.
Publisher
Saudi Arabian Armed Forces Hospital (E-mail: smjns.ksa@zajil.net)
Abstract
Objectives: To determine the gender differences in cardiovascular risk
profile and outcomes among patients undergoing percutaneous coronary
intervention (PCI). Methods: In a prospective multicenter study of
consecutive Middle Eastern patients managed with PCI from January 2013 to
February 2014 in 12 tertiary care centers in Amman and Irbid, Jordan.
Clinical and coronary angiographic features, and major cardiovascular
events were assessed for both genders from hospital stay to 1 year.
Results: Women comprised 20.6% of 2426 enrolled patients, were older (mean
age 62.9 years versus 57.2 years), had higher prevalence of hypertension
(81% versus 57%), diabetes (66% versus 44%), dyslipidemia (58% versus
46%), and obesity (44% versus 25%) compared with men, p<0.001. The PCI for
ST-segment elevation myocardial infarction was indicated for fewer women
than men (23% versus 33%; p=0.001). Prevalence of single or multi-vessel
coronary artery disease was similar in women and men. More women than men
had major bleeding during hospitalization (2.2% versus 0.6%; p=0.003) and
at one year (2.5% versus 0.9%; p=0.007). There were no significant
differences between women and men in mortality (3.1% versus 1.7%) or stent
thrombosis (2.1% versus 1.8%) at 1 year. Conclusion: Middle Eastern women
undergoing PCI had worse baseline risk profile compared with men. Except
for major bleeding, no gender differences in the incidence of major
adverse cardiovascular events were demonstrated. Copyright &#xa9; 2017,
Saudi Arabian Armed Forces Hospital. All rights reserved.

<44>
Accession Number
611879756
Author
Lim W.Y.; Ramasamy A.; Lloyd G.; Bhattacharyya S.
Institution
(Lim, Ramasamy, Lloyd, Bhattacharyya) Echocardiography Laboratory,
Valvular Heart Disease Clinic, Barts Heart Centre, St Bartholomew's
Hospital, Institute of Cardiovascular Sciences, UCL, London EC1 7AB,
United Kingdom
Title
Meta-analysis of the impact of intervention versus symptom-driven
management in asymptomatic severe aortic stenosis.
Source
Heart. 103 (4) (pp 268-272), 2017. Date of Publication: 15 Feb 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: The management of patients with asymptomatic, severe aortic
stenosis (AS) is controversial. We performed a meta-analysis to examine
the impact on outcomes of aortic valve replacement (AVR) in patients with
severe asymptomatic AS versus a symptom-driven intervention approach.
Methods: A search for studies that examined the outcomes of AVR and
management of asymptomatic severe AS was performed. We examined the end
points of all-cause mortality, cardiac mortality and sudden cardiac death.
Our analysis compared early AVR in asymptomatic patients with a
symptom-driven AVR approach (excluding symptomatic patients who did not
undergo AVR). Results: Four observational studies were identified with a
total of 1300 patients. There was significant heterogeneity between
studies (I²=72%). Using a random-effects model, there was a
trend towards reduced overall mortality in patients undergoing early AVR
compared with a symptom-driven AVR approach (OR 0.54, 95% CI 0.26 to 1.12,
p=0.1). There was no significant reduction in cardiac mortality or sudden
death (OR 0.78, p=0.85, and OR 0.34, p=0.25, respectively). Conclusions:
Although there was a trend towards reduced overall mortality when
comparing early AVR in patients with asymptomatic, severe AS to a
symptomdriven AVR approach, there was no significant difference in cardiac
mortality or sudden death. An individual approach focusing on individual
risk stratification and operative mortality is required until more robust,
randomised trial data are available. Copyright &#xa9; 2017 BMJ Publishing
Group Limited.

<45>
[Use Link to view the full text]
Accession Number
614539814
Author
Lubbers M.; Coenen A.; Bruning T.; Galema T.; Akkerhuis J.; Krenning B.;
Musters P.; Ouhlous M.; Liem A.; Niezen A.; Dedic A.; Van Domburg R.;
Hunink M.; Nieman K.
Institution
(Lubbers, Coenen, Galema, Musters, Dedic, Van Domburg, Nieman) Department
of Cardiology, Erasmus Medical Center, s-Gravendijkwal 230, Ca-207a,
Rotterdam 3015 CE, Netherlands
(Lubbers, Coenen, Ouhlous, Dedic, Hunink, Nieman) Department of Radiology,
Erasmus University Medical Center, Rotterdam, Netherlands
(Bruning) Department of Cardiology, Netherlands
(Niezen) Department of Radiology, Maasstad Hospital, Rotterdam,
Netherlands
(Akkerhuis, Liem) Department of Cardiology, Sint Franciscus Gasthuis,
Rotterdam, Netherlands
(Krenning) Department of Cardiology, Haven Hospital, Rotterdam,
Netherlands
(Van Domburg) Stanford Cardiovascular Institute, Stanford University, CA,
United States
Title
Sex Differences in the Performance of Cardiac Computed Tomography Compared
with Functional Testing in Evaluating Stable Chest Pain.
Source
Circulation: Cardiovascular Imaging. 10 (2) (no pagination), 2017. Article
Number: e005295. Date of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Cardiac computed tomography (CT) represents an alternative
diagnostic strategy for women with suspected coronary artery disease, with
potential benefits in terms of effectiveness and cost-efficiency. Methods
and Results - The CRESCENT trial (Calcium Imaging and Selective CT
Angiography in Comparison to Functional Testing for Suspected Coronary
Artery Disease) prospectively randomized 350 patients with stable angina
(55% women; aged 55+/-10 years), mostly with an intermediate coronary
artery disease probability, between cardiac CT and functional testing. The
tiered cardiac CT protocol included a calcium scan followed by CT
angiography if the Agatston calcium score was between 1 and 400. Patients
with test-specific contraindications were not excluded from study
participation. Sex differences were studied as a prespecified subanalysis.
Enrolled women presented more frequently with atypical chest pain and had
a lower pretest probability of coronary artery disease compared with men.
Independently of these differences, cardiac CT led in both sexes to a fast
final diagnosis when compared with functional testing, although the effect
was larger in women (P interaction=0.01). The reduced need for further
testing after CT, compared with functional testing, was most evident in
women (P interaction=0.009). However, no sex interaction was observed with
respect to changes in angina and quality of life, cumulative diagnostic
costs, and applied radiation dose (all P interactions>0.097). Conclusions
- Cardiac CT is more efficient in women than in men in terms of time to
reach the final diagnosis and downstream testing. However, overall
clinical outcome showed no significant difference between women and men
after 1 year. Clinical Trial Registration - URL:
http://www.clinicaltrials.gov. Unique identifier: NCT01393028. Copyright
&#xa9; 2017 American Heart Association, Inc.

<46>
Accession Number
614515058
Author
Duque-Sosa P.; Martinez-Urbistondo D.; Echarri G.; Callejas R.; Iribarren
M.J.; Rabago G.; Monedero P.; Garcia-Fernandez N.; Garcia C.; Barrios
J.M.; Novoa E.; Hualde J.B.; Pascual O.A.; Alvarez S.C.; Astillero I.P.;
Moreira B.C.; Iradier P.H.; Caballero L.-M.P.; Mate R.G.; Hernandez J.P.;
Crespo M.-J.T.; Panero B.M.; Bronchal M.-J.D.; Garcia-Heras E.A.; Refojo
F.A.; Arias L.F.; Suarez F.E.F.; Fraile L.I.; Roux C.; Belda I.; Matute
P.; Gomez E.T.; Alvarez-Fuente E.; Ruiz-Granado P.; Aguilar G.;
Garcia-Marquez C.; Fernando C.; Puig J.; Carbonell J.A.; Arocas B.;
Badenes R.; Pastor E.; Gomez A.; Belda F.J.; Rodriguez M.O.; Barcena M.A.;
Hernandez J.A.B.; Loureiro M.A.P.; Caamano R.P.-R.; Martinez M.A.V.;
Vazquez V.V.; Alvarez A.L.; Lorenzo C.E.; Fernandez A.R.; Tamayo J.P.;
Rodriguez G.B.; Lamas M.V.; Martinez S.J.; Gomez A.C.; Siguenza J.B.F.;
Garcia E.B.; Contreras J.M.M.; Irriguible T.T.; Marti P.R.; Del Campo
M.T.M.; Nunez A.G.S.; Brey A.G.; Collado I.G.; Casas R.B.; Garciperez
J.F.; Giralt S.S.; Rico G.A.; Toha A.C.; Roux D.P.; Martin L.G.; Borja
M.M.; Pajares A.D.P.; De Las Heras B.P.; Martin E.E.; Perez P.A.; Dapena
R.C.; Lopez S.A.; TorrentsFernandez M.A.; Gonzalez M.D.C.; PerisCuello X.;
RomaGarcia-Campomanes F.; Del Campo A.G.; Seoane E.C.; Palacios V.B.;
Alvarez A.C.; Cardenal M.F.L.; Belaustegui M.C.; Lera M.R.; Martinez N.R.;
Genoves D.B.; Moreno C.L.A.; Rubio R.J.; Fernandez F.J.G.; Cuadros S.I.;
Marquez E.A.; Gonzalez F.F.; Sanchez M.G.; Luque A.G.; Navarro M.R.;
Ortega M.G.; Oriach J.G.; Galo M.N.; Arce I.N.; Amaya J.F.; Dominguez
C.B.; Varo D.C.; Guerrero J.M.A.; Ysasi A.
Institution
(Duque-Sosa, Echarri, Callejas, Iribarren, Monedero, Garcia-Fernandez)
Department of Anesthesia and Critical Care, Clinica Universidad de
Navarra, Pamplona, Navarra, Spain
(Martinez-Urbistondo) Department of Internal Medicine, Division of
Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra,
Pamplona, Navarra, Spain
(Rabago) Department of Cardiovascular Surgery, Clinica Universidad de
Navarra, Pamplona, Navarra, Spain
(Garcia) Hospital General de Alicante, Spain
(Barrios, Novoa) Hospital Gregorio Maranon de Madrid, Spain
(Hualde, Pascual, Alvarez) Complejo Hospitalario de Navarra, Spain
(Astillero, Moreira, Iradier, Caballero, Mate, Hernandez, Crespo, Panero,
Bronchal, Garcia-Heras) Complejo Hospitalario Toledo, Spain
(Refojo, Arias) Complejo Hospitalario Universitario A Coruna, Spain
(Suarez, Fraile) Hospital Central de Asturias, Spain
(Roux, Belda, Matute) Hospital Clinic Barcelona, Spain
(Gomez, Alvarez-Fuente, Ruiz-Granado) Hospital Clinico Universitario de
Valladolid, Spain
(Aguilar, Garcia-Marquez, Fernando, Puig, Carbonell, Arocas, Badenes,
Pastor, Gomez, Belda) Hospital Clinico Universitario Valencia, Spain
(Rodriguez, Barcena, Hernandez) Hospital de Basurto Bilbao, Spain
(Loureiro, Caamano, Martinez, Vazquez, Alvarez, Lorenzo, Fernandez,
Tamayo, Rodriguez, Lamas) Hospital Do Meixoeiro Vigo, Spain
(Martinez, Gomez, Siguenza, Garcia, Contreras, Irriguible, Marti, Del
Campo, Nunez, Brey) Hospital Germans Trias i Pujol, Spain
(Collado, Casas, Garciperez, Giralt, Rico) Hospital Infanta Cristina de
Badajoz, Spain
(Toha, Roux, Martin, Borja, Pajares, De Las Heras, Martin, Perez, Dapena,
Lopez) Hospital Ramon y Cajal Madrid, Spain
(TorrentsFernandez, Gonzalez, PerisCuello, RomaGarcia-Campomanes, Del
Campo) Hospital Universitari Vall d'Hebron, Spain
(Seoane) Hospital Universitario Puerta del Mar de Cadiz, Spain
(Palacios, Alvarez, Cardenal, Belaustegui, Lera, Martinez) Hospital
Valdecilla Santander, Spain
(Genoves, Moreno, Rubio) Hospital Virgen Arrixaca Murcia, Spain
(Fernandez, Cuadros, Marquez, Gonzalez, Sanchez) Hospital Virgen Macarena
Sevilla, Spain
(Luque, Navarro, Ortega, Oriach, Galo, Arce, Amaya, Dominguez, Varo,
Guerrero) Hospital Virgen Victoria Malaga, Spain
(Ysasi) Hospital Rambla Tenerife, Spain
Title
Perioperative hemoglobin area under the curve is an independent predictor
of renal failure after cardiac surgery. Results from a Spanish multicenter
retrospective cohort study.
Source
PLoS ONE. 12 (2) (no pagination), 2017. Article Number: e0172021. Date of
Publication: February 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Perioperative anemia is an important risk factor for cardiac
surgery-associated acute kidney injury (CSA-AKI). Nonetheless, the
severity of the anemia and the time in the perioperative period in which
the hemoglobin level should be considered as a risk factor is conflicting.
The present study introduces the concept of perioperative hemoglobin area
under the curve (pHb-AUC) as a surrogate marker of the evolution of
perioperative hemoglobin concentration. Through a retrospective analysis
of prospectively collected data, we assessed this new variable as a risk
factor for the development of acute kidney injury after cardiac surgery in
966 adult patients who underwent cardiac surgery with cardiopulmonary
bypass, at twentythree academic hospitals in Spain. Exclusion criteria
were patients on renal replacement therapy, who needed a reoperation
because of bleeding and/or with missing perioperative hemoglobin or
creatinine values. Using a multivariate regression analysis, we found that
a pHb-AUC <19 g/dL was an independent risk factor for CSA-AKI even after
adjustment for intraoperative red blood cell transfusion (OR 1.41, p
<0.05). It was also associated with mortality (OR 2.48, p <0.01) and
prolonged hospital length of stay (4.67 +/- 0.99 days, p <0.001) Copyright
&#xa9; 2017 Duque-Sosa et al. This is an open access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<47>
Accession Number
613940591
Author
Aboyans V.; Desormais I.; Magne J.; Morange G.; Mohty D.; Lacroix P.
Institution
(Aboyans, Magne, Morange, Mohty) Department of Cardiology, Dupuytren
University Hospital, Limoges, France
(Aboyans, Desormais, Magne, Mohty, Lacroix) Inserm U1094, Tropical
Neuroepidemiology, Limoges University, Limoges, France
(Desormais, Lacroix) Department of Thoracic and Cardiovascular Surgery and
Angiology, Dupuytren University Hospital, Limoges, France
Title
Renal Artery Stenosis in Patients with Peripheral Artery Disease:
Prevalence, Risk Factors and Long-term Prognosis.
Source
European Journal of Vascular and Endovascular Surgery. 53 (3) (pp
380-385), 2017. Date of Publication: 01 Mar 2017.
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background The objective was to determine the prevalence and
clinical determinants of renal artery stenosis (RAS) in patients
undergoing digital subtraction angiography (DSA) for the assessment of
peripheral artery disease (PAD), and to evaluate its prognostic
significance. Methods All DSAs performed from January 2000 to January 2006
were retrospectively reviewed for assessment of PAD in patients naive for
any prior revascularisation of lower-limb arteries. All DSA studies were
read by two senior physicians blinded to outcome, and consensus was
reached in cases of disagreement. RAS was defined as the presence of >50%
stenosis in either renal artery. Patients' electronic medical files were
systematically reviewed and follow-up was completed by contact with family
physicians until January 2014. The primary outcome was composite,
including death, peripheral revascularisation, or any limb amputation.
Secondary outcomes were all-cause mortality, and another composite,
including death and non-fatal myocardial infarction or stroke or coronary
or carotid revascularisation. Results In total, 400 consecutive patients
having a first DSA of lower extremities, two thirds of whom were for
critical limb ischaemia, were studied. Thirteen patients were excluded
owing to poor renal artery imaging. RAS was detected in 57 patients (14%).
Only two factors were independently and significantly associated with RAS
in multivariate analysis: diffuse PAD (involving both proximal and distal
segments [odds ratio {OR} 3.50, 95% confidence interval {CI} 1.16-10.54; p
= .026]) and decreased glomerular filtration rate (OR 0.55 per 30
mL/minute/1.73 m², 95% CI 0.41-0.75; p < .001). During
follow-up (mean +/- SD 62 +/- 47 months), 25% experienced limb amputation
and 54% died. In multivariate analysis, no significant association was
found between RAS and primary outcome (hazard ratio 0.80; 95% CI
0.57-1.10). No significant association was found with secondary outcomes.
Conclusion Incidental RAS is frequent (14%) among patients with PAD
undergoing lower extremity imaging. No difference in outcome in patients
with RAS versus those without RAS was seen. Larger studies are necessary
to draw definite conclusions. Copyright &#xa9; 2016 European Society for
Vascular Surgery

<48>
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

<49>
Accession Number
614518941
Author
Liu X.; Xie G.; Zhang K.; Song S.; Song F.; Jin Y.; Fang X.
Institution
(Liu, Xie, Zhang, Song, Song, Jin, Fang) Department of Anesthesiology and
Intensive Care Medicine, the First Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou, China
Title
Dexmedetomidine vs propofol sedation reduces delirium in patients after
cardiac surgery: A meta-analysis with trial sequential analysis of
randomized controlled trials.
Source
Journal of Critical Care. 38 (pp 190-196), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Purpose It is uncertain whether dexmedetomidine is better than propofol
for sedation in postcardiac surgery patients. The purpose of this
meta-analysis was to compare the effects of dexmedetomidine and propofol
sedation on outcomes in adult patients after cardiac surgery. Methods
Randomized controlled trials comparing outcomes in cardiac surgery
patients sedated with dexmedetomidine or propofol were retrieved from
PubMed, Embase, Web of Science, the Cochrane Library, and
Clinicaltrials.Gov until May 23, 2016. Results A total of 969 patients in
8 studies met the selection criteria. The results revealed that
dexmedetomidine was associated with a lower risk of delirium (risk ratio,
0.40;95% confidence interval [CI], 0.24-0.64; P =.0002), a shorter length
of intubation (hours; mean difference, - 0.95; 95% CI, - 1.26 to - 0.64; P
<.00001), but a higher incidence of bradycardia (risk ratio 3.17; 95% CI,
1.41-7.10; P =.005) as compared to propofol. There were no statistical
differences in the incidence of hypotension or atrial fibrillation, or the
length of intensive care unit stay between dexmedetomidine and propofol
sedation regimens. Conclusions Dexmedetomidine sedation could reduce
postoperative delirium and was associated with shorter length of
intubation, but might increase bradycardia in patients after cardiac
surgery compared with propofol. Copyright &#xa9; 2016 The Authors

<50>
Accession Number
614518935
Author
Brascia D.; Garcia-Medina N.; Kinnunen E.-M.; Tauriainen T.; Airaksinen
J.; Biancari F.
Institution
(Brascia, Garcia-Medina, Kinnunen, Tauriainen, Biancari) Department of
Surgery, Oulu University Hospital, Oulu, Finland
(Airaksinen) Heart Center, Turku University Hospital, Turku, Finland
Title
Impact of transfusion on stroke after cardiovascular interventions:
Meta-analysis of comparative studies.
Source
Journal of Critical Care. 38 (pp 157-163), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Purpose To evaluate the impact of transfusion on the development of stroke
after cardiovascular interventions. Methods A literature search was
performed to identify comparative studies on the impact of blood
transfusion on the occurrence of stroke after adult cardiac surgery and
interventional cardiology procedures. Results Twenty-four studies compared
the outcome of 80 283 patients who received and 2 260 709 patients who did
not receive blood transfusion after cardiovascular interventions. Pooled
analysis showed that transfused patients had a higher risk of
postoperative stroke (2.1% vs 0.9%; P <.001; risk ratio [RR], 2.563; 95%
confidence interval [CI], 1.615-4.069; I² = 94%) compared with
patient who did not receive blood transfusion. The leave-one-out analysis
confirmed the consistency of the overall series (RR ranged from 2.367 [95%
CI, 1.978-2.834] to 2.676 [95% CI, 1.679-4.265]). Transfusion was
associated with increased risk of stroke after either interventional
cardiology interventions (3.2% vs 1.1%; RR, 3.325; 95% CI, 1.579-7.004) or
cardiac surgery (1.9% vs 0.8%; RR, 2.260; 95% CI, 1.845-2.769). Generic
inverse variance analysis of 11 studies reporting adjusted odds ratios for
baseline characteristics showed that transfusion after cardiovascular
interventions was an independent predictor of stroke (RR, 1.53; 95% CI,
1.10-2.14; I² = 0%). Conclusion Blood transfusion is associated
with a significantly increased risk of postoperative stroke in patients
undergoing cardiovascular interventions. Registration The present
meta-analysis is registered in PROSPERO, code CRD42016046426. Copyright
&#xa9; 2016 Elsevier Inc.

<51>
Accession Number
614518928
Author
Zhu Y.; Yin H.; Zhang R.; Wei J.
Institution
(Zhu, Yin, Zhang) Department of Intensive Care Unit, Guangzhou Red Cross
Hospital, Medical College, Jinan University, Guangzhou, Guangdong 510220,
China
(Wei) Department of Cardiology, Guangzhou Red Cross Hospital, Medical
College, Jinan University, Guangzhou, Guangdong 510220, China
Title
High-flow nasal cannula oxygen therapy vs conventional oxygen therapy in
cardiac surgical patients: A meta-analysis.
Source
Journal of Critical Care. 38 (pp 123-128), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Introduction The use of high-flow nasal cannula (HFNC) for the treatment
of many diseases has gained increasing popularity. In the present
meta-analysis, we aimed to assess the efficacy and safety of HFNCs
compared with conventional oxygen therapy (COT) in adult postextubation
cardiac surgical patients. Method We reviewed the Embase, PubMed, Cochrane
Central Register of Controlled Trials, Wanfang databases, and the China
National Knowledge Infrastructure. Two investigators independently
collected the data and assessed the quality of each study. RevMan 5.3 was
used for the present meta-analysis. Results We included 495 adult
postextubation cardiac surgical patients. There was no significant
heterogeneity among the studies. Compared with COT, HFNCs were associated
with a significant reduction in the escalation of respiratory support
(risk ratio, 0.61; 95% confidence interval [CI], 0.46-0.82; z = 3.32, P
<.001). There were no significant differences in the reintubation rate
(risk ratio, 0.96; 95% CI, 0.04-24.84; z = 0.02, P =.98) or length of
intensive care unit stay (weighted mean difference, 0.13; 95% CI, -0.88 to
7.92; z = 1.57, P =.12) between the 2 groups. No severe complications were
reported in either group. Conclusions The HFNC could reduce the need for
escalation of respiratory support compared with COT, and it could be
safely administered in adult postextubation cardiac surgical patients.
Copyright &#xa9; 2016 Elsevier Inc.

<52>
Accession Number
613137113
Author
Shah A.H.; Horlick E.M.; Eicken A.; Asnes J.D.; Bocks M.L.; Boudjemline
Y.; Cabalka A.K.; Fagan T.E.; Schubert S.; Mahadevan V.S.; Dvir D.; Osten
M.; McElhinney D.B.
Institution
(Shah, Horlick, Osten) Toronto General Hospital, Toronto, Canada
(Eicken) German Heart Centre, Munich, Germany
(Asnes) Yale University, New Haven, CT, United States
(Bocks) University of Michigan, Ann Arbor, MI, United States
(Boudjemline) Necker Enfants Malades Hospital, Paris, France
(Cabalka) Mayo Clinic, Rochester, MN, United States
(Fagan) University of Tennessee Health Science Center and Le Bonheur
Children's Hospital, Memphis, TN, United States
(Schubert) Deutsches Herzzentrum, Berlin, Germany
(Mahadevan) University of California, San Francisco, CA, United States
(Dvir) St. Paul's Hospital, Vancouver, Canada
(McElhinney) Stanford University, Palo Alto, CA, United States
Title
Transcatheter valve implantation for right atrium-to-right ventricle
conduit obstruction or regurgitation after modified Bjork-fontan
procedure.
Source
Catheterization and Cardiovascular Interventions. 89 (2) (pp 298-305),
2017. Date of Publication: 01 Feb 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The most common reason for reintervention after a Bjork
modification of the Fontan procedure, in which the right ventricle (RV) is
incorporated into the pulmonary circulation by connecting the right atrial
(RA) appendage to the RV directly or with an extra-anatomic graft, is
obstruction or regurgitation of the RA-RV connection. Transcatheter
implantation of a valved stent is an appealing option for the treatment of
RA-RV conduit dysfunction in these patients. In the present study, we
assessed early and intermediate results after transcatheter valve
implantation within an obstructed or regurgitant RA-RV modified Fontan
pathway. Methods: Through a retrospective multicenter registry, we
collected data from 16 patients with a modified Fontan circulation who
were treated with percutaneous Melody or Sapien valve implantation for
dysfunction of an extra-anatomic RA-RV conduit or valve. Results: All
patients had successful and uncomplicated implantation of a Melody (n =
15) or Sapien 3 (n = 1) valve with hemodynamic and, in most cases,
clinical improvement. During a median follow-up of 3.3 years, 3 patients
died of cardiovascular causes unrelated to the procedure or the valve, and
no major valve dysfunction was observed. Conclusion: Percutaneous
transcatheter valve deployment to treat a dysfunctional RA-RV connection
after a Bjork modification of the Fontan procedure is a viable alternative
to surgery, with low procedural risk, and appears to offer good early and
intermediate results.&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9;
2016 Wiley Periodicals, Inc.

<53>
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

<54>
Accession Number
614095871
Author
Cho Y.J.; Lee E.-H.; Lee K.; Kim T.K.; Hong D.M.; Chin J.-H.; Choi D.-K.;
Bahk J.-H.; Sim J.-Y.; Choi I.-C.; Jeon Y.
Institution
(Cho, Lee, Kim, Hong, Bahk, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
(Lee, Chin, Choi, Sim, Choi) Department of Anesthesiology and Pain
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
Title
Long-term clinical outcomes of Remote Ischemic Preconditioning and
Postconditioning Outcome (RISPO) trial in patients undergoing cardiac
surgery.
Source
International Journal of Cardiology. 231 (pp 84-89), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic conditioning has been shown to confer
myocardial protection. However, there is still no sufficient data on its
long-term clinical outcomes. We analyzed the long-term results of the
Remote Ischemic Preconditioning and Postconditioning Outcome (RISPO) trial
in cardiac surgery patients. Methods In the RISPO trial, 1280 patients
were randomized to receive remote ischemic preconditioning (RIPC) with
postconditioning (RIPostC, upper arm ischemia by four cycles of 5-min
inflation followed by 5-min deflation of a pneumatic cuff, N = 644) or
sham (N = 636) during cardiac surgery. Patient follow-up data were
collected by review of medical records, telephone interviews, and from the
National Statistical Office. The primary endpoint was major adverse
cardiac and cerebrovascular events (MACCE; a composite of all-cause
mortality, myocardial infarction (MI), stroke, and revascularization), and
the secondary endpoints were the individual components of the primary
endpoint. Results At completion of follow-up (mean 44 months), there was
no difference in MACCE between the groups (90 [14.0%] versus 101 [15.9%]
in the RIPC with RIPostC versus control groups; hazard ratio [HR], 0.893;
95% confidence interval [CI], 0.672-1.187; P = 0.435). However, MI was
reduced to half in the RIPC with RIPostC group (10 [1.6%] versus 23
[3.6%]; HR, 0.468; 95% CI, 0.222-0.984; P = 0.045). Conclusions Remote
ischemic preconditioning with RIPostC did not improve long-term MACCE
after cardiac surgery. However, MI was reduced in the RIPC with RIPostC
group compared with the control group during the follow-up period.
Clinical trial registration ClinicalTrials.gov identifier, NCT00997217
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<55>
Accession Number
613967152
Author
Kahlert P.; Hildebrandt H.A.; Patsalis P.C.; Al-Rashid F.; Janosi R.A.;
Nensa F.; Schlosser T.W.; Schlamann M.; Wendt D.; Thielmann M.; Kottenberg
E.; Frey U.; Neuhauser M.; Forsting M.; Jakob H.G.; Rassaf T.; Peters J.;
Heusch G.; Kleinbongard P.
Institution
(Kahlert, Hildebrandt, Patsalis, Al-Rashid, Janosi, Rassaf) Department of
Cardiology and Vascular Medicine, West-German Heart and Vascular Center
Essen, Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Nensa, Schlosser, Schlamann, Forsting) Institute for Diagnostic and
Interventional Radiology and Neuroradiology, Universitatsklinikum Essen,
Universitat Duisburg-Essen, Germany
(Wendt, Thielmann, Jakob) Department of Thoracic and Cardiovascular
Surgery, West-German Heart and Vascular Center Essen, Universitatsklinikum
Essen, Universitat Duisburg-Essen, Germany
(Kottenberg, Frey, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Neuhauser) Institute for Medical Informatics, Biometry, and Epidemiology,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Heusch, Kleinbongard) Institute for Pathophysiology, West-German Heart
and Vascular Center Essen, Universitatsklinikum Essen, Universitat
Duisburg-Essen, Germany
(Schlamann) Department of Neuroradiology, University Hospital Giesen,
Giesen, Germany
(Kottenberg) Klinik fur Anasthesiologie, Intensivmedizin und
Schmerztherapie, Evangelisches Krankenhaus Mulheim, Germany
(Neuhauser) Department of Mathematics and Technology, Koblenz, University
of Applied Science, Remagen, Germany
Title
No protection of heart, kidneys and brain by remote ischemic
preconditioning before transfemoral transcatheter aortic valve
implantation: Interim-analysis of a randomized single-blinded,
placebo-controlled, single-center trial.
Source
International Journal of Cardiology. 231 (pp 248-254), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic preconditioning (RIPC) reduces myocardial
injury and improves clinical outcome in patients undergoing coronary
revascularization, but only in the absence of propofol-anesthesia. We
investigated whether RIPC provides protection of heart, kidneys and brain
and improves outcome in patients undergoing transfemoral transcatheter
aortic valve implantation (TF-TAVI). Methods Patients undergoing TF-TAVI
were randomized to receive RIPC (3 cycles of 5 min left upper arm ischemia
and 5 min reperfusion) or placebo. The primary endpoint was myocardial
injury, reflected by the area under the curve for serum troponin I
concentrations (AUC-TnI) over the first 72 h. Secondary endpoints included
the incidences of periprocedural myocardial infarction, delayed gadolinium
enhancement on postprocedural cardiac MRI, acute kidney injury,
periprocedural stroke, and the incidence and volume of new lesions on
postprocedural cerebral MRI. All-cause and cardiovascular mortality and
major adverse cardiac and cerebrovascular events (MACCE) were assessed
over 1-year follow-up. A prespecified interim-analysis was performed after
the last patient had completed 1-year follow-up (NCT02080299). Results 100
consecutive patients were enrolled between September 2013 and June 2015.
There were no significant between-group differences in the primary
endpoint of peri-interventional myocardial injury (ratio RIPC/placebo
AUC-TnI: 0.87, 95% CI: 0.57-1.34, p = 0.53) or the secondary endpoints of
cardiac, renal and cerebral impairment. There was no significant treatment
effect in subgroup-analyses of patients undergoing cardiac or cerebral
MRI. Mortality and MACCE did not differ. No RIPC-related adverse events
were observed. Conclusions RIPC did neither protect heart, kidneys and
brain nor improve clinical outcome in patients undergoing TF-TAVI.
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<56>
Accession Number
614099211
Author
Godino C.; Chiarito M.; Donahue M.; Testa L.; Colantonio R.; Cappelletti
A.; Monello A.; Magni V.; Milazzo D.; Parisi R.; Nicolino A.; Moshiri S.;
Fattori R.; Aprigliano G.; Palloshi A.; Caramanno G.; Montorfano M.;
Bedogni F.; Briguori C.; Margonato A.; Colombo A.
Institution
(Godino, Chiarito, Cappelletti, Monello, Magni, Montorfano, Margonato,
Colombo) San Raffaele Scientific Institute, Milan, Italy
(Donahue, Briguori) Clinica Mediterranea, Naples, Italy
(Testa, Bedogni) IRCCS Policlinico San Donato, San Donato M.ne, Milan,
Italy
(Colantonio) Ospedale San Pietro FBF, Rome, Italy
(Milazzo, Caramanno) Ospedale San Giovanni di Dio, Agrigento, Italy
(Parisi, Fattori) Ospedali Riuniti Marche Nord, Pesaro, Italy
(Nicolino, Moshiri) Ospedale Santa Corona, Pietra Ligure, Italy
(Aprigliano, Palloshi) Istituto Clinico Citta Studi, Milan, Italy
(Colombo) EMO-GVM Centro Cuore Columbus, Milan, Italy
Title
Midterm and one-year outcome of amphilimus polymer free drug eluting stent
in patients needing short dual antiplatelet therapy. Insight from the
ASTUTE registry (AmphilimuS iTalian mUlticenTer rEgistry).
Source
International Journal of Cardiology. 231 (pp 54-60), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background To assess clinical outcomes of patients needing short dual
antiplatelet therapy (S-DAPT) after PCI with Cre8 polymer-free amphilimus
eluting-stent (AES). The Cre8-AES with pure i-Carbofilm coating was
supposed to induce faster stent endothelialization and reduce device
thrombogenicity. Methods We performed a sub-analysis of unrestricted
consecutive patients treated with Cre8-AES between August 2011 and January
2015. Two groups were formed: 1) patients discharged with S-DAPT (<
3-month), because of high bleeding risk or attending urgent non-cardiac
surgery; and 2) patients discharged with Recommended DAPT duration
(R-DAPT; > 6-month). The primary ischemic- and bleeding-safety endpoints
were Target Vessel Failure (TVF, composite endpoint of cardiac-death,
target vessel-myocardial infarction and target vessel-revascularization),
and major-bleeding (BARC > type-3a) at 6-month and 1-year. Results 106
patients (8.7%) were discharged with < 3-month DAPT (83 +/- 19 days;
S-DAPT group) and 1102 patients (90.6%) with > 6-month DAPT (342 +/- 62
days; R-DAPT group). Between S-DAPT and R-DAPT groups no significant
differences were observed in TVF at 1-year (5.7% vs 5.1%); 1-year BARC
major bleeding rate was higher in S-DAPT group (3.4% vs 0.2%, p = 0.007)
with all bleeding events occurred within 3 months. The landmark analysis
(started at 90 days, ended at 1 year) showed no differences in BARC major
bleedings between groups (0% vs. 0.3%). Conclusions The results of this
multicenter registry show that the use of Cre8 AES in patients needing
short DAPT (< 3-month) was safe regarding ischemic events and could favor
a reduction of bleeding events related to the recommended DAPT. A large
randomized trial is necessary to support these preliminary findings.
Copyright &#xa9; 2017 Elsevier B.V.

<57>
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.

<58>
Accession Number
614482798
Author
Peeters M.J.; van den Brand J.A.; van Zuilen A.D.; Koster Y.; Bots M.L.;
Vervloet M.G.; Blankestijn P.J.; Wetzels J.F.
Institution
(Peeters, van den Brand, Wetzels) 464 Department of Nephrology, Radboud
University Medical Center, PO box 9101, Nijmegen 6500 HB, Netherlands
(van Zuilen, Koster, Blankestijn) Department of Nephrology, University
Medical Center Utrecht, Utrecht, Netherlands
(Bots) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
(Vervloet) Department of Nephrology, VU University Medical Center,
Amsterdam, Netherlands
Title
Abdominal aortic calcification in patients with CKD.
Source
Journal of Nephrology. 30 (1) (pp 109-118), 2017. Date of Publication: 01
Feb 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Abdominal aortic calcification (AAC) is independently
associated with cardiovascular events in dialysis patients and in the
general population. However, data in non-dialysis chronic kidney disease
(CKD) patients are limited. We analyzed determinants and prognostic value
of AAC in non-dialysis CKD patients. Methods: We included patients with
CKD not receiving renal replacement therapy from the MASTERPLAN study, a
randomized controlled trial that started in 2004. In the period 2008-2009,
an X-ray to evaluate AAC was performed in a subgroup of patients. We
studied AAC using a semi-quantitative scoring system by lateral lumbar
X-ray. We used baseline and 2-year data to find determinants of AAC. We
used a composite cardiovascular endpoint and propensity score matching to
evaluate the prognostic value of AAC. Results: In 280 patients an X-ray
was performed. In 79 patients (28 %) the X-ray showed no calcification, in
62 patients (22 %) calcification was minor (<4), while 139 patients (50 %)
had moderate or heavy calcification (>4). Older age, prior cardiovascular
disease, higher triglyceride levels, and higher phosphate levels were
independent determinants of a calcification score >4. AAC score >4 was
independently associated with cardiovascular events, with a hazard ratio
of 5.5 (95 % confidence interval 1.2-24.8). Conclusions: Assessment of AAC
can identify CKD patients at higher cardiovascular risk, and may provide
important information for personalized treatment. Whether this approach
will ultimately translate into better outcomes remains to be answered.
Copyright &#xa9; 2016, The Author(s).

<59>
Accession Number
613782202
Author
Albers J.J.; Slee A.; Fleg J.L.; O'Brien K.D.; Marcovina S.M.
Institution
(Albers, Marcovina) University of Washington, Northwest Lipid Metabolism
and Diabetes Research Laboratories, 401 Queen Anne Ave N, Seattle, WA
98109, United States
(Slee) AIM-HIGH Coordinating Center, Axio Research, 2601 Fourth Ave, Ste
200, Seattle, WA 98121, United States
(Fleg) National Heart, Lung, and Blood Institute, Division of
Cardiovascular Diseases, 6701 Rockledge Dr, Rm 8150, Bethesda, MD 20892,
United States
(O'Brien) University of Washington, Division of Cardiology, Department of
Medicine, 1959 NE Pacific Ave, Box 356422, Seattle, WA 98195-6422, United
States
Title
Relationship of baseline HDL subclasses, small dense LDL and LDL
triglyceride to cardiovascular events in the AIM-HIGH clinical trial.
Source
Atherosclerosis. 251 (pp 454-459), 2016. Date of Publication: 01 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims Previous results of the AIM-HIGH trial showed that
baseline levels of the conventional lipid parameters were not predictive
of future cardiovascular (CV) outcomes. The aims of this secondary
analysis were to examine the levels of cholesterol in high density
lipoprotein (HDL) subclasses (HDL2-C and HDL3-C), small dense low density
lipoprotein (sdLDL-C), and LDL triglyceride (LDL-TG) at baseline, as well
as the relationship between these levels and CV outcomes. Methods
Individuals with CV disease and low baseline HDL-C levels were randomized
to simvastatin plus placebo or simvastatin plus extended release niacin
(ERN), 1500 to 2000 mg/day, with ezetimibe added as needed in both groups
to maintain an on-treatment LDL-C in the range of 40-80 mg/dL. The primary
composite endpoint was death from coronary disease, nonfatal myocardial
infarction, ischemic stroke, hospitalization for acute coronary syndrome,
or symptom-driven coronary or cerebrovascular revascularization. HDL-C,
HDL3-C, sdLDL-C and LDL-TG were measured at baseline by detergent-based
homogeneous assays. HDL2-C was computed by the difference between HDL-C
and HDL3-C. Analyses were performed on 3094 study participants who were
already on statin therapy prior to enrollment in the trial. Independent
contributions of lipoprotein fractions to CV events were determined by Cox
proportional hazards modeling. Results Baseline HDL3-C was protective
against CV events (HR: 0.84, p = 0.043) while HDL-C, HDL2-C, sdLDL-C and
LDL-TG were not event-related (HR: 0.96, p = 0.369; HR: 1.07, p = 0.373;
HR: 1.05, p = 0.492; HR: 1.03, p = 0.554, respectively). Conclusions The
results of this secondary analysis of the AIM-HIGH Study indicate that
levels of HDL3-C, but not other lipoprotein fractions, are predictive of
CV events, suggesting that the HDL3 subclass may be primarily responsible
for the inverse association of HDL-C and CV disease. Copyright &#xa9; 2016
Elsevier Ireland Ltd

<60>
Accession Number
614406617
Author
Hsu J.C.; Badhwar N.; Gerstenfeld E.P.; Lee R.J.; Mandyam M.C.; Dewland
T.A.; Imburgia K.E.; Hoffmayer K.S.; Vedantham V.; Lee B.K.; Tseng Z.H.;
Scheinman M.M.; Olgin J.E.; Marcus G.M.
Institution
(Hsu, Badhwar, Gerstenfeld, Lee, Mandyam, Dewland, Imburgia, Hoffmayer,
Vedantham, Lee, Tseng, Scheinman, Olgin, Marcus) Section of Cardiac
Electrophysiology, Division of Cardiology, Department of Medicine,
University of California, San Francisco, San Francisco, CA, United States
Title
Randomized trial of conventional transseptal needle versus radiofrequency
energy needle puncture for left atrial access (the TRAVERSE-LA Study).
Source
Journal of the American Heart Association. 2 (5) (no pagination), 2013.
Article Number: e000428. Date of Publication: 2013.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Transseptal puncture is a critical step in achieving left
atrial (LA) access for a variety of cardiac procedures. Although the
mechanical Brockenbrough needle has historically been used for this
procedure, a needle employing radiofrequency (RF) energy has more recently
been approved for clinical use. We sought to investigate the comparative
effectiveness of an RF versus conventional needle for transseptal LA
access. Methods and Results--In this prospective, single-blinded,
controlled trial, 72 patients were randomized in a 1:1 fashion to an RF
versus conventional (BRK-1) transseptal needle. In an intention-to-treat
analysis, the primary outcome was time required for transseptal LA access.
Secondary outcomes included failure of the assigned needle, visible
plastic dilator shavings from needle introduction, and any procedural
complication. The median transseptal puncture time was 68% shorter using
the RF needle compared with the conventional needle (2.3 minutes
[interquartile range (IQR), 1.7 to 3.8 minutes] versus 7.3 minutes [IQR,
2.7 to 14.1 minutes], P = 0.005). Failure to achieve transseptal LA access
with the assigned needle was less common using the RF versus conventional
needle (0/36 [0%] versus 10/36 [27.8%], P < 0.001). Plastic shavings were
grossly visible after needle advancement through the dilator and sheath in
0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P <
0.001). There were no differences in procedural complications (1/36 [2.8%]
versus 1/36 [2.8%]). Conclusions--Use of an RF needle resulted in shorter
time to transseptal LA access, less failure in achieving transseptal LA
access, and fewer visible plastic shavings. Copyright &#xa9; 2013 The
Authors.

<61>
Accession Number
614721435
Author
Korteland N.M.; Ahmed Y.; Koolbergen D.R.; Brouwer M.; De Heer F.; Kluin
J.; Bruggemans E.F.; Klautz R.J.M.; Stiggelbout A.M.; Bucx J.J.J.;
Roos-Hesselink J.W.; Polak P.; Markou T.; Van Den Broek I.; Ligthart R.;
Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Korteland, Bogers, Takkenberg) Department of Cardio-Thoracic Surgery,
Erasmus MC, PO Box 2040, Rotterdam 3000 CA, Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus MC, Rotterdam,
Netherlands
(Ahmed, Koolbergen, De Heer, Kluin) Department of Cardio-Thoracic Surgery,
Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Brouwer) Department of Cardio-Thoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Bruggemans, Klautz) Department of Cardio-Thoracic Surgery, Leiden
University Medical Center, Netherlands
(Stiggelbout) Department of Medical Decision Making, Leiden University
Medical Center, Netherlands
(Bucx) Department of Cardiology, Diakonessenhuis, Utrecht, Netherlands
(Polak) Department of Cardiology, St. Anna Hospital, Geldrop, Netherlands
(Markou) Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle,
Netherlands
(Van Den Broek, Ligthart) Patient Organisation De HartandVaatgroep, The
Hague, Netherlands
Title
Does the use of a decision aid improve decision making in prosthetic heart
valve selection?.
Source
Circulation: Cardiovascular Quality and Outcomes. 10 (2) (no pagination),
2017. Article Number: e003178. Date of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - A Dutch online patient decision aid to support prosthetic
heart valve selection was recently developed. A multicenter randomized
controlled trial was conducted to assess whether use of the patient
decision aid results in optimization of shared decision making in
prosthetic heart valve selection. Methods and Results - In a 5-center
randomized controlled trial, patients were allocated to receive either
standard preoperative care (control group) or additional access to the
patient decision aid (intervention group). Legally capable adult patients
accepted for elective isolated or combined aortic and mitral valve
replacement were included. Primary outcome was preoperative decisional
conflict (Decisional Conflict Scale); secondary outcomes included patient
knowledge, involvement in valve selection, anxiety and depression,
(valve-specific) quality of life, and regret. Out of 306 eligible
patients, 155 were randomized (78 control and 77 intervention).
Preoperative decisional conflict did not differ between the groups (34%
versus 33%; P=0.834). Intervention patients felt better informed (median
Decisional Conflict Scale informed subscore: 8 versus 17; P=0.046) and had
a better knowledge of prosthetic valves (85% versus 68%; P=0.004).
Intervention patients experienced less anxiety and depression (median
Hospital Anxiety and Depression Scale score: 6 versus 9; P=0.015) and
better mental well-being (mean Short Form Health Survey score: 54 versus
50; P=0.032). Three months postoperatively, valve-specific quality of life
and regret did not differ between the groups. Conclusions - A patient
decision aid to support shared decision making in prosthetic heart valve
selection does not lower decisional conflict. It does result in more
knowledgeable, better informed, and less anxious and depressed patients,
with a better mental well-being. Copyright &#xa9; 2017 American Heart
Association, Inc.

<62>
Accession Number
614686872
Author
Qi W.; Zhang N.; Korantzopoulos P.; Letsas K.P.; Cheng M.; Di F.; Tse G.;
Liu T.; Li G.
Institution
(Qi, Zhang, Liu, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Qi) School of Public Health, Chinese Academy of Medical Sciences, Peking
Union Medical College, Beijing, China
(Korantzopoulos) First Department of Cardiology, University of Ioannina
Medical School, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
(Cheng) State Key Laboratory of Cardiovascular Disease, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Di) Department of Endocrinology and Metabolism, Third Central Hospital of
Tianjin, Tianjin, China
(Tse) Department of Medicine and Therapeutics, Chinese University of Hong
Kong, Hong Kong, Hong Kong
(Tse) Li Ka Shing Institute of Health Sciences, Chinese University of Hong
Kong, Hong Kong, Hong Kong
Title
Serum glycated hemoglobin level as a predictor of atrial fibrillation: A
systematic review with meta-analysis and metaregression.
Source
PLoS ONE. 12 (3) (no pagination), 2017. Article Number: e0170955. Date of
Publication: March 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background and Aim Glycated hemoglobin (HbA1c) is a long-term measure of
glucose control. Although recent studies demonstrated a potential
association between HbA1c levels and the risk of atrial fibrillation (AF),
the results have been inconsistent. The aim of this meta-analysis is to
evaluate the utility of HbA1c level in predicting AF. Methods PubMed and
the Cochrane Library databases were searched for relevant studies up to
March 2016. Prospective cohort studies and retrospective case-control
studies were included. Relative risk (RR) or odds ratio (OR) with 95%
confidence intervals (CIs) of AF development were determined for different
HbA1c levels. The random effect model was conducted according to the test
of heterogeneity among studies. Subgroup analyses and meta-regression
models were carried out to identify potential sources of heterogeneity.
Results Eight prospective cohort studies with 102, 006 participants and 6
retrospective case-control studies with 57, 669 patients were finally
included in the meta-analysis. In the primary metaanalysis, HbA1c levels
were not associated with an increased risk of AF whether as a continuous
(RR, 1.06; 95% CI, 0.96-1.18) or categorical variable (RR, 0.99; 95% CI,
0.83- 1.18). Nevertheless, prospective studies showed about 10% increased
risk of AF with elevated HbA1c levels both as a continuous (RR, 1.11; 95%
CI, 1.06-1.16) and as a categorical variable (RR, 1.09; 95% CI,
1.00-1.18). In subgroup analyses, pooled results from studies with longer
follow-up durations, published after 2012, aged < 63 years, with exclusion
of cardiac surgery patients demonstrated an increased risk of AF for every
1% increase in HbA1c levels, while studies conducted in the United States
with longer follow-up (more than 96 months), larger sample size and higher
quality score (<6) showed an increased risk of AF for higher HbA1c level
as a categorical variable. Conclusions Elevated serum HbA1c levels may be
associated with an increased risk of AF, but further data are needed.
Serum HbA1c levels might be considered as a potential biomarker for
prediction of AF. Copyright &#xa9; 2017 Qi et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<63>
Accession Number
614732653
Author
Bilecen S.; De Groot J.A.H.; Kalkman C.J.; Spanjersberg A.J.; Brandon
Bravo Bruinsma G.J.; Moons K.G.M.; Nierich A.P.
Institution
(Bilecen, Kalkman, Moons) Division of Anesthesiology, Intensive Care and
Emergency Medicine, University Medical Center Utrecht, PO Box 85500,
Utrecht 3508 GA, Netherlands
(Bilecen, Spanjersberg, Nierich) Department of Cardiothoracic Anesthesia
and Intensive Care, Isala Zwolle, Netherlands
(De Groot, Moons) Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht, Netherlands
(Brandon Bravo Bruinsma) Department of Cardiothoracic Surgery, Isala
Zwolle, Netherlands
Title
Effect of fibrinogen concentrate on intraoperative blood loss among
patients with intraoperative bleeding during high-risk cardiac surgery: A
randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 317 (7) (pp 738-747),
2017. Date of Publication: 21 Feb 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Fibrinogen concentrate might partly restore coagulation
defects and reduce intraoperative bleeding. Objective: To determine
whether fibrinogen concentrate infusion dosed to achieve a plasma
fibrinogen level of 2.5 g/L in high-risk cardiac surgery patients with
intraoperative bleeding reduces intraoperative blood loss. Design,
Setting, and Participants: A randomized, placebo-controlled, double-blind
clinical trial conducted in Isala Zwolle, the Netherlands (February
2011-January 2015), involving patients undergoing elective, high-risk
cardiac surgery (ie, combined coronary artery bypass graft [CABG] surgery
and valve repair or replacement surgery, the replacement of multiple
valves, aortic root reconstruction, or reconstruction of the ascending
aorta or aortic arch) with intraoperative bleeding (blood volume between
60 and 250 mL suctioned from the thoracic cavity in a period of 5 minutes)
were randomized to receive either fibrinogen concentrate or placebo.
Interventions: Intravenous, single-dose administration of fibrinogen
concentrate (n = 60) or placebo (n = 60), targeted to achieve a
postinfusion plasma fibrinogen level of 2.5 g/L. Main Outcomes and
Measures: The primary outcomewas blood loss in milliliters between
intervention (ie, after removal of cardiopulmonary bypass) and closure of
chest. Safety variables (within 30 days) included: in-hospital mortality,
myocardial infarction, cerebrovascular accident or transient ischemic
attack, renal insufficiency or failure, venous thromboembolism, pulmonary
embolism, and operative complications. Results: Among 120 patients (mean
age; 71 [SD, 10] years, 37women [31%]) included in the study, combined
CABG and valve repair or replacement surgery comprised 72%of procedures
and had a mean (SD) cardiopulmonary bypass time of 200 minutes (83)
minutes. For the primary outcome, median blood loss in the fibrinogen
groupwas 50mL (interquartile range [IQR], 29-100 mL) compared with 70 mL
(IQR, 33-145 mL) in the control group (P = .19), the absolute difference
20 mL (95%CI, -13 to 35 mL). Therewere 6 cases of stroke or transient
ischemic attack (4 in the fibrinogen group); 4myocardial infarctions (3 in
the fibrinogen group); 2 deaths (both in the fibrinogen group); 5 cases
with renal insufficiency or failure (3 in the fibrinogen group); and 9
cases with reoperative thoracotomy (4 in the fibrinogen group).
Conclusions and Relevance: Among patients with intraoperative bleeding
during high-risk cardiac surgery, administration of fibrinogen
concentrate, compared with placebo, resulted in no significant difference
in the amount of intraoperative blood loss. Copyright &#xa9; 2017 American
Medical Association. All rights reserved.

<64>
Accession Number
614659366
Author
Zhu Z.G.; Xiong W.; Ding J.L.; Chen J.; Li Y.; Zhou J.L.; Xu J.J.
Institution
(Zhu, Chen, Li, Zhou, Xu) Department of Cardiothoracic Surgery, Second
Affiliated Hospital of Nanchang University, Nanchang, China
(Xiong) Guangxi University of Chinese Medicine, Nanning, China
(Ding) Department of Gastroenterology, Second Affiliated Hospital of
Nanchang University, Nanchang, China
Title
Comparison of outcomes between off-pump versus on-pump coronary artery
bypass surgery in elderly patients: A meta-analysis.
Source
Brazilian Journal of Medical and Biological Research. 50 (3) (no
pagination), 2017. Article Number: e5711. Date of Publication: 2017.
Publisher
Associacao Brasileira de Divulgacao Cientifica (E-mail:
bjournal@fmrp.usp.br)
Abstract
The aim of this study was to analyze if off-pump coronary artery bypass
surgery (CABG) is associated with better treatment outcomes in elderly
patients (>70 years of age) than on-pump CABG, using meta-analysis.
Medline, PubMed, Cochrane and Google Scholar databases were searched until
September 13, 2016. Sensitivity and quality assessment were performed.
Twenty-two studies, three randomized control trials (RCTs) and 20 non-RCTs
were included with 24,127 patients. The risk of death associated with
on-pump or off-pump CABG in the RCTs were similar (pooled OR=0.945,
95%CI=0.652 to 1.371, P=0.766). However, in the non-RCTs, mortality risk
was lower in patients treated with off-pump CABG than on-pump CABG (pooled
OR=0.631, 95%CI=0.587 to 0.944, P=0.003). No differences were observed
between the two treatment groups in terms of the occurrence of 30-day
post-operative stroke or myocardial infarction (P>0.147). In the non-RCTs,
off-pump CABG treatment was associated with a shorter length of hospital
stay (pooled standardized difference in means=-0.401, 95%CI=-0.621 to
-0.181, P<0.001). The meta-analysis with pooled data from non-RCTs, but
not RCTs, found that mortality was lower with off-pump compared with
on-pump CABG, and suggested that there may be some benefit of off-pump
CABG compared with on-pump CABG in the risk of mortality and length of
hospital stay. Copyright &#xa9; 2017, Associacao Brasileira de Divulgacao
Cientifica. All rights reserved.

<65>
Accession Number
614654024
Author
Checchia P.A.; Paes B.; Bont L.; Manzoni P.; Simoes E.A.F.; Fauroux B.;
Figueras-Aloy J.; Carbonell-Estrany X.
Institution
(Checchia) Baylor College of Medicine, Texas Children's Hospital Houston,
Houston, TX, United States
(Paes) Neonatal Division, Department of Paediatrics, McMaster University,
Hamilton, Canada
(Bont) University Medical Center Utrecht, Utrecht, Netherlands
(Manzoni) Sant'Anna Hospital, Turin, Italy
(Simoes) University of Colorado School of Medicine, Aurora, CO, United
States
(Fauroux) Necker University Hospital and Paris 5 University, Paris, France
(Figueras-Aloy) Hospital Clinic, Catedratic de Pediatria, Universitat de
Barcelona, Barcelona, Spain
(Carbonell-Estrany) Hospital Clinic, Institut d'Investigacions Biomediques
August Pi Suner (IDIBAPS), Barcelona, Spain
Title
Defining the Risk and Associated Morbidity and Mortality of Severe
Respiratory Syncytial Virus Infection Among Infants with Congenital Heart
Disease.
Source
Infectious Diseases and Therapy. 6 (1) (pp 37-56), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Springer Healthcare
Abstract
Introduction: The REGAL (RSV Evidence-a Geographical Archive of the
Literature) series provide a comprehensive review of the published
evidence in the field of respiratory syncytial virus (RSV) in Western
countries over the last 20 years. This fourth publication covers the risk
and burden of RSV infection in infants with congenital heart disease
(CHD). Methods: A systematic review was undertaken for articles published
between January 1, 1995 and December 31, 2015 across PubMed, Embase, The
Cochrane Library, and Clinicaltrials.gov. Studies reporting data for
hospital visits/admissions for RSV infection among children with CHD as
well as studies reporting RSV-associated morbidity, mortality, and
healthcare costs were included. The focus was on children not receiving
RSV prophylaxis. Study quality and strength of evidence (SOE) were graded
using recognized criteria. Results: A total of 1325 studies were
identified of which 38 were included. CHD, in particular hemodynamically
significant CHD, is an independent predictor for RSV hospitalization
(RSVH) (high SOE). RSVH rates were generally high in young children (<4
years) with CHD (various classifications), varying between 14 and 357/1000
(high SOE). Children (<6 years) with RSV infection spent 4.4-14 days in
hospital, with up to 53% requiring intensive care (high SOE). Infants (<2
years) with CHD had a more severe course of RSVH than those without CHD
(high SOE). Case fatality rates of up to 3% were associated with RSV
infection in children with CHD (high SOE). RSV infection in the
perioperative period of corrective surgery and nosocomial RSV infection in
intensive care units also represent important causes of morbidity
(moderate SOE). Conclusion: CHD poses a significant risk for RSVH and
subsequent morbidity and mortality. RSV infection often complicates
corrective heart surgery. To reduce the burden and improve outcomes,
further research and specific studies are needed to determine the
longer-term effects of severe RSV infection in young children with CHD.
Copyright &#xa9; 2017, The Author(s).

<66>
Accession Number
614668124
Author
Hummel J.; Rucker G.; Stiller B.
Institution
(Hummel, Stiller) Heart Center, University of Freiburg, Department of
Congenital Heart Defects and Pediatric Cardiology, Mathildenstr. 1,
Freiburg 79106, Germany
(Rucker) Faculty of Medicine and Medical Center - University of Freiburg,
Institute for Medical Biometry and Statistics, Stefan-Meier-Str. 26,
Freiburg 79104, Germany
Title
Prophylactic levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD011312. Date of Publication: 06 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Low cardiac output syndrome remains a serious complication,
and accounts for substantial morbidity and mortality in the postoperative
course of paediatric patients undergoing surgery for congenital heart
disease. Standard prophylactic and therapeutic strategies for low cardiac
output syndrome are based mainly on catecholamines, which are effective
drugs, but have considerable side effects. Levosimendan, a calcium
sensitiser, enhances the myocardial function by generating more
energy-efficient myocardial contractility than achieved via adrenergic
stimulation with catecholamines. Thus potentially, levosimendan is a
beneficial alternative to standard medication for the prevention of low
cardiac output syndrome in paediatric patients after open heart surgery.
Objectives: To review the efficacy and safety of the postoperative
prophylactic use of levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease. Search methods: We identified trials via
systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as
well as clinical trial registries, in June 2016. Reference lists from
primary studies and review articles were checked for additional
references. Selection criteria: We only included randomised controlled
trials (RCT) in our analysis that compared prophylactic levosimendan with
standard medication or placebo, in infants and children up to 18 years of
age, who were undergoing surgery for congenital heart disease. Data
collection and analysis: Two review authors independently extracted data
and assessed risk of bias according to a pre-defined protocol. We obtained
additional information from all but one of the study authors of the
included studies. We used the five GRADE considerations (study
limitations, consistency of effect, imprecision, indirectness, and
publication bias) to assess the quality of evidence from the studies that
contributed data to the meta-analyses for the prespecified outcomes. We
created a 'Summary of findings' table to summarise the results and the
quality of evidence for each outcome. Main results: We included five
randomised controlled trials with a total of 212 participants in the
analyses. All included participants were under five years of age. Using
GRADE, we assessed there was low-quality evidence for all analysed
outcomes. We assessed high risk of performance and detection bias for two
studies due to their unblinded setting. Levosimendan showed no clear
effect on risk of mortality (risk ratio (RR) 0.47, 95% confidence interval
(CI) 0.12 to 1.82; participants = 123; studies = 3) and no clear effect on
low cardiac output syndrome (RR 0.64, 95% CI 0.39 to 1.04; participants =
83; studies = 2) compared to standard treatments. Data on time-to-death
were not available from any of the included studies. There was no
conclusive evidence on the effect of levosimendan on the secondary
outcomes. The levosimendan groups had shorter length of intensive care
unit stays (mean difference (MD) 0.33 days, 95% CI -1.16 to 1.82;
participants = 188; studies = 4; I2 = 35%), length of hospital stays (0.26
days, 95% CI -3.50 to 4.03; participants = 75; studies = 2), and duration
of mechanical ventilation (MD -0.04 days, 95% CI -0.08 to 0.00;
participants = 208; studies = 5; I2 = 0%). The risk of mechanical
circulatory support or cardiac transplantation favoured the levosimendan
groups (RR 1.49, 95% CI 0.19 to 11.37; participants = 60; studies = 2).
Published data about adverse effects of levosimendan were limited. A
meta-analysis of hypotension, one of the most feared side effects of
levosimendan, was not feasible because of the heterogeneous expression of
blood pressure values. Authors' conclusions: The current level of evidence
is insufficient to judge whether prophylactic levosimendan prevents low
cardiac output syndrome and mortality in paediatric patients undergoing
surgery for congenital heart disease. So far, no significant differences
have been detected between levosimendan and standard inotrope treatments
in this setting. The authors evaluated the quality of evidence as low,
using the GRADE approach. Reasons for downgrading were serious risk of
bias (performance and detection bias due to unblinded setting of two
RCTs), serious risk of inconsistency, and serious to very serious risk of
imprecision (small number of included patients, low event rates).
Copyright &#xa9; 2017 The Cochrane Collaboration. Published by John Wiley
& Sons, Ltd.

<67>
Accession Number
614652703
Author
Bin Abdulhak A.A.; Tleyjeh I.M.
Institution
(Bin Abdulhak) Department of Medicine, Division of Cardiovascular
Diseases, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Int.
Med. E315 GH, Iowa City, IA 52242, United States
(Bin Abdulhak) College of Public Health, University of Iowa, Iowa City,
IA, United States
(Tleyjeh) Division of Infectious Diseases, Mayo Clinic, Rochester, MN,
United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Tleyjeh) Department of Medicine, Infectious Diseases Section, King Fahad
Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia
(Tleyjeh) College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
Title
Indications of Surgery in Infective Endocarditis.
Source
Current Infectious Disease Reports. 19 (3) (no pagination), 2017. Article
Number: 10. Date of Publication: 01 Mar 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of the Review: Infective endocarditis (IE) is a serious disease
with significant morbidity and mortality. Valve surgery is fundamental in
the standard of care of selected IE patients. Indeed, valve surgery can be
a lifesaving procedure in critically ill endocarditis patients. Our goal
from this review is to discuss the indications of surgery in IE population
and international cardiac societies' guideline recommendations. Recent
Findings: Though IE is an uncommon disease, its incidence is noted to be
on rise in some parts of the world, and the disease is expected to
continue to be a major health problem. Antimicrobials remain the mainstay
of IE therapy, but as many as 50% of endocarditis patients will undergo
surgical intervention. Heart failure most commonly from acute valvular
insufficiency, uncontrolled and persistent infection, and recurrent
embolic events are the major indications for valve surgery in IE
population. Heart failure is by far the most common indication for surgery
in IE patients. Despite the fact that many IE patients will require
surgical interventions, most of the international societies'
recommendations to perform valve surgery are based on observational
studies or experts' opinion. Summary: Surgery plays a major role in the
management of IE patients, and it is most commonly performed in patients
with heart failure, persistent or uncontrolled infection, and recurrent
emboli. Most of the current evidence supporting surgical intervention in
IE patients is based on observational studies and experts' opinion.
Randomized clinical trials are urgently needed to guide surgical therapy
in IE. Copyright &#xa9; 2017, Springer Science+Business Media New York.

<68>
Accession Number
614705442
Author
Varelmann D.J.; Muehlschlegel J.D.
Institution
(Varelmann, Muehlschlegel) Brigham and Women's Hospital, Harvard Medical
School, 75 Francis St., CWN L1, Boston, MA 02115, United States
Title
Noteworthy Literature Published in 2016 for the Cardiothoracic
Anesthesiologist.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 21 (1) (pp 8-16),
2017. Date of Publication: 01 Mar 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Clinical research and outcome studies dominated the publication spectrum
for the cardiothoracic anesthesiologist in 2016. Echocardiography is an
important tool in the armamentarium of the cardiothoracic
anesthesiologist. Technology is advancing at a fast pace: A new method to
quantify the regurgitant volume in mitral regurgitation has been described
in an experimental model and been validated in humans. Interesting studies
on key elements of our daily practice have been published: Does tranexamic
acid decrease the transfusion requirements after cardiac surgery? Are
patients with a postoperative cognitive deficit at risk for dementia 7.5
years after surgery? What is the best strategy for post-cardiac surgery
atrial fibrillation? What is the mechanism of preconditioning with
remifentanil? Large multicenter looked at the treatment strategies for
moderate and severe ischemic mitral regurgitation and benefits of
transcatheter aortic valve replacement versus the surgical approach. These
studies may give us ideas on how to tailor treatment to optimize the
patients' outcome and to minimize the associated risks. Copyright &#xa9;
The Author(s) 2016.

<69>
Accession Number
614616356
Author
Dong C.-S.; Zhang J.; Lu Q.; Sun P.; Yu J.-M.; Wu C.; Sun H.
Institution
(Dong, Zhang, Lu, Sun, Yu, Wu, Sun) Third affiliation hospital of Anhui
Medical University, Department of Anesthesiology, Hefei huaihe road No.
390, Hefei 230061, China
Title
Effect of Dexmedetomidine combined with sufentanil for post- thoracotomy
intravenous analgesia: A randomized, controlled clinical study.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 33. Date
of Publication: 01 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Few studies have investigated the use of dexmedetomidine in
patient-controlled intravenous analgesia (PCIA) after thoracic surgery.
This study to evaluate the effect of dexmedetomidine combined with
sufentanil for PCIA after thoracotomy under general anaesthesia. Methods:
Ninety-seven adults patients scheduled for thoracotomy surgery. All two
groups received PCIA with either sufentanil alone (control group) or
combining dexmedetomidine with sufentanil (dexmedetomidine group).
Hemodynamic measurements, visual analog scale (VAS) scores at rest and at
coughing, Ramsay sedation score (RSS), analgesic consumption, and
postoperative nausea and vomiting (PONV) as well as drug-related adverse
effects were compared at 2, 6, 12, 24, 36 and 48 h postoperatively.
Results: In the patients of the dexmedetomidine group, compared to the
control group, the pain scores at rest or at coughing during 48 h
postoperatively were lower (P < 0.001), the sedation scores were lower,
the consumption of sufentanil and rescue meperidine were lower, and the
number of episode of moderate PONV was three times lower. No signs of
toxicity or local complications were observed. There was a non-significant
trend for a lower HR and BP in the dexmedetomidine group vs. Control.
Conclusion: The combining dexmedetomidine with sufentanil for
post-thoracotomy PCIA can improve pain control together with the decrease
in sufentanil requirements, and improve postoperative patient's
satisfaction compared with sufentanil alone in PCIA. Trial Registration:
This trial was retrospectively registered on 27 April 2016 at the Chinese
Clinical Trial Register (number: ChiCTR-ONC-16008376 ). Copyright &#xa9;
2017 The Author(s).

<70>
Accession Number
614678370
Author
Bottet B.; Bouchard F.; Peillon C.; Baste J.-M.
Institution
(Bottet, Peillon, Baste) Department of General and Thoracic Surgery, Rouen
University Hospital, 1 rue de Germont, Rouen Cedex 1 76031, France
(Bouchard) Department of Thoracic and Cardiac Surgery, Rouen University
Hospital, Rouen, France
Title
When and how should we manage thoracic aortic injuries in the modern era?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (6) (pp 970-975),
2016. Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiovascular surgery was written according to a
structured protocol. The question addressed was what are the optimum
treatment modality and timing of intervention for blunt thoracic aortic
injury (BTAI) in the modern era? Of the 697 papers found using the
reported search, 14 (5 meta-Analyses, 2 prospective and 7 retrospective
studies) represented the best evidence to answer the clinical question.
The author, journal, country, date of publication, patient group studied,
study type, relevant outcomes, results and weakness of these papers are
tabulated. All five meta-Analyses reported a reduction in mortality with
thoracic endovascular aortic repair (TEVAR) compared with open repair
(OR), but only four found the same benefit on paraplegia rate. Similarly,
the two prospective and four retrospective studies showed significantly
lower mortality with TEVAR than with OR. Only one study (a meta-Analysis)
reported a significantly lower stroke rate with TEVAR than with OR,
whereas the 13 others reported a similar or even higher stroke rate. Other
complication rates were identical. Four studies demonstrated that
non-operative management (NOM) as a treatment option for BTAI was
associated with increased mortality, even if it has declined in recent
years. One study emphasized that some cases with minimal aortic injuries
(Grade I and II on CT scan) could benefit from NOM. Regarding the timing
of repair, only three studies analysed outcomes of delayed repair and
reported significantly lower mortality than for early repair. We conclude
that with lower mortality and similar overall complications including
paraplegia but higher stroke rate, TEVAR is the most suitable treatment
for BTAI in the modern era, where expertise exists, especially for cases
of multiple associated injuries and in the older age group. Delayed aortic
repair can be proposed based on CT scan analysis, but emergent repair
should still be advocated for imminent free aortic rupture. NOM remains a
therapeutic option but only with selected patients. Copyright &#xa9; The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<71>
Accession Number
614678367
Author
Tsitsias T.; Toufektzian L.; Routledge T.; Pilling J.
Institution
(Tsitsias, Toufektzian, Routledge, Pilling) Department of Thoracic
Surgery, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
Title
Are there recognized prognostic factors for patients undergoing pulmonary
metastasectomy for colorectal carcinoma?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (6) (pp 962-969),
2016. Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether there is a
specific subgroup of patients that would benefit from pulmonary
metastasectomy for colorectal carcinoma (CRC). A total of 524 papers were
identified using the reported search, of which 1 meta-Analysis, 1
systematic review and 17 retrospective studies represented the best
evidence to answer the clinical question. The authors, date, journal,
country, study type, population, outcomes and key results are tabulated.
Single pulmonary metastasis (PM) was identified as an independent
prognostic favourable factor of survival in 5 of the studies (P =
0.059-0.001), whereas in 2 of the retrospective studies there was linear
inverse correlation between the number of PMs and survival (P =
0.005-0.001). The presence of involved hilar and/or mediastinal lymph
nodes was reported as a significant negative prognostic factor on
multivariate analysis in 7 of the studies (P = 0.042 to <0.001), whereas
the level and number of lymph node stations affected were not
statistically significant. Seven studies showed an elevated
pre-Thoracotomy carcinoembrionic antigen (CEA) level (>5 ng/ml) to be a
significant predictor of poor survival (P = 0.047-0.0008). In one of the
studies, sublobar resection (wedge or segmentectomy) was associated with
better survival compared with anatomic resection (P = 0.04). The size of
the tumour (maximum diameter >3.75 cm) was associated with worse survival
in 1 of the studies (P = 0.04), while another one reported size as a
continuous variable to be a prognostic factor of poor survival.
Synchronous chemotherapy (P = 0.027) on one study and neo-Adjuvant
chemotherapy prior to pulmonary metastasectomy (P = 0.0001) on another
were found to be favourable prognostic factors, while disease progression
during chemotherapy was associated with poor outcome in another paper (P <
0.0001). Patients older than 70 years were shown to have a worse prognosis
in one of the studies. Rectal position of the tumour was associated with
worse survival in one of the studies and worse disease-free interval in
another one. Finally, one report showed no significant difference in terms
of overall survival between thoracotomy and video-Assisted thoracoscopic
surgery groups. In conclusion, the prognostic factors for patients
undergoing pulmonary metastasectomy for CRC include the size and number of
metastases, intra-Thoracic lymph node involvement, pre-Thoracotomy CEA
levels and the response to induction chemotherapy. Copyright &#xa9; The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<72>
Accession Number
614744919
Author
Frerker C.; Bestehorn K.; Schluter M.; Bestehorn M.; Hamm C.W.; Mollmann
H.; Katus H.A.; Kuck K.-H.
Institution
(Frerker, Kuck) Department of Cardiology, Asklepios Klinik St. Georg,
Lohmuhlenstr. 5, Hamburg 20099, Germany
(Bestehorn) Technische Universitat Dresden, Dresden, Germany
(Schluter) Asklepios Proresearch, Hamburg, Germany
(Bestehorn) ProMedCon GmbH, Ebenhausen, Germany
(Hamm) Department of Medical Clinic I, University of Giessen, Giessen,
Germany
(Hamm) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
(Mollmann) Department of Cardiology, St. Johannes Hospital, Dortmund,
Dortmund, Germany
(Katus) Center for Internal Medicine, Heidelberg University Hospital,
Heidelberg, Germany
Title
In-hospital mortality in propensity-score matched low-risk patients
undergoing routine isolated surgical or transfemoral transcatheter aortic
valve replacement in 2014 in Germany.
Source
Clinical Research in Cardiology. (pp 1-8), 2017. Date of Publication: 10
Mar 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Aims: Recent randomized trials have documented the superiority of
TAVR-particularly via transfemoral access-over SAVR in patients with
severe aortic stenosis considered to have a high or intermediate operative
risk of death. We sought to assess in-hospital outcomes of patients with
severe aortic stenosis and a low risk of operative mortality undergoing
routine surgical aortic valve replacement (SAVR) or transcatheter aortic
valve replacement (TAVR). Methods and results: We performed a
propensity-score matched comparison of all patients undergoing first-time
treatment by SAVR or transfemoral TAVR (TF-TAVR) in 2014 in Germany who
had a logistic EuroSCORE (logES) < 10%, considered to reflect low surgical
risk. The primary endpoint of our analysis was in-hospital mortality. Of
7624 SAVR and 9969 TF-TAVR procedures, 6844 (89.8%) and 2751 patients
(27.6%), respectively, were considered low risk with a logES between 1.505
and 10.0%. Matching yielded 805 TF-TAVR/SAVR patient pairs with identical
propensity scores and no difference in pertinent baseline characteristics,
except for the logES, which was significantly higher in TF-TAVR patients
(6.8 +/- 1.7 vs. 4.2 +/- 1.3% in SAVR patients, P < 0.001). Observed
in-hospital mortalities were 1.7% (95% confidence interval, 1.1-3.0%) in
SAVR and 2.0% (1.3-3.3%) in TF-TAVR patients (P = 0.85). Conclusion: Our
finding of no difference in in-hospital mortality in propensity-score
matched low-surgical-risk patients treated by SAVR or TF-TAVR in a routine
clinical setting indicates that TF-TAVR can be offered safely to
individual patients, despite their operative risk being low. This finding
needs to be confirmed in a randomized trial. Copyright &#xa9; 2017
Springer-Verlag Berlin Heidelberg

<73>
Accession Number
614738629
Author
Hascoet S.; Fournier E.; Jais X.; Le Gloan L.; Dauphin C.; Houeijeh A.;
Godart F.; Iriart X.; Richard A.; Radojevic J.; Amedro P.; Bosser G.;
Souletie N.; Bernard Y.; Moceri P.; Bouvaist H.; Mauran P.; Barre E.;
Basquin A.; Karsenty C.; Bonnet D.; Iserin L.; Sitbon O.; Petit J.; Fadel
E.; Humbert M.; Ladouceur M.
Institution
(Hascoet, Fournier, Petit) Department of congenital heart diseases, centre
de reference malformations cardiaques congenitales complexes M3C, hopital
Marie-Lannelongue, 133, avenue de la Resistance, 92350 Le
Plessis-Robinson, France
(Hascoet, Fournier, Petit) Faculte de medecine Paris-Sud, universite
Paris-Sud, universite Paris-Saclay, Paris, France
(Fournier, Iriart) Department of congenital heart diseases, centre de
competence M3C, CHU de Bordeaux, Bordeaux, France
(Jais, Sitbon, Humbert) Service de pneumologie, centre de reference de
l'hypertension pulmonaire severe, DHU thorax innovation, hopital Bicetre,
Le Kremlin-Bicetre, France
(Jais, Sitbon, Fadel, Humbert) UMR-S 999, Inserm, hopital
Marie-Lannelongue, universite Paris-Sud, universite Paris-Saclay, Paris,
France
(Le Gloan) Department of cardiology, centre de competence M3C, CHU de
Nantes, Nantes, France
(Dauphin) Department of cardiology, centre de competence M3C, CHU de
Clermont-Ferrand, Clermont-Ferrand, France
(Houeijeh, Godart) Department of paediatric cardiology, centre de
competence M3C, CHRU de Lille, Lille, France
(Richard) Paediatric and adult congenital heart diseases centre, cabinet
Intercard Vendome, Lille, France
(Radojevic) Fetal, paediatric and congenital cardiology, clinique de
l'Orangerie, Strasbourg, France
(Amedro) Paediatric and congenital cardiology department, M3C regional
reference centre, university hospital, physiology and experimental biology
of heart and muscles laboratory, PHYMEDEXP, UMR CNRS 9214-Inserm U1046,
university of Montpellier, Montpellier, France
(Bosser) Department of congenital heart diseases and paediatric
cardiology, centre de competence M3C, CHRU de Nancy, Nancy, France
(Souletie, Karsenty) Department of cardiology, centre de competence M3C,
CHU de Toulouse, Toulouse, France
(Bernard) Department of cardiology, centre de competence M3C, CHU de
Besancon, Besancon, France
(Moceri) Department of cardiology, centre de competence M3C, CHU de Nice,
Nice, France
(Bouvaist) Department of cardiology, centre de competence M3C, CHU de
Grenoble, Grenoble, France
(Mauran) Department of paediatric and congenital cardiology, centre de
competence M3C, American memorial hospital, CHU de Reims, Reims, France
(Barre) Department of paediatric and congenital cardiology, centre de
competence M3C, CHU de Rouen, Rouen, France
(Basquin) Department of cardiology, centre de competence M3C, CHU de
Rennes, Rennes, France
(Karsenty, Iserin, Ladouceur) Adult congenital heart diseases unit,
department of cardiology, centre de reference M3C, hopital europeen
Georges-Pompidou, Assistance publique-Hopitaux de Paris, Paris, France
(Karsenty, Iserin, Ladouceur) Paris cardiovascular research centre
(PARCC), Inserm U970, Paris Descartes University, Paris, France
(Bonnet, Ladouceur) Centre de reference malformations cardiaques
congenitales complexes M3C, hopital universitaire Necker-Enfants-Malades,
Assistance publique-Hopitaux de Paris, universite Paris Descartes,
Sorbonne Paris Cite, Paris, France
(Fadel) Department of thoracic surgery, hopital Marie-Lannelongue,
Plessis-Robinson, France
(Fadel) Faculte de medecine Paris-Sud, universite Paris Sud, universite
Paris-Saclay, Paris, France
Title
Outcome of adults with Eisenmenger syndrome treated with drugs specific to
pulmonary arterial hypertension: A French multicentre study.
Source
Archives of Cardiovascular Diseases. (no pagination), 2017. Date of
Publication: November 27, 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: The relationship between pulmonary arterial
hypertension-specific drug therapy (PAH-SDT) and mortality in Eisenmenger
syndrome (ES) is controversial. Aims: To investigate outcomes in patients
with ES, and their relationship with PAH-SDT. Methods: Retrospective,
observational, nationwide, multicentre cohort study. Results: We included
340 patients with ES: genetic syndrome (n = 119; 35.3%); pretricuspid
defect (n = 75; 22.1%). Overall, 276 (81.2%) patients received PAH-SDT:
monotherapy (endothelin receptor antagonist [ERA] or phosphodiesterase 5
inhibitor [PDE5I]) 46.7%; dual therapy (ERA + PDE5I) 40.9%; triple therapy
(ERA + PDE5I + prostanoid) 9.1%. Median PAH-SDT duration was 5.5 years
[3.0-9.1 years]. Events (death, lung or heart-lung transplantation)
occurred in 95 (27.9%) patients at a median age of 40.5 years [29.4-47.6].
The cumulative occurrence of events was 16.7% [95% confidence interval
12.8-21.6%] and 46.4% [95% confidence interval 38.2-55.4%] at age 40 and
60 years, respectively. With age at evaluation or time since PAH diagnosis
as time scales, cumulative occurrence of events was lower in patients
taking one or two PAH-SDTs (P = 0.0001 and P = 0.004, respectively), with
the largest differences in the post-tricuspid defect subgroup (P <. 0.001
and P <. 0.02, respectively) versus patients without PAH-SDT. By
multivariable Cox analysis, with time since PAH diagnosis as time scale,
New York Heart Association/World Health Organization functional class
III/IV, lower peripheral arterial oxygen saturation and pretricuspid
defect were associated with a higher risk of events (P = 0.002, P = 0.01
and P = 0.04, respectively), and one or two PAH-SDTs with a lower risk of
events (P = 0.009). Conclusions: Outcomes are poor in ES, but seem better
with PAH-SDT. ES with pretricuspid defects has worse outcomes despite the
delayed disease onset. Copyright &#xa9; 2017 Elsevier Masson SAS.

<74>
Accession Number
614735343
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Leprince P.; Cantrelle C.; Audry
B.; Porcher R.; Bastien O.; Dorent R.
Institution
(Jasseron) 1 Agence de la biomedecine, Direction Prelevement Greffe
Organes-Tissus, Saint-Denis La Plaine, France 2 Assistance Publique
Hopitaux de Paris, Service de chirurgie cardio-vasculaire, Hopital de la
Pitie Salpetriere, Paris, France 3 Assistance Publique Hopitaux de Paris,
Hotel-Dieu, Centre d'Epidemiologie Clinique, Universite Paris Descartes,
Inserm U1153, Paris, France
Title
Prediction of Waitlist Mortality in Adult Heart Transplant Candidates: The
Candidate Risk Score.
Source
Transplantation. (no pagination), 2017. Date of Publication: 08 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The cardiac allocation system in France is currently based on
urgency and geography. Medical urgency is defined by therapies without
considering objective patient mortality risk factors. This study aimed to
develop a waitlist mortality risk score from commonly available candidate
variables. METHODS: The study included all patients, aged 16 years or
older, registered on the national registry CRISTAL for first single-organ
heart transplantation between January 2010 and December 2014. This
population was randomly divided in a 2:1 ratio into derivation and
validation cohorts. The association of variables at listing with 1-year
waitlist death or delisting for worsening medical condition was assessed
within the derivation cohort. The predictors were used to generate a
candidate risk score (CRS). Validation of the CRS was performed in the
validation cohort. Concordance probability estimation (CPE) was used to
evaluate the discriminative capacity of the models. RESULTS: During the
study period, 2333 patients were newly listed. The derivation (n=1 555)
and the validation cohorts (n=778) were similar. Short-term mechanical
circulatory support, natriuretic peptide decile, glomerular filtration
rate and total bilirubin level were included in a simplified model and
incorporated into the score. The CPE of the CRS was 0.73 in the derivation
cohort and 0.71 in the validation cohort. The correlation between observed
and expected 1-year waitlist mortality in the validation cohort was 0.87.
CONCLUSIONS: The candidate risk score provides an accurate objective
prediction of waitlist mortality. It is currently being used to develop a
modified cardiac allocation system in France. Copyright &#xa9; 2017
Wolters Kluwer Health, Inc. All rights reserved.

<75>
Accession Number
614710300
Author
Huygens S.A.; Takkenberg J.J.M.; Rutten-van Molken M.P.M.H.
Institution
(Huygens, Takkenberg) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, PO Box 2040, Rotterdam 3000 CA, Netherlands
(Huygens, Rutten-van Molken) Department of Health Policy and
Management/Institute for Medical Technology Assessment, Erasmus University
Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, Rotterdam 3000
DR, Netherlands
Title
Systematic review of model-based economic evaluations of heart valve
implantations.
Source
European Journal of Health Economics. (pp 1-15), 2017. Date of
Publication: 06 Mar 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Objective: To review the evidence on the cost-effectiveness of heart valve
implantations generated by decision analytic models and to assess their
methodological quality. Methods: A systematic review was performed
including model-based cost-effectiveness analyses of heart valve
implantations. Study and model characteristics and cost-effectiveness
results were extracted and the methodological quality was assessed using
the Philips checklist. Results: Fourteen decision-analytic models
regarding the cost-effectiveness of heart valve implantations were
identified. In most studies transcatheter aortic valve implantation (TAVI)
was cost-effective compared to standard treatment (ST) in inoperable or
high-risk operable patients (ICER range 18,421-120,779 ) and in all
studies surgical aortic valve replacement (SAVR) was cost-effective
compared to ST in operable patients (ICER range 14,108-40,944 ), but the
results were not consistent on the cost-effectiveness of TAVI versus SAVR
in high-risk operable patients (ICER range: dominant to dominated by
SAVR). Mechanical mitral valve replacement (MVR) had the lowest costs per
success compared to mitral valve repair and biological MVR. The
methodological quality of the studies was moderate to good. Conclusion:
This review showed that improvements can be made in the description and
justification of methods and data sources, sensitivity analysis on
extrapolation of results, subgroup analyses, consideration of
methodological and structural uncertainty, and consistency (i.e. validity)
of the models. There are several opportunities for future
decision-analytic models of the cost-effectiveness of heart valve
implantations: considering heart valve implantations in other valve
positions besides the aortic valve, using a societal perspective, and
developing patient-simulation models to investigate the impact of patient
characteristics on outcomes. Copyright &#xa9; 2017 The Author(s)

<76>
Accession Number
614703408
Author
van Gelder T.; Fischer L.; Shihab F.; Shipkova M.
Institution
(van Gelder) Departments of Internal Medicine and Hospital Pharmacy,
Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
(Fischer) Department of Hepatobiliary and Transplant Surgery, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Shihab) Division of Nephrology, University of Utah School of Medicine,
Salt Lake City, UT, USA
(Shipkova) Klinikum Stuttgart, Zentralinstitut fur Klinische Chemie und
Laboratoriumsmedizin, Stuttgart, Germany
Title
Optimizing everolimus exposure when combined with calcineurin inhibitors
in solid organ transplantation.
Source
Transplantation Reviews. (no pagination), 2017. Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
The mammalian target of rapamycin (mTOR) inhibitor everolimus is a narrow
therapeutic index drug for which optimal exposure levels are essential.
The consistent pharmacokinetic profile of everolimus allows trough
concentration (C<inf>0</inf>) measurement to be an appropriate and
reliable index for therapeutic drug monitoring (TDM). Exposure-response
analyses of data from early fixed-dose trials demonstrated that rates of
biopsy-proven acute rejection (BPAR) are significantly higher if
everolimus C<inf>0</inf> declines below 3 ng/mL, an observation confirmed
in subsequent concentration-controlled trials. Evidence for the most
favorable upper limit is less clear but with reduced-exposure calcineurin
inhibitor (CNI) therapy, an upper limit of 8 ng/mL appears to balance
efficacy and safety outcomes. The recommended C<inf>0</inf> range is 3-8
ng/mL in kidney, liver and heart transplantation patients, based on
LC-MS/MS monitoring in whole blood. Randomized clinical trials based on
this target range have demonstrated rates of BPAR comparable to a regimen
of mycophenolic acid with standard-exposure CNI. Everolimus exhibits
moderate intrapatient pharmacokinetic variability, and it can be
challenging to maintain stable concentrations within target range in some
individuals. Many factors can influence everolimus exposure for a given
dose, including hepatic function, activity of the drug efflux pump
P-glycoprotein, the rate of everolimus metabolism, drug-drug interactions
(predominantly with CYP3A4 and P-glycoprotein inhibitors, including
cyclosporine), intake of fatty food, and patient adherence to the
prescribed regimen. Trough concentration levels should be monitored
4-5days after the first dose and after any change in everolimus dose, with
additional monitoring in response to any change in concomitant medication
or other clinical circumstances which could alter everolimus exposure.
Although LC-MS/MS is the gold standard for everolimus monitoring, various
immunoassays are widely used due to their relative simplicity and lower
cost, and results can show considerable discrepancies with reference
methods due to issues such as interassay variability and cross-reactivity.
Method standardization will be important in the future to improve the
consistency and reproducibility of results between centers. In conclusion,
based on an extensive program of clinical trials, the optimal exposure
range for everolimus in combination with reduced-exposure CNI therapy has
been established and can be achieved in most transplant recipients through
careful, planned TDM. Copyright &#xa9; 2017 The Authors.

<77>
Accession Number
614698026
Author
Guerrero M.; Wang D.D.; Himbert D.; Urena M.; Pursnani A.; Kaddissi G.;
Iyer V.; Salinger M.; Chakravarty T.; Greenbaum A.; Makkar R.; Vahanian
A.; Feldman T.; O'Neill W.
Institution
(Guerrero, Pursnani, Salinger, Feldman) Department of Medicine, Division
of CardiologyEvanston HospitalEvanston, Illinois
(Wang, Greenbaum, O'Neill) Department of Medicine Division of
CardiologyHenry Ford HospitalDetroit, Michigan
(Himbert, Urena, Vahanian) Cardiology DepartmentBichat-Claude Bernard
HospitalParis France
(Kaddissi) Division of CardiologyCooper University HospitalCamden, New
Jersey
(Iyer) Division of CardiologyBuffalo General Medical CenterBuffalo New
York
(Chakravarty, Makkar) Department of Medicine, Division of CardiologyCedars
Sinai Medical CenterLos Angeles, California
Title
Short-term results of alcohol septal ablation as a bail-out strategy to
treat severe left ventricular outflow tract obstruction after
transcatheter mitral valve replacement in patients with severe mitral
annular calcification.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To evaluate the outcomes of the early experience of
percutaneous alcohol septal ablation in patients with severe left
ventricular outflow tract (LVOT) obstruction post transcatheter mitral
valve replacement (TMVR). Background: Severe LVOT obstruction with
hemodynamic compromise is a complication of TMVR associated with high
mortality. Percutaneous alcohol septal ablation has recently been
described as a therapeutic option in this setting. Methods: Multicenter
retrospective review of clinical outcomes of patients undergoing alcohol
septal ablation to treat LVOT obstruction after TMVR for severe mitral
stenosis with severe mitral annular calcification. Results: Six patients
underwent percutaneous alcohol septal ablation to treat LVOT obstruction
post-TMVR at six different centers. Five patients had immediate
significant reduction in LVOT obstruction with improvement in hemodynamic
status while one had persistent LVOT gradient but hemodynamic instability
improved. The first patient died on postoperative day 4 due to complete
heart block. One patient had initial improvement in LVOT gradient with
recurrence on postoperative day 1 thought to be secondary to septal edema,
was treated with surgical removal of the transcatheter valve and resection
of the anterior mitral leaflet followed by transatrial TMVR and died 3
weeks later due to multi-organ failure. The remaining four patients
improved clinically after alcohol septal ablation, were discharged from
the hospital and were clinically stable at 30-day follow-up. Conclusions:
Percutaneous alcohol ablation provides acute relief of TMVR-induced LVOT
obstruction when septal hypertrophy is a contributing factor. This may be
a safer alternative to bail-out surgery in this extremely high-risk
patient population. Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<78>
Accession Number
614696019
Author
Saw J.; Fahmy P.; Azzalini L.; Marquis J.-F.; Hibbert B.; Morillo C.;
Carrizo A.; Ibrahim R.
Institution
(Saw, Fahmy) Division of Cardiology, Vancouver General Hospital University
of British Columbia Vancouver, British Columbia Canada
(Azzalini, Ibrahim) Division of Cardiology Montreal Heart Institute
Montreal, Quebec Canada
(Marquis, Hibbert) Division of Cardiology Ottawa Heart Institute Ottawa,
Ontario Canada
(Morillo, Carrizo) Division of Cardiology Hamilton General Hospital
Hamilton, Ontario Canada
Title
Early Canadian Multicenter Experience With WATCHMAN for Percutaneous Left
Atrial Appendage Closure.
Source
Journal of Cardiovascular Electrophysiology. (no pagination), 2017. Date
of Publication: 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Percutaneous Left Atrial Appendage Closure: Background: There are limited
data with WATCHMAN (Boston Scientific Corporation, Natick, MA, USA) for
left atrial appendage (LAA) closure in patients with nonvalvular atrial
fibrillation (AF) and contraindications to anticoagulation. The purpose of
this study was to evaluate the safety and efficacy of WATCHMAN in our
early Canadian experience. Methods: We report our pooled consecutive
series of patients who underwent WATCHMAN implantation at four major
Canadian centers. Indications for LAA closure were CHADS<inf>2</inf> > 1
or CHA<inf>2</inf>DS<inf>2</inf>-VASc > 2, and
contraindication/intolerance to or failure on anticoagulation. Follow-up
imaging was typically performed 1-6 months postprocedure. Results: One
hundred and six patients underwent LAA closure with WATCHMAN from May 2013
to October 2015. The mean age was 74.8 +/- 7.7, mean CHADS<inf>2</inf>
score was 2.8 +/- 1.2, CHA<inf>2</inf>DS<inf>2</inf>-VASc score was 4.3
+/- 1.5, and HASBLED score was 3.2 +/- 1.2. Permanent AF was present in
67.9% and paroxysmal AF in 32.1%. Indications for LAA closure were prior
bleeding 89.6% (87 major bleeding and 8 minor bleeding), 9.4% were deemed
high risk for bleeding, and 0.9% with recurrent strokes on warfarin.
Procedural success was 97.2% (103 of 106), with one device embolization
(snared percutaneously), one implant failure due to inadequate LAA depth,
and one cardiac perforation requiring surgical repair before WATCHMAN
implantation. The composite major safety event-rate was 1.9% (1 death and
1 device embolization). Mean hospital stay was 1.8 +/- 4.7 days.
Antithrombotic therapy postimplant included dual antiplatelet therapy in
76 of 103 (73.8%). Mean follow-up was 210 +/- 182 days; there were two
transient ischemic attacks, with estimated 66% reduction in thromboembolic
events relative to CHADS<inf>2</inf> predicted risk. Conclusion: In our
early Canadian experience, WATCHMAN for LAA closure in patients
contraindicated to anticoagulation appeared safe and effective. Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<79>
Accession Number
614692569
Author
Kristensen A.W.; Mortensen J.; Berg R.M.G.
Institution
(Kristensen, Mortensen) Department of Clinical Physiology, Nuclear
Medicine and PET University Hospital Rigshospitalet Copenhagen Denmark
(Berg) Department of Clinical Physiology and Nuclear Medicine Bispebjerg
and Frederiksberg Hospitals Copenhagen Denmark
Title
Pulmonary thromboembolism as a complication of lung transplantation.
Source
Clinical Transplantation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Post-transplantation mortality after lung transplantation (LTX) is higher
than for other solid organ transplantations. Thoracic surgery is
associated with increased risk of thromboembolic complications, and as LTX
recipients lack the collateral bronchial circulation, pulmonary
thromboembolism (PTE) may represent a pertinent yet largely underdiagnosed
cause of post-transplantation respiratory failure. In this systematic
review, we sought to elucidate the occurrence and predilection site of PTE
after LTX, and its potential impact on LTX-associated mortality. Based on
twelve original articles identified by a systematic search strategy in
PubMed, we found that PTE was reported in 4% of LTX recipients, and 38% of
these events occurred within the first 30 days after the LTX procedure. In
single-lung transplantation (SLTX) recipients, 12% were diagnosed with
PTE, with 92% of these affecting the allograft. Of LTX patients diagnosed
with PTE, 11% died within 1 year after LTX and 75% of these deaths
occurred within the first 30 days. Our findings suggest that PTE is a
potentially underdiagnosed cause of early post-LTX respiratory failure.
This should be confirmed in larger studies with systematic follow-up
diagnostic imaging. Copyright &#xa9; 2017 John Wiley & Sons A/S.

<80>
Accession Number
614681390
Author
Kohman L.J.; Gu L.; Altorki N.; Scalzetti E.; Veit L.J.; Wallen J.M.; Wang
X.
Institution
(Kohman, Veit, Wallen) Department of Surgery, State University of New York
Upstate Medical University, Syracuse, NY
(Gu, Wang) Alliance Statistics and Data Center, Duke University Medical
Center, Durham, NC
(Altorki) Department of Surgery, Weill Cornell Medicine, New York
Presbyterian Hospital, New York, NY
(Scalzetti) Department of Radiology, State University of New York Upstate
Medical University, Syracuse, NY
Title
Biopsy first: Lessons learned from Cancer and Leukemia Group B (CALGB)
140503.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: June 21, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Cancer and Leukemia Group B 140503 is an ongoing, multicenter
randomized trial assessing whether sublobar resection is equivalent to
lobectomy for the treatment of stage I A non-small cell lung cancer
(NSCLC) <2 cm in diameter. The objective of this report is to determine
the reasons precluding intraoperative randomization. Methods: From June
15, 2007, to March 22, 2013, 637 patients were preregistered to the trial.
Three hundred eighty-nine were randomized successfully (61%), and 248
patients were not randomized (39%). We analyzed the reasons for
nonrandomization among a subset of the nonrandomized patients (208) for
whom additional data were available. Results: Of these 208 patients,
undiagnosed benign nodules (n =104, 16% of all registered patients) and
understaging of NSCLC (n =45, 7% of all registered patients) were the
dominant reasons precluding randomization. Granulomas represent
one-quarter of the benign nodules. The understaged patients had
unsuspected nodal metastases (n =28) or other more advanced NSCLC. The
rate of randomization was significantly greater in those patients who had
a preoperative biopsy (P <.001). Conclusions: In a carefully monitored
cohort of patients with suspected small NSCLC <2 cm, a substantial number
are misdiagnosed (benign nodules) or understaged. These patients may not
have benefited from a thoracic surgical procedure. Preoperative biopsy
significantly increased the rate of correct diagnosis. Preoperative biopsy
of small suspected NSCLC will reduce the number of nontherapeutic or
unnecessary thoracic procedures. Accuracy in preoperative diagnosis is
increasingly important as more such small nodules are discovered through
lung cancer screening. Copyright &#xa9; 2017 The American Association for
Thoracic Surgery.

<81>
Accession Number
614676289
Author
Berger J.T.; Holubkov R.; Reeder R.; Wessel D.L.; Meert K.; Berg R.A.;
Bell M.J.; Tamburro R.; Dean J.M.; Pollack M.M.
Institution
(Berger, Wessel, Pollack) Department of Pediatrics, Children's National
Medical Center, Washington, DC
(Holubkov, Reeder) Department of Pediatrics, University of Utah School of
Medicine, Salt Lake City, Utah
(Meert, Dean) Department of Pediatrics, Children's Hospital of Michigan,
Detroit, Mich
(Berg) Department of Pediatrics, Children's Hospital of Philadelphia,
Philadelphia, Pa
(Bell) Department of Critical Care Medicine, Children's Hospital of
Philadelphia, Philadelphia, Pa
(Tamburro) Pediatric Trauma and Critical Illness Branch, Eunice Kennedy
Shriver National Institute of Child Health and Human Development, the
National Institutes of Health, Bethesda, Md
(Pollack) George Washington University School of Medicine and Health
Sciences, Washington, DC
Title
Morbidity and mortality prediction in pediatric heart surgery:
Physiological profiles and surgical complexity.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: May 02, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Outcome prediction for pediatric heart surgery has focused on
mortality but mortality has been significantly reduced over the past 2
decades. Clinical care practices now emphasize reducing morbidity.
Physiology-based profiles assessed by the Pediatric Risk of Mortality
(PRISM) score are associated with new significant functional morbidity
detected at hospital discharge. Our aims were to assess the relationship
between new functional morbidity and surgical risk categories (Risk
Adjustment for Congenital Heart Surgery [RACHS] and Society for Thoracic
Surgery Congenital Heart Surgery Database Mortality Risk [STAT]), measure
the performance of 3-level (intact survival, survival with new functional
morbidity, or death) and 2-level (survival or death) PRISM prediction
algorithms, and assess whether including RACHS or STAT complexity
categories improves the PRISM predictive performance. Methods: Patients
(newborn to age 18 years) were randomly selected from 7 sites (December
2011-April 2013). Morbidity (using the Functional Status Scale) and
mortality were assessed at hospital discharge. The most recently published
PRISM algorithms were tested for goodness of fit, and discrimination with
and without the RACHS and STAT complexity categories. Results: The
mortality rate in the 1550 patients was 3.2%. Significant new functional
morbidity rate occurred in 4.8%, increasing from 1.8% to 13.9%, 1.7%, and
12.9% from the lowest to the highest RACHS and STAT categories,
respectively. The 3-level and 2-level PRISM models had satisfactory
goodness of fit and substantial discriminative ability. Inclusion of RACHS
and STAT complexity categories did not improve model performance.
Conclusions: Both mortality and new, functional morbidity are important
outcomes associated with surgical complexity and can be predicted using
PRISM algorithms. Adding surgical complexity to the physiologic profiles
does not improve predictor performance. Copyright &#xa9; 2017 The American
Association for Thoracic Surgery.