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<1>
Accession Number
613675060
Author
Khorasani H.; Lassen M.H.; Kuzon W.; Bonde C.
Institution
(Khorasani, Lassen, Bonde) Department of Plastic Surgery, Breast Surgery
and Burns, Section 2102, Centre of Head and Orthopaedics, Rigshospitalet,
Copenhagen University Hospital, Denmark
(Kuzon) Section of Plastic Surgery, University of Michigan, Ann Arbor, MI,
United States
Title
Scientific impact of presentations from the EURAPS and the AAPS meetings:
A 10-year review.
Source
Journal of Plastic, Reconstructive and Aesthetic Surgery. 70 (1) (pp
31-36), 2017. Date of Publication: 01 Jan 2017.
Publisher
Churchill Livingstone
Abstract
Introduction Presentation at scientific meetings is the usual first step
to communicate new research findings. However, without subsequent,
peer-reviewed publication, the wider propagation and the permanent
documentation of important scholarly work may be lost. Our aim was to
analyze and compare the publication status of the work presented at the
European Association of Plastic Surgeons' (EURAPS) and at the American
Association of Plastic Surgeons' (AAPS) annual meetings. Materials and
methods By using the abstract booklets from the annual meetings, all
presentations given over a 10-year period (2000-2009) were analyzed. A
search using PubMed and Google Scholar was performed to obtain publication
status of each presentation as of 2014 (observation period: 5 years). Data
were analyzed according to subspecialty. Weighted chi-square was used to
examine differences in publication rates for the two societies and for
English speaking vs. non-English speaking countries. Results Seventy-two
percent (n = 246) of the abstracts from the AAPS were published in
peer-reviewed journals. The most published subspecialty was "Craniofacial
surgery" followed by "Breast surgery." Mean time to publication was 22.1
months (range -72-111 months). The most common journal for publication was
Plastic and Reconstructive Surgery (PRS). Sixty-seven percent (n = 449) of
the EURAPS abstracts were published in peer-reviewed journals. The most
published subspecialty was "Microsurgery" followed by "Clinical studies."
The mean time to publication was 17.3 months (range -67-111 months). The
most common journal for publication was PRS. Differences between the two
societies' publication status were not observed (p = 0.157), but EURAPS
abstracts had a significantly shorter time to publication (p = 0.007).
Differences between English-speaking and non-English-speaking countries
were not observed (p = 0.931). Mean level of evidence for published
studies from the AAPS and the EURAPS meetings was 3.5 and 3.7,
respectively. Conclusion A majority of the presented abstracts from both
societies have resulted in publication. After "The Society for
Cardiothoracic Surgery," AAPS and EURAPS have the highest publication
rates for surgical abstracts, indicating a high scientific value of these
meetings.
Copyright &#xa9; 2016 British Association of Plastic, Reconstructive and
Aesthetic Surgeons

<2>
Accession Number
605254074
Author
Abdelrahman A.M.; Bingener J.; Yu D.; Lowndes B.R.; Mohamed A.; McConico
A.L.; Hallbeck M.S.
Institution
(Abdelrahman, Yu, Lowndes, Hallbeck) Robert D. and Patricia E. Kern Center
for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN,
United States
(Bingener, Mohamed, McConico, Hallbeck) Department of Surgery, Mayo
Clinic, Rochester, MN, United States
(Abdelrahman, Yu, Lowndes, Mohamed, Hallbeck) Division of Health Care
Policy and Research, Department of Health Sciences Research, Mayo Clinic,
200 First Street SW, Rochester, MN 55905, United States
Title
Impact of single-incision laparoscopic cholecystectomy (SILC) versus
conventional laparoscopic cholecystectomy (CLC) procedures on surgeon
stress and workload: a randomized controlled trial.
Source
Surgical Endoscopy and Other Interventional Techniques. 30 (3) (pp
1205-1211), 2016. Date of Publication: 01 Mar 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Introduction: Single-incision laparoscopic cholecystectomy (SILC) may lead
to higher patient satisfaction; however, SILC may expose the surgeon to
increased workload. The goal of this study was to compare surgeon stress
and workload between SILC and conventional laparoscopic cholecystectomy
(CLC). Methods: During a double-blind randomized controlled trial
comparing patient outcomes for SILC versus CLC (NCT0148943), surgeon
workload was assessed by four measures: surgery task load index
questionnaire (Surg-TLX), maximum heart rate, salivary cortisol level, and
instruments usability survey. The maximum heart rate and salivary cortisol
levels were sampled from the surgeon before the random assignment of the
surgical procedure, intraoperatively after the cystic duct was clipped,
and at skin closure. After each procedure, the surgeon completed the
Surg-TLX and an instrument usability survey. Student's t tests, Wilcoxon
rank sum test, and Kruskal-Wallis nonparametric ANOVAs on the dependent
variables by the technique (SILC vs. CLC) were performed with alpha =
0.05. Results: Twenty-three SILC and 25 CLC procedures were included in
the intent-to-treat analysis. No significant differences were observed
between SILC and CLC for patient demographics and procedure duration. SILC
had significantly higher post-surgery surgeon maximum heart rates than CLC
(p < 0.05). SILC also had significantly higher mean change in the maximum
heart rate between during and post-procedure (p < 0.05) than CLC. Salivary
cortisol level was significantly higher during SILC than CLC (p < 0.01).
Awkward manipulation of the instruments and limited fine motions were
reported significantly more frequently with SILC than CLC (p < 0.01). In
the surgeon-reported Surg-TLX, subscale of physical demand was
significantly more demanding for SILC than CLC (p < 0.05). Conclusions:
Surgeon heart rate, salivary cortisol level, instrument usability, and
Surg-TLX ratings indicate that SILC is significantly more stressful and
physically demanding than the CLC. Surgeon stress and workload may impact
patients' outcomes; thus, ergonomic improvement on SILC is necessary.
Copyright &#xa9; 2015, The Author(s).

<3>
Accession Number
611357701
Author
Patel N.; Minhas J.S.; Chung E.M.L.
Institution
(Patel, Minhas, Chung) University of Leicester, RKCSB, Leicester Royal
Infirmary, Leicester LE2 7LX, United Kingdom
Title
Intraoperative embolization and cognitive decline after cardiac surgery: A
systematic review.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 20 (3) (pp 225-231),
2016. Date of Publication: 01 Sep 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Since the advent of cardiac surgery, complications have existed in many
forms. Recent work has focused on the safety of current cardiac surgery
with particular emphasis on cognitive outcomes. Cardiopulmonary bypass has
improved the safety of operative practice; however, increasing concern
surrounds the measurable and immeasurable impact embolization has on the
brain. New ischemic lesions have been associated with distant emboli,
which intraoperatively enter the cardiovascular system. This has prompted
better characterization of the nature of emboli manifesting as cognitive
impairment postoperatively. The difficulty in attributing causation
relates to the subclinical damage that does not necessarily manifest as
clinical stroke. Transcranial Doppler has become an important tool in
documenting cerebral emboli during surgery. The purpose of this systematic
review is to focus on the current literature to improve our understanding
of the impact embolization has on the brain. We also aim to investigate
which cardiac interventions hold the greatest burden of embolic load and
how previous literature has investigated the impact of emboli on cognition
by monitoring emboli during specific cardiac interventions. Significant
intraoperative factors such as the cardiopulmonary bypass machine and
surgical interventions have been highlighted to summarize the current
literature associating cerebral embolization with these factors and
postoperative cognitive outcomes. The findings of this review report that
the current literature is divided as to whether the impact of embolization
during cardiac surgery has any adverse impact on cognition. This review
highlights that the ultimate goal of improving cognitive safety will
involve further careful consideration of multifactorial events.
Copyright &#xa9; SAGE Publications.

<4>
Accession Number
606026172
Author
Roth C.; Berger R.; Scherzer S.; Krenn L.; Gangl C.; Dalos D.; Delle-Karth
G.; Neunteufl T.
Institution
(Roth, Berger, Scherzer, Krenn, Gangl, Dalos, Delle-Karth, Neunteufl)
Department of Internal Medicine II, Cardiology, Medical University of
Vienna, Vienna, Austria
(Berger) Department of Internal Medicine I, Cardiology and Nephrology,
Hospital of St. John of God, Eisenstadt, Austria
(Delle-Karth) Department of Internal Medicine IV, Cardiology, Hospital of
Hietzing, Vienna, Austria
(Neunteufl) Department of Internal Medicine I, Cardiology, University
Hospital of Krems, Krems an der Donau, Austria
(Neunteufl) Karl Landsteiner Private University for Health Sciences, Krems
an der Donau, Austria
Title
Comparison of magnetic wire navigation with the conventional wire
technique for percutaneous coronary intervention of chronic total
occlusions: a randomised, controlled study.
Source
Heart and Vessels. 31 (8) (pp 1266-1276), 2016. Date of Publication: 01
Aug 2016.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Wire crossing of a chronic total coronary occlusion (CTO) is time
consuming and limited by the amount of contrast agent and time of
radiation exposure. Magnetic wire navigation (MWN) might accelerate wire
crossing by maintaining a coaxial vessel orientation. This study compares
MWN with the conventional approach for recanalization of CTOs. Forty
symptomatic patients with CTO were randomised to MWN (n = 20) or
conventional approach (n = 20) for antegrade crossing of the occlusion. In
the intention-to-treat analysis, MWN showed a shorter crossing time (412
versus 1131 s; p = 0.001), and, consequently, lower usage of contrast
agent (primary endpoint 42 versus 116 ml; p = 0.01), and lower radiation
exposure (dose-area product: 29 versus 80 Gy*cm²; p = 0.002)
during wire crossing compared to the conventional approach. Accordingly,
in the per-protocol analysis, the wire-crossing rate was, in trend, higher
using the conventional approach (17 of 31) compared to MWN (9 of 28; p =
0.08). The use of MWN for revascularisation of CTOs is feasible and
reduces crossing time, use of contrast agent, and radiation exposure.
However, due to a broader selection of wires, the conventional approach
enables wire crossing in cases failed by MWN and seems to be the more
successful choice.
Copyright &#xa9; 2015, Springer Japan.

<5>
Accession Number
609835072
Author
Gavina C.; Falcao-Pires I.; Pinho P.; Manso M.-C.; Goncalves A.;
Rocha-Goncalves F.; Leite-Moreira A.
Institution
(Gavina, Goncalves, Rocha-Goncalves) Department of Medicine, Faculty of
Medicine, University of Porto, Porto, Portugal
(Falcao-Pires, Leite-Moreira) Department of Physiology and Cardiothoracic
Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
(Pinho, Leite-Moreira) Department of Cardiothoracic Surgery, Centro
Hospitalar Sao Joao, Porto, Portugal
(Manso) Department of Biostatistics, Faculty of Health Sciences,
University Fernando Pessoa - CIAGEB-UFP, Porto, Portugal
(Manso) REQUIMTE, University of Porto, Porto, Portugal
Title
Relevance of residual left ventricular hypertrophy after surgery for
isolated aortic stenosis.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 952-959), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Persistent left ventricular (LV) hypertrophy after surgery is
frequent, but its clinical relevance is controversial. We evaluated if
residual LV hypertrophy (LVH) is associated with clinical outcomes after
aortic valve replacement (AVR) for severe aortic stenosis (AS). METHODS:
We analysed clinical and echocardiographic parameters before and after
AVR, in a prospective cohort of 132 patients with severe AS. The mean
follow-up was 6.0 +/- 1.5 years. Clinical endpoints were all-cause death
and combination of as in all-cause death and non-fatal cardiovascular
hospitalization. At AVR, myocardial biopsies for collagen volume fraction
(CVF) evaluation were done in 56 random patients. RESULTS: Residual LVH
was present in 44% of patients after AVR. Patients with residual LVH were
older, more frequently women and had hypertension (HT). Preoperatively,
they had higher LV mass indices (LVMI), higher E/e' and left atrial volume
indices, as well as lower peak systolic annular velocity. Female gender,
HT, LVMI and E/e' were independent predictors of persistent LVH. CVF at
the time of surgery was higher in those with residual LVH (20.0 +/- 14.6
vs 13.2 +/- 11.5%, P = 0.027). The risk of all-cause death and non-fatal
cardiovascular hospitalization was higher in patients with residual LVH
[OR 2.89 (95% CI 1.12-7.44); P = 0.035], but there were no differences in
all-cause mortality. Residual LVH was associated with a worse outcome in
women but not in men. CONCLUSIONS: Residual LVH after AVR is common and is
associated with worse prognosis, particularly in women. In addition, HT,
higher baseline LVM and worse diastolic dysfunction can help to identify
patients at risk for incomplete normalization of LVM.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<6>
Accession Number
611526920
Author
Naito R.; Miyauchi K.; Daida H.; Morimoto T.; Hiro T.; Kimura T.; Nakagawa
Y.; Yamagishi M.; Ozaki Y.; Matsuzaki M.
Institution
(Naito, Miyauchi, Daida) Department of Cardiovascular Medicine, Juntendo
University School of Medicine, Tokyo, Japan
(Morimoto) Division of General Medicine, Department of Internal Medicine,
Hyogo College of Medicine, Hyogo, Japan
(Hiro) Division of Cardiology, Department of Medicine, Nihon University
School of Medicine, Tokyo, Japan
(Kimura) Department of Cardiovascular Medicine, Kyoto University Graduate
School of Medicine, Kyoto, Japan
(Nakagawa) Department of Cardiology, Tenri Hospital, Nara, Japan
(Yamagishi) Division of Cardiovascular Medicine, Kanazawa University
Graduate School of Medicine, Kanazawa, Japan
(Ozaki) Division of Cardiology, Fujita Health University, Toyoake, Japan
(Matsuzaki) Division of Cardiology, Department of Medicine and Clinical
Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
Title
Impact of total risk management on coronary plaque regression in diabetic
patients with acute coronary syndrome.
Source
Journal of Atherosclerosis and Thrombosis. 23 (8) (pp 922-931), 2016. Date
of Publication: 2016.
Publisher
Japan Atherosclerosis Society
Abstract
Aim: Diabetic patients with coronary artery disease have a high incidence
of cardiovascular events, which was associated with increased coronary
plaque volume. Low-density lipoprotein cholesterol (LDL-C) and blood
pressure (BP) play pivotal roles in the progression of coronary plaque.
Several trials have shown that intervention for a single risk factor
reduced the development of coronary plaque progression. However, it
remained uncertain whether total risk management for LDL-C, BP, and
glycosylated Hb (HbA1c) has a beneficial effect on coronary plaque volume
in diabetic patients. Methods: This study was a sub-study of the JAPAN-ACS
that was a prospective, randomized, openlabel trial that evaluated the
impact of intensive lipid-lowering therapy on coronary plaque volume in
patients with acute coronary syndrome (ACS). Among a total of 252
patients, 73 diabetic patients were analyzed. We examined the impact of
total risk management (LDL-C <80 mg/dL, systolic BP <130 mmHg, and HbA1c
<6.5%) on changes in coronary plaque volume. The patients were divided
into four groups according to the number of risk factors that achieved the
target value. Results: Baseline characteristics were similar among the
groups. The degree of coronary plaque regression was greater in patients
who achieved total risk management. The number of risk factors that
achieved the target level was associated with the extent of the coronary
plaque volume reduction in a dose-dependent manner. Conclusion: Total risk
management that focused on LDL-C, BP, and HbA1c had a beneficial impact on
the coronary plaque regression in diabetic patients with ACS.
Copyright &#xa9; 2016 Japan Atherosclerosis Society.

<7>
Accession Number
613928599
Author
Rafiq S.; Steinbruchel D.A.; Lilleor N.B.; Moller C.H.; Lund J.T.; Thiis
J.J.; Kober L.; Olsen P.S.
Institution
(Rafiq, Steinbruchel, Lilleor, Moller, Lund, Thiis, Olsen) Department of
Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen
University Hospital, Blegdamsvej 9, Copenhagen O 2100, Denmark
(Kober) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Blegdamsvej 9, Copenhagen O 2100, Denmark
Title
Antithrombotic therapy after bioprosthetic aortic valve implantation:
Warfarin versus aspirin, a randomized controlled trial.
Source
Thrombosis Research. 150 (pp 104-110), 2017. Date of Publication: 01 Feb
2017.
Publisher
Elsevier Ltd
Abstract
Background The optimal medical strategy for prevention of thromboembolic
events after surgical bioprosthetic aortic valve replacement (BAVR) is
still debated. The objective of this study was to compare warfarin therapy
(target INR of 2.0 to 3.0) with aspirin 150 mg daily as antithrombotic
therapy for the first three months after BAVR with or without concomitant
coronary artery bypass grafting (CABG). The aim was to evaluate
thromboembolic complications, major bleeding complications and death.
Materials and methods Prospective, single-centre, open-label, randomized
controlled trial. 370 patients were enrolled, 328 were available for data
analysis. Results At baseline the warfarin and aspirin groups were
comparable. Thromboembolic events were comparable between groups 11 (6.6%)
vs. 12 (7.5%), p = 0.83. Major bleeding events occurred numerically more
often in warfarin patients 9 (5.4%) vs. 3 (1.9%), p = 0.14. Warfarin was
in multivariate analysis significantly associated with major bleeding OR
5.18 (CI 1.06-25.43), p = 0.043. 90-day mortality was comparable between
groups 8 (4.7%) vs. 6 (3.7%), p = 0.79. Conclusions Our results suggest
that aspirin might be equally effective as warfarin in preventing
thromboembolic events after BAVR, but with less major bleedings. Although
this is numerically the largest trial testing this hypothesis in a
prospective randomized trial, further adequately powered studies are
warranted.
Copyright &#xa9; 2016 Elsevier Ltd

<8>
Accession Number
615509473
Author
Lonborg J.; Engstrom T.; Kelbaek H.; Helqvist S.; Klovgaard L.; Holmvang
L.; Pedersen F.; Jorgensen E.; Saunamaki K.; Clemmensen P.; De Backer O.;
Ravkilde J.; Tilsted H.-H.; Villadsen A.B.; Aaroe J.; Jensen S.E.;
Raungaard B.; Kober L.; Hofsten D.E.
Institution
(Lonborg, Engstrom, Helqvist, Klovgaard, Holmvang, Jorgensen, Saunamaki,
De Backer, Tilsted, Kober, Hofsten) Department of Cardiology,
Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100,
Denmark
(Kelbaek, Clemmensen) Department of Cardiology, Roskilde Hospital, Denmark
(Pedersen) Department of Cardiology, Nykoebing Falster Hospital, Denmark
(Ravkilde, Villadsen, Aaroe, Jensen, Raungaard) Department of Cardiology,
Aalborg University Hospital, Denmark
Title
Fractional Flow Reserve-Guided Complete Revascularization Improves the
Prognosis in Patients with ST-Segment-Elevation Myocardial Infarction and
Severe Nonculprit Disease.
Source
Circulation: Cardiovascular Interventions. 10 (4) (no pagination), 2017.
Article Number: e004460. Date of Publication: 01 Apr 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The impact of disease severity on the outcome after complete
revascularization in patients with ST-segment-elevation myocardial
infarction and multivessel disease is uncertain. The objective of this
post hoc study was to evaluate the impact of number of diseased vessel,
lesion location, and severity of the noninfarct-related stenosis on the
effect of fractional flow reserve-guided complete revascularization.
Methods and Results - In the DANAMI-3-PRIMULTI study (Primary PCI in
Patients With ST-Elevation Myocardial Infarction and Multivessel Disease:
Treatment of Culprit Lesion Only or Complete Revascularization), we
randomized 627 ST-segment-elevation myocardial infarction patients to
fractional flow reserve-guided complete revascularization or
infarct-related percutaneous coronary intervention only. In patients with
3-vessel disease, fractional flow reserve-guided complete
revascularization reduced the primary end point (all-cause mortality,
reinfarction, and ischemia-driven revascularization; hazard ratio [HR],
0.33; 95% confidence interval [CI], 0.17-0.64; P=0.001), with no
significant effect in patients with 2-vessel disease (HR, 0.77; 95% CI,
0.47-1.26; P=0.29; P for interaction =0.046). A similar effect was
observed in patients with diameter stenosis >90% of noninfarct-related
arteries (HR, 0.32; 95% CI, 0.18-0.62; P=0.001), but not in patients with
less severe lesions (HR, 0.72; 95% CI, 0.44-1.19; P=0.21; P for
interaction =0.06). The effect was most pronounced in patients with
3-vessel disease and noninfarct-related stenoses >90%, and in this
subgroup, there was a nonsignificant reduction in the end point of
mortality and reinfarction (HR, 0.32; 95% CI, 0.08-1.32; P=0.09). Proximal
versus distal location did not influence the benefit from complete
revascularization. Conclusions - The benefit from fractional flow
reserve-guided complete revascularization in ST-segment-elevation
myocardial infarction patients with multivessel disease was dependent on
the presence of 3-vessel disease and noninfarct diameter stenosis >90% and
was particularly pronounced in patients with both of these angiographic
characteristics. Clinical Trial Registration - URL:
http://www.clinicaltrials.gov. Unique identifier: NCT01960933.
Copyright &#xa9; 2017 American Heart Association, Inc.

<9>
[Use Link to view the full text]
Accession Number
613274162
Author
Etchill E.W.; Myers S.P.; Raval J.S.; Hassoune A.; Sengupta A.; Neal M.D.
Institution
(Etchill, Myers, Neal) Division of Trauma and Acute Care Surgery,
Department of Surgery, PUH 200 Lothrop Street, Pittsburgh, PA 15213,
United States
(Raval) University of North Carolina School of Medicine, Chapel Hill, NC,
United States
(Hassoune) American University of Beirut, Beirut, Lebanon
(Sengupta) Case Western Reserve University, Cleveland, OH, United States
Title
Platelet Transfusion in Critical Care and Surgery: Evidence-Based Review
of Contemporary Practice and Future Directions.
Source
Shock. 47 (5) (pp 537-549), 2017. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Thrombocytopenia is prevalent in critical care, surgical, and trauma
settings. Despite the fact that a significant proportion of these patients
receive platelet transfusion during their hospital course, much work
remains to be done with regard to development of platelet transfusion
guidelines. Given the wide variety of platelet transfusion practices and
the frequency with which patients present with thrombocytopenia, it is
paramount to understand standards of care and to identify deficiencies
that may exist. This review explores evidence and recommendations for
platelet transfusion thresholds and practices in a variety of critical
care and surgical settings with specific focus on the role of platelet
transfusion in trauma, management and reversal of anticoagulation, and
point of care laboratory assays. To this end, a literature review was
performed utilizing PubMed and Cochrane Central Register of Controlled
Trials to select 153 manuscripts that evaluate the current data supporting
platelet transfusions in surgical and critical care populations. Advances
in transfusion medicine and synthetic platelet substitutes that can be
engineered for potential future applications will also be discussed.
Copyright &#xa9; 2016 by the Shock Society.

<10>
Accession Number
614230602
Author
Tamura T.; Mori S.; Mori A.; Ando M.; Yokota S.; Shibata Y.; Nishiwaki K.
Institution
(Tamura, Yokota) Division of Anesthesia, Japanese Red Cross Nagoya Daiichi
Hospital, Nagoya, Japan
(Tamura, Shibata, Nishiwaki) Department of Anesthesiology, Nagoya
University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya
466-8550, Japan
(Mori) Division of Thoracic Surgery, Japanese Red Cross Nagoya Daiichi
Hospital, Nagoya, Japan
(Mori) Department of Perioperative Management System, Nagoya University
Graduate School of Medicine, Nagoya, Japan
(Ando) Center for Advanced Medicine and Clinical Research, Nagoya
University Hospital, Nagoya, Japan
Title
A randomized controlled trial comparing paravertebral block via the
surgical field with thoracic epidural block using ropivacaine for
post-thoracotomy pain relief.
Source
Journal of Anesthesia. 31 (2) (pp 263-270), 2017. Date of Publication: 01
Apr 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: We conducted a comparative study to evaluate analgesic efficacy
between paravertebral block via the surgical field (PVB-sf), in which the
catheter was inserted into the ventral side of the sympathetic trunk in
the paravertebral space by a thoracic surgeon under thoracoscopic
visualization, and epidural block (Epi) using ropivacaine for
post-thoracotomy pain relief. Methods: Lung cancer patients scheduled for
lobectomy via thoracotomy were randomly allocated to receive either PVB-sf
or Epi (n = 36 per group). Before thoracotomy closure, 0.375% ropivacaine
was administered as a bolus (PVB-sf, 20 mL; Epi, 5 mL), followed by a
300-mL continuous infusion of 0.2% ropivacaine at 5 mL/h. Postoperative
pain was assessed using a visual analog scale (VAS) score at various time
points, including the primary endpoint of 2 h after ropivacaine bolus
injection. Sensory block area, vital signs, serum ropivacaine
concentrations, and side effects were also evaluated. Results: The Epi
group showed significantly lower VAS scores and blood pressure and a wider
sensory block area than the PVB-sf group at all evaluation time points.
While the mean serum ropivacaine concentration in the PVB-sf group was
significantly higher than that in the Epi group until 1 h after injection
of the ropivacaine bolus, there was no significant difference at any
subsequent assessment point. The incidence of side effects was similar
between the groups. Conclusion: The Epi was superior to PVB-sf for the
management of post-thoracotomy pain in this patient cohort. The number of
dermatomes anaesthetized by Epi was greater than that anaesthetized by
PVB-sf. No difference in complication rates was observed between the two
groups.
Copyright &#xa9; 2017, Japanese Society of Anesthesiologists.

<11>
Accession Number
615013718
Author
Hansen T.B.; Zwisler A.D.; Berg S.K.; Sibilitz K.Lae.; Thygesen L.C.;
Kjellberg J.; Doherty P.; Oldridge N.; Sogaard R.
Institution
(Hansen) Department of Cardiology, Zealand University Hospital, Roskilde,
Sygehusvej 10, Roskilde 4000, Denmark
(Hansen, Thygesen) National Institute of Public Health, University of
Southern Denmark, Odense, Denmark
(Hansen, Zwisler, Berg, Sibilitz) Heart Centre, Department of Cardiology,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Zwisler) Danish Centre for Rehabilitation and Palliative Care, University
of Southern Denmark, University Hospital of Odense, Odense, Denmark
(Kjellberg) National Institute for Regional and Local Government Research,
Copenhagen, Denmark
(Doherty) Department of Health Sciences, University of York, York, United
Kingdom
(Oldridge) College of Health Sciences, University of Wisconsin-Milwaukee,
Milwaukee, WI, United States
(Sogaard) Department of Public Health, Aarhus University, Aarhus, Denmark
(Sogaard) Department of Clinical Medicine, Aarhus University, Aarhus,
Denmark
Title
Cost-utility analysis of cardiac rehabilitation after conventional heart
valve surgery versus usual care.
Source
European Journal of Preventive Cardiology. 24 (7) (pp 698-707), 2017. Date
of Publication: 01 May 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background While cardiac rehabilitation in patients with ischaemic heart
disease and heart failure is considered cost-effective, this evidence may
not be transferable to heart valve surgery patients. The aim of this study
was to investigate the cost-effectiveness of cardiac rehabilitation
following heart valve surgery. Design We conducted a cost-utility analysis
based on a randomised controlled trial of 147 patients who had undergone
heart valve surgery and were followed for 6 months. Methods Patients were
randomised to cardiac rehabilitation consisting of 12 weeks of physical
exercise training and monthly psycho-educational consultations or to usual
care. Costs were measured from a societal perspective and quality-adjusted
life years were based on the EuroQol five-dimensional questionnaire
(EQ-5D). Estimates were presented as means and 95% confidence intervals
(CIs) based on bootstrapping. Costs and effect differences were presented
in a cost-effectiveness plane and were transformed into net benefit and
presented in cost-effectiveness acceptability curves. Results No
statistically significant differences were found in total societal costs
(-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life
years (-0.000; 95% CI -0.021 to 0.020) between groups. However,
approximately 70% of the cost and effect differences were located below
the x-axis in the cost-effectiveness plane, and the cost-effectiveness
acceptability curves showed that the probability for cost- effectiveness
of cardiac rehabilitation compared to usual care is at minimum 75%, driven
by a tendency towards costs savings. Conclusions Cardiac rehabilitation
after heart valve surgery may not have improved health-related quality of
life in this study, but is likely to be cost-effective for society,
outweighing the extra costs of cardiac rehabilitation.
Copyright &#xa9; European Society of Cardiology 2017.

<12>
Accession Number
615013673
Author
Ribeiro G.S.; Melo R.D.; Deresz L.F.; Dal Lago P.; Pontes M.R.N.; Karsten
M.
Institution
(Ribeiro, Melo, Deresz, Dal Lago, Karsten) Programa de Pos-graduacao em
Ciencias da Reabilitacao, Universidade Federal de Ciencias da Saude de
Porto Alegre (UFCSPA), Brazil
(Deresz) Departamento de Educacao Fisica, Universidade Federal de Juiz de
Fora (UFJF), Brazil
(Dal Lago) Departamento de Fisioterapia, UFCSPA, Brazil
(Pontes) Departamento de Farmacociencias, UFCSPA, Brazil
(Pontes) Unidade de Pesquisa, Hospital Sao Francisco, Brazil
(Karsten) Departamento de Fisioterapia, Universidade Do Estado de Santa
Catarina (UDESC), Brazil
Title
Cardiac rehabilitation programme after transcatheter aortic valve
implantation versus surgical aortic valve replacement: Systematic review
and meta-analysis.
Source
European Journal of Preventive Cardiology. 24 (7) (pp 688-697), 2017. Date
of Publication: 01 May 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Aortic stenosis is a valvular heart disease characterised by
fixed obstruction of the left ventricular outflow. It can be managed by
surgical aortic valve replacement (sAVR) or transcatheter aortic valve
implantation (TAVI). This review aimed to describe the evidence supporting
a cardiac rehabilitation programme on functional capacity and quality of
life in aortic stenosis patients after sAVR or TAVI. Methods The search
was conducted on multiple databases from January to March 2016. All
studies were eligible that evaluated the effects of a post-interventional
cardiac rehabilitation programme in aortic stenosis patients. The
methodological quality was assessed using the PEDro scale. Meta-analysis
was performed separately by procedure and between procedures. The walked
distance during the six-minute walk test (6MWD) and Barthel index were
evaluated. The analysis was conducted in Review Manager. Results Five
studies were included (292 TAVI and 570 sAVR patients). The meta-analysis
showed that a cardiac rehabilitation programme was associated with a
significant improvement in 6MWD (0.69 (0.47, 0.91); P < 0.001) and Barthel
index (0.80 (0.29, 1.30); P = 0.002) after TAVI and 6MWD (0.79 (0.43,
1.15); P < 0.001) and Barthel index (0.93 (0.67, 1.18); P < 0.001) after
sAVR. In addition, the meta-analysis showed that the cardiac
rehabilitation programme promoted a similar gain in 6MWD (4.28% (-12.73,
21.29); P = 0.62) and Barthel index (-1.52 points (-4.81, 1.76); P = 0.36)
after sAVR or TAVI. Conclusions The cardiac rehabilitation programme
improved the functional capacity and quality of life in aortic stenosis
patients. Patients who underwent TAVI benefitted with a cardiac
rehabilitation programme similar to sAVR patients.
Copyright &#xa9; European Society of Cardiology 2017.

<13>
Accession Number
615012015
Author
Teng Z.; Ma X.; Zhang Q.; Yun Y.; Ma C.; Hu S.; Zou C.
Institution
(Ma, Zhang, Zou) Department of Cardiac Surgery, Shandong Provincial
Hospital, Affiliated to Shandong University, No.324 Jingwu Road, Jinan,
Shandong 250021, China
(Teng) Cardiovascular Center, Weihai Municipal Hospital, Weihai, China
(Ma, Yun, Ma, Zou) Shandong University, School of Medicine, Jinan, China
(Hu) Department of Postgraduate, Taishan Medical University, Taian, China
Title
Additional mitral valve procedure and coronary artery bypass grafting
versus isolated coronary artery bypass grafting in the management of
significant Functional ischemic mitral regurgitation: A meta-analysis.
Source
Journal of Cardiovascular Surgery. 58 (1) (pp 121-130), 2017. Date of
Publication: 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
NTRODUCTION: Functional ischemic mitral regurgitation (IMR) is commonly
present following acute myocardial infarction (AMI) and tightly associated
with a poorer prognosis. The optimal surgical strategy for the management
of significant IMR (.2+ grade) remains controversial and mitral valve
surgery (MVS) at the time of coronary artery bypass grafting (CABG) is
still debated. The primary objective of this meta-analysis was to clarify
the effects of additional MVS on the prognosis in the patients with
significant IMR, compared with isolated CABG. EVIDENCE ACQUISITION: A
meta-analysis of eligible studies, reporting concomitant MVS and CABG in
comparison with CABG alone in respects to in-hospital mortality, survival
and postoperative residual mitral regurgitation (MR) and cardiac
functional status, was carried out. The outcomes of interest included
in-hospital mortality, one-, three- and five-year survival and
postoperative New York Heart Association (NYHA) class, residual MR and
left ventricular ejection fraction (LVEF). EVIDENCE SYNTHESIS: Pooling 2
randomized controlled trials (RCTs) (N.=175) and 11 observational studies
(N.=2661) demonstrated that additional MVS did not significantly influence
in-hospital mortality (odds ratio [OR]=1.45, 95% confidence interval [CI]
0.93-2.28, P=0.10) and one-(OR=0.89, 95%CI 0.68-1.15, P=0.37),
three-(OR=1.10, 95%CI 0.79-1.55, P=0.56) and five-(OR=0.93, 95%CI
0.73-1.18, P=0.55) year survival in comparison with isolated CABG. And
pooling neither RCTs nor observational studies alone presented any
evidence of significant difference in in-hospital mortality and survival
between the two groups. Additionally, concomitant MVS was associated with
increased postoperative LVEF (standard mean differences [SMD]=0.28, 95%CI
0.10-0.46, P<0.01) and decreased postoperative residual MR (SMD=-4.22,
95%CI-6.48 to -1.97, P<0.0001). Similar outcomes were obtained when either
RCTs or observational studies were pooled alone. Additional MVS appeared
to decrease postoperative NYHA functional class (SMD=-0.48, 95%CI
-0.97-0.00, P=0.05) with evident heterogeneity (I²=87.5%,
P<0.0001). In the subgroup analysis, MVS significantly reduced
postoperative NYHA functional class in RCTs (SMD=-1.32, 95%CI -1.67 to
-0.97, P<0.0001) whereas it did not among observational studies
(SMD=-0.08, 95%CI -0.27-0.11, P=0.42), and heterogeneity was completely
eliminated (for RCTs, I2=0%, P=0.49; for observational studies, I2=0%,
P=0.40). CONCLUSIONS: Concomitant MVS at the time of CABG is associated
with greater improvement in postoperative residual MR and LVEF in the
patients with significant IMR. However, the evidence is still lacking of
advantages of combined surgery over CABG alone regarding in-hospital
mortality, survival and postoperative NYHA function class. Additional RCTs
are needed to assess the safety and efficacy outcomes of adding mitral
valve procedure in the surgical intervention of significant IMR.
Copyright &#xa9; 2016 EDIZIONI MINERVA MEDICA.

<14>
Accession Number
613853500
Author
Abd-Elsayed A.; Mascha E.J.; Yang D.; Sessler D.I.; Duncan A.
Institution
(Abd-Elsayed) Department of Anesthesiology, University of Wisconsin School
of Medicine and Public Health, 600 Highland Ave. B6/319, Madison, WI
53792-3272, United States
(Abd-Elsayed) Outcomes Research Consortium, Cleveland, OH, United States
(Mascha, Yang) Department of Quantitative Health Sciences, Cleveland
Clinic, Cleveland, OH, United States
(Mascha, Yang, Sessler, Duncan) Department of Outcomes Research, Cleveland
Clinic, Cleveland, OH, United States
(Duncan) Department of Cardiothoracic Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
Title
Hyperinsulinemic normoglycemia decreases glucose variability during
cardiac surgery.
Source
Journal of Anesthesia. 31 (2) (pp 185-192), 2017. Date of Publication: 01
Apr 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: Increased glucose variability may be associated with worse
outcomes in critically ill patients. Hyperinsulinemic normoglycemia
provides intensive glucose control during surgery and may reduce glucose
variability. Our objective was to compare glycemic variability between two
methods of glucose control in cardiac surgical patients: hyperinsulinemic
normoglycemia vs standard insulin infusion. We also assessed whether the
effect differed between patients with and without diabetes mellitus.
Methods: We compared measures of glycemic variability, including the
primary outcome, average real variability (ARV), and secondary outcomes,
within-patient standard deviation (SD) and glucose lability index (GLI),
in 252 patients who received hyperinsulinemic normoglycemia and 266
patients who received standard therapy. Data was randomly sampled from
each patient treated with hyperinsulinemic normoglycemia, so patients in
each group had a similar number of glucose measurements. The significance
level for each hypothesis was 0.05, and 0.025 within diabetic status.
Results: For nondiabetic patients, hyperinsulinemic normoglycemia reduced
mean glucose measure-to-measure variability for ARV by an estimated -0.23
(97.5% CI -0.30, -0.16) mg/dl/min (P < 0.001) versus standard care. There
was no difference in glycemic variability between groups for diabetic
patients, with difference in means (97.5% CI) of -0.10 (-0.20, 0.02)
mg/dl/min, P = 0.07. Mean SD was lower for hyperinsulinemic normoglycemia
patients overall, with difference in means (95% CI) of -19 (-22, -16), P <
0.001, with a stronger effect in nondiabetics (interaction P = 0.042). GLI
was also lower with hyperinsulinemic normoglycemia. Conclusion:
Hyperinsulinemic normoglycemia decreases glucose variability for cardiac
surgical patients with a stronger effect in nondiabetic patients.
Copyright &#xa9; 2016, Japanese Society of Anesthesiologists.

<15>
Accession Number
615439359
Author
Kwiatkowski D.M.; Goldstein S.L.; Cooper D.S.; Nelson D.P.; Morales
D.L.S.; Krawczeski C.D.
Institution
(Kwiatkowski, Goldstein, Cooper, Nelson, Morales, Krawczeski) Heart
Institute, Department of Pediatrics, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
(Kwiatkowski, Krawczeski) Division of Cardiology, Department of
Pediatrics, Stanford University, 750Welch Rd, Palo Alto, CA 94304, United
States
(Goldstein, Cooper, Nelson) Center for Acute Care Nephrology, Department
of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, United States
Title
Peritoneal Dialysis vs Furosemide for prevention of fluid overload in
infants after cardiac surgery a randomized clinical trial.
Source
JAMA Pediatrics. 171 (4) (pp 357-364), 2017. Date of Publication: 01 Apr
2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Fluid overload after congenital heart surgery is frequent and a
major cause of morbidity and mortality among infants. Many programs have
adopted the use of peritoneal dialysis (PD) for fluid management; however,
its benefits compared with those of traditional diuretic administration
are unknown. OBJECTIVE To determine whether infants randomized to PD vs
furosemide for the treatment of oliguria have a higher incidence of
negative fluid balance on postoperative day 1, as well as avoidance of 10%
fluid overload; shorter duration of mechanical ventilation, intensive care
unit stay, and inotrope use; and fewer electrolyte abnormalities. DESIGN,
SETTING, AND PARTICIPANTS This single-center, unblinded, randomized
clinical trial compared methods of fluid removal after cardiac surgery
from October 1, 2011, through March 13, 2015, in a large tertiary
pediatric hospital in Ohio. The parents or guardians of all eligible
infants (aged <6 months) undergoing cardiac surgery with catheter
placement for PD were approached for inclusion. No patients were withdrawn
for adverse effects. Recruitment was powered for the primary outcome, and
analysis was based on intention to treat. Patients randomized to PD were
hypothesized to have superior outcomes. INTERVENTIONS Infants received
intravenous furosemide (1mg/kg every 6 hours) or a standardized PD
regimen. MAIN OUTCOMES AND MEASURES The primary end pointwas incidence of
negative fluid balance on postoperative day 1. Secondary end points
included incidence of fluid overload, duration of mechanical ventilation
and intensive care unit stay, electrolyte abnormalities and repletion
doses, duration of inotropic administration, and mortality. RESULTS
Seventy-three patients (47 boys [64%]and 26 girls [35%]; median age, 8
[interquartile range (IQR), 6-14] days) received treatment and completed
the trial. No differencewas found between the PD and furosemide groups in
the incidence of negative fluid balance on the first postoperative day.
The furosemide groupwas 3 times more likely to have 10% fluid overload
(odds ratio [OR], 3.0; 95%CI, 1.3-6.9),was more likely to have prolonged
ventilator use (OR, 3.1; 95%CI, 1.2-8.2), and had a longer duration of
inotrope use (median, 5.5 [IQR, 4-8] vs 4.0[IQR, 3-6] days) and higher
electrolyte abnormality scores (median, 6 [IQR, 4-7] vs 3 [IQR, 2-5])
compared with the PD group.No statistically significant differences in
mortality (3 patients [9.4%] in the furosemide group vs 1 patient [3.1%]
in the PD group) or length of cardiac intensive care unit (median, 7 [IQR,
6-12] vs 9 [IQR, 5-15] days) or hospital (15 [IQR, 10-28] vs 14 [IQR,
9-22] days) staywere observed. No serious complicationswere observed.
Dialysiswas discontinued early in 9 of 41 patients in the PD group for
pleural-peritoneal communication. CONCLUSIONS AND RELEVANCE Use of PD is
safe and allows for superior fluid management with improved clinical
outcomes compared with diuretic administration. Use of PD should be
strongly considered among infants at high risk for postoperative acute
kidney injury and fluid overload.
Copyright &#xa9; 2017 American Medical Association.

<16>
Accession Number
609643361
Author
Mohari N.; Starr J.P.; Gates R.N.; Domico M.B.; Batra A.S.
Institution
(Mohari) Division of Pediatric Critical Care Medicine, Harbor-UCLA Medical
Center, Los Angeles, CA, United States
(Mohari, Domico) Division of Pediatric Critical Care Medicine, Children's
Hospital of Orange County, Orange, CA, United States
(Starr, Gates) Division of Cardiothoracic Surgery, Children's Hospital of
Orange County, Orange, CA, United States
(Batra) Department of Cardiology, University of California, Irvine,
Irvine, CA, United States
Title
Bipolar Versus Unipolar Temporary Epicardial Ventricular Pacing Leads Use
in Congenital Heart Disease: A Prospective Randomized Controlled Study.
Source
PACE - Pacing and Clinical Electrophysiology. 39 (5) (pp 471-477), 2016.
Date of Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: To compare the pacing parameters of unipolar versus bipolar
temporary ventricular epicardial pacing leads. Design: Prospective
Randomized Unblinded Controlled Study. Patients and Methods: Fifty
patients undergoing surgery for congenital heart disease who were
anticipated to require temporary ventricular pacing leads were recruited
preoperatively: 25 patients were randomized to receive unipolar temporary
ventricular epicardial pacing leads; the remaining 25 were randomized to
receive bipolar temporary ventricular epicardial leads. The baseline
characteristics of the groups were similar. The pacing parameters were
measured daily for up to first seven postoperative days (PODs) with the
day of surgery recorded as POD 0. Results: On the day of insertion, the
mean pacing and sensing thresholds were similar for both unipolar and
bipolar leads. Thresholds progressively deteriorated with each subsequent
POD. By POD 4, the mean +/- standard deviation pacing threshold of
ventricular bipolar lead was 2.87 +/- 0.37 mA compared with 5.6 +/- 0.85
mA for the unipolar leads (P = 0.005). The decrease in sensing threshold
of the unipolar ventricular pacing leads was significantly more than that
of bipolar leads (by POD 5, 5.7 +/- 2.64 vs 10.33 +/- 2.8, P = 0.01).
Conclusions: Our study shows that the bipolar leads (Medtronic 6495,
Medtronic Inc., Minneapolis, MN, USA) have superior sensing and pacing
thresholds in the ventricular position in patients undergoing surgery for
congenital heart disease when compared to the unipolar leads (Medical
Concepts Europe VF608ABB, Medical Concepts Europe Inc., Buffalo, NY, USA).
Copyright &#xa9;2016 Wiley Periodicals, Inc.

<17>
[Use Link to view the full text]
Accession Number
615598446
Author
Koehler D.; Marsh J.L.; Karam M.; Fruehling C.; Willey M.
Institution
(Koehler) 1Department of Orthopaedic Surgery and Rehabilitation,
University of Iowa Hospitals and Clinics, Iowa City, Iowa
Title
Efficacy of Surgical-Site, Multimodal Drug Injection Following Operative
Management of Femoral Fractures: A Randomized Controlled Trial.
Source
The Journal of bone and joint surgery. American volume. 99 (6) (pp
512-519), 2017. Date of Publication: 15 Mar 2017.
Abstract
BACKGROUND: Multimodal analgesia inclusive of periarticular injection with
a local anesthetic agent has been rapidly assimilated, with demonstrated
safety and efficacy, into the care of patients undergoing elective
lower-extremity arthroplasty. The present study was performed to evaluate
the efficacy and safety of a surgical-site, multimodal drug injection for
postoperative pain control following operative management of femoral
fractures.
METHODS: There were 102 patients undergoing operative intervention (plate
fixation, intramedullary device, or arthroplasty) for a broad range of
femoral fracture patterns who were prospectively randomized either to
receive an intraoperative, surgical-site injection into the superficial
and deep tissues containing ropivacaine, epinephrine, and morphine or to
receive no injection. Visual analog scale (VAS) scores were recorded at
regular intervals as the primary outcome measure. Narcotic consumption and
medication-related side effects were also monitored.
RESULTS: The injection group demonstrated significantly lower VAS scores
(p < 0.05) than the control cohort in the recovery room and at the 4, 8,
and 12-hour postoperative time points. The median score (and interquartile
range) was 1.6 (0 to 4.0) for the injection group and 3.2 (1.3 to 5.7) for
the control group immediately postoperatively, 1.0 (0 to 3.0) for the
injection group and 5.0 (2.0 to 7.0) for the control group at 4 hours, 2.0
(0 to 4.0) for the injection group and 5.0 (2.0 to 6.8) for the control
group at 8 hours, and 3.5 (0 to 5.0) for the injection group and 5.0 (2.0
to 8.0) for the control group at 12 hours. Additionally, narcotic
consumption was significantly lower (p = 0.007) in the injection group
(5.0 mg [1.3 to 8.0 mg]) compared with the control group (9.7 mg [3.9 to
15.6 mg]) over the first 8 hours following the surgical procedure. No
cardiac or central nervous system toxicity was observed secondary to
infiltration of the local anesthetic.
CONCLUSIONS: Surgical-site injection with a multimodal analgesic cocktail
provides improved pain control and reduces narcotic utilization over the
first postoperative day, with no observed adverse effects attributable to
the local injection, across a diverse orthopaedic trauma population
undergoing operative intervention for femoral fractures.
LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a
complete description of levels of evidence.

<18>
Accession Number
615600877
Author
Cheng M.; Li J.-Q.; Wu T.-C.; Tian W.-C.
Institution
(Cheng, Li, Wu, Tian) Department of Cardiac Surgery, The Second Affiliated
Hospital of Harbin Medical University, Nangang, Harbin, 150086,
Heilongjiang, People's Republic of China
Title
Short-Term Effects and Safety Analysis of Retrograde Autologous Blood
Priming for Cardiopulmonary Bypass in Patients with Cardiac Valve
Replacement Surgery.
Source
Cell biochemistry and biophysics. 73 (2) (pp 441-446), 2015. Date of
Publication: 01 Nov 2015.
Abstract
This randomized, double-blind study evaluated the short-term effects and
safety of perioperative retrograde autologous priming (RAP) for
cardiopulmonary bypass (CPB) in patients with cardiac replacement surgery
to determine if this approach is a better substitute for crystal liquids
priming in patients with valvular heart disease. We observed that RAP
significantly decreased the actual priming volume, preserved the
hematocrit and hemoglobin level during CPB to a certain degree, and
decreased lactate accumulation in CPB period. Moreover, RAP lowered the
volume of transfusion and dosage blood products. Thus, our results showed
that RAP approach effectively improved tissue perfusion and lowered
intraoperative Lac levels, by reducing the hemodilution, which safely and
reliably improve the microcirculation perfusion.

<19>
Accession Number
615494573
Author
Vasheghani Farahani A.; Yousefi Azar A.; Goodarzynejad H.R.; Khorrami E.;
Hosseinzadeh-Attar M.J.; Oshnouei S.; Alizadeh Ghavidel A.; Golfeshan E.;
Ghourban Pour F.
Institution
(Vasheghani Farahani) Department of Cardiology, School of Medicine, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Yousefi Azar) Department of Operating Room Technology, Faculty of
Paramedical Sciences, Urmia University of Medical Sciences, Urmia, Iran,
Islamic Republic of
(Yousefi Azar) Rajaie Cardiovascular Medical & Research Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Goodarzynejad) Tehran Heart Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Khorrami, Hosseinzadeh-Attar) Department of Clinical Nutrition, School of
Nutritional Sciences and Dietetics, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Oshnouei) Reproductive Health Research Center, Urmia University of
Medical Sciences, Urmia, Iran, Islamic Republic of
(Alizadeh Ghavidel) Rajaie Cardiovascular Medical & Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Golfeshan) Qum University of Medical Sciences, Qum, Iran, Islamic
Republic of
(Ghourban Pour) Rajaie Cardiovascular Medical & Research Center, Tehran,
Iran, Islamic Republic of
Title
Fish oil supplementation for primary prevention of atrial fibrillation
after coronary artery bypass graft surgery: A randomized clinical trial.
Source
International Journal of Surgery. 42 (pp 41-48), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Ltd
Abstract
Background Atrial fibrillation (AF) after cardiac surgery is a common
complication that may influence patients' early and long term outcomes and
hospital costs. The purpose of this study was to assess the effect of fish
oil on occurrence of AF following coronary artery bypass graft surgery
(CABG). Methods This study was a single-center, randomized, double
blinded, placebo-controlled clinical trial. Four-hundred and one patients
undergoing coronary artery bypass graft surgery were randomly assigned to
receive 2 g/d fish oil or placebo (olive oil) for at least 5 days before
surgery. The primary end point was defined as time to AF improvement After
AF incidence following isolated CABG or a need for pharmacologic therapy
or cardioversion. Results The time to AF improvement in intervention group
was shorter than control group (HR: 2.05; 95% CI = 0.70-6.22, P = 0.20).
The incidence of AF in the intervention and control groups was 8.40% vs.
14.07% respectively (p = 0.07). Mean total duration of AF was 20.96 +/-
4.71 h in intervention groups and 46.87 +/- 7.44 h in control groups (p =
0.04). Mean duration of stay in the ICU and total hospital stay showed a
significant reduction in the intervention group (p = 0.003 and p = 0.04,
respectively). Conclusion The consumption of PUFA leads to a shorter time
to AF improvement, which was not statistically significant. The incidence
of AF in patients undergoing CABG surgery was decreased by approximately
5.7%; which was statistically on the borderline. Fish oil reduced median
length of stay in the ICU and hospital. Further well-designed studies are
needed to overcome the limitations of the existing trials and provide
conclusive conclusions.
Copyright &#xa9; 2017 IJS Publishing Group Ltd

<20>
Accession Number
615591860
Author
Garg A.; Rao S.V.; Agrawal S.; Theodoropoulos K.; Mennuni M.; Sharma A.;
Garg L.; Ferrante G.; Meelu O.A.; Sargsyan D.; Reimers B.; Cohen M.;
Kostis J.B.; Stefanini G.G.
Institution
(Garg) Department of Medicine, St. Peter's University Hospital, Rutgers
Robert Wood Johnson Medical School, New Brunswick, New Jersey
(Garg, Sargsyan, Kostis) Division of Cardiology, Cardiovascular Institute,
Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
(Rao) Division of Cardiology, Duke Clinical Research Institute, Durham,
North Carolina
(Agrawal) Division of Cardiology, St. Luke's University Hospital,
Bethlehem, Pennsylvania
(Theodoropoulos) Department of Medicine, James J. Peters Veterans Affairs
Medical Center, Bronx, New York
(Mennuni, Ferrante, Reimers, Stefanini) Division of Cardiology, Cardio
Center, Humanitas Research Hospital, Rozzano, Milan, Italy
(Sharma) Department of Cardiovascular Medicine, State University of New
York Downstate Medical Center, Brooklyn, New York
(Garg) Division of Cardiology, Lehigh Valley Hospital, Allentown,
Pennsylvania
(Meelu) Division of Cardiology, Mount Sinai Heart, Icahn School of
Medicine at Mount Sinai Hospital, New York, New York
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Newark,
New Jersey
(Stefanini) Department of Biomedical Sciences, Humanitas University,
Rozzano, Milan, Italy
Title
Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary
Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass
Grafting in Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: December 06, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Few randomized controlled trials (RCTs) and observational studies had
shown acceptable short-term efficacy and safety of percutaneous coronary
intervention (PCI) with drug-eluting stents (DES) compared with coronary
artery bypass grafting (CABG) in selected patients with left main coronary
artery disease (LMCAD). We aimed to evaluate long-term outcomes of PCI
using DES compared with CABG in patients with LMCAD. On November 1, 2016,
we searched available databases for published RCTs directly comparing DES
PCI with CABG in patients with LMCAD. Odds ratios (ORs) were used as the
metric of choice for treatment effects using a random-effects model.
I-squared index was used to assess heterogeneity across trials.
Prespecified end points were all-cause mortality, cardiovascular
mortality, myocardial infarction (MI), stroke, and repeat
revascularization at maximal available follow-up. We identified 5 RCTs
including a total of 4,595 patients, with a median follow-up of 60 months.
The risk of all-cause mortality (OR 1.01; 95% confidence interval [CI]
0.76 to 1.34) and cardiovascular mortality (OR 1.02; 95% CI 0.73 to 1.42)
were comparable between PCI with DES and CABG. Similarly, there were no
statistically significant differences between PCI with DES and CABG for MI
(OR 1.45; 95% CI 0.87 to 2.40) and stroke (OR 0.87; 95% CI 0.38 to 1.98).
Conversely, repeat revascularization was significantly higher with PCI
compared with CABG (OR 1.82; 95% CI 1.51 to 2.21). In conclusion, in
patients with LMCAD, PCI with DES appears to be a viable alternative to
CABG at long-term follow-up, with similar risks of ischemic adverse events
(mortality, MI, and stroke) but a higher risk of repeat revascularization.
Copyright &#xa9; 2017 Elsevier Inc.

<21>
Accession Number
615576856
Author
Galindo A.; Gomez-Montes E.; Gomez O.; Bennasar M.; Crispi F.; Herraiz I.;
Mendoza A.; Escribano D.; Garcia-Torres E.; Carretero J.M.; Gratacos E.;
Martinez J.M.
Institution
(Galindo, Gomez-Montes, Gomez, Bennasar, Crispi, Herraiz, Mendoza,
Escribano, Garcia-Torres, Carretero, Gratacos, Martinez) aFetal Medicine
Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12
de Octubre, Facultad de Medicina, Universidad Complutense de Madrid,
Madrid, bFetal Cardiology Unit, BCNatal-Barcelona Center for
Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant
Joan de Deu), IDIBAPS, University of Barcelona, and cCenter for Biomedical
Research on Rare Diseases (CIBER-ER), Barcelona, dPediatric Heart
Institute, Department of Pediatrics, Hospital Universitario 12 de Octubre,
Madrid, and ePediatric Cardiology, Hospital Sant Joan de Deu, Barcelona,
Spain
Title
Fetal Aortic Valvuloplasty: Experience and Results of Two Tertiary Centers
in Spain.
Source
Fetal Diagnosis and Therapy. (no pagination), 2017. Date of Publication:
07 Apr 2017.
Publisher
S. Karger AG
Abstract
Objective: Fetal aortic valvuloplasty (FAV) may avoid progression of
critical aortic stenosis (CAS) to hypoplastic left ventricle, improving
the options for biventricular circulation (BVC). We describe the results
of FAV in 2 referral centers in Spain. Methods: We analyzed all FAVs
performed in the period 2007-2015. The selection of candidates, the
technique, and postnatal management were made following an agreed
protocol. A descriptive analysis of survival, type of circulation after
birth, and complications was made, considering all deaths in the first 48
h after FAV as FAV-related. Results: FAV was performed in 28 fetuses at a
median gestational age (GA) of 23 weeks (range, 20-32). FAV was
technically successful in 22 (78.6%), of whom 11 were born alive and with
intention to treat. Eight (72.7%) resulted in BVC and 3 (27.3%) in
univentricular circulation. The rate of FAV-related deaths was 32%. These
patients underwent FAV earlier than live-born fetuses (median GA at FAV 22
weeks [range, 20.0-25.0] vs. 24.5 weeks [range, 21.0-32.0], respectively,
p = 0.031). Conclusions: A significant proportion of fetuses with CAS who
undergo technically successful FAV have BVC postnatally. However, FAV
implies a high risk of fetal death, which highly depends on the GA at
which this intervention is required.
Copyright &#xa9; 2017 S. Karger AG, Basel

<22>
Accession Number
615576620
Author
Huntgeburth M.; Schier R.; Pfister R.; ten Freyhaus H.; Dahlem K.;
Friedrichs K.; Baldus S.; Rudolph V.
Institution
(Huntgeburth, Schier, Pfister, ten Freyhaus, Dahlem, Friedrichs, Baldus,
Rudolph) aClinic III for Internal Medicine, Department of Cardiology,
Heart Center, and bDepartment of Anesthesiology and Intensive Care
Medicine, University of Cologne, Cologne, Germany
Title
End-Tidal CO2 Predicts Reduction in Mitral Regurgitation in Patients
Undergoing Percutaneous Mitral Valve Edge-to-Edge Repair.
Source
Cardiology (Switzerland). (pp 151-158), 2017. Date of Publication: 08 Apr
2017.
Publisher
S. Karger AG
Abstract
Objectives: We evaluated end-tidal CO<inf>2</inf> (etCO<inf>2</inf>),
which has been proposed to assess acute hemodynamic changes, to guide
percutaneous edge-to-edge mitral valve repair (PMVR) with the MitraClip
system. Methods: Thirty-nine patients (aged 78 +/- 14 years) undergoing
PMVR for moderate-to-severe mitral regurgitation (MR) of primary and
secondary etiology were included. General anesthesia was maintained with
sevoflurane and constant ventilation parameters to ensure stable
etCO<inf>2</inf> tension. MR grade was determined semiquantitatively by
transesophageal echocardiography by 2 experienced operators blinded to
etCO<inf>2</inf> measurements. etCO<inf>2</inf> levels were measured 3, 5,
10, and 15 min after final MitraClip placement. Results: Overall,
etCO<inf>2</inf> increased from 32.2 +/- 1.7 before to 35.4 +/- 3.0, 34.6
+/- 2.6, and 34.2 +/- 2.4 mm Hg 3, 5, and 10 min after implantation. A
significant correlation was noted between the echocardiographic reduction
in MR grade and the increase in etCO<inf>2</inf>. ANOVA for repeated
measures confirmed a significant increase in etCO<inf>2</inf> after clip
implantation (corrected F = 20.0; p < 0.001) and revealed a significantly
greater increase in etCO<inf>2</inf> in patients with MR reduction >2
grades as compared to lesser MR reductions (F = 6.47; p = 0.015). Blood
pressure changes did not correlate with the degree of MR reduction.
Conclusions: We observed a close correlation between the reduction in MR
grade during PMVR and etCO<inf>2</inf>, which might evolve as a useful
parameter to complement treatment guidance during PMVR.
Copyright &#xa9; 2017 S. Karger AG, Basel

<23>
Accession Number
612175899
Author
Briguori C.; Visconti G.; Donahue M.; Di Palma V.; De Micco F.;
Signoriello G.; Focaccio A.
Institution
(Briguori, Visconti, Donahue, Di Palma, De Micco, Focaccio) Interventional
Cardiology, Clinica Mediterranea, Naples, Italy
(Signoriello) Department of Mental Health and Preventive Medicine, Second
University of Naples, Naples, Italy
Title
Performance of the XLIMUS Sirolimus-Eluting Coronary Stent in Very Complex
Lesions.
Source
Journal of Interventional Cardiology. 29 (6) (pp 559-568), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: Stent delivery failure may occur especially when treating
complex coronary artery stenosis. XLIMUS (CARDIONOVUM GmbH, Bonn, Germany)
is a new sirolimus-eluting stent (SES) with the following features: 1)
cobalt chromium stent platform, with low (73 mum) strut thickness, (2)
biodegradable polymer, and 3) potent antiproliferative drug (Sirolimus).
Preliminary data suggest that XLIMUS SES may be ideal for the treatment of
complex lesions. Methods: In this registry, we assessed the
deliverability, safety, and efficacy of percutaneous coronary
interventions (PCI) using the XLIMUS SES in patients undergoing elective
PCI in native coronary vessels for complex de novo lesions, including
severe calcification, severe tortuosity, and chronic total occlusion. The
primary objective of the study is the delivery success of the XLIMUS SES.
The secondary objective is the 1-year rate of major adverse cardiac events
(MACE; including all-cause death, nonfatal myocardial infarction, and
repeat revascularization). Results: A total of 200 consecutive patients
with 255 lesions were included. Delivery success was obtained in 196 (98%)
patients and in 251 (98.4%) lesions. The XLIMUS SES was successfully
implanted on the first attempt with a single guidewire in 176 (88%)
patients and in 208 (81.6%) lesions. Additional techniques to facilitate
stent delivery (i.e., buddy wire, anchoring-balloon, or GuideLiner
catheter) were necessary in 47 (18.4%) lesions. Failure in XLIMUS SES
implantation occurred in 4 (1.6%) lesions. MACE rate at 1 year was 9%.
Conclusions: This registry supports the positive performance of the XLIMUS
SES in the treatment of complex coronary artery lesions.
Copyright &#xa9; 2016, Wiley Periodicals, Inc.

<24>
Accession Number
614297390
Author
Dobbels F.; De Bleser L.; Berben L.; Kristanto P.; Dupont L.; Nevens F.;
Vanhaecke J.; Verleden G.; De Geest S.
Institution
(Dobbels, De Bleser, De Geest) Academic Centre for Nursing and Midwifery,
KU Leuven, Leuven, Belgium
(Dobbels, Berben, De Geest) Institute of Nursing Science, University of
Basel, Basel, Switzerland
(Kristanto) AARDEX Group, a WestRock Healthcare Company, Vise, Belgium
(Dupont, Verleden) Lung Transplant Program, University Hospitals of
Leuven, Leuven, Belgium
(Nevens) Liver Transplant Program, University Hospitals of Leuven, Leuven,
Belgium
(Vanhaecke) Heart Transplant Program, University Hospitals of Leuven,
Leuven, Belgium
Title
Efficacy of a medication adherence enhancing intervention in
transplantation: The MAESTRO-Tx trial.
Source
Journal of Heart and Lung Transplantation. 36 (5) (pp 499-508), 2017. Date
of Publication: May 2017.
Publisher
Elsevier USA
Abstract
Background Well-designed randomized controlled trials (RCTs) testing
efficacy of post-transplant medication adherence enhancing interventions
and clinical outcomes are scarce. Methods This randomized controlled trial
enrolled adult heart, liver, and lung transplant recipients who were >1
year post-transplant and on tacrolimus twice daily (convenience sample)
(visit 1). After a 3-month run-in period, patients were randomly assigned
1:1 to intervention group (IG) or control group (CG) (visit 2), followed
by a 6-month intervention (visits 2-4) and a 6-month adherence follow-up
period (visit 5). All patients used electronic monitoring for 15 months
for adherence measurement, generating a daily binary adherence score per
patient. Post-intervention 5-year clinical event-free survival (mortality
or retransplantation) was evaluated. The IG received staged multicomponent
tailored behavioral interventions (visits 2-4) building on social
cognitive theory and trans-theoretical model (e.g., electronic monitoring
feedback, motivational interviewing). The CG received usual care and
attended visits 1-5 only. Intention-to-treat analysis used generalized
estimating equation modeling and Kaplan-Meier survival analysis. Results
Of 247 patients, 205 were randomly assigned (103 IG, 102 CG). At baseline,
average daily proportions of patients with correct dosing (82.6% IG, 78.4%
CG) and timing adherence (75.8% IG, 72.2% CG) were comparable. The IG had
a 16% higher dosing adherence post-intervention (95.1% IG, 79.1% CG; p <
0.001), resulting in odds of adherence being 5 times higher in the IG than
in the CG (odds ratio 5.17, 95% confidence interval 2.86-9.38). This
effect was sustained at end of follow-up (similar results for timing
adherence). In the IG, 5-year clinical event-free survival was 82.5% vs
72.5% in the CG (p = 0.18). Conclusion Our intervention was efficacious in
improving adherence and sustainable. Further research should investigate
clinical impact, cost-effectiveness, and scalability.
Copyright &#xa9; 2017 International Society for Heart and Lung
Transplantation

<25>
Accession Number
614296341
Author
Clarke B.; Ducharme A.; Giannetti N.; Kim D.; McDonald M.; Pflugfelder P.;
Rajda M.; Senechal M.; Stadnick E.; Toma M.; Zieroth S.; Isaac D.
Institution
(Clarke, Isaac) Division of Cardiac Sciences, Libin Cardiovascular
Institute, Foothills Medical Center, University of Calgary, Calgary,
Alberta, Canada
(Ducharme) Division of Cardiology, Montreal Heart Institute, Universite de
Montreal, Montreal, Quebec, Canada
(Giannetti) Division of Cardiology, McGill University Medical Center,
McGill University, Montreal, Quebec, Canada
(Kim) Division of Cardiology, University of Alberta Hospital, University
of Alberta, Edmonton, Alberta, Canada
(McDonald) Division of Cardiology, Peter Munk Cardiac Centre, University
Health Network, Toronto, Ontario, Canada
(Pflugfelder) Division of Cardiology, London Health Science Center,
University of Western Ontario, London, Ontario, Canada
(Rajda) Division of Cardiology, Queen Elizabeth II Health Science Center,
Dalhousie University, Halifax, Nova Scotia, Canada
(Senechal) Division of Cardiology, Institut Universitaire de Cardiologie
et de Pneumologie de Quebec, Quebec City, Quebec, Canada
(Stadnick) Division of Cardiology, Ottawa Heart Institute, University of
Ottawa, Ottawa, Ontario, Canada
(Toma) Division of Cardiology, St. Paul's Hospital, University of British
Columbia, Vancouver, British Columbia, Canada
(Zieroth) Division of Cardiology, St. Boniface Hospital, University of
Manitoba, Winnipeg, Manitoba, Canada
Title
Multicenter evaluation of a national organ sharing policy for highly
sensitized patients listed for heart transplantation in Canada.
Source
Journal of Heart and Lung Transplantation. 36 (5) (pp 491-498), 2017. Date
of Publication: May 2017.
Publisher
Elsevier USA
Abstract
Background Transplantation of sensitized recipients has been associated
with increased risk of post-transplant complications. In 2010, the
Canadian Cardiac Transplant Network (CCTN) created a unique status listing
for highly sensitized heart transplant candidates. Status 4S listing
requires calculated panel-reactive antibody (cPRA) level >80% as the sole
listing criteria and enables geographic expansion of the donor pool by
providing national access. In this study, we describe patient
characteristics and outcomes of those transplanted as Status 4S in Canada.
Methods Patients' characteristics and clinical outcomes were
retrospectively collected from all 11 adult heart transplant centers in
Canada. Results Ninety-six patients were listed Status 4S from January
2010 to September 2015. Fifty-two were transplanted as Status 4S. Of these
52 transplants, mean cPRA level was 93.4%, mean age was 47 years, 46% were
male, 44% had dilated cardiomyopathy and 17% were re-transplanted for
cardiac allograft vasculopathy (CAV). Blood group O comprised 42% and 53%
had a left ventricular assist device as a bridge to transplant.
Desensitization therapy occurred in 9 patients (17%). Over a mean
follow-up period of 28 months (1 week to 5.3 years), 9 patients died
(17%). Kaplan-Meier 1-year year survival is 86%. Two patients were treated
for antibody-mediated rejection (AMR) in the first year post-transplant
and 33% of patients had at least 1 ISHLT Grade >2R cellular rejection in
the first year. Twenty-nine percent of patients developed de novo
door-specific antibodies and demonstrated no correlation with AMR. Freedom
from CAV at 1 year is 88.5% and at 5 years is 81.0%. Fifty-two percent of
donor hearts originated from outside the recipients' geographic and organ
donation organization. Conclusions A national strategy of prioritizing
highly sensitized heart transplant recipients has demonstrated effective
expansion of the donor pool, acceptable short-term survival, freedom from
CAV and low rates of clinically relevant AMR. However, we observed
significantly higher rates of cellular rejection and de novo
donor-specific antibody development in this population. It is currently
unknown whether this will translate into poorer long-term outcome.
Copyright &#xa9; 2017 International Society for Heart and Lung
Transplantation

<26>
Accession Number
613820003
Author
Sarmiento E.; Jaramillo M.; Calahorra L.; Fernandez-Yanez J.;
Gomez-Sanchez M.; Crespo-Leiro M.G.; Paniagua M.; Almenar L.; Cebrian M.;
Rabago G.; Levy B.; Segovia J.; Gomez-Bueno M.; Lopez J.; Mirabet S.;
Navarro J.; Rodriguez-Molina J.J.; Fernandez-Cruz E.; Carbone J.
Institution
(Sarmiento, Jaramillo, Calahorra, Navarro, Rodriguez-Molina,
Fernandez-Cruz, Carbone) Clinical Immunology Department, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
(Fernandez-Yanez) Cardiology Department, Hospital General Universitario
Gregorio Maranon, Madrid, Spain
(Gomez-Sanchez) Cardiology Department, Hospital Universitario Doce de
Octubre, Madrid, Spain
(Crespo-Leiro, Paniagua) Cardiology Department, Complexo Hospitalario
Universitario de A Coruna, A Coruna, Spain
(Almenar, Cebrian) Heart Failure and Heart Transplant Unit, Cardiology
Department, Hospital Universitario La Fe, Valencia, Spain
(Rabago, Levy) Heart Surgery Department, Clinica Universidad de Navarra,
Pamplona, Spain
(Segovia, Gomez-Bueno) Heart Failure and Cardiomyopathy Unit, Heart
Failure and Heart Transplant Section, Department of Cardiology, Hospital
Universitario Puerta de Hierro, Madrid, Spain
(Lopez) Heart Failure and Heart Transplant Unit, Hospital Clinico
Universitario, Valladolid, Spain
(Mirabet) Cardiology Department, Sant Pau Hospital, Barcelona, Spain
Title
Evaluation of humoral immunity profiles to identify heart recipients at
risk for development of severe infections: A multicenter prospective
study.
Source
Journal of Heart and Lung Transplantation. 36 (5) (pp 529-539), 2017. Date
of Publication: May 2017.
Publisher
Elsevier USA
Abstract
Background New biomarkers are necessary to improve detection of the risk
of infection in heart transplantation. We performed a multicenter study to
evaluate humoral immunity profiles that could better enable us to identify
heart recipients at risk of severe infections. Methods We prospectively
analyzed 170 adult heart recipients at 8 centers in Spain. Study points
were before transplantation and 7 and 30 days after transplantation.
Immune parameters included IgG, IgM, IgA and complement factors C3 and C4,
and titers of specific antibody to pneumococcal polysaccharide antigens
(anti-PPS) and to cytomegalovirus (CMV). To evaluate potential immunologic
mechanisms leading to IgG hypogammaglobulinemia, before heart
transplantation we assessed serum B-cell activating factor (BAFF) levels
using enzyme-linked immunoassay. The clinical follow-up period lasted 6
months. Clinical outcome was need for intravenous anti-microbials for
therapy of infection. Results During follow-up, 53 patients (31.2%)
developed at least 1 severe infection. We confirmed that IgG
hypogammaglobulinemia at Day 7 (defined as IgG <600 mg/dl) is a risk
factor for infection in general, bacterial infections in particular, and
CMV disease. At Day 7 after transplantation, the combination of IgG <600
mg/dl + C3 <80 mg/dl was more strongly associated with the outcome
(adjusted odds ratio 7.40; 95% confidence interval 1.48 to 37.03; p =
0.014). We found that quantification of anti-CMV antibody titers and lower
anti-PPS antibody concentrations were independent predictors of CMV
disease and bacterial infections, respectively. Higher pre-transplant BAFF
levels were a risk factor of acute cellular rejection. Conclusion Early
immunologic monitoring of humoral immunity profiles proved useful for the
identification of heart recipients who are at risk of severe infection.
Copyright &#xa9; 2017 International Society for Heart and Lung
Transplantation

<27>
Accession Number
615581540
Author
Ning J.; Nguyen B.C.; Kassim T.A.; Vivekanandan R.
Institution
(Vivekanandan) Creighton Medical center, Omaha, NE, United States
(Kassim) Creighton University, Omaha, NE, United States
(Ning, Nguyen) Creighton University, School of Medicine, Omaha, NE, United
States
Title
Expect the unexpected-a case of necrotizing pancreatitis.
Source
Journal of General Internal Medicine. Conference: 40th Annual Meeting of
the Society of General Internal Medicine, SGIM 2017. United States. 32 (2
Supplement 1) (pp S495-S496), 2017. Date of Publication: April 2017.
Publisher
Springer New York LLC
Abstract
LEARNING OBJECTIVE #1: Recognize the clinical features of necrotizing
pancreatitis LEARNING OBJECTIVE #2: Treat necrotizing pancreatitis
conservatively in patient with multiple co-morbidities CASE: A 61 year-old
female presented with acute abdominal pain, shortness of breath and fever.
The patient was in respiratory failure with an elevated White Blood Cell
(WBC) count at 20.7 k/ul, elevated inflammatory markers and a serum Lipase
of 3198 u/l. Patient was resuscitated aggressively with Intravenous (IV)
fluids, started on IV Meropenem, and placed on oxygen. The patient's past
medical history included hemothorax status post Video-Assisted
Thoracoscopic Surgery, Heart Failure with preserved ejection fraction,
Chronic Kidney Disease stage III, and Chronic Obstructive Lung Disease.
The patient smoked 0.25 packs/day and had no history of alcohol use.
Abdominal ultrasound (US) showed findings suggestive of acute
cholecystitis with cholelithiasis. Abdominal computerized tomography (CT)
scan showed findings consistent with cholelithiasis, acute pancreatitis
with necrosis of the uncinate process and pancreatic body with no
pancreatic duct or common bile duct dilatation. Due to concern from
findings of necrotizing pancreatitis multiple teams were consulted. After
stabilization, the patient underwent a cholecystectomy by our general
surgery team without complications. On post-op day 2, patient developed a
fever and went into respiratory distress, requiring 8 Liters on oxymizer.
After a 10-day antibiotic treatment, her symptoms resolved. The patient
was discharged home in stable condition. IMPACT: This case has significant
impact on ourmanagement of pancreatitis. Due to its unlikely occurrence,
necrotizing pancreatitis may be overlooked by clinicians as a potential
diagnosis. With the possibility of severe sequelae in mind, it is
imperative to formulate a systematic and thorough differential diagnosis
that includes all possible causes in order to provide prompt evaluation
with proper imaging and treatment. DISCUSSION: Acute pancreatitis can be
divided into two subtypes-interstitial edematous pancreatitis and
necrotizing pancreatitis. Majority of patients with acute pancreatitis
have diffuse inflammatory edema, while only 5-10% develop necrosis of the
pancreatic parenchyma, peripancreatic tissue, or both. Bacterial
infections developed in 40-70% of those with necrotizing pancreatitis with
mortality rates up to 40%. Recent articles have discussed the use of
prophylactic antibiotic treatment. One meta-analysis has suggested that
the use of prophylactic antibiotics did not reduce the incidence of
infected necrosis, while another meta-analysis on randomized control
trials showed a statistically significant decrease in mortality rates in
those who took antibiotics (7.4% vs. 14.4%). Due to its high morbidity and
mortality rates, it is imperative to recognize the prospect of necrotizing
pancreatitis when suspecting acute pancreatitis and initiate prompt
evaluation and effective treatment.

<28>
Accession Number
615580603
Author
Nguyen V.; Webb M.; Neely Panton O.
Institution
(Nguyen, Webb, Neely Panton) University of British Columbia, Canada
Title
Incisional negative pressure wound therapy following colorectal resection:
Preliminary report from a single site, prospective, randomized control
trial.
Source
Surgical Endoscopy and Other Interventional Techniques. Conference: 2017
Scientific Session of the Society of American Gastrointestinal and
Endoscopic Surgeons, SAGES 2017. United States. 31 (pp S226), 2017. Date
of Publication: 2017.
Publisher
Springer New York LLC
Abstract
Background: Superficial surgical site infection (SSI) is a preventable
postoperative complication that impacts length of hospital stay, health
care spending, and patient morbidity/mortality. Numerous trials have
sought to establish perioperative protocols to reduce the incidence of
SSI. Recently, literature has been produced on the efficacy of incisional
Negative PressureWound Therapy (iNWPT) in orthopaedic, vascular, and
cardiac surgical patient populations. Previous studies in general surgery
have demonstrated a reduction of up to 50%in the SSI rate with the use of
iNWPT. Currently there is no randomized data to support the use of
iNWPT.Our objective is to examine the effect of iNWPT onwound complication
rates in elective colorectal resections both open and laparoscopic. This
will be accomplished in a single center, prospective randomized clinical
trial. Methods: This is a single-institution, prospective, randomized,
open-label, superiority trial. Patients scheduled for elective colorectal
resection with or without creation of an ostomy (open or laparoscopic)
will be considered eligible. Exclusion criteria includes patients who are
under 19, pregnant, immune compromised, allergic/sensitive to adhesive
dressings, operations performed under an emergent basis, without an
anastamosis(e.g. APR/Hartmann), for palliation or without a midline
incision made for specimen extraction. Cases involving additional
procedures at time of CRR (eg. hernia repair) will also not be included.
Patients will be randomized to receive iNWPT or conventional dressings.
Primary outcomes will be wound complications within the first 30 post
operative days. SSI rate will also be reported as a subgroup analysis.
Secondary outcomeswill include length of stay, # of post-operative visits
in the 30 day period, complications, wound vac specific complications and
patient satisfaction. Data will be collected prospectively through our
Enhanced Recovery After Surgery (ERAS) audit group. Results: Currently
recruitment is yet to start however we hope to present preliminary results
at the upcoming SAGES meeting in March 2017. Conclusions: We hope to show
that iNWPT leads to a lower incidence of wound complications and should be
integrated in to a standard ERAS care pathway.

<29>
Accession Number
613214183
Author
Bahit M.C.; Lopes R.D.; Wojdyla D.M.; Held C.; Hanna M.; Vinereanu D.;
Hylek E.M.; Verheugt F.; Goto S.; Alexander J.H.; Wallentin L.; Granger
C.B.
Institution
(Bahit) INECO Neurociencias Orono, Rosario, Santa Fe, Argentina
(Lopes, Wojdyla, Alexander, Granger) Duke Clinical Research Institute,
Duke University School of Medicine, Durham, NC, United States
(Held, Wallentin) Uppsala Clinical Research Center, Uppsala University,
Uppsala, Sweden
(Hanna) Bristol-Myers Squibb, Princeton, NJ, United States
(Vinereanu) University of Medicine and Pharmacy Carol Davila, Bucharest,
Romania
(Hylek) Boston University Medical Center, Boston, MA, United States
(Verheugt) Heartcenter, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam,
Netherlands
(Goto) Tokai University School of Medicine, Isehara, Japan
Title
Non-major bleeding with apixaban versus warfarin in patients with atrial
fibrillation.
Source
Heart. 103 (8) (pp 623-628), 2017. Date of Publication: 01 Apr 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: non-major bleeding and clinical outcomes in patients with
atrial fibrillation (AF) receiving anticoagulation therapy enrolled in
Apixaban for Reduction in Stroke and other Thromboembolic Events in Atrial
Fibrillation (ARISTOTLE). Methods: We included patients who received >1
dose of study drug (n=18 140). Non-major bleeding was defined as the first
bleeding event considered to be clinically relevant non-major (CRNM) or
minor bleeding, and not preceded by a major bleeding event. Results:
Non-major bleeding was three times more common than major bleeding (12.1%
vs 3.8%). Like major bleeding, non-major bleeding was less frequent with
apixaban (6.4 per 100 patient-years) than warfarin (9.4 per 100
patient-years) (adjusted HR 0.69, 95% CI 0.63 to 0.75). The most frequent
sites of non-major bleeding were haematuria (16.4%), epistaxis (14.8%),
gastrointestinal (13.3%), haematoma (11.5%) and bruising/ecchymosis
(10.1%). Medical or surgical intervention was similar among patients with
non-major bleeding on warfarin versus apixaban (24.7% vs 24.5%). A change
in antithrombotic therapy (58.6% vs 50.0%) and permanent study drug
discontinuation (5.1% (61) vs 3.6% (30), p=0.10) was numerically higher
with warfarin than apixaban. CRNM bleeding was independently associated
with an increased risk of overall death (adjusted HR 1.70, 95% CI 1.32 to
2.18) and subsequent major bleeding (adjusted HR 2.18, 95% CI 1.56 to
3.04). Conclusions: In ARISTOTLE, non-major bleeding was common and
substantially less frequent with apixaban than with warfarin. CRNM
bleeding was independently associated with a higher risk of death and
subsequent major bleeding. Our results highlight the importance of any
severity of bleeding in patients with AF treated with anticoagulation
therapy and suggest that non-major bleeding, including minor bleeding,
might not be minor. Trial registration number: NCT00412984; post-results.
Copyright &#xa9; 2017, BMJ Publishing Group. All rights reserved.

<30>
Accession Number
614211087
Author
Yanagawa B.; Verma S.; Juni P.; Tam D.Y.; Mazine A.; Puskas J.D.;
Friedrich J.O.
Institution
(Yanagawa, Verma, Tam, Mazine) Division of Cardiac Surgery, Department of
Surgery, Toronto, Ontario, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute,
Toronto, Ontario, Canada
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai Beth Israel,
New York, NY, United States
(Friedrich) Critical Care and Medicine Departments, St Michael's Hospital,
University of Toronto, Toronto, Ontario, Canada
Title
A systematic review and meta-analysis of in situ versus composite
bilateral internal thoracic artery grafting.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (5) (pp
1108-1116.e16), 2017. Date of Publication: May 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives This meta-analysis examines whether there is any advantage of
coronary artery bypass graft with bilateral internal thoracic artery
(BITA) as an in situ versus composite graft. Methods We searched MEDLINE
and EMBASE Databases from 1996 to 2016 for studies that compared coronary
artery bypass graft with BITA as in situ versus composite graft. Data were
extracted by 2 independent investigators and meta-analyzed with the use of
random effects. Results Two randomized controlled trials (RCTs; n = 705),
2 matched (n = 1688), and 4 unadjusted observational studies (n = 3517)
met inclusion criteria. Composite grafting trended towards greater distal
anastomoses (+0.22, 95% confidence interval, -0.01 to +0.45
anastomoses/patient; P = .06 [4 unadjusted observational studies]) and
greater distal anastomoses using an internal thoracic artery (+0.80, 95%
confidence interval, 0.41-1.18 anastomoses/patient; P < .001 [1 RCT]).
There were no differences in perioperative or longer-term composite
cardiovascular outcomes comparing in situ versus composite BITA or
individual outcomes of mortality, repeat revascularization, myocardial
infarction, and cardiovascular mortality. Pooled results differed by study
type with pooled results from lower-risk-of-bias RCTs typically showing
increases in events rates, and pooled results from higher-risk-of-bias
unadjusted observational studies typically showing decreases in event
rates of in situ versus composite BITA. Post hoc subgroup analysis
suggested possible improvements in all-cause mortality and
revascularization for in situ BITA in studies with short-term (<5 years)
versus longer-term follow-up, regardless of study type. Conclusions Our
meta-analysis found that use of BITA as a composite graft configuration
facilitated greater internal thoracic artery revascularization but both
grafting strategies offer similar clinical outcomes. Our study supports
the use of in situ and composite BITA for select patients but
high-quality, long-term prospective trials are needed.
Copyright &#xa9; 2016 The American Association for Thoracic Surgery

<31>
Accession Number
614488909
Author
Jennings D.L.; Baker W.L.
Institution
(Jennings) Department of Pharmacy, NewYork Presbyterian Columbia
University Irving Medical Center, New York, NY, United States
(Baker) School of Pharmacy, University of Connecticut, Storrs, CT, United
States
Title
Pre-cardiac transplant amiodarone use is not associated with postoperative
mortality: An updated meta-analysis.
Source
International Journal of Cardiology. 236 (pp 345-347), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Amiodarone remains the preferred agent for the treatment and
prevention of life-threatening ventricular arrhythmias in patients with
end-stage heart failure. While several reports suggest that pre-operative
amiodarone exposure worsens outcomes in heart transplant recipients, other
studies have failed to validate this relationship. We sought to clarify
this issue by performing a meta-analysis of the available literature
surrounding this topic. Methods We searched Medline, SCOPUS and the
Cochrane Central Register of Controlled Trials through December 15th 2016,
as well as proceedings from related conferences over the prior 3 years.
Included studies evaluated patients undergoing cardiac transplantation who
had received pre-transplant amiodarone and reported postoperative
mortality. Outcomes were pooled using a Hartung-Knapp random-effects model
producing odds ratios (OR) and 95% confidence intervals (CI). Statistical
heterogeneity was evaluated using the Cochrane Q statistic p-value and
I² value. Publication bias was assessed by visual inspection of
funnel plots and using Egger's weighted regression statistic. Results Nine
studies including 16,509 participants were included in the overall
analysis. Use of pre-transplant amiodarone was not associated with an
increase in postoperative mortality versus control (OR 1.38, 95% 0.8 to
2.36). Moderate statistical heterogeneity was present (I² =
45.8%, p = 0.06); visual inspection of funnel plot analysis did not
suggest publication bias. No association was noted between a longer
duration of follow-up and higher odds of mortality with amiodarone use (p
= 0.91). Conclusion Meta-analysis of the available evidence suggests that
pre-operative amiodarone exposure does not increase mortality in cardiac
transplant recipients.
Copyright &#xa9; 2017 Elsevier Ireland Ltd

<32>
Accession Number
613709874
Author
Peek J.; Vos C.G.; Unlu C.; van de Pavoordt H.D.W.M.; van den Akker P.J.;
de Vries J.-P.P.M.
Institution
(Peek, van de Pavoordt, de Vries) Department of Vascular Surgery, St
Antonius Hospital, Nieuwegein, Netherlands
(Vos, Unlu, van den Akker) Department of Vascular Surgery, Noordwest
Ziekenhuisgroep, Alkmaar, Netherlands
Title
Outcome of Surgical Treatment for Thoracic Outlet Syndrome: Systematic
Review and Meta-Analysis.
Source
Annals of Vascular Surgery. 40 (pp 303-326), 2017. Date of Publication:
April 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Many publications report outcomes of surgical treatment for
thoracic outlet syndrome (TOS); however, high-quality reviews and
meta-analyses are lacking. This systematic review and meta-analysis
summarizes and compares the outcomes and major complications of the
surgical procedures for the 3 types of TOS: arterial, venous, and
neurogenic. Methods MEDLINE, EMBASE, and CINAHL databases, and the
Cochrane Database of Systematic Reviews were searched for papers published
between January 1980 and February 2015, using the keywords thoracic outlet
syndrome, and treatment and surgical. Articles were eligible for inclusion
if the following criteria were met: studies describing outcomes of surgery
for TOS, published in English, human studies, and available full-text. The
exclusion criteria were case-series and case reports (n < 5), reviews,
abstracts, and studies of endoscopic-assisted or robotic
endoscopic-assisted transaxillary first rib resection. Results A total of
12 papers met our inclusion criteria and were finally included in this
systematic review. All included articles showed improvement of complaints
after surgical treatment. In our meta-analysis, improvement to Derkash's
classification category excellent/good was achieved in 90% of the arterial
and venous TOS groups. Preoperative and postoperative Disabilities of the
Arm, Shoulder, and Hand scores show improvement of 28.3 points after
operative treatment of neurogenic TOS. Conclusions In conclusion, surgical
treatment of TOS seems to be beneficial in most patients and is relatively
safe. The largest challenge remains the diagnosis of TOS, especially
neurogenic TOS, because standardized diagnostic criteria are lacking.
Future studies should focus on the diagnostic work-up of TOS.
Copyright &#xa9; 2016 Elsevier Inc.

<33>
Accession Number
614130201
Author
Wang T.K.M.; Wang M.T.M.; Gamble G.D.; Webster M.; Ruygrok P.N.
Institution
(Wang, Webster, Ruygrok) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang, Wang, Gamble, Ruygrok) Department of Medicine, University of
Auckland, Auckland, New Zealand
Title
Performance of contemporary surgical risk scores for transcatheter aortic
valve implantation: A meta-analysis.
Source
International Journal of Cardiology. 236 (pp 350-355), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve implantation (TAVI) is considered
for severe aortic valve disease at high and now intermediate risk for
surgical aortic valve replacement. Risk stratification plays a critical
role decision-making for intervention and modality. We compared the
prognostic utility of surgical risk scores for TAVI in this meta-analysis.
Methods MEDLINE, Embase, Cochrane and Web of Science databases from 1
January 1980 to 31 December 2015 were searched. Studies were
systematically reviewed for inclusion, and data extracted for pooled
analyses. Results Amongst 1688 articles searched, 47 full-text articles
were screened and 24 studies (12,346 TAVI cases) included for analyses.
Pooled c-statistics (95% confidence interval) for operative mortality were
EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.62 (0.59-0.66), STS Score 0.62
(0.59-0.65). Pooled calibration odds ratios (95%CI) were EuroSCORE 0.31
(0.25-0.38), EuroSCORE II 1.26 (1.06-1.51), STS 0.95 (0.72-1.27).
C-statistics (95%CI) for 1-year mortality were EuroSCORE 0.62 (0.57-0.67),
EuroSCORE II 0.66 (0.61-0.71) and STS Score 0.58 (0.53-0.64). Conclusion
Surgical risk scores at most modestly discriminated operative and 1-year
mortality. The EuroSCORE grossly over-estimated operative mortality while
the EuroSCORE II and STS Scores fitted better to TAVI outcomes with their
own limitations. There is a need for the development and validation of
TAVI-specific risk models.
Copyright &#xa9; 2017 Elsevier B.V.

<34>
Accession Number
615250033
Author
Reardon M.J.; Van Mieghem N.M.; Popma J.J.; Kleiman N.S.; Sondergaard L.;
Mumtaz M.; Adams D.H.; Deeb G.M.; Maini B.; Gada H.; Chetcuti S.; Gleason
T.; Heiser J.; Lange R.; Merhi W.; Oh J.K.; Olsen P.S.; Piazza N.;
Williams M.; Windecker S.; Yakubov S.J.; Grube E.; Makkar R.; Lee J.S.;
Conte J.; Vang E.; Nguyen H.; Chang Y.; Mugglin A.S.; Serruys P.W.J.C.;
Kappetein A.P.
Institution
(Reardon, Kleiman) Methodist DeBakey Heart and Vascular Center, 6550
Fannin St., Houston, TX 77030, United States
(Van Mieghem, Serruys, Kappetein) Erasmus University Medical Center,
Rotterdam, Netherlands
(Popma) Beth Israel Deaconess Medical Center, Boston, PA, United States
(Sondergaard, Olsen) Rigshospitalet Heart Center, Copenhagen, PA, Denmark
(Mumtaz, Gada) PinnacleHealth Hospitals, Harrisburg, PA, United States
(Gleason, Lee) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Adams, Williams) Mount Sinai Health System, United States
(Deeb) New York University Langone Medical Center, New York, MI, United
States
(Chetcuti) University of Michigan, Ann Arbor, MI, United States
(Heiser, Merhi) Spectrum Health Hospitals, Grand Rapids, MI, United States
(Maini) Tenet Healthcare, Delray Beach, FL, United States
(Lange) German Heart Center Munich, Munich, Germany
(Grube) Siegburg Heart Center, Siegburg, Germany
(Oh) Mayo Clinic, Rochester, United States
(Vang, Nguyen, Chang) Medtronic, Minneapolis, United States
(Mugglin) Paradigm Biostatistics, Anoka, MN, United States
(Piazza) McGill University Medical Centre, Montreal, Canada
(Windecker) University Hospital Bern, Bern, Switzerland
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, United States
(Conte) Johns Hopkins University, Baltimore, United States
Title
Surgical or transcatheter aortic-valve replacement in intermediate-risk
patients.
Source
New England Journal of Medicine. 376 (14) (pp 1321-1331), 2017. Date of
Publication: 06 Apr 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Although transcatheter aortic-valve replacement (TAVR) is an
accepted alternative to surgery in patients with severe aortic stenosis
who are at high surgical risk, less is known about comparative outcomes
among patients with aortic stenosis who are at intermediate surgical risk.
METHODS We evaluated the clinical outcomes in intermediate-risk patients
with severe, symptomatic aortic stenosis in a randomized trial comparing
TAVR (performed with the use of a self-expanding prosthesis) with surgical
aortic-valve replacement. The primary end point was a composite of death
from any cause or disabling stroke at 24 months in patients undergoing
attempted aortic-valve replacement. We used Bayesian analytical methods
(with a margin of 0.07) to evaluate the noninferiority of TAVR as compared
with surgical valve replacement. RESULTS A total of 1746 patients
underwent randomization at 87 centers. Of these patients, 1660 underwent
an attempted TAVR or surgical procedure. The mean (?}SD) age of the
patients was 79.8?}6.2 years, and all were at intermediate risk for
surgery (Society of Thoracic Surgeons Predicted Risk of Mortality,
4.5?}1.6%). At 24 months, the estimated incidence of the primary end point
was 12.6% in the TAVR group and 14.0% in the surgery group (95% credible
interval [Bayesian analysis] for difference, -5.2 to 2.3%; posterior
probability of noninferiority, >0.999). Surgery was associated with higher
rates of acute kidney injury, atrial fibrillation, and transfusion
requirements, whereas TAVR had higher rates of residual aortic
regurgitation and need for pacemaker implantation. TAVR resulted in lower
mean gradients and larger aortic-valve areas than surgery. Structural
valve deterioration at 24 months did not occur in either group.
CONCLUSIONS TAVR was a noninferior alternative to surgery in patients with
severe aortic stenosis at intermediate surgical risk, with a different
pattern of adverse events associated with each procedure. (Funded by
Medtronic; SURTAVI ClinicalTrials.gov number, NCT01586910.).

<35>
Accession Number
614331370
Author
Lansac E.; Di Centa I.; Sleilaty G.; Lejeune S.; Berrebi A.; Zacek P.;
Debauchez M.
Institution
(Lansac, Sleilaty, Lejeune, Berrebi, Debauchez) Department of Cardiac
Pathology, Institut Mutualiste Montsouris, Paris, France
(Di Centa) Vascular Surgery Unit, Hopital Foch, Suresnes, France
(Zacek) Department of Cardiac Surgery, Charles University in Prague,
Faculty of Medicine and Faculty Hospital, Hradec Kralove, Czech Republic
Title
Remodeling root repair with an external aortic ring annuloplasty.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (5) (pp 1033-1042),
2017. Date of Publication: May 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Although the remodeling technique provides the most dynamic
valve-sparing root replacement, a dilated annulus (>25 mm) is a risk
factor for failure. Aortic annuloplasty aims to reduce the annulus
diameter, thus increasing coaptation height to protect the repair. The
results of 177 patients with remodeling and external aortic ring
annuloplasty were studied. Methods Data were collected from the Aortic
Valve repair InternATiOnal Registry. Preoperative aortic insufficiency
grade 3 or greater was present in 79 patients (44.7%). The valve was
bicuspid in 59 patients (33.3%). External annuloplasty was performed
through a homemade Dacron ring (56) or a dedicated expansible aortic ring
(121). Results Thirty-day mortality was 2.9% (5). Mean follow-up was 41.1
+/- 36.4 months. For the whole series, freedom from valve-related
reoperation, aortic insufficiency grade 3 or greater, aortic insufficiency
grade 2 or greater, and major adverse valve-related events were 89.5%,
90.5%, 77.4%, and 86.6% at 7 years, respectively, with similar results for
tricuspid and bicuspid valves. Since 2007, systematic use of calibrated
expansible ring annuloplasty, followed 1 year later by systematic cusp
effective height assessment, significantly increased 7-year freedom from
valve-related reoperation, aortic insufficiency grade 3 or greater, and
major adverse valve-related events up to 99.1% +/- 0.9% (P = .017), 100%
(P = .026), and 96.3% +/- 1.8% (P = .035), respectively, whereas freedom
from aortic insufficiency grade 2 or greater remained unaffected (78.1%
+/- 7.6%). Calibrated annuloplasty and effective height assessment were
identified as protective factors from reoperation: hazard ratio, 0.13; 95%
confidence interval, 0.02-1.06; P = .057 and hazard ratio, 0.11; 95%
confidence interval, 0.01-0.95; P = .044, respectively. Conclusions The
standardization of remodeling root repair with calibrated expansible
aortic ring annuloplasty and cusp effective height assessment improves
valve repair outcomes.
Copyright &#xa9; 2017 The American Association for Thoracic Surgery

<36>
Accession Number
615382108
Author
Chee Y.R.; Watson R.W.; McCarthy J.; Chughtai J.Z.; Nolke L.; Healy D.G.
Institution
(Chee, McCarthy, Chughtai, Nolke, Healy) Cardiothoracic Surgery, Mater
Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
(Chee, Watson) Conway Institute of Biomolecular and Biomedical Research,
University College Dublin, Belfield, Dublin 4, Ireland
Title
High dose statin prophylaxis in cardiopulmonary bypass related surgery:
clinical utility.
Source
Journal of cardiothoracic surgery. 12 (1) (pp 20), 2017. Date of
Publication: 31 Mar 2017.
Abstract
BACKGROUND: Previous studies from our group demonstrated the
anti-inflammatory properties of statins on cardiopulmonary bypass (CPB),
through inhibition of neutrophil transendothelial migration. We sought to
determine the utility of preoperative statin on patients undergoing
cardiac surgery, to investigate any moderating effects on the systemic
inflammatory response (SIRS) with CPB, and to evaluate any clinical impact
on our patients.
METHODS: This is a prospective, randomised controlled trial with national
regulatory body approval. Eligible patients were already on oral statin
therapy. They were then randomly assigned to either investigation arm
(n=15, atorvastatin 80 mg for 2 weeks before surgery) or control arm
(n=15, no change to current statin therapy). Blood and urine samples were
collected at 3 timepoints. Postoperative clinical measures were
documented.
RESULTS: Patients in the investigation arm have significantly lower
troponin level (p=0.016), and lower level of urine neutrophil
gelatinase-associated lipocalin (NGAL; p=0.002); thus demonstrating a
lesser degree of cardiac and renal injury in these patients. Higher level
of Interleukin-8 (IL-8) at baseline (p=0.036) and 4 h post cross-clamp
removal (p=0.035) in the investiation arm. A similar trend is also
observed in Matrix Metalloproteinase-9 (MMP-9; p>0.05). There were however
no differences in clinical outcomes.
CONCLUSIONS: Maximizing the dose of statin in patients waiting for cardiac
surgery has measurable biological effects. There is evidence of less
cardiac and renal damage. The use of preoperative statins and in
particular, high dose preoperative statin therapy, may prove a useful new
tool for optimal preparation of patients for cardiac surgery.
TRIAL REGISTRATION: EudraCT no. 2012-003396-20 . Registered 05 November
2012.

<37>
Accession Number
615427486
Author
Goldberg S.L.; Meredith I.; Marwick T.; Haluska B.A.; Lipiecki J.;
Siminiak T.; Mehta N.; Kaye D.M.; Sievert H.
Institution
(Goldberg) Tyler Heart Institute at Community Hospital of the Monterey
Peninsula, Monterey, WA, United States
(Goldberg, Mehta) Cardiac Dimensions, Kirkland, WA, United States
(Meredith) Monash University, Melbourne, Australia
(Marwick) Baker IDI Heart and Diabetes Institute, Melbourne, Australia
(Lipiecki) Centre de Cardiologie Interventionnelle, Clermont-Ferrand,
France
(Siminiak) Poznan University of Medical Sciences, HCP Medical Center,
Poznan, Poland
(Kaye) Cardiovascular Medicine Alfred Hospital, Melbourne, Australia
(Sievert) CardioVascular Center Sankt Katherinen, Frankfurt, Germany
(Haluska) University of Tasmania, Hobart, Australia
(Sievert) Anglia Ruskin University, Chelmsford, United Kingdom
Title
A randomized double-blind trial of an interventional device treatment of
functional mitral regurgitation in patients with symptomatic congestive
heart failure-Trial design of the REDUCE FMR study.
Source
American Heart Journal. 188 (pp 167-174), 2017. Date of Publication: 01
Jun 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
The Carillon Mitral Contour System has been studied in 3 nonrandomized
trials in patients with symptomatic congestive heart failure and
functional mitral regurgitation. The REDUCE FMR study is a uniquely
designed, double-blind trial evaluating the impact of the Carillon device
on reducing regurgitant volume, as well as assessing the safety and
clinical efficacy of this device. Carillon is a coronary sinus-based
indirect annuloplasty device. Eligible patients undergo an invasive
venogram to assess coronary sinus vein suitability for the Carillon
device. If the venous dimensions are suitable, they are randomized on a
3:1 basis to receive a device or not. Patients and assessors are blinded
to the treatment assignment. The primary end point is the difference in
regurgitant volume at 1 year between the implanted and nonimplanted
groups. Other comparisons include clinical parameters such as heart
failure hospitalizations, 6-minute walk test, Kansas City Cardiomyopathy
Questionnaire (KCCQ), and other echocardiographic parameters. An exercise
echo substudy will also be included.
Copyright &#xa9; 2017 The Authors

<38>
[Use Link to view the full text]
Accession Number
615510276
Author
Saleh A.; Klika A.K.; Barsoum W.K.
Institution
(Saleh, Klika, Barsoum) Department of Orthopaedic Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
Title
Reply to Letter: "glycopeptides Versus Beta-lactams for the Prevention of
Surgical Site Infections in Cardiovascular and Orthopedic Surgery: A
Meta-analysis".
Source
Annals of Surgery. 265 (5) (pp e71-e72), 2017. Date of Publication: 01 May
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<39>
[Use Link to view the full text]
Accession Number
615510272
Author
Dellinger E.P.
Institution
(Dellinger) Division of General Surgery, University of Washington,
Seattle, WA, United States
Title
Glycopeptides Versus Beta-lactams for the Prevention of Surgical Site
Infections in Cardiovascular and Orthopedic Surgery: A Meta-analysis.
Source
Annals of Surgery. 265 (5) (pp e70-e71), 2017. Date of Publication: 01 May
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<40>
[Use Link to view the full text]
Accession Number
615490049
Author
Zhu H.; Xu X.; Ding Y.; Zhou L.; Huang J.
Institution
(Zhu, Xu) Zhejiang Chinese Medical University, Nanjing Medical University,
Department of Cardiology, Hangzhou, Zhejiang, China
(Ding, Zhou, Huang) Hnagzhou First People's Hospital, Nanjing Medical
University, Department of Cardiology, Hangzhou, Zhejiang, China
Title
Effects of prostaglandin E1 on reperfusion injury patients.
Source
Medicine (United States). 96 (15) (no pagination), 2017. Article Number:
e6591. Date of Publication: 01 Apr 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Prostaglandin E1 (PGE1) is widely used as a pretreatment for
myocardial reperfusion injury in animal experiments. However, the
cardioprotective effects of PGE1 in patients have not been established. We
performed a meta-analysis to investigate whether PGE1 is cardioprotective,
based on the reduction of correlative reperfusion injury events (CRIE),
major adverse cardiac events (MACE), and biomarker release in patients
with ischemia reperfusion injury. Methods: The Medline, EMBASE, and
Cochrane databases were searched for randomized clinical trials confirming
the effects of PGE1. Two investigators independently selected suitable
trials, assessed trial quality, and extracted data. Results: Six studies
in patients undergoing percutaneous coronary intervention (4 studies) and
cardiac surgery (2 studies), comprising a total of 445 patients, were
included in this review. The results showed that PGE1 reduced the
incidence of CRIE (relative ratio 0.4 [95% confidence interval 0.43,
0.95]), the incidence of MACE (0.35 [0.17, 0.70]), and the level of
troponin T (standardized mean difference 20.28 [20.47, 20.09]), creatine
kinase-MB (-1.74 [-3.21, - 0.27]), interleukin-6 (-1.37 [-2.69, - 0.04]),
and interleukin-8 (-2.05 [-2.75, - 1.34]). Conclusion: PGE1 may have
beneficial effects on myocardial reperfusion injury in the clinic.
Copyright &#xa9; 2017 the Author(s). Published by Wolters Kluwer Health,
Inc.

<41>
Accession Number
615548519
Author
Sardar P.; Kundu A.; Chatterjee S.; Feldman D.N.; Owan T.; Kakouros N.;
Nairooz R.; Pape L.A.; Feldman T.; Dawn Abbott J.; Elmariah S.
Institution
(Sardar, Owan) Division of Cardiovascular MedicineUniversity of UtahSalt
Lake City, Utah
(Kundu, Kakouros, Pape) Department of MedicineUniversity of Massachusetts
Medical SchoolWorcester, Massachusetts
(Chatterjee) Division of CardiologyTemple University School of
MedicinePhiladelphia, Pennsylvania
(Feldman) Division of CardiologyWeill Cornell Medical College, New York
Presbyterian HospitalNew York, New York
(Nairooz) University of Arkansas for Medical SciencesLittle Rock, Arkansas
(Feldman) Department of MedicineDivision of Cardiology, Evanston
HospitalEvanston, Illinois
(Dawn Abbott) Division of CardiologyBrown Medical School, Rhode Island
HospitalProvidence, Rhode Island
(Elmariah) Cardiology DivisionDepartment of Medicine, Massachusetts
General Hospital, Harvard Medical SchoolBoston, Massachusetts
Title
Transcatheter versus surgical aortic valve replacement in
intermediate-risk patients: Evidence from a meta-analysis.
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: We performed a meta-analysis to evaluate the efficacy and
safety of transcatheter aortic valve replacement (TAVR) in comparison to
surgical aortic valve replacement (SAVR) in intermediate-risk patients.
Background: TAVR is an established treatment option in high-risk patients
with severe aortic valve stenosis (AS). There are fewer data regarding
efficacy of TAVR in intermediate-risk patients. Methods: Databases were
searched through April 30, 2016 for studies that compared TAVR with SAVR
for the treatment of intermediate-risk patients with severe AS. We
calculated summary risk ratios (RRs) and 95% confidence intervals (CIs)
with the random-effects model. Results: The analysis included 4,601
patients from 7 studies (2 randomized and 5 observational). There was no
significant difference in all-cause mortality between the two groups after
mean follow-up of 1.15 years [14.7% with TAVR vs 15.4% with SAVR; RR 0.93;
95% CI 0.77-1.12]. TAVR resulted in lower rates of acute kidney injury
[number needed to treat (NNT)=26], major bleeding (NNT=4), and
atrial-fibrillation (NNT=6), but higher rates of major vascular
complications [number needed to harm (NNH)= 18], and moderate/severe
aortic regurgitation (NNH=13). The rate of permanent-pacemaker
implantation was significantly higher with TAVR in observational studies
(RR 2.31; 95% CI 1.22-2.81), but not in RCTs (RR 1.21; 95% CI 0.93-1.56).
No significant difference in the rate of stroke or myocardial infarction
was observed. Conclusions: Our analysis of mid-term results showed that
TAVR has similar clinical efficacy to SAVR in intermediate-risk patients
with severe AS, and can be a suitable alternative to surgical valve
replacement.
Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<42>
Accession Number
615546686
Author
Guzzetta N.A.; Williams G.D.
Institution
(Guzzetta) Department of Anesthesiology Emory University School of
Medicine Children's Healthcare of Atlanta Atlanta, GA USA
(Williams) Department of Anesthesiology Stanford University School of
Medicine Lucile Packard Children's Hospital Palo Alto, CA USA
Title
Current use of factor concentrates in pediatric cardiac anesthesia.
Source
Paediatric Anaesthesia. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Excessive bleeding following pediatric cardiopulmonary bypass is
associated with increased morbidity and mortality, both from the effects
of hemorrhage and the therapies employed to achieve hemostasis. Neonates
and infants are especially at risk because their coagulation systems are
immature, surgeries are often complex, and cardiopulmonary bypass
technologies are inappropriately matched to patient size and physiology.
Consequently, these young children receive substantial amounts of
adult-derived blood products to restore adequate hemostasis. Adult and
pediatric data demonstrate associations between blood product transfusions
and adverse patient outcomes. Thus, efforts to limit bleeding after
pediatric cardiopulmonary bypass and minimize allogeneic blood product
exposure are warranted. The off-label use of factor concentrates, such as
fibrinogen concentrate, recombinant activated factor VII, and prothrombin
complex concentrates, is increasing as these hemostatic agents appear to
offer several advantages over conventional blood products. However,
recognizing that these agents have the potential for both benefit and
harm, well-designed studies are needed to enhance our knowledge and to
determine the optimal use of these agents. In this review, our primary
objective was to examine the evidence regarding the use of factor
concentrates to treat bleeding after pediatric CPB and identify where
further research is required. PubMed, MEDLINE/OVID, The Cochrane Library
and the Cochrane Central Register of Controlled Trials (CENTRAL) were
systematically searched to identify existing studies.
Copyright &#xa9; 2017 John Wiley & Sons Ltd.

<43>
Accession Number
614558803
Author
Tabarsi N.; Guan M.; Simmonds J.; Toma M.; Kiess M.; Tsang V.; Ruygrok P.;
Konstantinov I.; Shi W.; Grewal J.
Institution
(Tabarsi, Guan, Toma, Kiess, Grewal) Division of Cardiology, St. Paul's
Hospital, University of British Columbia, Vancouver, British Columbia,
Canada
(Simmonds, Tsang) Division of Cardiology, Great Ormond Street Hospital for
Children, London, United Kingdom
(Ruygrok) Division of Cardiology, Auckland City Hospital, Auckland, New
Zealand
(Konstantinov, Shi) Division of Cardiothoracic Surgery, Royal Children's
Hospital, Melbourne, Australia
Title
Meta-Analysis of the Effectiveness of Heart Transplantation in Patients
With a Failing Fontan.
Source
American Journal of Cardiology. 119 (8) (pp 1269-1274), 2017. Date of
Publication: 15 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The Fontan procedure is increasingly being used to palliate univentricular
physiology. It is a complex anatomic and physiologic repair that can fail
at any age, often leaving heart transplantation as the only remaining
solution. A meta-analysis was performed to achieve the aim of
systematically evaluating the existing evidence for survival after heart
transplantation in patients who have undergone a Fontan palliation.
MEDLINE, Embase, PubMed, and Web of Science were searched for original
research studies. The primary outcome was mortality at 1 and 5 years after
transplantation. Five hundred eighty-two records were screened, after the
removal of duplicates, 12 retrospective observational studies were
selected for inclusion in our meta-analysis. This encompassed a total of
351 Fontan patients undergoing heart transplantation. Mean age was 14
years (range 7 to 24 years) and 65% were men. One- and 5-year survival
rates after heart transplantation were found to be 80.3% (95% CI 75.9% to
84.2%) and 71.2% (95% CI 66.3% to 75.7%), respectively. No significant
association was found between age, gender, and pulmonary pressures and
1-year mortality. In conclusion, in the largest analysis to date, we found
that heart transplantation in younger patients after Fontan procedure has
an acceptable early and mid-term mortality. It is comparable to published
mortality data of heart transplantation for other forms of congenital
heart disease. Heart transplantation in the younger failing Fontan
population appears to be a reasonable option when all other avenues have
been exhausted and appropriate screening has taken place.
Copyright &#xa9; 2017 Elsevier Inc.

<44>
[Use Link to view the full text]
Accession Number
611774807
Author
O'Brien H.; Mohan H.; Hare C.O.; Reynolds J.V.; Kenny R.A.
Institution
(O'Brien, Hare, Kenny) Irish Longitudinal Study on Ageing (TILDA), Trinity
College Dublin, Lincoln Gate, Dublin 2, Ireland
(O'Brien, Hare, Kenny) Department of Medical Gerontology, St. James's
Hospital, Trinity College Dublin, Dublin, Ireland
(Mohan) Department of Surgery, Cork University Hospital, Wilton, Co. Cork,
Ireland
(Reynolds) Department of Surgery, St. James's Hospital, Trinity College
Dublin, Dublin, Ireland
Title
Mind over matter? The hidden epidemic of cognitive dysfunction in the
older surgical patient.
Source
Annals of Surgery. 265 (4) (pp 677-691), 2017. Date of Publication: 01 Apr
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: The aim of this study was to highlight the vulnerability of the
aging brain to surgery and anesthesia, examine postoperative cognitive
outcomes, and recommend possible interventions. Background: Surgeons are
facing increasingly difficult ethical and clinical decisions given the
rapidly expanding aging demographic. Cognitive function is not routinely
assessed either preoperatively or postoperatively. Potential short and
long-term cognitive implications are rarely discussed with the patient
despite evidence that postoperative cognitive impairment occurs in up to
65% of older patients. Furthermore, surgery may accelerate the trajectory
of cognitive decline and dementia. Methods: An electronic search was
conducted using Pubmed/Medline. References from selected studies were
cross-referenced and relevant articles retrieved. Data were summarized in
a narrative format. Results: There is a hidden epidemic of cognitive
dysfunction in the perioperative setting. Up to 40% of patients who
develop postoperative delirium (POD) never return to their preoperative
cognitive baseline. POD can lead to postoperative cognitive dysfunction
(POCD), a more prolonged cognitive impairment associated with longer
length of hospital stay and cost, premature withdrawal from the workforce,
and greater 1-year mortality. Standardized perioperative cognitive
assessment is needed to enable progress. Improving outcomes will depend on
a multifaceted approach, including correction of modifiable preoperative
risk factors and prompt treatment of POD. Risk factors are discussed and
possible interventional strategies are presented. Conclusion: Closer
preoperative collaboration between surgeons, geriatricians, and
anesthetists will enable identification of complex at-risk older patients.
A paradigm shift in the approach to management of the older surgical
patient is critical to improve postoperative cognitive outcomes in modern
surgery.
Copyright &#xa9; 2016 Wolters Kluwer Health, Inc.

<45>
Accession Number
610600134
Author
Do H.P.; Yoon A.J.; Fong M.W.; Saremi F.; Barr M.L.; Nayak K.S.
Institution
(Do) Department of Physics and Astronomy, University of Southern
California, Los Angeles, CA, United States
(Yoon, Fong) Department of Medicine, Division of Cardiology, Keck School
of Medicine of USC, University of Southern California, Los Angeles, CA,
United States
(Saremi) Department of Radiology, Keck School of Medicine of USC,
University of Southern California, Los Angeles, CA, United States
(Barr) Department of Cardiothoracic Surgery, Keck School of Medicine of
USC, University of Southern California, Los Angeles, CA, United States
(Nayak) Ming Hsieh Department of Electrical Engineering, University of
Southern California, Los Angeles, CA, United States
Title
Double-gated myocardial ASL perfusion imaging is robust to heart rate
variation.
Source
Magnetic Resonance in Medicine. 77 (5) (pp 1975-1980), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Purpose: Cardiac motion is a dominant source of physiological noise (PN)
in myocardial arterial spin labeled (ASL) perfusion imaging. This study
investigates the sensitivity to heart rate variation (HRV) of double-gated
myocardial ASL compared with the more widely used single-gated method.
Methods: Double-gating and single-gating were performed on 10 healthy
volunteers (n = 10, 3F/7M; age, 23-34 years) and eight heart transplant
recipients (n = 8, 1F/7M; age, 26-76 years) at rest in the randomized
order. Myocardial blood flow (MBF), PN, temporal signal-to-noise ratio
(SNR), and HRV were measured. Results: HRV ranged from 0.2 to 7.8 bpm.
Double-gating PN did not depend on HRV, while single-gating PN increased
with HRV. Over all subjects, double-gating provided a significant
reduction in global PN (from 0.20 +/- 0.15 to 0.11 +/- 0.03 mL/g/min; P =
0.01) and per-segment PN (from 0.33 +/- 0.23 to 0.21 +/- 0.12 mL/g/min; P
< 0.001), with significant increases in global temporal SNR (from 11 +/- 8
to 18 +/- 8; P = 0.02) and per-segment temporal SNR (from 7 +/- 4 to 11
+/- 12; P < 0.001) without significant difference in measured MBF.
Conclusion: Single-gated myocardial ASL suffers from reduced temporal SNR,
while double-gated myocardial ASL provides consistent temporal SNR
independent of HRV. Magn Reson Med 77:1975-1980, 2017. &#xa9; 2016
International Society for Magnetic Resonance in Medicine.
Copyright &#xa9; 2016 International Society for Magnetic Resonance in
Medicine

<46>
Accession Number
615403211
Author
Tsu L.V.; Berry A.J.; Krunic N.; Penny S.; Le S.
Institution
(Tsu) Chapman University School of Pharmacy, 9401 Jeronimo Road, Irvine,
CA 92618, United States
(Berry) Banner University Medical Center, Phoenix, AZ, United States
(Krunic) Midwestern University College of Pharmacy-Glendale, Glendale, AZ,
United States
(Penny, Le) Midwestern University College of Pharmacy-Glendale, Chapman
University School of Pharmacy, United States
Title
A clinical review of surgical vs transcatheter aortic valve replacement in
geriatric patients.
Source
Consultant Pharmacist. 32 (4) (pp 202-214), 2017. Date of Publication:
April 2017.
Publisher
American Society of Consultant Pharmacists (1321 Duke Street, Alexandria
VA 22314-3563, United States)
Abstract
OBJECTIVE: To provide an up-to-date review of the available evidence
regarding management of elderly patients after transcatheter aortic valve
replacement (TAVR). DATA SOURCES: A PubMed search of articles published
(September 1969-December 2016) was done using a combination of the
following words: aortic valve stenosis, geriatric, elderly, transcatheter
aortic valve replacement, surgical aortic valve replacement, transcatheter
aortic valve implantation (TAVI), and dual antiplatelet therapy. STUDY
SELECTION/DATA EXTRACTION: Relevant original research, review articles,
and guidelines were assessed for the management of elderly patients after
TAVR. References from the above literature were also evaluated. Articles
were selected for inclusion based on relevance to the topic, detailed
methods, and complete results. DATA SYNTHESIS: Aortic valve stenosis is
common in the geriatric population. While patients were historically
treated with surgical aortic valve replacement (AVR), more patients are
now undergoing TAVR. This article reviews the current literature regarding
outcomes and pharmacotherapy between surgical and TAVR in the elderly
population. CONCLUSION: Appropriate management of pharmacotherapy after
surgical or TAVR can help improve outcomes in elderly patients, and
pharmacists can provide guidance regarding evidence-based therapy.
Copyright &#xa9; 2017 American Society of Consultant Pharmacists, Inc. All
rights reserved.

<47>
Accession Number
615318675
Author
Hoshijima H.; Denawa Y.; Mihara T.; Takeuchi R.; Kuratani N.; Mieda T.;
Iwase Y.; Shiga T.; Wajima Z.; Nagasaka H.
Institution
(Hoshijima, Takeuchi, Mieda, Iwase, Nagasaka) Department of
Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama,
Japan
(Denawa) Department of Anesthesiology, Allegheny Health Network, PA,
United States
(Mihara) Departments of Anesthesiology and Critical Care Medicine,
Yokohama City University Graduate School of Medicine, Yokohama, Japan
(Kuratani) Department of Anesthesiology, Saitama Children's Medical
Center, Saitama, Japan
(Shiga) Department of Anesthesia, Chemotherapy Research Institute, Kaken
Hospital, International University of Health and Welfare, Chiba, Japan
(Wajima) Department of Anesthesiology, International University of Health
and Welfare Shioya Hospital, Tochigi, Japan and Department of
Anesthesiology, International University of Health and Welfare Hospital,
Tochigi, Japan
(Wajima) Department of Anesthesiology, Tokyo Medical University, Hachioji
Medical Center, Tokyo, Japan
Title
Efficacy of prophylactic doses of intravenous nitroglycerin in preventing
myocardial ischemia under general anesthesia: A systematic review and
meta-analysis with trial sequential analysis.
Source
Journal of Clinical Anesthesia. 40 (pp 16-22), 2017. Date of Publication:
01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study Objective To evaluate the efficacy of intravenous nitroglycerin
(TNG) in preventing intraoperative myocardial ischemia (MI) under general
anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate
(HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure
(PCWP) associated with TNG administration both before and after the
induction of anesthesia. Design Meta-analysis. Setting Operating room,
cardiac surgery or non-cardiac surgery, all surgeries were elective
measurements. We performed a computerized search of articles on PubMed,
Scopus, and the Cochrane Central Register of Controlled Trials.
Meta-analysis was performed using Review Manager. The data from the
individual trials were combined using a random-effects model to calculate
either the pooled relative risk (RR) or the weighted mean difference (WMD)
with 95% confidence interval (CI). We conducted trial sequential analysis
(TSA). The primary outcome was the incidence of MI and the secondary
outcomes were hemodynamic changes (HR, MBP, and PCWP). Main Results Using
electronic databases, we selected 10 trials with a total of 353 patients
for our review. Prophylactic intravenous TNG did not significantly
decrease the incidence of MI (RR = 0.61; CI, 0.33 to 1.13; P = 0.12;
I² = 55). TSA corrected the CI to 0.05 to 7.39 and showed that
9.5% of the required information size was achieved. In terms of
hemodynamic changes, intravenous TNG significantly reduced MBP in
comparison with the placebo (MBP pre-induction: WMD = - 7.27; 95% CI -
14.2 to - 0.33; P = 0.04; I² = 97%; MBP post-induction: WMD = -
5.13; 95% CI - 9.17 to - 1.09; P = 0.01; I² = 73%). Conclusions
Our analyses showed that prophylactic intravenous TNG does not reduce the
incidence of intraoperative MI. Moreover, TSA suggests that further
studies are necessary to confirm the results (GRADE: very low).
Prophylactic doses of intravenous TNG significantly reduced the MBP both
pre and post anesthesia induction (GRADE: very low).
Copyright &#xa9; 2017 Elsevier Inc.

<48>
Accession Number
615318634
Author
Dalby A.J.; Gottlieb S.; Cyr D.D.; Magnus Ohman E.; McGuire D.K.; Ruzyllo
W.; Bhatt D.L.; Wiviott S.D.; Winters K.J.; Fox K.A.A.; Armstrong P.W.;
White H.D.; Prabhakaran D.; Roe M.T.
Institution
(Dalby) Milpark Hospital, Johannesburg, South Africa
(Gottlieb) Department of Cardiology, Shaare Zedek Medical Center,
Jerusalem, Israel
(Cyr, Magnus Ohman, Roe) Duke Clinical Research Institute, Durham, NC,
United States
(Magnus Ohman, Roe) Division of Cardiology, Department of Medicine, Duke
University School of Medicine, Durham, NC, United States
(McGuire) Division of Cardiology, University of Texas Southwestern Medical
Center, Dallas, TX, United States
(Ruzyllo) Department of Coronary Artery Disease, Institute of Cardiology,
Warsaw, Poland
(Bhatt, Wiviott) Brigham and Women's Hospital and Harvard Medical School,
Boston, MA, United States
(Winters) Eli Lilly and Company, Indianapolis, IN, United States
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, Scotland, United Kingdom
(Armstrong) Canadian VIGOUR Centre and Division of Cardiology, Department
of Medicine, University of Alberta, Edmonton, Alberta, Canada
(White) Green Lane Cardiovascular Service, City Hospital, Auckland,
Auckland, New Zealand
(Prabhakaran) Centre for Chronic Disease Control and Public Health
Foundation of India, New Delhi, India
Title
Dual antiplatelet therapy in patients with diabetes and acute coronary
syndromes managed without revascularization.
Source
American Heart Journal. 188 (pp 156-166), 2017. Date of Publication: 01
Jun 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Patients with diabetes mellitus (DM) presenting with acute
coronary syndrome (ACS) and undergoing percutaneous coronary intervention
(PCI) derived enhanced benefit with dual antiplatelet therapy (DAPT) with
prasugrel vs. clopidogrel. The risk profile and treatment response to DAPT
for medically managed ACS patients with DM remains uncertain. Methods The
TRILOGY ACS trial compared aspirin + prasugrel vs. aspirin + clopidogrel
for up to 30 months in non-ST-segment elevation (NSTE) ACS patients
managed medically without revascularization. We compared treatment-related
outcomes among 3539 patients with DM vs. 5767 patients without DM. The
primary endpoint was a composite of cardiovascular death, myocardial
infarction, or stroke. Results Patients with vs. without DM were younger,
more commonly female, heavier, and more often had revascularization prior
to the index ACS event. The frequency of the primary endpoint through 30
months was higher among patients with vs. without DM (24.8% vs. 16.3%),
with a higher risk for those patients with DM treated with insulin vs.
those treated without insulin (35.3% vs. 19.9%). There was no significant
difference in the frequency of the primary endpoint by treatment with
prasugrel vs. clopiodgrel in those with or without DM (P<inf>int</inf> =
0.82) and with or without insulin treatment among those with DM
(P<inf>int</inf> = 0.304). Conclusions Among NSTE ACS patients managed
medically without revascularization, patients with DM had a higher risk of
ischemic events that was amplified among those treated with insulin. There
was no differential treatment effect with a more potent DAPT regimen of
aspirin + prasugrel vs. aspirin + clopidogrel.
Copyright &#xa9; 2017 Elsevier Inc.

<49>
Accession Number
615000470
Author
Woolf-King S.E.; Anger A.; Arnold E.A.; Weiss S.J.; Teitel D.
Institution
(Woolf-King) Department of Psychology, Syracuse University, Syracuse, NY,
United States
(Woolf-King, Arnold, Weiss) Department of Medicine, University of
California, San Francisco, San Francisco, CA, United States
(Anger) Department of Community Health Systems, School of Nursing,
University of California, San Francisco, San Francisco, CA, United States
(Anger, Teitel) Department of Pediatrics, Pediatric Heart Center,
University of California, San Francisco, San Francisco, CA, United States
Title
Mental health among parents of children with critical congenital heart
defects: A systematic review.
Source
Journal of the American Heart Association. 6 (2) (no pagination), 2017.
Article Number: e004862. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Parents of children with critical congenital heart defects
(PCCHDs) may be at high risk for mental health morbidity; however, the
literature is not well characterized. Given that compromised parental
mental health can lead to long-term cognitive, health-related, and
behavioral problems in children, a systematic review of this literature
could provide informed recommendations for continued research and enhance
the care of families of children living with critical congenital heart
defects. Methods and Results-We conducted a systematic review using the
Preferred Reporting Items for Systematic Reviews and Meta- Analyses
guidelines that resulted in 30 studies on the mental health of PCCHDs. The
literature revealed that PCCHDs are at an elevated risk for psychological
problems, particularly in the immediate weeks and months following cardiac
surgery. Up to 30% of PCCHDs have symptoms consistent with a diagnosis of
posttraumatic stress disorder, with over 80% presenting with clinically
significant symptoms of trauma; 25% to 50% of PCCHDs reported clinically
elevated symptoms of depression and/or anxiety, and 30% to 80% reported
experiencing severe psychological distress. There was high variability in
measurements used to assess study outcomes, methodological quality, and
sociocultural composition of the parents included in the studies.
Conclusions-There is an urgent need for additional research on the
severity, course, persistence, and moderators of these mental health
problems over time, and for the development and testing of screening
approaches and interventions that can be feasibly delivered in the context
of ongoing pediatric cardiac care.
Copyright &#xa9; 2017 The Authors.

<50>
Accession Number
615000462
Author
Martin G.P.; Sperrin M.; Bagur R.; de Belder M.A.; Buchan I.; Gunning M.;
Ludman P.F.; Mamas M.A.
Institution
(Martin, Sperrin, Buchan, Mamas) Health e-Research Centre, University of
Manchester, Manchester, United Kingdom
(Bagur) Division of Cardiology, Department of Medicine, London Health
Sciences Centre, University Hospital, Western University, London, ON,
Canada
(de Belder) James Cook University Hospital, Middlesbrough, United Kingdom
(Gunning, Mamas) Royal Stoke Hospital, University Hospitals North
Midlands, Stoke-on-Trent, United Kingdom
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
(Mamas) Keele Cardiovascular Research Group, Keele University,
Stoke-on-Trent, United Kingdom
Title
Pre-implantation balloon aortic valvuloplasty and clinical outcomes
following transcatheter aortic valve implantation: A propensity score
analysis of the UK registry.
Source
Journal of the American Heart Association. 6 (2) (no pagination), 2017.
Article Number: e004695. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Aortic valve predilation with balloon aortic valvuloplasty
(BAV) is recommended before transcatheter aortic valve implantation
(TAVI), despite limited data around the requirement of this preprocedural
step and the potential risks of embolization. This study aimed to
investigate the trends in practice and associations of BAV on short-term
outcomes in the UK TAVI registry. Methods and Results-Eleven clinical
endpoints were investigated, including 30-day mortality, myocardial
infarction, aortic regurgitation, valve dysfunction, and composite early
safety. All endpoints were defined as per the VARC-2 definitions. Odd
ratios of each endpoint were estimated using logistic regression, with
data analyzed in balloon- and self-expandable valve subgroups. Propensity
scores were calculated using patient demographics and procedural
variables, which were included in the models of each endpoint to adjust
for measured confounding. Between 2007 and 2014, 5887 patients met the
study inclusion criteria, 1421 (24.1%) of whom had no BAV before TAVI
valve deployment. We observed heterogeneity in the use of BAV nationally,
both temporally and by center experience; rates of BAV in pre-TAVI workup
varied between 30% and 97% across TAVI centers. All endpoints were similar
between treatment groups in SAPIEN (Edwards Lifesciences Inc., Irvine, CA)
valve patients. After correction for multiple testing, none of the
endpoints in CoreValve (Medtronic, Minneapolis, MN) patients were
significantly different between patients with or without predilation.
Conclusions-Performing TAVI without predilation was not associated with
adverse short-term outcomes post procedure, especially when using a
balloon-expandable prosthesis. Randomized trials including different valve
types are required to provide conclusive evidence regarding the utility of
predilation before-TAVI.
Copyright &#xa9; 2017 The Authors.

<51>
Accession Number
615000456
Author
Pierce B.; Bole I.; Patel V.; Brown D.L.
Institution
(Pierce, Bole, Patel) Hospitalist Division, Washington University School
of Medicine, St. Louis, MO, United States
(Brown) Cardiovascular Division, Washington University School of Medicine,
St. Louis, MO, United States
Title
Clinical outcomes of remote ischemic preconditioning prior to cardiac
surgery: A meta-analysis of randomized controlled trials.
Source
Journal of the American Heart Association. 6 (2) (no pagination), 2017.
Article Number: e004666. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Multiple randomized controlled trials of remote ischemic
preconditioning (RIPC) prior to cardiac surgery have failed to demonstrate
clinical benefit. The aim of this updated meta-analysis was to evaluate
the effect of RIPC on outcomes following cardiac surgery. Methods and
Results-Searches of PubMed, Cochrane, EMBASE, and Web of Science databases
were performed for 1970 to December 13, 2015. Randomized controlled trials
comparing RIPC with a sham procedure prior to cardiac surgery performed
with cardiopulmonary bypass were assessed. All-cause mortality, acute
kidney injury (AKI), and myocardial infarction were the primary outcomes
of interest. We identified 21 trials that randomized 5262 patients to RIPC
or a sham procedure prior to undergoing cardiac surgery. The majority of
patients were men (72.6%) and the mean or median age ranged from 42.3 to
76.3 years. Of the 9 trials that evaluated mortality, 188 deaths occurred
out of a total of 4210 randomized patients, with 96 deaths occurring in
2098 patients (4.6%) randomized to RIPC and 92 deaths occurring in 2112
patients (4.4%) randomized to a sham control procedure, demonstrating no
significant reduction in all-cause mortality (risk ratio [RR], 0.987; 95%
CI, 0.653-1.492, P=0.95). Twelve studies evaluated AKI in 4209 randomized
patients. In these studies, AKI was observed in 516 of 2091 patients
(24.7%) undergoing RIPC and in 577 of 2118 patients (27.2%) randomized to
a sham procedure. RIPC did not result in a significant reduction in AKI
(RR, 0.839; 95% CI, 0.703-1.001 [P=0.052]). In 6 studies consisting of
3799 randomized participants, myocardial infarction occurred in 237 of
1891 patients (12.5%) randomized to RIPC and in 282 of 1908 patients
(14.8%) randomized to a sham procedure, resulting in no significant
reduction in postoperative myocardial infarction (RR, 0.809; 95% CI,
0.615-1.064 [P=0.13]). A subgroup analysis was performed a priori based on
previous studies suggesting that propofol may mitigate the protective
benefits of RIPC. Three studies randomized patients undergoing cardiac
surgery to RIPC or sham procedure in the absence of propofol anesthesia.
Most of these patients were men (60.3%) and the mean or median age ranged
from 57.0 to 70.6 years. In this propofol-free subgroup of 434 randomized
patients, 71 of 217 patients (32.7%) who underwent RIPC developed AKI
compared with 103 of 217 patients (47.5%) treated with a sham procedure.
In this cohort, RIPC resulted in a significant reduction in AKI (RR,
0.700; 95% CI, 0.527-0.930 [P=0.014]). In studies of patients who received
propofol anesthesia, 445 of 1874 (23.7%) patients randomized to RIPC
developed AKI compared with 474 of 1901 (24.9%) who underwent a sham
procedure. The RR for AKI was 0.928 (95% CI, 0.781-1.102; P=0.39) for RIPC
versus sham. There was no significant interaction between the two
subgroups (P=0.098). Conclusions-RIPC does not reduce morbidity or
mortality in patients undergoing cardiac surgery with cardiopulmonary
bypass. In the subgroup of studies in which propofol was not used, a
reduction in AKI was seen, suggesting that propofol may interact with the
protective effects of RIPC. Future studies should evaluate RIPC in the
absence of propofol anesthesia.
Copyright &#xa9; 2017 The Authors.

<52>
Accession Number
615000347
Author
Paradis J.-M.; White J.M.; Genereux P.; Urena M.; Doshi D.; Nazif T.; Hahn
R.; George I.; Khalique O.; Harjai K.; Lasalle L.; Labbe B.M.;
DeLarochelliere R.; Doyle D.; Dumont E.; Mohammadi S.; Leon M.B.;
Rodes-Cabau J.; Kodali S.
Institution
(Paradis, Urena, Labbe, DeLarochelliere, Doyle, Dumont, Mohammadi,
Rodes-Cabau) Quebec Heart and Lung Institute, Quebec, Canada
(Paradis, Genereux, Hahn, Lasalle, Leon, Kodali) Cardiovascular Research
Foundation, New-York, NY, United States
(Genereux) Hopital du Sacre- Coeur de Montreal, Montreal, QC, Canada
(White, Doshi, Nazif, Hahn, George, Khalique, Harjai) Gagnon
Cardiovascular Institute, Morristown Medical Center, Morristown, NJ,
United States
(Leon, Kodali) Columbia University Medical Center, New-York, NY, United
States
Title
Impact of coronary artery disease severity assessed with the SYNTAX score
on outcomes following transcatheter aortic valve replacement.
Source
Journal of the American Heart Association. 6 (2) (no pagination), 2017.
Article Number: e005070. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-The influence of coronary artery disease (CAD) on clinical and
echocardiographic outcomes after transcatheter aortic valve replacement
(TAVR) is still controversial. We sought to evaluate the impact of CAD
severity as measured by the SYNTAX score (SS) on patients undergoing TAVR.
Methods and Results-A total of 377 patients who underwent TAVR in 2
high-volume centers in North America were included in our retrospective
analysis. A blinded angiographic core laboratory calculated the SS on all
available coronary angiograms with the use of quantitative coronary
analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0) (2)
low SS (SS between 1 and 22) (3) intermediate SS (SS between 23 and 32)
and (4) high SS (SS =33). Patients who had undergone percutaneous coronary
intervention within 6 months prior to TAVR were separated into 2
categories based on their residual SS (< 8 and =8). Patients with previous
coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low
CABG SS and (2) high CABG SS. The primary end point was a composite of
all-cause mortality, myocardial infarction, and stroke. At 30 days and 1
year, both the presence and the severity of CAD had no impact on the rate
of the combined primary end point and on all-cause mortality,
cardiovascular mortality, and myocardial infarction. Patients with less
complete revascularization (residual SS =8 versus residual SS < 8 and low
CABG SS versus high CABG SS, had similar rates of the combined primary end
point, all-cause mortality, cardiovascular mortality, MI, and stroke, at
both 30 days and 1 year. Conclusions-In our core laboratory-validated
study, neither the severity of CAD nor completeness of revascularization
after percutaneous coronary intervention or CABG were associated with
clinical outcomes after TAVR, at both 30 days and 1 year.
Copyright &#xa9; 2017 The Authors.

<53>
Accession Number
614998047
Author
Lee A.; Mu J.L.; Joynt G.M.; Chiu C.H.; Lai V.K.W.; Gin T.; Underwood M.J.
Institution
(Lee, Mu, Joynt, Chiu, Lai, Gin) Department of Anaesthesia and Intensive
Care, Chinese University of Hong Kong, Hong Kong, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong, Hong Kong
Title
Risk prediction models for delirium in the intensive care unit after
cardiac surgery: A systematic review and independent external validation.
Source
British Journal of Anaesthesia. 118 (3) (pp 391-399), 2017. Date of
Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Numerous risk prediction models are available for predicting delirium
after cardiac surgery, but few have been directly compared with one
another or been validated in an independent data set.We conducted a
systematic review to identify validated risk prediction models of
delirium(using the Confusion Assessment Method-Intensive Care Unit tool)
after cardiac surgery and assessed the transportability of the risk
prediction models on a prospective cohort of 600 consecutive patients
undergoing cardiac surgery at a university hospital in Hong Kong from July
2013 to July 2015. The discrimination (c-statistic), calibration (GiViTI
calibration belt), and clinical usefulness (decision curve analysis) of
the risk predictionmodels were examined in a stepwisemanner. Three
published high-quality intensive care unit deliriumrisk prediction models
(n5939) were identified: Katznelson, the original PRE-DELIRIC, and the
international recalibrated PRE-DELIRIC model. Deliriumoccurred in 83
patients (13.8%, 95% CI: 11.2-16.9%). After updating the intercept and
regression coefficients in the Katznelsonmodel, there was fair
discrimination (0.62, 95% CI: 0.58-0.66) and good calibration. As the
original PRE-DELIRIC model was already validated externally and
recalibrated in six countries, we performed a logistic calibration on the
recalibrated model and found acceptable discrimination (0.75, 95% CI:
0.72-0.79) and good calibration. Decision curve analysis demonstrated that
the recalibrated PREDELIRIC riskmodel was marginally more clinically
useful than the Katznelsonmodel. Current models predict deliriumrisk in
the intensive care unit after cardiac surgery with only fair to moderate
accuracy and are insufficient for routine clinical use.
Copyright &#xa9; The Author 2017.

<54>
Accession Number
615442933
Author
Costa Leme A.; Hajjar L.A.; Volpe M.S.; Fukushima J.T.; De Santis Santiago
R.R.; Osawa E.A.; Pinheiro De Almeida J.; Gerent A.M.; Franco R.A.;
Feltrim M.I.Z.; Nozawa E.; De Moraes Coimbra V.R.; De Moraes Ianotti R.;
Hashizume C.S.; Filho R.K.; Auler J.O.C.; Jatene F.B.; Galas F.R.B.G.;
Amato M.B.P.
Institution
(Costa Leme, Volpe, Fukushima, De Santis Santiago, Osawa, Pinheiro De
Almeida, Gerent, Franco, Feltrim, Nozawa, De Moraes Coimbra, De Moraes
Ianotti, Hashizume, Filho, Auler, Galas) Department of Anesthesia and
Intensive Care, Heart Institute (InCor), University of Sao Paulo, Sao
Paulo, Brazil
(Hajjar, Jatene, Amato) Cardio-Pulmonary Department, Heart Institute
(Incor), Hospital Das Clinicas da FMUSP - University of Sao Paulo, Avenue
Dr Arnaldo 455, Sao Paulo 01246-903, Brazil
(Volpe) Departament of Applied Physiotherapy, Federal University of
Triangulo Mineiro, Uberaba, Brazil
Title
Effect of intensive vs moderate alveolar recruitment strategies added to
lung-protective ventilation on postoperative pulmonary complications a
randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 317 (14) (pp
1422-1432), 2017. Date of Publication: 11 Apr 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Perioperative lung-protective ventilation has been recommended
to reduce pulmonary complications after cardiac surgery. The protective
role of a small tidal volume (VT) has been established, whereas the added
protection afforded by alveolar recruiting strategies remains
controversial. OBJECTIVE To determine whether an intensive alveolar
recruitment strategy could reduce postoperative pulmonary complications,
when added to a protective ventilation with small VT. DESIGN, SETTING, AND
PARTICIPANTS Randomized clinical trial of patients with hypoxemia after
cardiac surgery at a single ICU in Brazil (December 2011-2014).
INTERVENTIONS Intensive recruitment strategy (n=157) or moderate
recruitment strategy (n=163) plus protective ventilation with small VT.
MAIN OUTCOMES AND MEASURES Severity of postoperative pulmonary
complications computed until hospital discharge, analyzed with a common
odds ratio (OR) to detect ordinal shift in distribution of pulmonary
complication severity score (0-To-5 scale, 0, no complications; 5, death).
Prespecified secondary outcomes were length of stay in the ICU and
hospital, incidence of barotrauma, and hospital mortality. RESULTS All 320
patients (median age, 62 years; IQR, 56-69 years; 125 women [39%])
completed the trial. The intensive recruitment strategy group had a mean
1.8 (95%CI, 1.7 to 2.0) and a median 1.7 (IQR, 1.0-2.0) pulmonary
complications score vs 2.1 (95%CI, 2.0-2.3) and 2.0 (IQR, 1.5-3.0) for the
moderate strategy group. Overall, the distribution of primary outcome
scores shifted consistently in favor of the intensive strategy, with a
common OR for lower scores of 1.86 (95%CI, 1.22 to 2.83; P = .003). The
mean hospital stay for the moderate group was 12.4 days vs 10.9 days in
the intensive group (absolute difference, 1.5 days; 95% CI, 3.1 to 0.3; P
= .04). The mean ICU stay for the moderate group was 4.8 days vs 3.8 days
for the intensive group (absolute difference, 1.0 days; 95%CI, 1.6 to 0.2;
P = .01). Hospital mortality (2.5%in the intensive group vs 4.9% in the
moderate group; absolute difference, 2.4%, 95%CI, 7.1%to 2.2%) and
barotrauma incidence (0% in the intensive group vs 0.6% in the moderate
group; absolute difference, 0.6%; 95%CI, 1.8%to 0.6%; P = .51) did not
differ significantly between groups. CONCLUSIONS AND RELEVANCE Among
patients with hypoxemia after cardiac surgery, the use of an intensive vs
a moderate alveolar recruitment strategy resulted in less severe pulmonary
complications while in the hospital.

<55>
Accession Number
615411194
Author
Zhai M.; Kang F.; Han M.; Huang X.; Li J.
Institution
(Zhai, Li) School of Medicine, Shandong University, Ji nan, Shandong,
China
(Zhai, Kang, Han, Huang, Li) Department of Anesthesiology, Anhui
Provincial Hospital, Anhui Medical University, Hefei, Anhui, China
Title
The effect of dexmedetomidine on renal function in patients undergoing
cardiac valve replacement under cardiopulmonary bypass: A double-blind
randomized controlled trial.
Source
Journal of Clinical Anesthesia. 40 (pp 33-38), 2017. Date of Publication:
01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective We attempted to explore the effect of Dex on renal
function in patients with cardiac valve replacement under cardiopulmonary
bypass (CPB). Design We designed a prospective, randomized,
placebo-controlled, single-center, parallel-arm double-blind trial.
Setting Operating room. Patients Seven-two eligible patients were randomly
divided into Dex group and placebo group. Interventions Dexmedetomidine
(Dex) (0.6 mug.kg^{- 1}) was administered in patients of Dex group
at 15 min before anesthesia induction, followed by a treatment of 0.2
mug.kg^{- 1}.h^{- 1} Dex until the end of operation.
Patients in placebo group were treated with normal saline equally.
Measurements The levels of serum urea nitrogen (BUN), creatinine (Cr),
neutrophil gelatinase-associated lipocalin (NGAL), urine interleukin-8
(IL-18) and superoxide dismutase (SOD) activity were tested before
anesthesia induction (T1) and after operation at 0, 12 h, 24 h and 72 h
(T2-5). The urine output during operation and the post-operative
complication of acute kidney injury (AKI) were recorded. Main results The
levels of BUN and Cr were significantly increased at T5, and similar
findings were found in the levels of NGAL and urine IL-18 at T3 and T4.
The SOD activity was significantly declined at T2 and T3 in the two
groups. The levels of BUN and Cr at T5 and the NGAL level at T3 and T4
were significantly lower in Dex group, comparable to placebo group. The
intraoperative urine output was significantly increased and the
postoperative incidence of AKI was significantly lower in Dex group.
Conclusions Dex may attenuate the renal injury and decrease the incidence
of AKI in patients undergoing cardiac valve replacement under CPB.
Copyright &#xa9; 2017 Elsevier Inc.

<56>
Accession Number
615438403
Author
Bagur R.; Solo K.; Alghofaili S.; Nombela-Franco L.; Kwok C.S.; Hayman S.;
Siemieniuk R.A.; Foroutan F.; Spencer F.A.; Vandvik P.O.; Schaufele T.G.;
Mamas M.A.
Institution
(Bagur) From the Division of Cardiology, Department of Medicine, London
Health Sciences Center (R.B., S.A., S.H.) and Department of Epidemiology
and Biostatistics (R.B., K.S.), Schulich School of Medicine & Dentistry,
Western University, London, Ontario, Canada; Keele Cardiovascular Research
Group, Institute of Applied Clinical Science (R.B., C.S.K., M.A.M.), Keele
University and Royal Stoke Hospital, Stoke-on-Trent, United Kingdom;
Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
(L.N.-F.); Department of Medicine, University of Toronto, Ontario
(R.A.S.); Department of Clinical Epidemiology & Biostatistics (F.F.) and
Division of Cardiology, Department of Medicine (F.A.S.), McMaster
University, Hamilton, Ontario, Canada; Department of Medicine, Innlandet
Hospital Tr
Title
Cerebral Embolic Protection Devices During Transcatheter Aortic Valve
Implantation: Systematic Review and Meta-Analysis.
Source
Stroke. (no pagination), 2017. Date of Publication: 14 Apr 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND AND PURPOSE-: Silent ischemic embolic lesions are common after
transcatheter aortic valve implantation (TAVI). The use of embolic
protection devices (EPD) may reduce the occurrence of these embolic
lesions. Thus, a quantitative overview and credibility assessment of the
literature was necessary to draw a robust message about EPD. Therefore,
the aim of this meta-analysis was to study whether the use of EPD reduces
silent ischemic and clinically evident cerebrovascular events associated
with TAVI. METHODS-: We conducted a comprehensive search to identify
studies that evaluated patients undergoing TAVI with or without EPD.
Random-effects meta-analyses were performed to estimate the effect of EPD
compared with no-EPD during TAVI using aggregate data. RESULTS-: Sixteen
studies involving 1170 patients (865/305 with/without EPD) fulfilled the
inclusion criteria. The EPD delivery success rate was reported in all
studies and was achieved in 94.5% of patients. Meta-analyses evaluating
EPD versus without EPD strategies could not confirm or exclude any
differences in terms of clinically evident stroke (relative risk, 0.70;
95% confidence interval [CI], 0.38-1.29; P=0.26) or 30-day mortality
(relative risk, 0.58; 95% CI, 0.20-1.64; P=0.30). There were no
significant differences in new-single, multiple, or total number of
lesions. The use of EPD was associated with a significantly smaller
ischemic volume per lesion (standardized mean difference, -0.52; 95% CI,
-0.85 to -0.20; P=0.002) and smaller total volume of lesions (standardized
mean difference, -0.23; 95% CI, -0.42 to -0.03; P=0.02). Subgroup analysis
by type of valve showed an overall trend toward significant reduction in
new lesions per patient using EPD (standardized mean difference, -0.41;
95% CI, -0.82 to 0.00; P=0.05), driven by self-expanding devices.
CONCLUSIONS-: The use of EPD during TAVI may be associated with smaller
volume of silent ischemic lesions and smaller total volume of silent
ischemic lesions. However, EPD may not reduce the number of new-single,
multiple, or total number of lesions. There was only very low quality of
evidence showing no significant differences between patients undergoing
TAVI with or without EPD with respect to clinically evident stroke and
mortality.
Copyright &#xa9; 2017 American Heart Association, Inc.

<57>
Accession Number
607898218
Author
Amat-Santos I.J.; Cortes C.; Varela-Falcon L.H.
Institution
(Amat-Santos, Cortes, Varela-Falcon) Cardiology Department, Hospital
Clinico Universitario De Valladolid, Spain
Title
Delayed left anterior mitral leaflet perforation and infective
endocarditis after transapical aortic valve implantation-Case report and
systematic review.
Source
Catheterization and Cardiovascular Interventions. 89 (5) (pp 951-954),
2017. Date of Publication: April 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Aim: We aimed to illustrate the physiopathology of anterior mitral leaflet
perforation after TAVI in patients suffering from infective endocarditis
(IE). Methods and Results: The first known case of balloon-expandable
transapical case from our series suffering from this complication was
reported. In addition, a systematic electronic search of all published
cases reporting both entities was performed. Five transfemoral cases have
been published to the date, all males with mean age of 79.2 year (range:
66-88). Four were treated with self-expandable prostheses (deeply
implanted in the outflow tract). There was moderate residual aortic
regurgitation in four. Fever and positive blood cultures for typical
micoorganisms were present at certain time point in all cases between the
first week and up to 11 months (early IE). Three cases underwent cardiac
surgery with adequate outcomes and two others died during hospitalization.
Medical management in the case from our series allowed patient's survival
at 1-year follow up. Conclusions: Early suspicion of IE whenever anterior
mitral perforation is found after TAVI can be life-saving. The
hypothetical higher risk of this complication due to higher rate of aortic
regurgitation has to be prevented through adequate prosthesis depth and
careful sterile surgical technique. &#xa9; 2016 Wiley Periodicals, Inc.
Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<58>
Accession Number
615441381
Author
Evans C.; Tobin S.; Phillips G.; Obase O.; Klein A.; Richards T.
Institution
(Evans, Tobin, Phillips, Obase) Department of Anaesthesia, University
Hospital ofWales, Cardiff, United Kingdom
(Klein) Department of Anaesthesia, Papworth Hospital, Cambridge, United
Kingdom
(Richards) Department of Surgery, UCL, London, United Kingdom
Title
Patient outcome following implementation of an anaemia management pathway
in cardiac surgery-addressing the first pillar of perioperative blood
management.
Source
Transfusion Medicine. Conference: 18th Annual NATA Symposium on Patient
Blood Management, Haemostasis and Thrombosis. Italy. 27 (pp 52), 2017.
Date of Publication: April 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Global awareness of patient blood management and recently
published UK guidelines1,2 on the detection, optimisation and management
of anaemia before surgery provided a platform to implement anaemia
management at our centre. We have developed a simple, one-step, virtual
diagnosis and treatment pathway to identify and treat patients who are
anaemic with intravenous iron (IV Fe) prior to cardiac surgery. We have
compared transfusion and outcome data with an untreated group of anaemic
patients. Method: Anaemic patients offered IV Fe as part of this pathway
were analysed. Haemoglobin (Hb) pre- and post-iron infusion were recorded
along with packed red cell (PRC) transfusion data, ICU and hospital LOS.
Results were compared with data collected on non-anaemic and anaemic
patients who did not receive treatment with IV Fr as part of setting up
this new service. Results: 29 anaemic patients received IV Fe as iron
isomaltoside (Monofer) prior to cardiac surgery. 50 anaemic patients
received no treatment. 320 patients were non-anaemic. There were no
differences in basic demographic data between the three groups. Patients
treated with IV Fe had a median transfusion of 1 (IQR 0-2 [range 0-9])
units PRC. The median transfusion in the untreated anaemic group was 2
(IQR 0-3 [range 0-14]) PRCs and in non-anaemic patients was 0 (IQR 0-2
[range 0-17]) PRCs. 32% of untreated anaemic patients, 45% of IV Fe
patients and 58.1% of non-anaemic patients received no PRC transfusion
during their entire hospital stay. Mortality rate was 3.4% (one patient)
in the IV Fe, 6% (three patients) in the untreated anaemic and 0.9% (three
patients) in the non-anaemic group. Conclusion: IV iron consistently
increases Hb in preoperative cardiac surgical patients with a screened
ferritin <100 ng/mL. We estimate that 1 unit of blood is saved per
patient. Exposing less patients to transfusion risk and some requiring no
transfusion. Patient outcomes show a trend towards improvement in PRC
transfusion requirement and overall hospital LOS. A prospective randomised
control trial would answer these questions as well as the timing of IV Fe
for optimum Hb rise.

<59>
Accession Number
615441302
Author
Siemens K.; Hunt B.J.; Harris J.; Nyman A.; Perkins J.; Murdoch I.A.;
Tibby S.M.
Institution
(Siemens, Harris, Nyman, Perkins, Murdoch, Tibby) PICU, Evelina London
Children's Hospital, StThomas' Hospital, London, United Kingdom
(Hunt) Haematology, St Thomas' Hospital, London, United Kingdom
Title
Fibrinogen in paediatric cardiac surgery: The FIB-CON trial-breaking RCT
news.
Source
Transfusion Medicine. Conference: 18th Annual NATA Symposium on Patient
Blood Management, Haemostasis and Thrombosis. Italy. 27 (pp 19), 2017.
Date of Publication: April 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Objectives: (1) To determine dose, safety and efficacy of fibrinogen
concentrate (FC) supplementation during paediatric cardiac cardiopulmonary
bypass (CPB) surgery. (2) To demonstrate the feasibility of using
intraoperative ROTEM to predict postoperative bleeding and guide FC dose
calculation. Methods: Patients were screened intraoperatively using the
ROTEM variable FibTEM-MCF, which was measured 1 hour pre-end bypass.
Patients were randomised to receive FC : placebo (2:1 ratio) if FibTEM-MCF
<6 mm (physiological 7-24 mm). If FibTEM-MCF >7 mm patients entered the
monitoring cohort. Individualised FC dose calculation included patient
weight, bypass circuit volume, haematocrit and intraoperative FibTEM-MCF.
Desired MCF was 8-13 mm and fibrinogen levels 1.5-2.5 g/L. Primary
outcome: FibTEM-MCF within 5 minutes post FC administration. Secondary
outcome: postoperative mediastinal blood loss. Results: Results from 111
patients (FC n = 60, placebo n = 30, cohort n = 21; mean age 6.4 (+5.8)
mo;mean weight 5.9 (+2.0) kg) demonstrated no patients exhibiting severe
bleeding (>10 mL/kg/4 h) if FibTEM-MCF >7 mm compared to FibTEM-MCF <6 mm
(Figure). FibTEM-MCF on bypass correlated well with fibrinogen levels. The
median (range) FCdose used was 114mg/kg (51-218). Fibrinogen levels
increased from a mean (+SD) of 0.91 (+0.22) g/L to 1.7 (+0.41). The range
of post-dose fibrinogen was 0.94 to 2.8 g/L. Ten patients exhibited 12
possible thromboses; none were clearly related to study drug. The number
of patients with blood loss >10 mL/kg/4 h was lower in the FC group (6.7%)
compared to placebo (16.7%) (Figure). In the placebo group more patients
required blood products/24 h (60% vs. 41.2%). Conclusion: Intraoperative
screening based on FibTEM-MCF identified patients unlikely to bleed and
correlated with fibrinogen levels. Individualised FC administration on
bypass is feasible, safe, and achieves therapeutic fibrinogen levels.
(Figure Presented).

<60>
Accession Number
615441299
Author
Meier J.; Waters J.H.; Myers G.; Martinetti M.; Bagnardi V.
Institution
(Meier) Department of Anesthesiology and Intensive Care Medicine, Kepler
University Hospital, Linz, Austria
(Waters) Department of Anesthesiology, Magee Womens Hospital, Pittsburgh,
PA, United States
(Myers) Eastern Perfusion International, Dartmouth, NS, Canada
(Martinetti, Bagnardi) Department of Statistics and Quantitative Methods,
University of Milan-Bicocca, Milan, Italy
Title
Clinical efficacy of washed autotransfusion in non-cardiac settings such
as vascular, orthopaedic and obstetric surgery: A systematic review and
meta-analysis of randomised controlled trials.
Source
Transfusion Medicine. Conference: 18th Annual NATA Symposium on Patient
Blood Management, Haemostasis and Thrombosis. Italy. 27 (pp 40), 2017.
Date of Publication: April 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Washed autotransfusion (w-ATS) is a contemporary blood
management strategy that is widely used in cardiac surgery and recommended
by the American Society of Thoracic Surgeons and the Society of
Cardiovascular Anesthesiologists. Nevertheless, it is not universally
utilised in many non-cardiac applications despite its potential benefits
in reducing red blood cell transfusion and improving patient outcomes.
This systemic review and meta-analysis investigated the efficacy of intra-
and/or postoperative w-ATS in reducing allogeneic blood transfusions
during major surgical procedures other than cardiac surgery, such as
orthopaedic, vascular and obstetric surgery. Methods: A literature search
was performed in PubMed for randomised controlled clinical trials (RCT),
published before September 2016, comparing w-ATS with standard suction
drainage, or comparing w-ATS used concurrently with other active
strategies intended to minimise allogeneic transfusion vs. the same active
strategies. The primary efficacy measure was the risk ratio (RR) for
allogeneic blood transfusion in the w-ATS group compared with the control
group. Secondary efficacy measures were the mean difference (MD) between
w-ATS and control group of units of packed red blood cells (RBC)
transfused, total blood loss, postoperative haemoglobin levels, and length
of hospital stay. Random-effect models were fitted to obtain the pooled RR
and MD estimates. Results: The study included 21 RCTs, comprising 1922
patients who underwent w-ATS. Fifteen RCTs involved patients undergoing
orthopaedic surgery, five undergoing vascular surgery, and one undergoing
obstetric surgery. The pooled RR of allogeneic transfusion for w-ATS,
compared to control, was 0.49 (95% CI: 0.36, 0.65, P<0.0001). The pooled
MD of packed RBCs and duration of hospital stay were, respectively, -1.1
units (P<0.0001) and -1.0 days (P = 0.024) in favour of w-ATS. Conclusion:
The use of washed autotransfusion in non-cardiac settings such as
vascular, orthopaedic and obstetric surgery significantly reduces the risk
of exposure to homologous blood transfusion and length of hospital stay.

<61>
Accession Number
615441294
Author
Carson J.L.
Institution
(Carson) Provost, Rutgers Biomedical and Health Sciences, NB, United
States
(Carson) Richard C Reynolds Department of Medicine, Rutgers Robert Wood
Johnson Medical School, NB, United States
Title
Red blood cell transfusion thresholds-2016 AABB clinical practice
guidelines.
Source
Transfusion Medicine. Conference: 18th Annual NATA Symposium on Patient
Blood Management, Haemostasis and Thrombosis. Italy. 27 (pp 17), 2017.
Date of Publication: April 2017.
Publisher
Blackwell Publishing Ltd
Abstract
The updated AABB red blood cell transfusion guidelines were recently
published.1 The rationale for updating the guidelines was that the numbers
of patients enrolled in clinical trials hadmore than doubled since the
AABB guidelines were last published in 2012 and this additional
information would permit more refined and reliable advice. The guidelines
were developed by a committee composed of specialist in transfusion
medicine, clinical trials, evidence-based medicine, cardiology, surgery,
paediatrics, and lay representative. The initial step was to conduct a
systematic review of the literature which included 31 clinical trials.2 As
in the past, the recommendations were based on the results of these
clinical trials. The committee endorsed the good practice statement that
transfusion should consider, in addition to the haemoglobin level, the
overall clinical context, patient pREFERENCES, and alternative
treatmentswhenmakingdecision to transfuse. The committee recommended a 7
g/dL threshold in haemodynamically stable patients, including critically
ill patients in the intensive care unit, rather than a 10 g/dL threshold.
However, the committee recommended a restrictive transfusion threshold of
8 g/dL for patients undergoing orthopaedic surgery, cardiac surgery, and
those with pre-existing cardiovascular disease because the trials used an
8 g/dL threshold rather than a 7 g/dL threshold. The guidelines did not
provide recommendations for patients with acute myocardial infarction,
thrombocytopenic patients with anaemia, or chronic transfusion-dependent
patients because of the lack of clinical trial evidence.

<62>
Accession Number
615441257
Author
Van Der Linden P.
Institution
(Van Der Linden) Department of Anesthesiology, Queen Fabiola Children
University Hospital, Universite Libre De Bruxelles, Brussels, Belgium
Title
Quality management in PBM-audits and benchmarking.
Source
Transfusion Medicine. Conference: 18th Annual NATA Symposium on Patient
Blood Management, Haemostasis and Thrombosis. Italy. 27 (pp 5-6), 2017.
Date of Publication: April 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Patient blood management (PBM) has been defined as the appropriate use of
blood and blood components with a goal of minimizing their use.1 PBM
relies on three key approaches to achieve its goals: optimising the
patient's red blood cell mass, minimising blood loss and improving
patient's tolerance to anaemia.1 Therefore, it involves a patient-centred,
evidence-based medical and surgical approach that is both
multidisciplinary (transfusion medicine specialists, surgeons,
anaesthesiologists and critical care specialists) and multi-professional
(physicians, nurses, pump technologists and pharmacists). After the 63.12
WHO resolution adopted in May 2010, the implementation of PBM has been
encouraged in all WHO states. PBM has been successfully implemented in
some centres in the USA, while the government ofWestern Australia has
implemented PBM state-wide as the standard of care.2 Implementation
ofPBMinEuropehasbeenvariable and inconsistent.2While some countries such
as the Netherlands have been using some PBM strategies for a decade,
mainly in orthopaedic surgery, other countries have adopted few, if any,
of them.2 Although there is increasing evidence that PBM is useful and
could improves outcome, implementation of the concept remains difficult,
is time consuming and as a consequence seldomaccomplished.3 There appears
to be considerable variation in the availability and use of guidelines for
preoperative anaemia treatment and transfusion between and within
countries. A recent prospective observational multicentre European study
reported that although the transfusion trigger used intraoperatively is
probably appropriate, post-transfusion haemoglobin levels were high,
suggesting the need to develop a single-unit transfusion strategy.4
Implementation of transfusion guidelines in cardiac and non-cardiac
surgery has been reported to be poor or moderate,5,6 but focused
implementation guidelines at single institutions appeared more
successful.7-9 Organisational and peer leadership and the internal
organisational structure could significantly affect the success of
guideline implementation at the institution level.10 Comparison of blood
usage between institutions and/or countries with the aim of standardising
and improving practices has been reported for more than 30 years, but not
until recently has the term "benchmarking" been introduced in transfusion
medicine.11 Given the documented major variations in transfusions
practices, benchmarking, defined as a structured continuous collaborative
process in which comparisons for selected indicators are used to identify
factors that, when implemented, will improve practice, can be particularly
useful in modulating transfusion practice. Benchmarking should be
performed repeatedly or continuously to monitor practices and use the
information obtained to improve quality in a persistentmanner.12 Gombotz
et al. performed a first benchmark study to measure the current
transfusion practice and to identify predictors of transfusion in 18
randomly selected public hospital in Austria from 2004 to 2005.13 The
authors reported significant variations in transfusion practice and in the
use of blood conservation methods among the hospitals. The same authors
performed a second benchmark study 5 years later, in all but one hospital
which participated in the first study.14 Although small but significant
reductions in red blood cell transfusions (RBC) and RBC loss were observed
in orthopaedic surgery (but not in cardiac surgery), this study confirms
the previously reported high variability in RBC transfusions, blood loss
and use of PBM strategies. Overall, the relative modest impact of this
approach might be related to the fact that centreswere not audited between
the two benchmark studies in order to define with themwhich measures they
intended to take to improve their transfusion practice. The Network for
the Advancement of Patient Blood Management, Haemostasis and Thrombosis
(NATA) initiated a benchmark project with the aim of providing the basis
for educational strategies to implement optimal PBM in participating
centres.15 This observational study with online data collection included
10 European and one Canadian centres interested in developing PBM between
January 2010 and June 2011. The study reported two main observations.
First, PBM implementation remains highly variable between centres despite
significant efforts designed to disseminate knowledge in this field.
Second, the development of PBM strategies has to take into account not
only the individual needs of the patient but also the specificities of the
individual healthcare facility. This study represents only the first step
of the NATA benchmark project. It should be followed by audits, performed
in the different participating centres to help them develop specific
strategies to improve their PBM programme. Once these measures have been
implemented, a second observational study could be launched in order to
assess the impact of the differentmeasures taken in each centre on their
transfusion practice. When this step has been completed, the project
should then be extended to other centres interested in PBM, with the help
of the centres that have completed the benchmark process.

<63>
[Use Link to view the full text]
Accession Number
615369281
Author
Sible A.M.; Nawarskas J.J.
Institution
(Sible, Nawarskas) College of Pharmacy, University of New Mexico, 2502
Marble NE, Albuquerque, NM 87131, United States
Title
Cangrelor: A New Route for P2Y12 Inhibition.
Source
Cardiology in Review. 25 (3) (pp 133-139), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Antiplatelet therapy with a P2Y 12 inhibitor is a key component of
treatment for patients with acute coronary syndromes undergoing
percutaneous coronary intervention. Before the development of cangrelor
(Kengreal, The Medicines Company, Parsippany, NJ), only oral P2Y 12
inhibitors were available. Cangrelor is a reversible P2Y 12 inhibitor that
is administered as an intravenous infusion, and its quick onset and offset
make it an appealing option for antiplatelet therapy, particularly for
patients who are unable to take oral medications. Although cangrelor
struggled to show benefit in early trials, the positive results of the
CHAMPION PHOENIX trial led to its approval for use as an adjunct to
percutaneous coronary intervention to reduce the risk of periprocedural
myocardial infarction, repeat coronary revascularization, and stent
thrombosis in patients who have not been treated with another P2Y 12
inhibitor and are not being given a glycoprotein IIb/IIIa inhibitor.
Cangrelor has also been evaluated as an option for bridging therapy in
patients who must discontinue their oral P2Y 12 inhibitor before coronary
artery bypass grafting. This review of cangrelor will discuss its
mechanism of action, its pharmacodynamics and pharmacokinetics, the
clinical trial experience, and its potential place in therapy.
Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All rights reserved.

<64>
Accession Number
604108138
Author
Paudel S.; Zacharioudakis I.M.; Zervou F.N.; Ziakas P.D.; Mylonakis E.
Institution
(Paudel, Zacharioudakis, Zervou, Ziakas, Mylonakis) Infectious Diseases
Division, Warren Alpert Medical School of Brown University, Rhode Island
Hospital, Providence, RI, United States
Title
Prevalence of clostridium difficile infection among solid organ transplant
recipients: A meta-analysis of published studies.
Source
PLoS ONE. 10 (4) (no pagination), 2015. Article Number: e0124483. Date of
Publication: 17 Apr 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Several factors including antibiotic use, immunosuppression and frequent
hospitalizations make solid organ transplant (SOT) recipients vulnerable
to Clostridium difficile infection (CDI). We conducted a meta-analysis of
published studies from 1991-2014 to estimate the prevalence of CDI in this
patient population. We searched PubMed, EMBASE and Google Scholar
databases. Among the 75,940 retrieved citations, we found 30 studies coded
from 35 articles that were relevant to our study. Based on these studies,
we estimated the prevalence of CDI among 21,683 patients who underwent
transplantation of kidney, liver, lungs, heart, pancreas, intestine or
more than one organ and stratified each study based on the type of
transplanted organ, place of the study conduction, and size of patient
population. The overall estimated prevalence in SOT recipients was 7.4%
[95%CI, (5.6-9.5%)] and it varied based on the type of organ transplant.
The prevalence was 12.7% [95%CI, (6.4%-20.9%)] among patients who
underwent transplantation for more than one organ. The prevalence among
other SOT recipients was: lung 10.8% [95% CI, (5.5%-17.7%)], liver 9.1%
[95%CI, (5.8%-13.2%)], intestine 8% [95% CI, (2.6%-15.9%)], heart 5.2%
[95%CI, (1.8%-10.2%)], kidney 4.7% [95% CI, (2.6%-7.3%)], and pancreas
3.2% [95% CI, (0.5%-7.9%)]. Among the studies that reported relevant data,
the estimated prevalence of severe CDI was 5.3% [95% CI (2.3%-9.3%)] and
the overall recurrence rate was 19.7% [95% CI, (13.7%-26.6%)]. In summary,
CDI is a significant complication after SOT and preventive strategies are
important in order to reduce the CDI related morbidity and mortality.
Copyright &#xa9; 2015 Paudel et al.

<65>
Accession Number
615417875
Author
Noble S.; Stortecky S.; Heg D.; Tueller D.; Jeger R.; Toggweiler S.;
Ferrari E.; Nietlispach F.; Taramasso M.; Maisano F.; Grunenfelder J.;
Juni P.; Huber C.; Carre T.; Windecker S.; Wenaweser P.; Roffi M.
Institution
(Noble, Huber, Carre, Roffi) Cardiology Division, University Hospital,
Geneva, Switzerland
(Stortecky, Windecker, Wenaweser) Cardiology and Cardiovascular Surgery
Departments, Swiss Cardiovascular Center, University Hospital, Bern 3010,
Switzerland
(Heg) Clinical Research Department, Clinical Trials Unit, Institute of
Social and Preventive Medicine, Bern University, Bern, Switzerland
(Tueller) Triemli Hospital Zurich, Zurich, Switzerland
(Jeger) Cardiology Department, Basel University Hospital, Basel,
Switzerland
(Toggweiler) Kantonsspital, Luzern, Switzerland
(Ferrari) Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland
(Nietlispach, Taramasso, Maisano) Cardiology and Cardiovascular Surgery
Departments, University Hospital, Zurich, Switzerland
(Grunenfelder) Hirslanden Clinic Zurich, Zurich, Switzerland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Department of Medicine, University of Toronto,
Toronto, Canada
(Wenaweser) Cardiology Department, Klinik im Park, Zurich, Switzerland
Title
Comparison of procedural and clinical outcomes with Evolut R versus
Medtronic CoreValve: A Swiss TAVI registry analysis.
Source
EuroIntervention. 12 (18) (pp e2170-e2176), 2017. Date of Publication:
April 2017.
Publisher
EuroPCR
Abstract
Aims: Data on procedural and clinical outcomes after transcatheter aortic
valve implantation (TAVI) with the new-generation self-expanding Medtronic
Evolut R prosthesis in comparison with its predecessor, the Medtronic
CoreValve, are scarce. The aim of this study was to assess the safety and
efficacy of the Evolut R device compared with the former-generation
CoreValve. Methods and results: In a nationwide, prospective, multicentre
cohort study (Swiss TAVI registry, NCT01368250), outcomes of consecutive
transfemoral TAVI patients treated with the new-generation Medtronic
Evolut R (September 2014 - February 2016) and the Medtronic CoreValve
(February 2011 - February 2016) were investigated. Events were reported
according to VARC-2 and adjudicated by a clinical events committee. During
the study period, 317 and 678 consecutive patients underwent TAVI with the
Evolut R and the CoreValve bioprosthesis, respectively. Baseline clinical
characteristics between the groups were comparable, although Evolut R
patients were lower risk according to the STS score (4.8+/-3.4% vs.
6.9+/-5.0%, p<0.001) and logistic EuroSCORE (17.3+/-13% vs. 20.1+/-13%,
p=0.009). Implantation of the Evolut R was associated with a lower use of
predilatation (48.1% vs. 72.4%, p<0.001), a shorter procedure time
(67.9+/-36 min vs. 76.7+/-42 min, p=0.002), and less contrast dye use
during the procedure (155.2+/-98 ml vs. 208.0+/-117 ml, p<0.001).
Post-procedural mean gradient was comparable (7.4+/-4.7 mmHg vs. 7.5+/-5.0
mmHg), as were the 30-day rates of moderate to severe aortic regurgitation
(8.5% vs. 10.5%), major vascular (9.8% vs. 10.3%) and life-threatening
bleeding complications (5.4% vs. 5.3%), disabling stroke (1.9% vs. 1.6%),
all-cause mortality (3.2% vs. 3.4%) as well as permanent pacemaker
implantation (22.1% vs. 23.4%). Conclusions: Thirty-day clinical outcomes
were favourable and comparable between the Evolut R and the CoreValve
bioprosthesis.
Copyright &#xa9; Europa Digital & Publishing 2017. All rights reserved.

<66>
Accession Number
615430352
Author
Peterson S.; Su J.A.; Szmuszkovicz J.R.; Johnson R.; Sargent B.
Institution
(Peterson) Division of Pediatric Rehabilitation Medicine Physical Therapy
Children's Hospital Los Angeles Los Angeles, CA USA
(Peterson, Sargent) Division of Biokinesiology and Physical Therapy Herman
Ostrow School of Dentistry University of Southern California Los Angeles,
CA USA
(Su, Szmuszkovicz) Division of Cardiology Department of Pediatrics
Children's Hospital Los Angeles Los Angeles, CA USA
(Johnson) Norris Medical Library University of Southern California Los
Angeles, CA USA
Title
Exercise capacity following pediatric heart transplantation: A systematic
review.
Source
Pediatric Transplantation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Pediatric HTs account for 13% of all HTs with >60% of recipients surviving
at least 10 years post-HT. The purpose of this systematic review is to
synthesize the literature on exercise capacity of pediatric HT recipients
to improve understanding of the mechanisms that may explain the decreased
exercise capacity. Six databases were searched for studies that compared
the exercise capacity of HT recipients <21 years old with a control group
or normative data. Sixteen studies were included. Pediatric HT recipients,
as compared to controls or normative data, exhibit significantly higher
resting HR, and at peak exercise exhibit significantly decreased HR,
VO<inf>2</inf>, power, work, minute ventilation, and exercise duration.
Peak VO<inf>2</inf> appears to improve within the first 2.5 years post-HT;
peak work remains constant; and there is inconclusive evidence that peak
HR, HR recovery, and HR reserve improve with time since HT. These results
are discussed in the context of the mechanisms that may explain the
impaired exercise capacity of pediatric HT recipients, including
chronotropic incompetence, graft dysfunction, side effects of
immunosuppression therapy, and deconditioning. In addition, the limited
literature on rehabilitation after pediatric HT is summarized.
Copyright &#xa9; 2017 John Wiley & Sons A/S.

<67>
Accession Number
615431818
Author
Kwok C.S.; Bagur R.; Rashid M.; Lavi R.; Cibelli M.; de Belder M.A.; Moat
N.; Hildick-Smith D.; Ludman P.; Mamas M.A.
Institution
(Kwok, Bagur, Rashid, Mamas) Cardiovascular Research Group, Keele
University, Stoke-on-Trent, UK
(Bagur) Division of Cardiology, London Health Sciences Centre, Department
of Medicine, Western University, London, Ontario, Canada
(Bagur) Department of Epidemiology and Biostatistics, Western University,
London, Ontario, Canada
(Lavi) Department of Anesthesia and Perioperative Medicine, London Health
Sciences Centre, Western University, London, Ontario, Canada
(Cibelli, Moat) Royal Brompton Hospital, London, UK
(de Belder) The James Cook University Hospital, Middlesbrough, UK
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University
Hospitals, Brighton, UK
(Ludman) Queen Elizabeth Hospital, Birmingham, UK
Title
Aortic stenosis and non-cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2016. Date of
Publication: December 29, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Aortic stenosis (AS) poses a perioperative management dilemma
to physicians looking after patients who require non-cardiac surgery. The
objective of this review is to investigate mortality and adverse
cardiovascular events in patients with and without AS who underwent
non-cardiac surgery. Methods: We searched MEDLINE and EMBASE for studies
that evaluated mortality and adverse cardiovascular events in patients
with and without AS who underwent non-cardiac surgery. Pooled risk ratios
for mortality and adverse outcomes (myocardial infarction, stroke, heart
failure, death) were calculated using the dichotomous analysis method and
subgroup analysis was performed considering the effect of severity of AS
and symptoms. Results: We identified 9 relevant studies with 29,327
participants. Among studies of severe AS, there was no significant
difference in mortality (RR: 1.49, 95%CI:0.85-2.61; P = 0.16) associated
with non-cardiac surgery, but there was a significant increase in the
composite adverse outcome (RR: 2.30, 95%CI:1.33-3.97; P = 0.003). When the
analysis involved any other degree of AS, eight studies were included and
the pooled results showed a significant increase in composite adverse
outcome (RR: 1.64, 95%CI:1.23-2.19; P <. 0.001) and myocardial infarction
(RR: 1.90, 95%CI:1.54-2.34; P <. 0.001). When patients with asymptomatic
AS were considered, the pooled results of four studies suggested an
increased risk of composite adverse outcomes (RR: 1.59, 95%CI:1.19-2.12; P
= 0.002) but not mortality, myocardial infarction, heart failure or
stroke. Conclusions: Patients with AS undergoing non-cardiac surgery have
not been shown to be at increased risk of mortality, but have
significantly higher rates of adverse cardiovascular events compared to
patients without AS.
Copyright &#xa9; 2016.

<68>
Accession Number
615419795
Author
Slavik L.; Hajek R.; Fluger I.; Lonsky V.; Zuchcich O.; Caletka P.;
Ulehlova J.
Institution
(Slavik, Hajek, Fluger, Lonsky, Zuchcich, Caletka, Ulehlova) University
Hospital Olomouc, Czech Republic
Title
Platelet dysfunction during and after cardiopulmonary bypass detected with
thrombelastography and platelet aggregation assays.
Source
Haematologica. Conference: European Hematology Association Scientific
Conference on Bleeding Disorders 2016. Spain. 101 (pp 11), 2016. Date of
Publication: September 2016.
Publisher
Ferrata Storti Foundation
Abstract
Cardiopulmonary bypass (CPB) is associated with complex activation of
hemostatic system. The complexity of this patterns cannot be described by
standard laboratory tests especially during full heparinization.
Thrombelastography (TEG) is reliable method for detection of hemostatic
abnormalities during surgery. Some limitation of this examination are
necessity to know platelet count and function, concentration of
fibrinogen, threshold level of ionised calcium and temperature adjustment.
Two groups of elective cardiac surgery patients were evaluated in
prospective randomized study. Group TEG (n=499) was monitored both with
TEG and laboratory tests (prothrombin time - PT, thrombin time, - TT,
activated partial thromboplastin time-aPTT, fibrinogen - FBG, platelet
count and function, fibrin degradation products- FDP). Standard ACT
(Activated Clotting Time - HemochronR - kaolin activated) monitoring was
provided. Group Control (n=475) was monitored only with laboratory tests.
Thrombelastograph TEGR5000 Series (Haemoscope, Niles, IL, USA) was used.
Blood was sampled from central venous cathether without heparin flush.
Kaolin activated cuvettes were used.The following TEG measurements were
performed: 1st after induction of anesthesia (native), 2nd during
cardiopulmonary bypass (CPB) after X-clamp releasing (heparinase), 3rd and
4th 10min after protamine administrativ (nativ and heparinase). Hemostatic
profile with using TEG algorithm (delivered by manufacturer), changes of
TEG parameters and laboratory tests before and after CPB, blood loss,
number of transfusion and reexploration because of bleeding were
evaluated. Standard dosing of heparin (3mg/kg bolus+1mg/kg to CPB) and no
profylactic antifibrinolytics were used. Chronic
antiplatelet/anticoagulation drugs were withdrawn according to ESC/ESA
guidelines. Results Both groups were comparable by demographics
(TEG/Control):. Mean age 67,5 vs 68,4. Type of surgery% (CABG 65/73,
valvular 17/12, combined 15/13, other 2/1). No difference in CPB
parameters (CPB time 80/78 min, total heparin 310/311 mg and protamin
339/339 mg dose). No significant difference in peroperative blood loss
(373+/-351/351+/-229 ml), number of transfusion (RBC 0,63/0,70 RBC
unit/pt, 0,34/0,40 FFP unit/pt, 0,01/0,01 platelet unit/pt), therapeutic
antifibrinolytics administration (12/10,7%) and reexploration because of
bleeding (1,6%/2,5%) were recorded. The only significant difference in
postoperative blood loss (819+/-519 vs 861+/-422 ml, p<0,05) was assessed.
Values of PT, aPTT, TT significantly increased, fibrinogen and platelets
significantly decreased during CPB (212+/-64 vs 134+/-44 in TEG, 218+/-65
vs 139+/-46 in control). Changes of PT, aPTT and platelets correlated with
CPB duration. The main hemostatic patterns according to TEG algorithm: T1:
18,0% platelet hyperfunction, 12,4% enzymatic hypercoagulability. T2:
22,8% platelet hypofunction, 19% primary fibrinolysis. T3: 9,4% platelet
hypofunction, 7% primary fibrinolysis. T4: 15,0% platelet hypofunction, 8%
enzymatic hypercoagulation. Conclusions Platelet decrease is usual during
CPB. Platelet hypofunction and primary fibrinolysis were the most common
patterns during CPB. We need a new technique to preserve platelets during
CPB. One option is using of autologous platelet-rich plasma apheresis
before CPB and monitoring their function by aggregation methods.

<69>
Accession Number
613459465
Author
Cholette J.M.; Swartz M.F.; Rubenstein J.; Henrichs K.F.; Wang H.; Powers
K.S.; Daugherty L.E.; Alfieris G.M.; Gensini F.; Blumberg N.
Institution
(Cholette, Rubenstein, Powers, Daugherty) Department of Pediatrics,
University of Rochester, Rochester, New York, United States
(Swartz, Alfieris, Gensini) Department of Surgery, University of
Rochester, Rochester, New York, United States
(Henrichs, Blumberg) Department of Pathology and Laboratory Medicine,
University of Rochester, Rochester, New York, United States
(Wang) Department of Biostatistics, University of Rochester, Rochester,
New York, United States
Title
Outcomes Using a Conservative Versus Liberal Red Blood Cell Transfusion
Strategy in Infants Requiring Cardiac Operation.
Source
Annals of Thoracic Surgery. 103 (1) (pp 206-214), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier USA
Abstract
Background The optimal hemoglobin for infants after cardiac operation is
unknown. Red blood cells (RBCs) are commonly transfused to maintain high
hemoglobin concentrations in the absence of a clinical indication. We
hypothesized that infants can be managed with a postoperative conservative
RBC transfusion strategy, resulting in lower daily hemoglobin
concentrations, without evidence of impaired oxygen delivery (ie, lactate,
arteriovenous oxygen difference [avO<inf>2</inf>diff]), or adverse
clinical outcomes. Methods Infants weighing 10 kg or less undergoing
biventricular repair or palliative (nonseptated) operation were randomly
assigned to either a postoperative conservative or liberal transfusion
strategy. Conservative group strategy was RBC transfusion for a hemoglobin
less than 7.0 g/dL for biventricular repairs or less than 9.0 g/dL for
palliative procedures plus a clinical indication. Liberal group strategy
was RBC transfusion for hemoglobin less than 9.5 g/dL for biventricular
repairs or less than 12 g/dL for palliative procedures regardless of
clinical indication. Results After the operation of 162 infants (82
conservative [53 biventricular, 29 palliative], 80 liberal [52
biventricular, 28 palliative]), including 12 Norwood procedures (6
conservative, 6 liberal), daily hemoglobin concentrations were
significantly lower within the conservative group than the liberal group
by postoperative day 1 and remained lower for more than 10 days. The
percentage of patients requiring a RBC transfusion, number of
transfusions, and volume of transfusions were all significantly lower
within the conservative group. Despite lower hemoglobin concentrations
within the conservative group, lactate, avO<inf>2</inf>diff, and clinical
outcomes were similar. Conclusions Infants undergoing cardiac operation
can be managed with a conservative RBC transfusion strategy. Clinical
indications should help guide the decision for RBC transfusion even in
this uniquely vulnerable population. Larger multicenter trials are needed
to confirm these results, and focus on the highest risk patients would be
of great interest.
Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<70>
Accession Number
613213864
Author
Schneider U.; Hofmann C.; Aicher D.; Takahashi H.; Miura Y.; Schafers
H.-J.
Institution
(Schneider, Hofmann, Aicher, Takahashi, Miura, Schafers) Department of
Thoracic and Cardiovascular Surgery, Saarland University Medical Center,
Homburg/Saar, Germany
Title
Suture Annuloplasty Significantly Improves the Durability of Bicuspid
Aortic Valve Repair.
Source
Annals of Thoracic Surgery. 103 (2) (pp 504-510), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier USA
Abstract
Background Isolated repair of the regurgitant bicuspid aortic valve (BAV)
has yielded suboptimal durability, with annular dilatation being important
risk factor for recurrent aortic regurgitation. We hypothesized that
adding a suture annuloplasty (SA) should lead to improved repair
stability. Methods Between July 1999 and September 2014, 268 patients
(mean age, 41 +/- 13 years, 249 male) underwent isolated BAV repair. From
January 2009 to September 2014, 164 consecutive patients (study group)
underwent SA using either braided polyester (n = 37) or expanded
polytetrafluorethylene (PTFE) (n = 127). Patients who underwent surgery
prior to January 2009 served as controls (n = 104). All patients were
followed (98.9% complete, 1 week to 181 months). Results Annular size was
larger in the study group (p < 0.001) and age was lower (p < 0.001). There
were no differences between the groups regarding other clinical data.
Hospital mortality was 0.7% (n = 2), 10-year survival was 94.2%.
Thirty-six patients required valve-related reoperations (8 days to 94
months postoperatively; controls = 32, study = 4). Complications related
to SA (ventricular septal defect, interference with coronary artery)
occurred in 6 (3.7%) patients, in 4 (10.8%) patients with polyester SA and
in 2 (1.6%) patients with PTFE. In the control group freedom from
reoperation at 5 and 10 years was 73.2% and 63.7%, respectively. With SA,
5-year stability was significantly improved to 92.6% (p = 0.0006); it was
96.7% for PTFE versus 83.5% for polyester SA (p = 0.0132). Conclusions
Annular dilatation is a risk factor for failure after repair of
regurgitant BAV. Its elimination through the use of SA significantly
improves repair stability. With PTFE as material for SA optimal repair
stability and minimal local complications are achieved.
Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<71>
Accession Number
613424695
Author
Ivert T.; Dalen M.; Ander C.; Stalesen R.; Nasman P.; Lordkipanidze M.;
Hjemdahl P.
Institution
(Ivert, Dalen) Department of Cardiothoracic Surgery and Anesthesiology,
Karolinska University Hospital and Department of Molecular Medicine and
Surgery, Karolinska Institutet, Stockholm, Sweden
(Ander, Stalesen, Hjemdahl) Department of Clinical Pharmacology,
Karolinska University Hospital and Department of Medicine Solna,
Karolinska Institutet, Stockholm, Sweden
(Nasman) Center for Safety Research, KTH Royal Institute of Technology,
Stockholm, Sweden
(Lordkipanidze) Faculte de pharmacie, Universite de Montreal and Research
Center, Montreal Heart Institute, Montreal, Quebec, Canada
Title
Platelet function one and three months after coronary bypass surgery in
relation to once or twice daily dosing of acetylsalicylic acid.
Source
Thrombosis Research. 149 (pp 64-69), 2017. Date of Publication: 01 Jan
2017.
Publisher
Elsevier Ltd
Abstract
Introduction Current guidelines recommend acetylsalicylic acid (ASA)
treatment after coronary artery bypass grafting (CABG) to reduce
thrombotic vein graft occlusion. The optimal dosage of ASA is not known.
Materials and methods Forty-two patients undergoing elective CABG were
randomized to receive either ASA 75 mg or 160 mg once daily (OD) or 75 mg
twice daily (BID) after the operation. Platelet function testing was
performed before, and one and three months after the operation. Results
White blood cell counts increased during the initial postoperative days
whereas platelet counts were initially slightly reduced after the
operation but increased after one month without any major changes of mean
platelet volumes. Serum thromboxane B<inf>2</inf> was more effectively
suppressed at one and three months after the operation with ASA 75 mg BID
or 160 mg OD than with 75 mg OD (p < 0.001). ASA 75 mg BID and 160 mg OD
were equally effective. Adenosine diphosphate stimulated platelet
aggregation in whole blood (Multiplate) was increased one and three months
after the operation, and this was counteracted by ASA 75 mg BID but not by
75 or 160 mg OD. Arachidonic acid-induced aggregation was more effectively
inhibited by 75 mg BID or 160 mg OD compared to 75 mg OD at three months.
Conclusions Less effective inhibition of platelet activation was obtained
with ASA 75 mg OD than with ASA 160 mg OD or 75 mg BID up to three months
after CABG. Especially the latter dose is of interest for further studies
of efficacy and clinical outcomes after CABG.
Copyright &#xa9; 2016 Elsevier Ltd

<72>
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.

<73>
Accession Number
615026821
Author
Tan M.K.H.; Jarral O.A.; Thong E.H.E.; Kidher E.; Uppal R.; Punjabi P.P.;
Athanasiou T.
Institution
(Tan, Jarral, Thong, Kidher, Athanasiou) Department of Surgery and Cancer,
Imperial College London, London W2 1NY, United Kingdom
(Uppal) Department of Cardiothoracic Surgery, St. Bartholomew's Hospital,
London, United Kingdom
(Punjabi) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Title
Quality of life after mitral valve intervention.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (2) (pp 265-272),
2017. Date of Publication: 01 Feb 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Advancements in surgical technique and understanding of the
pathophysiology of mitral valve (MV) dysfunction have led to improved
outcomes. Seen as a development beyond measures of morbidity and
mortality, health-related quality-of-life (HRQOL) outcome measures are
becoming increasingly popular. These measures are important because
complications following routine (i.e. low-risk) operations on the MV are
uncommon and further markers of outcome are needed. Surgeons are
increasingly operating earlier on asymptomatic patients and will need to
prove that HRQOL is not impacted. Novel minimally invasive and
transcatheter technologies will also need to demonstrate satisfactory
HRQOL outcomes prior to widespread use. This systematic review provides an
overview of all available literature detailing HRQOL in patients receiving
MV interventions. In the 43 studies included, 6865 patients underwent
procedures ranging from open replacement to percutaneous repair using
devices such as the Mitraclip Clip Delivery System (MitraClip) (Abbott
Vascular, Santa Clara, CA, USA). Most studies performed baseline HRQOL
assessment, allowing postinterventional comparison. While the underlying
literature had deficiencies, most studies report acceptable
postintervention HRQOL that was comparable to that of matched general
populations. Patient-specific (e.g. female gender, renal dysfunction) and
surgical-specific factors (e.g. replacement instead of repair, elevated
transmitral gradient) were identified that predispose patients to poorer
long-term HRQOL outcomes. These factors are important for clinicians
developing strategies to maximize their HRQOL outcomes. Future randomized
studies would benefit from HRQOL measurements at specific time points to
allow large-scale comparisons. Establishing a common HRQOL instrument for
use in MV intervention studies may support detailed comparisons between
specific techniques. Physical activity monitors, physiological biomarkers
and radiological markers could also be used as innovative indicators of
functional outcome.
Copyright &#xa9; The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<74>
Accession Number
615026805
Author
Gronlykke L.; Ihlemann N.; Ngo A.T.; Thyregod H.G.H.; Kjaergaard J.;
Korshin A.; Gustafsson F.; Hassager C.; Nilsson J.C.; Sondergaard L.; Ravn
H.B.
Institution
(Gronlykke, Korshin, Nilsson, Ravn) Department of Cardiothoracic
Anaesthesiology, Rigshospitalet, Copenhagen University Hospital,
Thoraxanaestesiologisk Afdeling. 4141, Copenhagen 2100, Denmark
(Ihlemann, Ngo, Kjaergaard, Gustafsson, Hassager, Sondergaard) Department
of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Thyregod) Department of Cardiothoracic Surgery, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Title
Measures of right ventricular function after transcatheter versus surgical
aortic valve replacement.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (2) (pp 181-187),
2017. Date of Publication: 01 Feb 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Describe changes in measures of right ventricular (RV)
function in patients treated for aortic stenosis using open-chest surgery
(SAVR) or transcatheter treatment (TAVR). METHODS: Patients in the Nordic
Aortic Valve Intervention (NOTION) trial were randomized 1:1 to TAVR (n =
114) or SAVR (n = 106). Echocardiography was performed at baseline and 3
and 12 months post-procedure. Tricuspid annular plane systolic excursion
(TAPSE) and right ventricular fractional area change (RVFAC) were used as
measures of longitudinal and transverse RV contraction. Left ventricular
ejection fraction (LVEF) and LV atrioventricular plane displacement (AVPD)
were recorded as measures of LV function. Association to NYHA class was
examined. RESULTS: There were no differences in echocardiographic
measurements between TAVR and SAVR at baseline. In the SAVR group, TAPSE
was reduced after 3 months (2.4 +/- 0.5 cm vs 1.6 +/- 0.4 cm; P < 0.001),
and 12 months (2.4 +/- 0.5 cm vs 1.7 +/- 0.4 cm; P < 0.001). RVFAC was
reduced after 3 months (44% +/- 11% vs 39% +/- 10%; P = 0.001), but
recovered at 12 months (43% +/- 10%; P = 0.39). AVPD lateral increased
during follow-up (1.4 +/- 0.3 cm vs 1.6 +/- 0.4 cm (P = 0.001) and 1.7 +/-
0.4 cm, respectively; P < 0.001), whereas AVPD medial remained stable
(baseline vs 3 months: P = 0.06 and baseline vs 12 months: P = 0.59). In
the TAVR group, all echocardiographic measures remained unchanged from
baseline to 12 months postoperatively. We found no association between
echocardiographic changes and NYHA class. CONCLUSIONS: TAPSE and AVPD
lateral differed between TAVR and SAVR at 3 and 12 months follow-up, but
these findings were not related to any changes in NYHA class. These
observations indicate that following SAVR, echocardiographic changes may
not reflect right ventricular function, but merely a change in the
physiological conditions. CLINICALTRIALS.GOV IDENTIFIER: NCT01057173.
Copyright &#xa9; The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<75>
Accession Number
615348189
Author
Yang R.-F.; Jiang Z.-M.; Zhang R.-Q.; Yu B.; Wang X.-H.; Wang P.
Institution
(Yang, Jiang) Department of Thoracic Surgery, Qianfoshan Hospital of
Shandong Province, Shandong University, Ji'nan, Shandong 250012, China
(Yang, Zhang, Wang) Department of Thoracic Surgery, Tai'an City Central
Hospital, Tai'an, Shandong 271000, China
(Yu) Department of Colorectal Surgery, Tai'an City Central Hospital,
Tai'an, Shandong 271000, China
(Wang) Department of Digestive System, Tai'an City Central Hospital,
Tai'an, Shandong 271000, China
Title
Effect of ligation of the thoracic duct during oesophagectomy on the
absorption of D-xylose.
Source
Journal of the College of Physicians and Surgeons Pakistan. 27 (3) (pp
153-156), 2017. Date of Publication: 01 Mar 2017.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To assess if prophylactic thoracic duct ligation during
oesophagectomy influences the absorptive function of oesophageal cancer
patients. Study Design: Randomized controlled trial. Place and Duration of
Study: Department of Thoracic Surgery, Tai'an City Central Hospital,
Tai'an, from August 2014 to December 2015. Methodology: Based on the
management of the thoracic duct during oesophagectomy, 60 patients were
randomized into two groups. D-xylose absorption test was used to evaluate
the absorptive function. The two-independent-samples t-test was employed
for statistical analysis with statistical significance at p < 0.05.
Results: The serum D-xylose concentration of ligation-group was
significantly lower than that of no-ligation group on the first day after
operation, (t=2.82, p=0.0066). However, there was no significant
differences between them even before operation (t=1.34, p=0.1849).
Conclusion: Ligation of the thoracic duct during oesophagectomy
immediately affected the absorption of D-xylose, which may lead to
malabsorption in the long run.

<76>
Accession Number
615341291
Author
Miyahara S.; Miyata H.; Motomura N.; Takamoto S.; Okita Y.
Institution
(Miyahara, Okita) Department of Surgery, Division of Cardiovascular
Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
(Miyata) Health Care Quality Assessment, University of Tokyo, Tokyo, Japan
(Motomura) Department of Cardiovascular Surgery, Toho University Medical
Center Sakura Hospital, Chiba, Japan
(Takamoto) Mitsui Memorial Hospital, Tokyo, Japan
Title
Clinical significance of chronic obstructive pulmonary disease in patients
undergoing elective total arch replacement: Analysis based on the Japan
adult cardiovascular surgery database.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 761-766), 2017.
Article Number: ezw371. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVE: We investigated the impact of chronic obstructive pulmonary
disease (COPD) on in-hospital outcomes of patients undergoing conventional
total aortic arch replacement (TAR), based on the Japan Adult
Cardiovascular Surgery Database. METHODS: A total of 12 590 patients who
underwent elective TAR between 2008 and 2013 were retrospectively
reviewed. Patients were divided into 4 categories: normal respiratory
function (control), with ratio of forced expiratory volume of air in 1 s
(FEV<inf>1</inf>) to forced vital capacity (FVC) of 76% or greater (TAR, n
= 10 040); mild COPD, with FEV<inf>1</inf>/FVC ratio 60-75% and/or use of
bronchodilator (TAR, n = 1890); moderate COPD, FEV<inf>1</inf>/FVC ratio
50 to 59% and/or use of steroids (TAR, n = 504); and severe COPD,
FEV<inf>1</inf>/FVC ratio less than 50% and/or presence of respiratory
failure (TAR, n = 156). RESULTS: In-hospital mortality was 5.7% (5.2% in
controls, 7.0% in mild COPD, 9.3% in moderate COPD and 9.0% in severe
COPD). A significant trend towards the severity of COPD was noted (P <
0.0001). A higher incidence of postoperative pneumonia (6.0% in control,
11.0% in mild COPD, 12.3% in moderate COPD and 15.4% in severe COPD; P <
0.0001) and a greater need for prolonged ventilation (17.5% in control,
22.0% in mild COPD, 26.6% in moderate COPD and 29.5% in severe COPD; P <
0.0001) were observed in cases of more severe COPD. The odds ratio of
moderate/severe COPD for in-hospital mortality was 1.44 with confidence
interval of 1.08-1.91 (P = 0.012). CONCLUSIONS: There was a significant
increase in in-hospital mortality and morbidity with increasing severity
of COPD in patients who underwent TAR.
Copyright &#xa9; The Author 2017. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<77>
Accession Number
615341281
Author
Andresen B.; Mishra V.; Lewandowska M.; Andersen J.G.; Andersen M.H.;
Lindbergb H.; Dohlen G.; Fosse E.
Institution
(Andresen, Lewandowska, Fosse) The Intervention Centre, Oslo University
Hospital, Oslo, Norway
(Andresen) The Department of Cardiothoracic Surgery, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Mishra) Department of Finance and Resource Management Unit, Oslo
University Hospital, Rikshospitalet, Oslo, Norway
(Andersen) Division of Radiology and Nuclear Medicine, Oslo University
Hospital, Ulleva l, Oslo, Norway
(Andersen) Division of Surgery, Inflammation Medicine and Transplantation,
Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Lindbergb) Institute for Clinical Medicine, Faculty of Medicine,
University of Oslo, Oslo, Norway
(Dohlen, Fosse) The Department of Pediatric Cardiology, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
Title
In-hospital cost comparison between percutaneous pulmonary valve
implantation and surgery.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 747-753), 2017.
Article Number: ezw371. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Today, both surgical and percutaneous techniques are available
for pulmonary valve implantation in patients with right ventricle outflow
tract obstruction or insufficiency. In this controlled, non-randomized
study the hospital costs per patient of the two treatment options were
identified and compared. METHODS: During the period of June 2011 until
October 2014 cost data in 20 patients treated with the percutaneous
technique and 14 patients treated with open surgery were consecutively
included. Two methods for cost analysis were used, a retrospective average
cost estimate (overhead costs) and a direct prospective detailed cost
acquisition related to each individual patient (patient-specific costs).
RESULTS: The equipment cost, particularly the stents and valve itself was
by far the main cost-driving factor in the percutaneous pulmonary valve
group, representing 96% of the direct costs, whereas in the open surgery
group the main costs derived from the postoperative care and particularly
the stay in the intensive care department. The device-related cost in this
group represented 13.5% of the direct costs. Length-of-stay-related costs
in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060)
in the open surgery group. The difference in postoperative stay between
the groups was statistically significant (P < 0.001). CONCLUSIONS: Given
the high postoperative cost in open surgery, the percutaneous procedure
could be cost saving even with a device cost of more than five times the
cost of the surgical device.
Copyright &#xa9; The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery.

<78>
Accession Number
615341253
Author
Carnero-Alcazar M.; Maroto L.C.; Cobiella-Carnicer J.; Vilacosta I.;
Nombela-Franco L.; Alswies A.; Villagran-Medinilla E.; Macaya C.
Institution
(Carnero-Alcazar, Maroto, Cobiella-Carnicer, Alswies, Villagran-Medinilla)
Department of Cardiac Surgery, Hospital Clinico San Carlos, Madrid, Spain
(Vilacosta, Nombela-Franco, Macaya) Department of Cardiology, Hospital
Clinico San Carlos, Madrid, Spain
Title
Transcatheter versus surgical aortic valve replacement in moderate and
high-risk patients: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 644-652), 2017.
Article Number: ezw373. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The evidence of the benefits of transcatheter aortic valve
replacement (TAVR) or surgical aortic valve replacement (SAVR) for
patients of high or intermediate surgical risk is not consistent. We
performed a meta-analysis to compare major adverse outcomes after TAVR or
SAVR. METHODS: We searched propensity score matched studies or randomized
clinical trials comparing the risks of mortality, stroke, major bleeding,
acute renal injury, pacemaker implantation, vascular complications and
prostheses haemodynamic performance between TAVR and SAVR in patients with
moderate or high risk. Combined odds ratios (ORs), relative risk or mean
differences with corresponding 95% confidence intervals (CIs) were
calculated using a random effects model. Analyses of sensitivity and
publication bias were also conducted. RESULTS: We included 5 clinical
trials and 37 observational studies, enrolling 20 224 patients (TAVR, n =
9099 and SAVR, n = 11 125). The pooled analysis suggested no differences
in early (OR = 1.11, 95% CI 0.9-1.39, P = 0.355) or late mortality
(relative risk = 0.91, 95% CI 0.78- 1.05, P = 0.194). TAVR was associated
with a lower risk of major bleeding (OR = 0.42, 95% CI 0.25-0.69, P <
0.001) and acute kidney injury (OR = 0.51, 95% CI 0.34-0.71) but with an
increase in the incidence of pacemaker implantation (OR = 2.31, 95% CI
1.73-3.08) and vascular complications (OR = 4.88, 95% CI 2.84-8.39).
Residual aortic regurgitation was more frequent after TAVR (OR= 6.83, 95%
CI 4.87-9.6). SAVR prostheses were associated with poor trans-prosthetic
gradients (mean difference: -2.4 mmHg, 95% CI - 3.27 to - 1.53).
CONCLUSIONS: TAVR and SAVR have similar short and long-term all-cause
mortality and risk of stroke among patients of moderate or high surgical
risk. TAVR decreases the risk of major bleeding, acute kidney injury and
improves haemodynamic performance compared with SAVR but increases the
risk of vascular complications, the need for a pacemaker and residual
aortic regurgitation.
Copyright &#xa9; The Author 2016.

<79>
Accession Number
615341249
Author
Yi B.; Chen X.; Shi H.; Lin T.; Lin H.; Xu Y.; Rong J.
Institution
(Yi) Department of Cardiothoracic Surgery, Heart Center, The First
Affiliated Hospital, Ministry of Health, Sun Yat-Sen University, and Key
Laboratory on Assisted Circulation, Guangzhou, China
(Yi, Shi, Rong) Department of Extracorporeal Circulation, Heart Center,
The First Affiliated Hospital, Sun Yat-Sen Department of General Surgery,
The Second Xiangya Hospital, Central South University, Changsha, China
(Chen) Musculoskeletal Oncology Center, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Lin) Scientific Research Section, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Lin) Department of Oncology, The First Affiliated Hospital, Sun Yat-Sen
University, Guangzhou, China
Title
Remote ischaemic preconditioning reduces acute kidney injury in adult
patients undergoing cardiac surgery with cardiopulmonary bypass: A
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 616-623), 2017.
Article Number: ezw372. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This article represents the first attempt to perform a pooled analysis
about remote ischaemic preconditioning (RIPC) in reduction of acute kidney
injury (AKI) of adult patients undergoing cardiac surgery with
cardiopulmonary bypass (CPB). A systematic search was performed using
PubMed (1966-5 January 2016), the Cochrane Library (1996-5 January 2016),
the Web of Science (1986-5 January 2016) and Chinese database (SinoMed)
(1978-5 January 2016) to identify studies that have described the effect
of RIPC on AKI in adult patients undergoing cardiac surgery with CPB. The
outcomes used for this analysis included the incidence of AKI and the need
for renal replacement therapy (RRT). Thirteen randomized controlled trials
(4370 participants) were included in this analysis. RIPC significantly
reduced the risk of AKI (risk ratio, 0.81; 95% confidence interval, [0.66,
0.99]; P = 0.04; I²=46%) for adult patients compared with
control group. However, there was no significant difference with respect
to the incidence of RRT between the two groups. The present meta-analysis
found that RIPC may reduce the incidence of AKI among adult patients
following cardiac surgery with CPB. Adequately powered trials are
warranted to provide further corroboration of our findings in the future.
Copyright &#xa9; The Author 2016.

<80>
Accession Number
615211068
Author
Dogan M.; Yasar M.; Gokahmetoglu G.; Guneri E.; Ozcan I.
Institution
(Dogan, Yasar, Guneri, Ozcan) Department of ENT, Kayseri Training and
Research Hospital, Kayseri, Turkey
(Gokahmetoglu) Department of Anesthesiology, Kayseri Training and Research
Hospital, Kayseri, Turkey
Title
Assessment of hearing via otoacoustic emission in patients that underwent
spinal anesthesia.
Source
European Review for Medical and Pharmacological Sciences. 20 (7) (pp
1224-1228), 2016. Date of Publication: 2016.
Publisher
Verduci Editore (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: In this study, our aim is to show the differences between the
preoperative and postoperative otoacoustic emissions (OAE) value in
patients, who underwent spinal anesthesia. PATIENTS AND METHODS: The
presented study was carried out as a randomized, doubleblinded,
prospective study upon the approval of Ethics Committee of Medicine
School, Erciyes University. The study was conducted in accordance with the
Helsinki Declaration. The study involved 39 ASA I-II patients (aged 18-65
years), who underwent varicectomy operation in the Cardiovascular Surgery
Department. For each of the patients, 3 OAE measurements were performed;
the day before surgery, during surgery and the 1st day after surgery.
RESULTS: Significant differences were detected between the 2000 F2
measurements performed before, during and after the surgery (p<0.05). The
differences originated from measurements performed before and during
surgery. Significant differences were detected among 3000 F1 measurements
performed before, during and after surgery (p<0.05). Hearing loss is one
of the late complications of spinal anesthesia. In this study, we observed
the differences between the preoperative and postoperative OAE values. The
incidence of hearing loss detectable with auditory measurements has been
reported to vary between 10 and 50%. Of these, 25% is clinically relevant
or recognizable. However, it is considered to be a subjective test,
because it is influenced from mental, motor and psychological status of
the patient. But the management in hearing loss following spinal
anesthesia is still controversial. Hearing loss is generally spontaneously
resolved within a few days. However, there are case reports of hearing
loss lasting for months. CONCLUSIONS: In this study, we observed
differences between some preoperative and postoperative OAE values.

<81>
Accession Number
613230914
Author
Ripolles J.; Espinosa A.; Martinez-Hurtado E.; Abad-Gurumeta A.;
Casans-Frances R.; Fernandez-Perez C.; Lopez-Timoneda F.; Calvo-Vecino
J.M.
Institution
(Ripolles, Martinez-Hurtado, Calvo-Vecino) Departamento de Anestesia,
Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid,
Madrid, Spain
(Espinosa) Department of Anesthesia, Blekinge County Council Hospital,
WamoCenter, Karlskrona, Suecia, Sweden
(Abad-Gurumeta) Departamento de Anestesia, Hospital Universitario la Paz,
Madrid, Spain
(Casans-Frances) Departamento de Anestesia, Hospital Universitario Lozano
Blesa, Zaragoza, Spain
(Fernandez-Perez) Departamento de Medicina Preventiva y Salud Publica,
Hospital Clinico San Carlos, Madrid, Spain
(Lopez-Timoneda) Departamento de Anestesia, Hospital Clinico San Carlos,
Universidad Complutense de Madrid, Madrid, Spain
Title
Intraoperative goal directed hemodynamic therapy in noncardiac surgery: a
systematic review and meta-analysis.
Source
Brazilian Journal of Anesthesiology. 66 (5) (pp 513-528), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Editora Ltda
Abstract
Background The goal directed hemodynamic therapy is an approach focused on
the use of cardiac output and related parameters as end-points for fluids
and drugs to optimize tissue perfusion and oxygen delivery. Primary aim:
To determine the effects of intraoperative goal directed hemodynamic
therapy on postoperative complications rates. Methods A meta-analysis was
carried out of the effects of goal directed hemodynamic therapy in adult
noncardiac surgery on postoperative complications and mortality using
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
methodology. A systematic search was performed in Medline PubMed, Embase,
and the Cochrane Library (last update, October 2014). Inclusion criteria
were randomized clinical trials in which intraoperative goal directed
hemodynamic therapy was compared to conventional fluid management in
noncardiac surgery. Exclusion criteria were trauma and pediatric surgery
studies and that using pulmonary artery catheter. End-points were
postoperative complications (primary) and mortality (secondary). Those
studies that fulfilled the entry criteria were examined in full and
subjected to quantifiable analysis, predefined subgroup analysis
(stratified by type of monitor, therapy, and hemodynamic goal), and
predefined sensitivity analysis. Results 51 RCTs were initially
identified, 24 fulfilling the inclusion criteria. 5 randomized clinical
trials were added by manual search, resulting in 29 randomized clinical
trials in the final analysis, including 2654 patients. A significant
reduction in complications for goal directed hemodynamic therapy was
observed (RR: 0.70, 95% CI: 0.62-0.79, p < 0.001). No significant decrease
in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p = 0.30). Quality
sensitive analyses confirmed the main overall results. Conclusions
Intraoperative goal directed hemodynamic therapy with minimally invasive
monitoring decreases postoperative complications in noncardiac surgery,
although it was not able to show a significant decrease in mortality rate.
Copyright &#xa9; 2015 Sociedade Brasileira de Anestesiologia

<82>
Accession Number
612502114
Author
Mori H.; Maeda A.; Wakabayashi K.; Sato T.; Sasai M.; Tashiro K.; Iso Y.;
Ebato M.; Suzuki H.
Institution
(Mori, Maeda, Wakabayashi, Sato, Sasai, Tashiro, Iso, Ebato, Suzuki)
Department of Cardiology, Showa University Fujigaoka Hospital, Japan
Title
The effect of cilostazol on endothelial function as assessed by
flow-mediated dilation in patients with coronary artery disease.
Source
Journal of Atherosclerosis and Thrombosis. 23 (10) (pp 1168-1177), 2016.
Date of Publication: 2016.
Publisher
Japan Atherosclerosis Society
Abstract
Aim: The vascular endothelium plays a key role in the pathophysiology of
atherosclerosis. Flowmediated dilation (FMD) is a novel way of assessing
endothelial function. Cilostazol is a unique antiplatelet drug that also
has the potential to improve endothelial function. The objective of this
present study was to investigate the effects of cilosatzol on endothelial
function as assessed by FMD. Methods: Fifty-one patients with coronary
artery disease (CAD) were assigned to one of two groups: the
Cilostazol(<inf>+</inf>) group (with cilostazol) and
Cilostazol(<inf>-</inf>) group (without cilostazol). In addition to
conventional dual antiplatelet therapy with aspirin and
clopidogrel/ticlopidine, the Cilostazol(<inf>+</inf>) group
(n<inf>=</inf>27) was also given cilostazol (100 mg/day). The
Cilostazol(<inf>-</inf>) group (n<inf>=</inf>24) did not receive
cilostazol. FMD was assessed at enrollment and after 6-9 months. Results:
The FMD of both the Cilostazol(<inf>+</inf>) and Cilostazol(<inf>-</inf>)
groups remained similar at 5.2 (interquartile range: 3.8-8.5) to 5.4
(interquartile range: 4.2-6.7) (P<inf>=</inf>0.29) and 5.0 (interquartile
range: 3.6-6.4) to 4.9 (interquartile range: 4.0-7.0) (P<inf>=</inf>0.38),
respectively. However, the diameters of the baseline and maximal brachial
arteries tended to increase in the Cilostazol(<inf>+</inf>) group
(baseline: 4.2<inf>+/-</inf>0.7 to 4.4<inf>+/-</inf>0.7,
P<inf>=</inf>0.18; maximal: 4.5<inf>+/-</inf>0.7 to 4.6<inf>+/-</inf>0.7
P<inf>=</inf>0.22), whereas that of the Cilostazol(-) group tended to
decrease (baseline: 4.1<inf>+/-</inf>0.6 to 3.9<inf>+/-</inf>0.5,
P<inf>=</inf>0.10; maximal: 4.3<inf>+/-</inf>0.7 to 4.1<inf>+/-</inf>0.5,
P<inf>=</inf>0.05). The rates of change in the baseline diameter
(Cilostazol(<inf>+</inf>): 3.7<inf>+/-</inf>9.8% vs.
Cilostazol(-):<inf>-</inf>3.8<inf>+/-</inf>12.2%, P<inf>=</inf>0.03) and
maximal diameter
(Cilostazol(<inf>+</inf>):<inf>+</inf>3.1<inf>+/-</inf>8.9% vs.
Cilostazol(-):<inf>-</inf>4.4<inf>+/-</inf>12.0%, P<inf>=</inf>0.02) were
significantly different. Conclusion: Although cilostazol didn't affect the
FMD, there was a significant difference in the rates of change in baseline
and maximal brachial artery diameter. This may have a beneficial effect in
patients with cardiovascular disease.
Copyright &#xa9; 2016 Japan Atherosclerosis Society.

<83>
Accession Number
609611832
Author
Agzarian J.; Fahim C.; Shargall Y.; Yasufuku K.; Waddell T.K.; Hanna W.C.
Institution
(Agzarian, Shargall, Hanna) Department of Surgery, McMaster University,
Hamilton, Ontario, Canada
(Fahim) Department of Epidemiology and Biostatistics, McMaster University,
Hamilton, Ontario, Canada
(Yasufuku, Waddell) Department of Surgery, University of Toronto, Toronto,
Canada
Title
The Use of Robotic-Assisted Thoracic Surgery for Lung Resection: A
Comprehensive Systematic Review.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (1) (pp 182-192),
2016. Date of Publication: 01 Feb 2016.
Publisher
W.B. Saunders
Abstract
The primary objective of this study is to systematically review all
pertinent literature related to robotic-assisted lung resection.
Robotic-assisted thoracic surgery (RATS) case series and studies comparing
RATS with video-assisted thoracoscopic surgery (VATS) or thoracotomy were
included in the search. In accordance with preferred reporting items for
systematic reviews and meta-analyses guidelines, 2 independent reviewers
performed the search and review of resulting titles and abstracts.
Following full-text screening, a total of 20 articles met the inclusion
criteria and are presented in the review. Amenable results were pooled and
presented as a single outcome, and meta-analyses were performed for
outcomes having more than 3 comparative analyses. Data are presented in
the following 4 categories: technical outcomes, perioperative outcomes,
oncological outcomes, and cost comparison. RATS was associated with longer
operative time, but did not result in a greater rate of conversion to
thoracotomy than VATS. RATS was superior to thoracotomy and equivalent to
VATS for the incidence of prolonged air leak and hospital length-of-stay.
Oncological outcomes like nodal upstaging and survival were no different
between VATS and RATS. RATS was more costly than VATS, with most of the
costs attributed to capital and disposable expenses of the robotic
platform. Although limited by a lack of prospective analysis, lung
resection via RATS compares favorably with thoracotomy and appears to be
no different than VATS. Prospective studies are required to determine if
there are outcome differences between RATS and VATS.
Copyright &#xa9; 2016 Elsevier Inc.

<84>
[Use Link to view the full text]
Accession Number
606280338
Author
De Egea V.; Munoz P.; Valerio M.; De Alarcon A.; Lepe J.A.; Miro J.M.;
Galvez-Acebal J.; Garcia-Pavia P.; Navas E.; Goenaga M.A.; Farinas M.C.;
Vazquez E.G.; Marin M.; Bouza E.
Institution
(De Egea, Munoz, Valerio, Marin, Bouza) Microbiology and Infectious
Diseases Department, Servicio de Microbiologia Clinica y Enfermedades
Infecciosas, Hospital General Universitario Gregorio Maranon, Doctor
Esquerdo 46, Madrid, Spain
(Munoz, Marin, Bouza) Department of Medicine, Universidad Complutense
Madrid (UCM), Madrid, Spain
(Munoz, Marin, Bouza) CIBER de Enfermedades Respiratorias, Instituto de
Salud Carlos III (CIBERES), Madrid, Spain
(Munoz, Valerio, Marin, Bouza) Instituto de Investigacion Sanitaria
Gregorio Maranon (IiSGM), Madrid, Spain
(De Alarcon, Lepe) Microbiology and Infectious Disease Department,
Hospital Universitario Virgen Del Rocio, Sevilla, Spain
(Miro) Infectious Diseases Department, Hospital Clinic-IDIBAPS, University
of Barcelona (Barcelona), Madrid, Spain
(Galvez-Acebal) Department of Medicine, Unidad Clinica Intercentros de
Enfermedades Infecciosas, Microbiolo Gia y Medicina Preventiva Hospital
Universitario Virgen Macarena, Departamento de Medicina, Universidad de
Sevilla, Madrid, Spain
(Garcia-Pavia) Department of Cardiology, Hospital Universitario Puerta de
Hierro Majadahonda, Madrid, Spain
(Navas) Hospital Ramon y Cajal, Madrid, Spain
(Goenaga) UEI HU Donostia, San Sebastian, Spain
(Farinas) Hospital Marques de Valdecilla, University of Catabria,
Santander, Spain
(Vazquez) Hospital Clinico Universitario Virgen de la Arrixaca, Instituto
Murciano de Investigacion Biosanitaria (IMIB), Facultad de
Medicina-Universidad de Murcia, Spain
Title
Characteristics and outcome of Streptococcus pneumoniae endocarditis in
the XXI century: A systematic review of 111 cases (2000-2013).
Source
Medicine (United States). 94 (39) (pp e1562), 2015. Date of Publication:
2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
Streptococcus pneumoniae is an infrequent cause of severe infectious
endocarditis (IE). The aim of our study was to describe the epidemiology,
clinical and microbiological characteristics, and outcome of a series of
cases of S. pneumoniae IE diagnosed in Spain and in a series of cases
published since 2000 in the medical literature. We prospectively collected
all cases of IE diagnosed in a multicenter cohort of patients from 27
Spanish hospitals (n=2539). We also performed a systematic review of the
literature since 2000 and retrieved all cases with complete clinical data
using a pre-established protocol. Predictors of mortality were identified
using a logistic regression model. We collected 111 cases of pneumococcal
IE: 24 patients from the Spanish cohort and 87 cases from the literature
review. Median age was 51 years, and 23 patients (20.7%) were under 15
years. Men accounted for 64% of patients, and infection was
community-Acquired in 96.4% of cases. The most important underlying
conditions were liver disease (27.9%) and immunosuppression (10.8%). A
predisposing heart condition was present in only 18 patients (16.2%).
Pneumococcal IE affected a native valve in 93.7% of patients. Left-sided
endocarditis predominated (aortic valve 53.2% and mitral valve 40.5%). The
microbiological diagnosis was obtained from blood cultures in 84.7% of
cases. In the Spanish cohort, nonsusceptibility to penicillin was detected
in 4.2%. The most common clinical manifestations included fever (71.2%), a
new heart murmur (55%), pneumonia (45.9%), meningitis (40.5%), and
Austrian syndrome (26.1%). Cardiac surgery was performed in 47.7% of
patients. The in-hospital mortality rate was 20.7%. The multivariate
analysis revealed the independent risk factors for mortality to be
meningitis (OR, 4.3; 95% CI, 1.4-12.9; P<0.01). Valve surgery was
protective (OR, 0.1; 95% CI, 0.04-0.4; P<0.01). Streptococcus pneumoniae
IE is a community-Acquired disease that mainly affects native aortic
valves. Half of the cases in the present study had concomitant pneumonia,
and a considerable number developed meningitis. Mortality was high, mainly
in patients with central nervous system (CNS) involvement. Surgery was
protective.
Copyright &#xa9; 2015 Wolters Kluwer Health, Inc. All rights reserved.

<85>
Accession Number
603463153
Author
Mulkey S.B.; Yap V.L.; Bai S.; Ramakrishnaiah R.H.; Glasier C.M.;
Bornemeier R.A.; Schmitz M.L.; Bhutta A.T.
Institution
(Mulkey) Department of Pediatrics, Section of Pediatric Neurology,
University of Arkansas for Medical Sciences, 1 Childrens Way, Slot 512-15,
Little Rock, AR 72202, United States
(Yap) Department of Pediatrics, Section of Neonatology, Arkansas
Children's Hospital, Little Rock, AR, United States
(Bai) Department of Pediatrics, Section of Biostatistics, University of
Arkansas for Medical Sciences, Little Rock, AR, United States
(Ramakrishnaiah, Glasier) Department of Radiology, Section of Pediatric
Neuroradiology, Arkansas Children's Hospital, Little Rock, AR, United
States
(Bornemeier) Department of Pediatrics, Section of Cardiology, Arkansas
Children's Hospital, Little Rock, AR, United States
(Schmitz) Department of Anesthesiology, Section of Pediatric
Cardiothoracic Anesthesia, Arkansas Children's Hospital, Little Rock, AR,
United States
(Bhutta) Department of Pediatrics, Section of Critical Care, Arkansas
Children's Hospital, Little Rock, AR, United States
(Yap) New York Presbyterian Weill Cornell Medical College, New York, NY,
United States
(Bhutta) University of Maryland, Baltimore, MD, United States
Title
Amplitude-integrated EEG in newborns with critical congenital heart
disease predicts preoperative brain magnetic resonance imaging findings.
Source
Pediatric Neurology. 52 (6) (pp 599-605), 2015. Date of Publication: 01
Jun 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective The study aims are to evaluate cerebral background patterns
using amplitude-integrated electroencephalography in newborns with
critical congenital heart disease, determine if amplitude-integrated
electroencephalography is predictive of preoperative brain injury, and
assess the incidence of preoperative seizures. We hypothesize that
amplitude-integrated electroencephalography will show abnormal background
patterns in the early preoperative period in infants with congenital heart
disease that have preoperative brain injury on magnetic resonance imaging.
Methods Twenty-four newborns with congenital heart disease requiring
surgery at younger than 30 days of age were prospectively enrolled within
the first 3 days of age at a tertiary care pediatric hospital. Infants had
amplitude-integrated electroencephalography for 24 hours beginning close
to birth and preoperative brain magnetic resonance imaging. The
amplitude-integrated electroencephalographies were read to determine if
the background pattern was normal, mildly abnormal, or severely abnormal.
The presence of seizures and sleep-wake cycling were noted. The
preoperative brain magnetic resonance imaging scans were used for brain
injury and brain atrophy assessment. Results Fifteen of 24 infants had
abnormal amplitude-integrated electroencephalography at 0.71 (0-2) (mean
[range]) days of age. In five infants, the background pattern was severely
abnormal. (burst suppression and/or continuous low voltage). Of the 15
infants with abnormal amplitude-integrated electroencephalography, 9 (60%)
had brain injury. One infant with brain injury had a seizure on
amplitude-integrated electroencephalography. A severely abnormal
background pattern on amplitude-integrated electroencephalography was
associated with brain atrophy (P = 0.03) and absent sleep-wake cycling (P
= 0.022). Conclusion Background cerebral activity is abnormal on
amplitude-integrated electroencephalography following birth in newborns
with congenital heart disease who have findings of brain injury and/or
brain atrophy on preoperative brain magnetic resonance imaging.
Copyright &#xa9; 2015 Elsevier Inc.

<86>
Accession Number
603270855
Author
Chen C.; Zhao Z.-G.; Liao Y.-B.; Peng Y.; Meng Q.-T.; Chai H.; Li Q.; Luo
X.-L.; Liu W.; Zhang C.; Chen M.; Huang D.-J.
Institution
(Chen, Zhao, Liao, Peng, Meng, Chai, Li, Luo, Liu, Zhang, Chen, Huang)
Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
Title
Impact of renal dysfunction on mid-term outcome after transcatheter aortic
valve implantation: A systematic review and meta-analysis.
Source
PLoS ONE. 10 (3) (no pagination), 2015. Article Number: e0119817. Date of
Publication: 20 Mar 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background There is conflicting evidence regarding the impact of
preexisting renal dysfunction (RD) on mid-term outcomes after
transcatheter aortic valve implantation (TAVI) in patients with
symptomatic aortic stenosis (AS). Methods and results Forty-seven articles
representing 32,131 patients with AS undergoing a TAVI procedure were
included in this systematic review and meta-analysis. Pooled analyses were
performed with both univariate and multivariate models, using a fixed or
random effects method when appropriate. Compared with patients with normal
renal function, mid-term mortality was significantly higher in patients
with preexisting RD, as defined by the author (univariate hazard ratio
[HR]: 1.69; 95% confidence interval [CI]: 1.50-1.90; multivariate HR:
1.47; 95% CI: 1.17 -1.84), baseline estimated glomerular filtration rate
(eGFR) (univariate HR: 1.65; 95% CI: 1.47-1.86; multivariate HR: 1.46; 95%
CI: 1.24- 1.71), and serum creatinine (univariate HR: 1.69; 95% CI: 1.48
-1.92; multivariate HR: 1.65; 95% CI: 1.36-1.99). Advanced stage of
chronic kidney disease (CKD stage 3-5) was strongly related to bleeding
(univariate HR in CKD stage 3: 1.30, 95% CI: 1.13-1.49; in CKD stage 4:
1.30, 95% CI: 1.04-1.62), acute kidney injure (AKI) (univariate HR in CKD
stage 3: 1.28, 95% CI: 1.03-1.59; in CKD stage 4: 2.27, 95% CI:
1.74-2.96), stroke (univariate HR in CKD stage 4: 3.37, 95% CI:
1.52-7.46), and mid-term mortality (univariate HR in CKD stage 3: 1.57,
95% CI: 1.26-1.95; in CKD stage 4: 2.77, 95% CI: 2.06 -3.72; in CKD stage
5: 2.64, 95% CI: 1.91-3.65) compared with CKD stage 1+2. Patients with CKD
stage 4 had a higher incidence of AKI (univariate HR: 1.70, 95% CI:
1.34-2.16) and all-cause death (univariate HR: 1.60, 95% CI: 1.28-1.99)
compared with those with CKD stage 3. A per unit decrease in serum
creatinine was also associated with a higher mortality at mid-term
follow-up (univariate HR: 1.24, 95% CI: 1.18-1.30; multivariate HR: 1.19,
95% CI: 1.08-1.30). Conclusions Preexisting RD was associated with
increased mid-term mortality after TAVI. Patients with CKD stage 4 had
significantly higher incidences of peri-procedural complications and a
poorer prognosis, a finding that should be factored into the clinical
decision-making process regarding these patients.
Copyright &#xa9; 2015 Chen et al.

<87>
Accession Number
603600137
Author
Benstoem C.; Moza A.; Autschbach R.; Stoppe C.; Goetzenich A.
Institution
(Benstoem, Moza, Autschbach, Stoppe, Goetzenich) Department of Thoracic
and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen,
Germany
(Stoppe) Department of Anaesthesiology, University Hospital RWTH Aachen,
Aachen, Germany
Title
Evaluating outcomes used in cardiothoracic surgery interventional
research: A systematic review of reviews to develop a core outcome set.
Source
PLoS ONE. 10 (4) (no pagination), 2015. Article Number: e0122204. Date of
Publication: 01 Apr 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: When planning clinical trials, it is a key element to choose
appropriate outcomes that ensure the comparability of effects of
interventions in ways that minimise bias. We hypothesise that outcome
measures in cardiothoracic surgical trials are inconsistent and without
standard. Therefore, comparing the relative effectiveness of interventions
across studies is problematic. We surmise that cardiothoracic research has
focused habitually on the identification of risk factors and on the
reduction of adverse outcomes with less consideration of factors that
contribute to well being and positive health outcomes (salutogenesis).
Methods and Findings: We conducted a systematic review of reviews to
determine both the type and number of outcomes reported in current
cardiothoracic surgery interventional research, in order to identify a
list of potential outcomes for a minimum core outcome set (COS). Special
focus was placed on outcomes that emphasise salutogenesis. We interpreted
salutogenic outcomes as those relating to optimum and/or positive health
and well being. We searched Issue 7 (July 2014) of the Cochrane Database
of Systematic Reviews. Systematic reviews of randomised trials on
non-minimal-invasive off- or on-pump cardiothoracic surgery (elective and
emergency, excluding transplants) investigating pre-, intra- or
postsurgical interventions related to the outcome of the procedure were
eligible for inclusion. We excluded protocols and withdrawn systematic
reviews. Two review authors extracted outcome data independently. Unique
lists of salutogenically and non-salutogenically focused outcomes were
established. 15 systematic reviews involving 371 randomized trials and
58,253 patients were included in this review. Applied definitions of
single and composite endpoints varied significantly, and patient-centred,
salutogenically focused outcomes were seldom reported. One third of
included reviews did not assess patient-centred outcomes at all; all other
reviews were unable to perform meta-analyses due to an absence of data or
heterogeneity in outcome measures. This compares to 36 non-salutogenically
focused outcome domains representing 121 individual non-salutogenically
focused outcomes, whereof 50% were assessed only once. Measures of
mortality, cerebrovascular complications and hospitalisation were reported
most frequently. Two reviews chose a composite endpoint as primary
outcome. Pooled analysis of composite endpoints was not possible, as the
required data was not reported per patient in all components. Conclusion:
In cardiothoracic surgical trials, choice and definition of
non-salutogenically focused single and composite outcomes are
inconsistent. There is an absence of patient centred, salutogenically
focused outcome parameters in cardiac trials. We recommend the development
of a core outcome set of salutogenically focused and non-salutogenically
focused outcomes for cardiothoracic surgical research.
Copyright: &#xa9; 2015 Benstoem et al.

<88>
Accession Number
603554833
Author
Hepponstall M.; Ignjatovic V.; Binos S.; Attard C.; Karlaftis V.; D'Udekem
Y.; Monagle P.; Konstantinov I.E.
Institution
(Hepponstall, Ignjatovic, Attard, Karlaftis, D'Udekem, Monagle,
Konstantinov) Murdoch Childrens Research Institute, Melbourne, Australia
(Hepponstall, D'Udekem, Konstantinov) Cardiac Surgery Unit and Cardiology,
Royal Children's Hospital, Melbourne, Australia
(Hepponstall, Ignjatovic, Monagle, Konstantinov) Department of
Paediatrics, University of Melbourne, Melbourne, Australia
(Hepponstall, Binos) Department of Environment and Primary Industries,
Bioscience Research Division, Melbourne, Australia
Title
Remote Ischemic Preconditioning (RIPC) modifies the plasma proteome in
children undergoing repair of tetralogy of fallot: A randomized controlled
trial.
Source
PLoS ONE. 10 (3) (no pagination), 2015. Article Number: e0122778. Date of
Publication: 31 Mar 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Remote ischemic preconditioning (RIPC) has been applied in
paediatric cardiac surgery. We have demonstrated that RIPC induces a
proteomic response in plasma of healthy volunteers. We tested the
hypothesis that RIPC modifies the proteomic response in children
undergoing Tetralogy of Fallot (TOF) repair. Methods and Results: Children
(n=40) were randomized to RIPC and control groups. Blood was sampled at
baseline, after cardiopulmonary bypass (CPB) and 6, 12 and 24h post-CPB.
Plasma was analysed by liquid chromatography mass spectrometry (LC-MS) in
an untargeted approach. Peptides demonstrating differential expression (p
<0.01) were subjected to tandem LC-MS/MS and protein identification.
Corresponding proteins were identified using the NCBI protein database.
There was no difference in age (7.3+/- 3.5vs6.8+/-3.6 months)(p=0.89),
weight (7.7 +/-1.8vs7.5+/-1.9 kg)(p=0.71), CPB time (104+/-7vs94+/-7
min)(p=0.98) or aortic cross-clamp time (83+/-22vs75+/-20 min)(p=0.36). No
peptides were differentially expressed at baseline or immediately after
CPB. There were 48 peptides with higher expression in the RIPC group 6h
post-CPB. This was no longer evident at 12 or 24h, with one peptide
down-regulated in the RIPC group. The proteins identified were:
inter-alpha globulin inhibitor (42.0+/-11.8 vs 820.8 +/-181.1, p=0.006),
fibrinogen preproprotein (59.3+/-11.2 vs 1192.6+/-278.3, p=0.007),
complement-C3 precursor (391.2 +/-160.9 vs 5385.1 +/-689.4, p=0.0005),
complement C4B (151.5+/-17.8 vs 4587.8 +/-799.2, p=0.003), apolipoprotein
B100 (53.4 +/-8.3 vs 1364.5+/-278.2, p=0.005) and urinary proteinase
inhibitor (358.6+/- 74.9 vs 5758.1+/- 1343.1, p=0.009). These proteins are
involved in metabolism, haemostasis, immunity and inflammation.
Conclusions: We provided the first comprehensive analysis of RIPC-induced
proteomic changes in children undergoing surgery. The proteomic changes
peak 6h post-CPB and return to baseline within 24h of surgery. Trial
Registration: ACTR.org.au ACTRN12610000496011
Copyright &#xa9; 2015 Hepponstall et al.

<89>
Accession Number
615392290
Author
Toikkanen V.; Rinne T.; Nieminen R.; Moilanen E.; Laurikka J.; Porkkala
H.; Tarkka M.; Mennander A.
Institution
(Toikkanen, Laurikka, Tarkka, Mennander) 1 Department of Cardiothoracic
Surgery, Heart Center Co., Tampere University Hospital, University of
Tampere, SDSKIR, Tampere, Finland
(Rinne, Porkkala) 2 Division of Cardiac Anesthesia, Heart Center Co.,
Tampere University Hospital, University of Tampere, Tampere, Finland
(Nieminen, Moilanen) 3 Department of Immunopharmacology, Tampere
University Hospital, University of Tampere, Tampere, Finland
Title
The Impact of Lung Ventilation on Some Cytokines after Coronary Artery
Bypass Grafting.
Source
Scandinavian journal of surgery : SJS : official organ for the Finnish
Surgical Society and the Scandinavian Surgical Society. 106 (1) (pp
87-93), 2017. Date of Publication: 01 Mar 2017.
Abstract
BACKGROUND AND AIMS: Cardiopulmonary bypass induces a systematic
inflammatory response, which is partly understood by investigation of
peripheral blood cytokine levels alone; the lungs may interfere with the
net cytokine concentration. We investigated whether lung ventilation
influences lung passage of some cytokines after coronary artery bypass
grafting.
MATERIAL AND METHODS: In total, 47 patients undergoing coronary artery
bypass grafting were enrolled, and 37 were randomized according to the
ventilation technique: (1) No-ventilation group, with intubation tube
detached from the ventilator; (2) low tidal volume group, with continuous
low tidal volume ventilation; and (3) continuous 10cm H2O positive airway
pressure. Ten selected patients undergoing surgery without cardiopulmonary
bypass served as a referral group. Representative pulmonary and radial
artery blood samples were collected for the evaluation of calculated lung
passage (pulmonary/radial artery) of the pro-inflammatory cytokines
(interleukin 6 and interleukin 8) and the anti-inflammatory interleukin 10
immediately after induction of anesthesia (T1), 1h after restoring
ventilation/return of flow in all grafts (T2), and 20h after restoring
ventilation/return of flow in all grafts (T3).
RESULTS: Pulmonary/radial artery interleukin 6 and pulmonary/radial artery
interleukin 8 ratios ( p=0.001 and p=0.05, respectively) decreased, while
pulmonary/radial artery interleukin 10 ratio ( p=0.001) increased in
patients without cardiopulmonary bypass as compared with patients with
cardiopulmonary bypass.
CONCLUSIONS: The pulmonary/radial artery equation is an innovative means
for the evaluation of cytokine lung passage after coronary artery bypass
grafting. The mode of lung ventilation has no impact on some cytokines
after coronary artery bypass grafting in patients treated with
cardiopulmonary bypass.

<90>
Accession Number
615411557
Author
Auffret V.; Regueiro A.; Campelo-Parada F.; del Trigo M.; Chiche O.;
Chamandi C.; Puri R.; Rodes-Cabau J.
Institution
(Auffret, Regueiro, Campelo-Parada, del Trigo, Chiche, Chamandi, Puri,
Rodes-Cabau) Quebec Heart and Lung Institute, Laval UniversityQuebec City,
Quebec Canada
(Auffret) Signal and Image Processing LaboratoryRennes 1 UniversityRennes
France
Title
Feasibility, safety, and efficacy of transcatheter aortic valve
replacement without balloon predilation: A systematic review and
meta-analysis.
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 feasibility, safety, and efficacy of direct
transcatheter aortic valve replacement (TAVR), that is, TAVR without
balloon predilation (BPD), by performing a systematic review and
meta-analysis of available evidence. Background: Avoiding BPD during TAVR
was shown to be feasible in previous studies but the risks and benefits of
this technique are unknown owing to the limited number of patients
included in these studies. Methods: We performed a systematic search for
studies comparing direct TAVR vs TAVR performed with BPD. Crude risk
ratios (RRs) or mean differences and 95% confidence intervals (CI) for
each endpoint were calculated using random effects models. Results: Twenty
studies including 3586 patients (1606 undergoing direct TAVR) were
selected for the analysis. Mean device success with direct TAVR was 88%
with <5% of bail-out techniques. There were no differences between direct
and BPD-TAVR in short-term (in-hospital or 30-day) mortality (RR: 1.06;
95% CI: 0.78-1.43) or cerebrovascular events (RR: 0.92; 95% CI:
0.58-1.46). Direct TAVR associated with reduced moderate or severe
paravalvular leak post-TAVR (RR: 0.59; 95% CI: 0.36-0.98) but not with a
reduced risk of permanent pacemaker implantation (RR: 0.85, 95% CI:
0.71-1.02). A slight increase in postdilation was observed in direct
transfemoral-TAVR recipients (RR: 1.2; 95% CI: 1.00-1.44). Conclusion:
Direct TAVR is feasible and safe. However, given the unadjusted nature of
our results, uncertainties remain regarding the independent effect of
direct TAVR on outcomes post-TAVR. Randomized studies are warranted to
determine the potential benefits of direct TAVR.
Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<91>
Accession Number
615407118
Author
Ray Mohapatra C.K.; Mishra P.; Saxena P.; Raut C.; Khandekar J.; Ammannaya
G.K.; Seth H.S.; Shah V.; Singh J.
Institution
(Ray Mohapatra, Mishra, Raut, Khandekar, Ammannaya, Seth, Shah, Singh)
Department of Cardiovascular and Thoracic Surgery, Lokmanya Tilak
Municipal Medical College and Sion Hospital, Mumbai, India
(Saxena) Department of Cardiothoracic Surgery, The Townsville Hospital,
James Cook University, Australia
Title
Use of nitroglycerin and verapamil solution by organ bath technique in
preparation of left internal thoracic artery for coronary artery bypass
surgery.
Source
Indian Heart Journal. (no pagination), 2017. Date of Publication: February
07, 2017.
Publisher
Elsevier B.V.
Abstract
Background: The aim of this prospective study was to compare the effect of
application of nitroglycerin and verapamil solution (GV) by organ bath
technique with other methods of applications and solutions on the free
blood flow of LITA. The technique was not described for in situ graft
before. Method: The patients were randomly assigned to four groups: group
I (n_32, GV solution by organ bath technique), group II (n_30, papaverine
solution by organ bath technique), group III (n_29, topical GV solution)
or group IV (n_29, topical papaverine solution). In each patient, pedicled
LITA was harvested; thereafter applied with the randomized different
methods and solutions. The free flow from the distal end of the divided
LITA was measured for 15. s under controlled hemodynamic conditions after
harvesting (Flow 1). The flow of LITA was measured again just prior to
anastomosing the conduit (Flow 2). Result: The mean blood flow in LITA was
56.2. +/-. 5.0. ml/min before application of solutions. After application,
the mean blood flow in group I:102.3. +/-. 7.0. ml/min, in group II: 92.7.
+/-. 3.4. ml/min, and in group III: 88.6. +/-. 2.2. ml/min and in group
IV: 81.4. +/-. 2.1. Proportional increases in blood flow observed in group
I (82.6%). >. group II (65.1%). >. group III (57.6). >. group IV (44.8%)
(p< 0.05). Conclusions: GV solution by organ bath technique is effective
and superior in comparison to use of papaverine using organ bath technique
or topical spray of GV or papaverine solution.
Copyright &#xa9; 2017 Cardiological Society of India.

<92>
Accession Number
615404941
Author
Anselmino M.; Garberoglio L.; Gili S.; Bertaglia E.; Stabile G.; Marazzi
R.; Themistoclakis S.; Solimene F.; Frea S.; Grosso Marra W.; Morello M.;
Scaglione M.; De Ponti R.; Gaita F.
Institution
(Anselmino, Garberoglio, Gili, Frea, Grosso Marra, Morello, Gaita)
Division of Cardiology, Department of Medical Sciences, Citta della Salute
e della Scienza Hospital, University of Turin, Italy
(Scaglione) Division of Cardiology, Department of Internal Medicine,
Cardinal Massaia Hospital, Asti, Italy
(Bertaglia) Department of Cardiac, Thoracic and Vascular Sciences,
University of Padova, Padova, Italy
(Stabile) Clinica Mediterranea, Naples, Italy
(Marazzi, De Ponti) Department of Heart and Vessels, Ospedale di Circolo e
Fondazone Macchi, University of Insubria, Varese, Italy
(Themistoclakis) Department of Cardiothoracic and Vascular Medicine,
Dell'Angelo Hospital, Mestre, Venice, Italy
(Solimene) Clinica Montevergine, Mercogliano (AV), Italy
Title
Left atrial appendage thrombi relate to easily accessible clinical
parameters in patients undergoing atrial fibrillation transcatheter
ablation: A multicenter study.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: October 07, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Transesophageal echocardiography (TEE) is routinely performed
before atrial fibrillation (AF) transcatheter ablation to exclude the
presence of left atrial (LA) or LA appendage (LAA) thrombi. The aim of the
study is to evaluate if easily accessible clinical parameters may relate
to the presence of LA or LAA thrombi to identify patients who could
potentially avoid TEE. Methods and results: Between January 2012 and
September 2014, data from 1539 consecutive patients undergoing TEE, as a
work-up before AF transcatheter ablation, in six large volume centers were
collected. Baseline clinical features, CHA<inf>2</inf>DS<inf>2</inf>-VASc
score, transthoracic echocardiography and presence of thrombi at TEE were
recorded. Exclusion criteria were valvular, hypertrophic or dilated
cardiomyopathy, previous heart surgery or an ejection fraction <35%. Mean
age was 59.6+/-10.4years, 1215 (78.9%) were males; 951 (62.9%) presented
in sinus rhythm (SR) on admission, 324 (21.1%) had undergone at least one
previous ablation and 900 (58.5%) had CHA<inf>2</inf>DS<inf>2</inf>-VASc
score 0-1. Thrombi were encountered in 12 patients (0.8%). SR at TEE
independently related to the absence of thrombi (OR 5.15, 95% CI
1.38-19.02, p =0.015); in addition to this, no patient with a
CHA<inf>2</inf>DS<inf>2</inf>-VASc score 0-1 and SR on admission presented
thrombi at TEE (specificity 100%, p =0.011). Conclusion: In a selected
population of patients referred for AF ablation, LA/LAA thrombi prevalence
is low. No patients in SR with CHA<inf>2</inf>DS<inf>2</inf>-VASc score
0-1 presented LAA thrombi at TEE, identifying a significant subset of
patients who could potentially safely be spared from pre-procedural TEE.
Copyright &#xa9; 2017 Elsevier B.V.

<93>
Accession Number
615402298
Author
Maddali M.M.; Arora N.R.; Chatterjee N.
Institution
(Maddali, Arora) Department of Cardiac Anesthesia, National Heart Center
Royal Hospital, Muscat, Oman
(Chatterjee) Department of Anesthesia, Khoula Hospital, Muscat, Oman
Title
Ultrasound Guided Out-of-Plane Versus In-Plane Transpectoral Left Axillary
Vein Cannulation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: The primary objective was to compare the frequency of
first-attempt successful axillary vein cannulation by the Seldinger
technique using out-of-plane ultrasound guidance versus in-plane imaging.
Between the two ultrasound imaging planes, this study also compared the
number of attempts that were necessary for the cannulation of the left
axillary vein along with the number of needle redirections that had to be
done for final cannulation of the vein. Incidence of complications and the
number of times the procedure was abandoned also were compared between the
two imaging planes. Design: Prospective, randomized, interventional study.
Setting: Tertiary care cardiac center. Participants: Cardiac surgical
patients. Interventions: Left axillary vein cannulation under ultrasound
guidance by Seldinger technique. Measurements and Main Results: The left
axillary vein was accessed under ultrasound guidance in 86 consecutive
adult cardiac surgical patients. They were randomized to out-of-plane
(Group I, n = 43) and in-plane (Group II, n = 43) groups. In group I, the
number of first-attempt cannulations was very high (p < 0.01). The number
of attempts to access the vein was significantly lower in this group (p <
0.05). The duration for completion of the procedure was also less in group
I with out-of-plane ultrasound guidance (p < 0.01). The number of needle
redirections and the incidence of complications (arterial puncture,
pneumothorax hematoma formation) were similar between the groups. There
was no difference in the number of times the procedure was abandoned
between the two groups. With an assumption that the first 10 patients in
each group would suffice for overcoming the learning curve, the above
aspects were analyzed further in each group. The first-attempt cannulation
success continued to be significantly higher in the out-of-plane group.
Conclusions: Out-of-plane ultrasound imaging during axillary vein
cannulation increased the chance of first-attempt successful cannulation.
Axillary vein cannulation under out-of-plane ultrasound imaging also
appeared to be quicker and was preferable in terms of the fewer number of
attempts that were necessary for a successful vein cannulation.
Copyright &#xa9; 2017 Elsevier Inc.