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<1>
Accession Number
614599511
Author
Wang J.; Yu W.; Jin Q.; Li Y.; Liu N.; Hou X.; Yu Y.
Institution
(Wang, Yu, Yu) Department of Cardiac Surgery, Beijing An Zhen Hospital
Capital Medical University, Beijing, China
(Wang, Jin, Li, Liu, Hou) Center for Cardiac Intensive Care, Beijing An
Zhen Hospital Capital Medical University, Beijing, China
Title
Risk Factors for Post-TAVI Bleeding According to the VARC-2 Bleeding
Definition and Effect of the Bleeding on Short-Term Mortality: A
Meta-analysis.
Source
Canadian Journal of Cardiology. 33 (4) (pp 525-534), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Pulsus Group Inc.
Abstract
Background In this study we investigated the effect of post-transcatheter
aortic valve implantation (TAVI) bleeding (per Valve Academic Research
Consortium-2 [VARC-2] bleeding criteria) on 30-day postoperative mortality
and examined the correlation between pre- or intraoperative variables and
bleeding. Methods Multiple electronic literature databases were searched
using predefined criteria, with bleeding defined per Valve Academic
Research Consortium-2 criteria. A total of 10 eligible articles with 3602
patients were included in the meta-analysis. Results The meta-analysis
revealed that post-TAVI bleeding was associated with a 323% increase in
30-day postoperative mortality (odds risk [OR]; 4.23, 95% confidence
interval [CI], 2.80-6.40; P < 0.0001) without significant study
heterogeneity or publication bias. In subgroup analysis we found that
patients with major bleeding/life-threatening bleeding showed a 410%
increase in mortality compared with patients without bleeding (OR, 5.10;
95% CI, 3.17-8.19; P < 0.0001). Transapical access was associated with an
83% increase in the incidence of bleeding compared with transfemoral
access (OR, 1.83; 95% CI, 1.43-2.33; P < 0.0001). Multiple logistic
regression analysis revealed that atrial fibrillation (AF) was
independently correlated with TAVI-associated bleeding (OR, 2.63; 95% CI,
1.33-5.21; P = 0.005). Meta-regression showed that potential modifiers
like the Society of Thoracic Surgeons (STS) score, mortality, the logistic
European System for Cardiac Operative Risk Evaluation (EuroSCORE), aortic
valve area, mean pressure gradient, left ventricular ejection fraction,
preoperative hemoglobin and platelet levels, and study design had no
significant effects on the results of the meta-analysis. Conclusions
Post-TAVI bleeding, in particular, major bleeding/life-threatening
bleeding, increased 30-day postoperative mortality. Transapical access was
a significant bleeding risk factor. Preexisting AF independently
correlated with TAVI-associated bleeding, likely because of AF-related
anticoagulation. Recognition of the importance and determinants of
post-TAVI bleeding should lead to strategies to improve outcomes.
Copyright &#xa9; 2016 Canadian Cardiovascular Society

<2>
Accession Number
614635335
Author
Liang M.; Chen Q.; Zhang Y.; He L.; Wang J.; Cai Y.; Li L.
Institution
(Liang, He, Wang, Cai) Department of Psychiatry, The Second Xiangya
Hospital, Central South University, Changsha, Hunan Province, China
(Chen, Li) Department of Nursing, The Second Xiangya Hospital, Central
South University, Hunan Province, Changsha, China
(Zhang) Nursing Teaching and Research Institute, Medical College of
Guangxi University of Science and Technology, Liuzhou, Guangxi Province,
China
Title
Impact of diabetes on the risk of bedsore in patients undergoing surgery:
An updated quantitative analysis of cohort studies.
Source
Oncotarget. 8 (9) (pp 14516-14524), 2017. Date of Publication: 2017.
Publisher
Impact Journals LLC (E-mail: editors@impactaging.com)
Abstract
Diabetes is a major cause of morbidity for patients undergoing surgery and
can increase the incidence of some postoperative complications such as
bedsores. We conducted a meta-analysis of observational studies to examine
whether patients with diabetes undergoing surgery had high risk of
bedsore. We performed a systematic literature search in Pubmed, Embase and
the Cochrane Library Central Register of Controlled Trials database from
inception to November 2016. Studies were selected if they reported
estimates of the relative risk (RR) for bedsore risk in postoperative
diabetic patients compared with that of in non-diabetic patients.
Random-effects meta-analysis was conducted to pool the estimates. A total
of 16 studies with 24,112 individuals were included in our meta-analysis.
The pooled RR of bedsore development for patients with diatetes was 1.77
(95% CI 1.45 to 2.16). The results of subgroup analyses were consistent
when stratified by surgery type, study design, research region, sample
size, inclusion period, analysis method and study quality. There was
evidence of publication bias among studies and a sensitivity analysis
using the Duval and Tweedie "trim-and-fill" method did not significantly
alter the pooled results (adjusted RR 1.17, 95% CI 1.02 to 1.36).This
meta-analysis provides indications that diabetic patients undergoing
surgery could have a higher risk of developing bedsores. Further
large-scale prospective trials should be implemented to comfirm the
association.

<3>
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Accession Number
614895929
Author
Echarri G.; Duque-Sosa P.; Callejas R.; Garcia-Fernandez N.; Nunez-Cordoba
J.M.; Iribarren M.J.; Monedero P.
Institution
(Echarri, Duque-Sosa, Callejas, Iribarren, Monedero) Department of
Anesthesia and Critical Care, University of Navarra Clinic, University of
Navarra, Pio XII, 36, Pamplon 31008, Spain
(Garcia-Fernandez) Service of Nephrology, University of Navarra Clinic,
University of Navarra, Spain
(Nunez-Cordoba) Research Support Service, Central Clinical Trials Unit,
University of Navarra Clinic, University of Navarra, Pamplona, Spain
Title
External validation of predictive models for acute kidney injury following
cardiac surgery A prospective multicentre cohort study.
Source
European Journal of Anaesthesiology. 34 (2) (pp 81-88), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Four predictive models for acute kidney injury associated with
cardiac surgery were developed by Demirjian in the United States in 2012.
However, the usefulness of these models in clinical practice needs to be
established in different populations independent of that used to develop
the models. OBJECTIVES Our aim was to evaluate the predictive performance
of these models in a Spanish population. DESIGN A multicentre, prospective
observational study. DATA SOURCES Twenty-three Spanish hospitals in 2012
and 2013. ELIGIBILITY CRITERIA Of 1067 consecutive cardiac patients
recruited for the study, 1014 patients remained suitable for the final
analysis. MAIN OUTCOME MEASURES Dialysis therapy, and a composite outcome
of either a doubling of the serum creatinine level or dialysis therapy, in
the 2 weeks (or until discharge, if sooner) after cardiac surgery. RESULTS
Of the 1014 patients analysed, 34 (3.4%) required dialysis and 95 (9.4%)
had either dialysis or doubled their serum creatinine level. The areas
under the receiver operating characteristic curves of the two predictive
models for dialysis therapy, which include either presurgical variables
only, or combined presurgical and intrasurgical variables, were 0.79 and
0.80, respectively. The model for the composite endpoint that combined
presurgical and intrasurgical variables showed better discriminatory
ability than the model that included only presurgical variables: the areas
under the receiver operating characteristic curves were 0.76 and 0.70,
respectively. All four models lacked calibration for their respective
outcomes in our Spanish population. CONCLUSION Overall, the lack of
calibration of these models and the difficulty in using the models
clinically because of the large number of variables limit their
applicability. Copyright &#xa9; 2017 European Society of Anaesthesiology.
All rights reserved.

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Accession Number
614895927
Author
Longo S.; Siri J.; Acosta C.; Palencia A.; Echegaray A.; Chiotti I.;
Parisi A.; Ricci L.; Natal M.; Suarez-Sipmann F.; Tusman G.
Institution
(Longo, Siri, Tusman) Department of Anesthesia, Hospital Privado de
Comunidad, Mar del Plata, Argentina
(Chiotti) Department of Intensive Care, Spain
(Acosta, Palencia) Department of Cardiovascular Surgery, Hospital Privado
Universitario de Cordoba, Cordoba, Spain
(Acosta, Tusman) Department of Anesthesia, Hospital Privado de Comunidad,
Argentina
(Ricci, Natal) Department of Mathematics, Facultad de Ciencias Exactas,
Universidad Nacional de Mar Del Plata, Mar del Plata, Argentina
(Echegaray, Parisi) Department of Surgical Sciences, Section of Anesthesia
and Critical Care, Uppsala University Hospital, Sweden
(Suarez-Sipmann) Hedenstierna Laboratory, Uppsala, Sweden
(Suarez-Sipmann) CIBERES, Madrid, Spain
Title
Lung recruitment improves right ventricular performance after
cardiopulmonary bypass A randomised controlled trial.
Source
European Journal of Anaesthesiology. 34 (2) (pp 66-74), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Atelectasis after cardiopulmonary bypass (CPB) can affect right
ventricular (RV) performance by increasing its outflow impedance.
OBJECTIVE The aim of this study was to determine whether a lung
recruitment manoeuvre improves RV function by reaerating the lung after
CPB. DESIGN Randomised controlled study. SETTING Single-institution study,
community hospital, Co rdoba, Argentina. PATIENTS Forty anaesthetised
patients with New York Heart Association class I or II, preoperative left
ventricular ejection fraction at least 50% and Euroscore 6 or less
scheduled for cardiac surgery with CPB. INTERVENTIONS Patients were
assigned to receive either standard ventilation with 6 cmH<inf>2</inf>O of
positive end-expiratory pressure (PEEP; group C, n = 20) or standard
ventilation with a recruitment manoeuvre and 10 cmH2O of PEEP after
surgery (group RM, n = 20). RV function, left ventricular cardiac index
(CI) and lung aeration were assessed by transoesophageal echocardiography
(TOE) before, at the end of surgery and 30 min after surgery. MAIN OUTCOME
MEASURES RV function parameters and atelectasis assessed by TOE. RESULTS
Haemodynamic data and atelectasis were similar between groups before
surgery. At the end of surgery, CI had decreased from 2.9-1.1 to 2.6-0.9 l
min^-1 m^-2 in group C (P = 0.24) and from 2.8-1.0 to
2.6-0.8 l min^-1 m^-2 in group RM (P = 0.32).
TOE-derived RV function parameters confirmed a mild decrease in RV
performance in 95% of patients, without significant differences between
groups (multivariate Hotelling t-test P = 0.16). Atelectasis was present
in 18 patients in group C and 19 patients in group RM (P = 0.88). After
surgery, CI decreased further from 2.6 to 2.4 l min^-1
m^-2 in group C (P = 0.17) but increased from 2.6 to 3.7 l
min^-1 m^-2 in group RM (P < 0.001). TOE-derived RV
function parameters improved only in group RM (Hotelling ttest P < 0.001).
Atelectasis was present in 100% of patients in group C but only in 10% of
those in group RM (P < 0.001). CONCLUSION Atelectasis after CPB impairs RV
function but this can be resolved by lung recruitment using 10
cmH<inf>2</inf>O of PEEP. Copyright &#xa9; 2017 European Society of
Anaesthesiology. All rights reserved.

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Accession Number
614895925
Author
Eljezi V.; Imhoff E.; Bourdeaux D.; Pereira B.; Farhat M.; Schoeffler P.;
Azarnoush K.; Duale C.
Institution
(Eljezi, Imhoff, Schoeffler) CHU Clermont-Ferrand, Medecine
Peri-Operatoire, CHU Clermont-Ferrand, France
(Bourdeaux) Pharmacie Centrale, Hopital Gabriel-Montpied, France
(Pereira) CHU ClermontFerrand, Direction de la Recherche Clinique et des
Innovations, CHU Clermont-Ferrand, France
(Farhat, Azarnoush) Pole Cardiologie, Chirurgie Cardio-Vasculaire, Univ
Clermont1, France
(Schoeffler, Azarnoush, Duale) Fac Medecine, CHU Clermont-Ferrand, France
(Duale) Centre de Pharmacologie Clinique, Inserm, CIC1405, U1107
Neuro-Dol, 58 rue Montalembert, ClermontFerrand Cedex 1 63003, France
Title
Bilateral sternal infusion of ropivacaine and length of stay in ICU after
cardiac surgery with increased respiratory risk A randomised controlled
trial.
Source
European Journal of Anaesthesiology. 34 (2) (pp 56-65), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background The continuous bilateral infusion of a local anaesthetic
solution around the sternotomy wound (bilateral sternal) is an innovative
technique for reducing pain after sternotomy. OBJECTIVE To assess the
effects of the technique on the need for intensive care in cardiac
patients at increased risk of respiratory complications. DESIGN
Randomised, observer-blind controlled trial. SETTING Single centre, French
University Hospital. PATIENTS In total, 120 adults scheduled for
open-heart surgery, with one of the following conditions: age more than 75
years, BMI >30 kg m^-2, chronic obstructive pulmonary disease,
active smoking habit. INTERVENTION Either a bilateral sternal infusion of
0.2% ropivacaine (3 ml h^-1 through each catheter;
'intervention' group), or standardised care only ('control' group).
Analgesia was provided with paracetamol and self-administered intravenous
morphine. MAIN OUTCOME MEASURES The length of time to readiness for
discharge from ICU, blindly assessed by a committee of experts. RESULTS No
effect was found between groups for the primary outcome (P = 0.680,
intention to treat); the median values were 42.4 and 37.7 h, respectively
for the control and intervention groups (P = 0.873). Similar
nonsignificant trends were noted for other postoperative delays.
Significant effects favouring the intervention were noted for dynamic
pain, patient satisfaction, occurrence of nausea and vomiting, occurrence
of delirium or mental confusion and occurrence of pulmonary complications.
In 12 patients, although no symptoms actually occurred, the total
ropivacaine plasma level exceeded the lowest value for which neurological
symptoms have been observed in healthy volunteers. CONCLUSION Because of a
small size effect, and despite significant analgesic effects, this
strategy failed to reduce the time spent in ICU. Copyright &#xa9; 2017
European Society of Anaesthesiology. All rights reserved.

<6>
Accession Number
614202103
Author
Bangalore S.; Davis B.R.; Cushman W.C.; Pressel S.L.; Muntner P.M.;
Calhoun D.A.; Kostis J.B.; Whelton P.K.; Probstfield J.L.; Rahman M.;
Black H.R.
Institution
(Bangalore, Black) Department of Medicine, New York University School of
Medicine, United States
(Davis, Pressel) Coordinating Center for Clinical Trials, The University
of Texas School of Public Health, Houston, United States
(Cushman) Memphis Veterans Affairs Medical Center, University of Tennessee
College of Medicine, United States
(Muntner, Calhoun) Vascular Biology and Hypertension Program, University
of Alabama, Birmingham, United States
(Kostis) Cardiovascular Institute, Rutgers Robert Wood Johnson Medical
School, New Brunswick, NJ, United States
(Whelton) Department of Epidemiology, Tulane University School of Public
Health and Tropical Medicine, New Orleans, La, United States
(Probstfield) Department of Medicine, The University of Washington Medical
Center, Seattle, United States
(Rahman) Department of Medicine, University Hospitals Case Medical Center,
Case Western Reserve University, Cleveland, Ohio, United States
Title
Treatment-Resistant Hypertension and Outcomes Based on Randomized
Treatment Group in ALLHAT.
Source
American Journal of Medicine. 130 (4) (pp 439-448.e9), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Although hypertension guidelines define treatment-resistant
hypertension as blood pressure uncontrolled by >3 antihypertensive
medications, including a diuretic, it is unknown whether patient prognosis
differs when a diuretic is included. Methods Participants in the
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial (ALLHAT) were randomly assigned to first-step therapy with
chlorthalidone, amlodipine, or lisinopril. At a Year 2 follow-up visit,
those with average blood pressure >140 mm Hg systolic or >90 mm Hg
diastolic on >3 antihypertensive medications, or blood pressure <140/90 mm
Hg on >4 antihypertensive medications were identified as having apparent
treatment-resistant hypertension. The prevalence of treatment-resistant
hypertension and its association with ALLHAT primary (combined fatal
coronary heart disease or nonfatal myocardial infarction) and secondary
(all-cause mortality, stroke, heart failure, combined coronary heart
disease, and combined cardiovascular disease) outcomes were identified for
each treatment group. Results Of participants assigned to chlorthalidone,
amlodipine, or lisinopril, 9.6%, 11.4%, and 19.7%, respectively, had
treatment-resistant hypertension. During mean follow-up of 2.9 years,
primary outcome incidence was similar for those assigned to chlorthalidone
compared with amlodipine or lisinopril (amlodipine- vs
chlorthalidone-adjusted hazard ratio [HR] 0.86; 95% confidence interval
[CI], 0.53-1.39; P = .53; lisinopril- vs chlorthalidone-adjusted HR =
1.06; 95% CI, 0.70-1.60; P = .78). Secondary outcome risks were similar
for most comparisons except coronary revascularization, which was higher
with amlodipine than with chlorthalidone (HR 1.86; 95% CI, 1.11-3.11; P =
.02). An as-treated analysis based on diuretic use produced similar
results. Conclusions In this study, which titrated medications to a goal,
participants assigned to chlorthalidone were less likely to develop
treatment-resistant hypertension. However, prognoses in those with
treatment-resistant hypertension were similar across treatment groups.
Copyright &#xa9; 2016 Elsevier Inc.

<7>
Accession Number
614477738
Author
Chang M.; Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Park
D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Park S.-W.; Serruys P.W.; Park
S.-J.
Institution
(Chang) Seoul St. Mary's Hospital, Catholic University of Korea, Seoul,
South Korea
(Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Heart Institute, University
of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
(Cavalcante, Onuma, Serruys) Erasmus University Medical Center, Rotterdam,
Netherlands
(Sotomi) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Serruys) International Center for Circulatory Health, Imperial College of
London, London, United Kingdom
Title
Outcomes of Coronary Artery Bypass Graft Surgery Versus Drug-Eluting
Stents in Older Adults.
Source
Journal of the American Geriatrics Society. 65 (3) (pp 625-630), 2017.
Date of Publication: 01 Mar 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: Little data are available to compare coronary artery bypass
graft surgery (CABG) vs percutaneous coronary intervention (PCI) with
drug-eluting stents (DES) in older adults. We evaluate the long-term
outcomes of CABG vs PCI with DES in older adults with left main or
multivessel coronary artery disease (CAD). Design: Individual
patient-level meta-analysis. Settings: Databases from the BEST, PRECOMBAT,
and SYNTAX trials were combined. Participants: A total 1,079 adults aged
70 to 89 years were pooled. Measurements: The primary outcome was a
composite of death from any causes, myocardial infarction, stroke, or
repeat revascularization. Results: During a total of 6.3 (median, 4.9)
years of follow-up, the primary composite outcome of all-cause mortality,
myocardial infarction, stroke, or repeat revascularization occurred in 26%
(141/550) and 34% (179/529) of patients in the CABG and PCI groups,
respectively (hazard ratio (HR), 0.75; 95% confidence interval (CI),
0.60-0.94; P =.012). CABG was associated with fewer myocardial infarction
(4% vs 8% for PCI; HR, 0.48; 95% CI, 0.29-0.80; P =.037); and repeat
revascularizations (8% vs 17% for PCI; HR, 044; 95% CI, 0.31-0.64; P
<.001), but had little association with all-cause mortality or stroke.
Conclusion: Older adults age 70 to 89 years with left main or multivessel
CAD who participated in the BEST, PRECOMBAT, and SYNTAX trials; compared
to PCI, CABG was associated with lower risk of primary outcome which was
mostly driven by lower risk of myocardial infarction. &#xa9; 2017,
Copyright the Authors Journal compilation &#xa9; 2017, The American
Geriatrics Society

<8>
Accession Number
614922993
Author
Kosova E.C.; Bonaca M.P.; Dellborg M.; He P.; Morais J.; Oude Ophuis T.;
Scirica B.M.; Tendera M.; Theroux P.; Braunwald E.; Morrow D.A.
Institution
(Kosova) Department of Medicine, Brigham and Women's Hospital, Boston,
United States
(Bonaca, He, Scirica, Braunwald, Morrow) TIMI Study Group, Cardiovascular
Division, Brigham and Women's Hospital, Boston, United States
(Dellborg) Sahlgrenska Academy, University of Gothenburg and Sahlgrenska
University Hospital, Gothenburg, Sweden
(Morais) Santo Andre's Hospital, Leiria, Portugal
(Oude Ophuis) Canisius-Willhelmina Hospital, Nijmegen, Netherlands
(Tendera) Third Division of Cardiology, Medical University of Silesia,
Katowice, Poland
(Theroux) Montreal Heart Institute, University of Montreal, Canada
Title
Vorapaxar in patients with coronary artery bypass grafting: Findings from
the TRA 2degreeP-TIMI 50 trial.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (2) (pp 164-172),
2017. Date of Publication: 01 Mar 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Vorapaxar is a first-in-class protease-activated receptor-1
antagonist indicated for the reduction of cardiovascular death, myocardial
infarction, and stroke in stable patients with prior atherothrombosis, who
have not had a prior stroke or transient ischemic attack. The aims of this
study were to investigate: 1) the role of vorapaxar in patients with
severe coronary artery disease treated previously with coronary artery
bypass grafting (CABG); and 2) safety in patients undergoing CABG while
receiving vorapaxar. Methods: TRA 2degreeP-TIMI 50 was a randomized,
double-blinded, placebo-controlled trial of vorapaxar in 26,449 stable
patients with prior atherothrombosis followed for a median of 30 months.
We 1) investigated the efficacy of vorapaxar among patients with a history
of CABG prior to randomization (n=2942); and 2) assessed the safety among
367 patients who underwent a new CABG during the trial. Results: Patients
with a prior CABG were at higher risk for cardiovascular death, myocardial
infarction, or stroke at three years compared with patients without a
prior CABG (13.7% vs. 7.8%, p<0.001). Among patients with a prior CABG,
vorapaxar significantly reduced the risk of cardiovascular death,
myocardial infarction, or stroke (11.9% vs. 15.6%, hazard ratio 0.71, 95%
confidence interval 0.58-0.88, p=0.001; number-needed-to-treat = 27). In
patients undergoing CABG while receiving vorapaxar, the rate of
Thrombolysis in Myocardial Infarction CABG major bleeding was 6.3% vs.
4.1% with placebo (hazard ratio 1.53, 95% confidence interval 0.58-4.01,
p=0.39). Conclusions: In patients with a prior CABG, vorapaxar
significantly reduced the risk of recurrent major cardiovascular events.
In patients undergoing CABG while receiving vorapaxar, bleeding risk
appeared similar to that seen in the overall trial population. Copyright
&#xa9; 2016, &#xa9; The European Society of Cardiology 2016.

<9>
Accession Number
614064526
Author
AlKherayf F.; Xu Y.; Westwick H.; Moldovan I.D.; Wells P.S.
Institution
(AlKherayf, Moldovan) Division of Neurosurgery, Department of Surgery,
University of Ottawa, Ottawa, Canada
(Xu) School of Medicine, Queen's University, Kingston, Canada
(Westwick) Division of Neurosurgery, Department of Surgery, Hopital du
Sacre-Coeur de Montreal, Montreal, Canada
(Xu, Wells) Division of Hematology, Department of Medicine, Ottawa, Canada
(AlKherayf, Wells) The Ottawa Hospital Research Institute, Ottawa, Canada
Title
Timing of anticoagulant re-initiation following intracerebral hemorrhage
in mechanical heart valves: Survey of neurosurgeons and thrombosis
experts.
Source
Clinical Neurology and Neurosurgery. 154 (pp 23-27), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier B.V.
Abstract
Background While oral anticoagulation (OAC) is universally indicated for
patients with mechanical heart valves (MHVs), OAC resumption following
anticoagulant-associated intracerebral hemorrhage (ICH) is an area of
uncertainty. We sought to determine the practice preferences of North
American neurosurgeons and thrombosis experts on optimal timing of OAC
re-initiation. Methods A cross-sectional survey was disseminated to North
American members of the American Association of Neurological Surgeons and
the International Society for Thrombosis and Haemostasis. Demographic
factors, as well as a clinical scenario with 14 modifiable clinical risk
factors were included in the survey. Results 504 physicians completed our
survey (response rate 34.3%). Majority of participants were affiliated
with academic centres, and managed < 10 ICH patients with MHV per year.
There was wide distribution in response in optimal timing for OAC
resumption following an ICH: 59% and 60% preferred to re-start OAC between
3 and 14 days following the hemorrhagic event (median of 6-7 days).
Smaller hemorrhages (<30 cm²). CHADS<inf>2</inf> score >2,
concomitant venous thromboembolism, mitral valve prosthesis, caged-ball
valves and multiple valves prompted earlier OAC resumption. Conclusion
Wide variation in the current practice of neurosurgeons and thrombosis
specialists exist when they encounter patients with ICH and MHV, though
decisions were influenced by patient- and valve-related factors. As our
observed variation likely reflects the immense gap in current evidence,
prospective randomized trials in this population are therefore urgently
needed. Copyright &#xa9; 2017 Elsevier B.V.

<10>
Accession Number
614902123
Author
Solanki N.; Engineer S.; Vecham P.
Institution
(Solanki, Engineer, Vecham) Department of Anesthesia, B. J. Medical
College and Civil Hospital, 44Devshrusti BungalowsII, B/H Kena Bungalows,
Motera Stadium Road, Motera, Sabarmati, Ahmedabad, Gujarat 380 005, India
Title
Comparison of epidural versus systemic analgesia for major surgeries in
neonates and infants.
Source
Journal of Clinical Neonatology. 6 (1) (pp 23-28), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background and Aims: Postoperative analgesia in neonate reduces acute
behavioral responses to pain. It also protects the developing nervous
system from persistent sensitization of pain pathway and potential
damaging effects of altered neural activity on central nervous system
development. We compared the effectiveness of epidural versus systemic
modes of analgesia for major surgeries in neonates and infants. Materials
and Methods: This randomized, single center, prospective, controlled study
was conducted in sixty patients, aged 1 day to 6 months, weighing 2-5 kg
belonging to the American Society of Anesthesiology physical Grade II to
IV, posted for major thoracic and abdominal surgery. After general
anesthesia, in Group A, the epidural catheter was inserted through
standard caudal epidural technique. Initial bolus of 0.125% bupivacaine
(0.75 ml/kg) and postoperatively caudal infusion of 0.0625% bupivacaine
(0.1 ml/kg/h) was given. Intraoperatively Group B received fentanyl (1-2
mug/kg) and paracetamol (10 mg/kg) intravenously and postoperatively
paracetamol (10 mg/kg)/intravenous (IV) six hourly or pain score > 4.
Postoperative pain was assessed using face, legs, activity, cry, and
consolability pain scale and sedation score was assessed by using
four-point sedation score for 48 h. Results: Patients in Group A remained
hemodynamically stable except occasional bradycardia below 100 which was
successfully managed with anticholinergics. There was less requirement of
sevoflurane in the intraoperative period and good quality of analgesia.
While in Group B, multiple and regular dosage of IV paracetamol was
required to maintain adequate analgesia. Conclusion: Very efficient
postoperative analgesia can be achieved via caudal epidural catheter in
combination with general anesthesia compared to IV paracetamol in neonates
and infants. Copyright &#xa9; 2017 Journal of Clinical Neonatology
Published by Wolters Kluwer - Medknow.

<11>
Accession Number
611100604
Author
Adwan M.H.
Institution
(Adwan) Department of Medicine, Division of Rheumatology, The University
of Jordan, Queen Rania Street, Amman 11942, Jordan
Title
Voriconazole-induced periostitis: a new rheumatic disorder.
Source
Clinical Rheumatology. 36 (3) (pp 609-615), 2017. Date of Publication: 01
Mar 2017.
Publisher
Springer London
Abstract
Over the past few years, several reports of periostitis affecting patients
treated with voriconazole appeared in the literature. As rheumatologists
are likely to be called to see such patients, a review of the reported
cases was undertaken. A systematic search of Pubmed and Google scholar for
case reports, case series and observational studies was undertaken.
Twenty-six articles including 23 case reports/case series (total 40
patients), a prospective study and two retrospective studies of 58 cases
were included. Age ranged from 3 months to 77 years. Eleven cases (27.5 %)
were male and 29 cases (72.5 %) were female. The duration of treatment
varied from 6 weeks to 8 years (mean 53.6, SD 77.4 weeks). Most cases
presented with diffuse skeletal pain affecting various sites in
association with elevated alkaline phosphatase. Periostitis is
increasingly reported and should be considered in patients taking
voriconazole who present with bone pain and/or alkaline phosphatase
elevation. Copyright &#xa9; 2016, International League of Associations for
Rheumatology (ILAR).

<12>
Accession Number
614272324
Author
de Souza Brito F.; Mehta R.H.; Lopes R.D.; Harskamp R.E.; Lucas B.D.;
Schulte P.J.; Tardif J.-C.; Alexander J.H.
Institution
(de Souza Brito, Mehta, Lopes, Harskamp, Alexander) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC, United States
(Lucas) Clinical Research, Charleston Area Medical Center Health Education
and Research Institute, Charleston, WVa, United States
(Schulte) Department of Health Sciences Research, Mayo Clinic, Rochester,
Minn, United States
(Tardif) Montreal Heart Institute, Quebec, Canada
Title
Nonsteroidal Anti-Inflammatory Drugs and Clinical Outcomes in Patients
Undergoing Coronary Artery Bypass Surgery.
Source
American Journal of Medicine. 130 (4) (pp 462-468), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used
in perioperative pain management of patients undergoing coronary artery
bypass graft surgery. However, the association of periprocedural use of
NSAIDs and clinical outcomes after coronary artery bypass graft is
understudied. Methods We conducted a retrospective analysis using pooled
data from 2 multicenter randomized controlled trials (PREVENT IV [n =
3014] and MEND-CABG II [n = 3023]). Rates of death, death or myocardial
infarction, and death, myocardial infarction, or stroke in the 30 days
following coronary artery bypass graft surgery were compared in patients
using or not using perioperative NSAIDs. Inverse probability of treatment
weighting and Cox proportional hazards regression models were used to
adjust for confounding. Results A total of 5887 patients were studied.
Median age was 65 years, 78% were male, and 91% were White. NSAIDs were
used in 2368 (40.2%) patients. The majority of patients (1822 [30.9%])
received NSAIDs after coronary artery bypass graft surgery; 289 (4.9%)
used them prior to and after the surgery; and 257 (4.4) received NSAIDs
prior to the surgery only. Adjusted 30-day outcomes were similar in
patients receiving and not receiving NSAIDs (death: hazard ratio [HR]
1.18; 95% confidence interval [CI], 0.48-2.92; death or myocardial
infarction: HR 0.87; 95% CI, 0.42-1.79; death, myocardial infarction, or
stroke: HR 0.87; 95% CI, 0.46-1.65). Conclusion In this pooled data
analysis, perioperative NSAID use was common among patients undergoing
coronary artery bypass graft surgery and was not associated with an
increased short-term risk for major adverse clinical outcomes. Copyright
&#xa9; 2016 Elsevier Inc.

<13>
Accession Number
614883192
Author
Messenger J.C.; Salcedo E.E.
Institution
(Messenger) Division of Cardiology, Cardiac Catheterization Laboratories,
University of Colorado School of Medicine, 12401 E. 17th Avenue, Box B132,
Aurora, CO 80045, United States
(Salcedo) Division of Cardiology, Echocardiography Laboratory,
Hypertrophic Obstructive Cardiomyopathy Clinic, University of Colorado
School of Medicine, Aurora, CO 80045, United States
Title
Alcohol Septal Ablation for Treatment of Symptomatic Hypertrophic
Obstructive Cardiomyopathy.
Source
Current Cardiovascular Risk Reports. 11 (5) (no pagination), 2017. Article
Number: 15. Date of Publication: 01 May 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: To provide a contemporary review of data regarding
patient selection and outcomes for patients with symptomatic obstructive
hypertrophic cardiomyopathy (HCM) undergoing septal reduction therapy with
alcohol septal ablation (ASA). Recent Findings: This review focuses on
recent guideline updates from the USA and Europe, multiple recently
published large multicenter, multinational registries of patients being
treated with ASA, and a recent review of "real world" outcomes of ASA and
surgical myectomy (SM) treated in hospitals in the USA. Summary: Recent
data have demonstrated that ASA is a safe procedure and is effective for
the reduction of symptoms associated with obstructive HCM. Both short-and
long-term outcomes after ASA appear similar to outcomes in patients
undergoing SM and medical treatment. Outcomes in a real-world setting
evaluating ASA and SM outside of high volume centers specializing in
treatment of HCM show that ASA is increasing in use and that outcomes are
fairly consistent across centers performing the procedure. Copyright
&#xa9; 2017, Springer Science+Business Media New York.

<14>
Accession Number
613244125
Author
Murphy M.E.; Hakim J.S.; Kerezoudis P.; Alvi M.A.; Ubl D.S.; Habermann
E.B.; Bydon M.
Institution
(Murphy, Kerezoudis, Alvi, Bydon) Department of Neurologic Surgery, Mayo
Clinic, Rochester, Minnesota, 200 1st St. SW, Rochester, MN 55905, United
States
(Murphy, Hakim, Kerezoudis, Alvi, Bydon) Mayo Clinic Neuro-Informatics
Laboratory, Mayo Clinic, Rochester, Minnesota, 200 1st St. SW, Rochester,
MN 55905, United States
(Hakim) Mayo Medical School, Mayo Clinic, Rochester, Minnesota, 200 1st
St. SW, Rochester, MN 55905, United States
(Ubl, Habermann) Department of Health Sciences Research Mayo Clinic, 200
1st St. SW, MN, Rochester, MN 55905, United States
Title
Micro vs. macrodiscectomy: Does use of the microscope reduce complication
rates?.
Source
Clinical Neurology and Neurosurgery. 152 (pp 28-33), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier B.V.
Abstract
Objective A single level discectomy is one of the most common procedures
performed by spine surgeons. While some practitioners utilize the
microscope, others do not. We postulate improved visualization with an
intraoperative microscope decreases complications and inferior outcomes.
Methods A multicenter surgical registry was utilized for this
retrospective cohort analysis. Patients with degenerative spinal diagnoses
undergoing elective single level discectomies from 2010 to 2014 were
included. Univariate analysis was performed comparing demographics,
patient characteristics, operative data, and outcomes for discectomies
performed with and without a microscope. Multivariable logistic regression
analysis was then applied to compare outcomes of micro- and
macrodiscectomies. Results Query of the registry yielded 23,583 patients
meeting inclusion criteria. On univariate analysis the microscope was used
in a greater proportion of the oldest age group as well as Hispanic white
patients. Patients with any functional dependency, history of congestive
heart failure, chronic corticosteroid use, or anemia (hematocrit < 35%)
also had greater proportions of microdiscectomies. Thoracic region
discectomies more frequently involved use of the microscope than cervical
or lumbar discectomies (25.0% vs. 16.4% and 13.0%, respectively, p <
0.001). Median operative time (IQR) was increased in microscope cases [80
min (60, 108) vs. 74 min (54, 102), p < 0.001]. Of the patients that
required reoperation within 30 days, 2.5% of them had undergone a
microdiscectomy compared to 1.9% who had undergone a macrodiscectomy, p =
0.044. On multivariable analysis, microdiscectomies were more likely to
have an operative time in the top quartile of discectomy operative times,
>103 min (OR 1.256, 95% CI 1.151-1.371, p < 0.001). In regards to other
multivariable outcome models for any complication, surgical site
infection, dural tears, reoperation, and readmission, no significant
association with microdiscectomy was found. Conclusions The use of the
microscope was found to significantly increase the odds of longer
operative time, but not influence rates of postoperative complications.
Thus, without evidence from this study that the microscope decreases
complications, the use of the microscope should be at the surgeon's
discretion, validating the use of both macro and micro approaches to
discectomy as acceptable standards of care. Copyright &#xa9; 2016 Elsevier
B.V.

<15>
Accession Number
608745934
Author
Yildirim A.; Goktekin O.; Gorgulu S.; Norgaz T.; Akkaya E.; Aydin U.; Unal
Aksu H.; Bakir I.
Institution
(Yildirim, Akkaya, Unal Aksu) Cardiology Department, Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital,
Istanbul, Turkey
(Goktekin) Cardiology Department, Bezmialem University Medical Faculty,
Istanbul, Turkey
(Gorgulu, Norgaz) Cardiology Department, Acibadem University Medical
Faculty, Istanbul, Turkey
(Aydin, Bakir) Cardiovascular Surgery Department, Mehmet Akif Ersoy Chest
and Cardiovascular Surgery Training and Research Hospital, Istanbul,
Turkey
Title
A New Specific Device in Transcatheter Prosthetic Paravalvular Leak
Closure: A Prospective Two-Center Trial.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 618-624),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: This study sought to compare various outcomes among a new
specifically designed transcatheter paravalvular leak closure (TPVLC)
device and the devices that are being utilized off-label. Methods: Between
April 2012 and January 2015, in a prospective two-center study, 52
patients who needed surgical reintervention due to a hemodynamically
significant prosthetic paravalvular leak were studied. This study
population was divided into two groups. Group I was composed of 32
patients who underwent paravalvular leak (PVL) closure with the currently
available devices that are being utilized off-label, while group II
consisted of 20 patients who were treated with the new specifically
designed Occlutech PVL device. Results: Demographic and clinical variables
indicated a higher rate of atrial fibrillation (P = 0.027) and chronic
obstructive airway disease (P = 0.009) in group II. The apical approach
was the most commonly used intervention route used for group II (P =
0.019). The procedural success rate was 100% (29 of 29 leaks) in group II
while the rate was 92% (39 of 42 leaks) in group I. However, more
secondary events were observed in group I, but they did not reach
statistical significance (8 vs. 1, P = 0.064). Conclusions: With its high
procedural success rate and encouraging outcome results, the Occlutech
device seems to satisfy the expectations of a specifically designed PVL
closure device. &#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016
Wiley Periodicals, Inc.

<16>
Accession Number
610663691
Author
Werner N.; Zeymer U.; Schneider S.; Bauer T.; Gerckens U.; Linke A.; Hamm
C.; Sievert H.; Eggebrecht H.; Zahn R.
Institution
(Werner, Zeymer, Zahn) Medizinische Klinik B, Klinikum Ludwigshafen,
Ludwigshafen, Germany
(Zeymer, Schneider) Institut fur Herzinfarktforschung, Ludwigshafen,
Germany
(Bauer) Medizinische Klinik I, Universitatsklinikum Giesen, Giesen,
Germany
(Gerckens) Klinik fur Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonn,
Germany
(Linke) Klinik fur Kardiologie, Herzzentrum, Leipzig, Germany
(Hamm) Abteilung fur Kardiologie, Kerckhoff-Klinik, Bad Nauheim, Germany
(Sievert) CardioVasculares Centrum Frankfurt, Frankfurt, Germany
(Eggebrecht) Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
Title
Incidence and Clinical Impact of Stroke Complicating Transcatheter Aortic
Valve Implantation: Results From the German TAVI Registry.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 644-653),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
a safe and effective treatment for patients with severe, symptomatic
aortic valve stenosis at high surgical risk over the last years. However,
besides its minimal invasive character, TAVI still is an invasive
procedure usually performed in a population, carrying a substantial risk
for vascular complications, like stroke. Stroke is known to be a rare but
serious complication of transvascular interventions in clinical practice,
which is associated with high morbidity and mortality rates. Despite broad
clinical research in many fields of TAVI over the last years, only sparse
data still exist on the incidence and clinical risk factors of stroke
complicating TAVI in clinical practice today. Methods: We analyzed data of
1.413 TAVIs, which were enrolled at 30 sites into the prospective and
multicenter German TAVI Registry from January 2009 until June 2010.
Results: The overall incidence of cerebrovascular events complicating TAVI
was 3.2% (n = 45/1.413) in a real-world population today. 40% of all
cerebrovascular events were classified as transient ischemic attacks (TIA)
with symptoms lasting < 24 hr (18/45) and 60% were classified as stroke
with symptoms persisting > 24 hr (27/45). All strokes complicating TAVI of
50% were classified as major strokes leading to notable disability in
patients, who survive this complication (Modified Ranking Scale 3-6).
In-hospital mortality rate in patients with stroke/TIA was 28.9%, compared
to 6.9% in patients without stroke/TIA and 1-year mortality rate 46.7%
versus 18.6%, respectively. In multivariate analysis, prior stroke and
renal impairment were found as the only independent predictors for stroke
complicating TAVI. Conclusions: Stroke complicating TAVI is a serious
complication with a clinically relevant incidence even in daily practice
leading to a fivefold increase in 30-day-mortality rate, as well as a
significant increase in morbidity and disability in patients, who survive
this devastating complication. Further research is needed to identify risk
factors and ways to reduce stroke after TAVI. &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<17>
Accession Number
610663667
Author
Eftychiou C.; Barmby D.S.; Wilson S.J.; Ubaid S.; Markwick A.J.; Makri L.;
Blaxill J.M.; Spratt J.C.; Gunning M.; Greenwood J.P.
Institution
(Eftychiou, Barmby, Makri, Blaxill, Greenwood) Department of Cardiology,
Leeds General Infirmary, Leeds, United Kingdom
(Wilson) Department of Cardiology, Royal Infirmary of Edinburgh,
Edinburgh, United Kingdom
(Ubaid, Markwick, Gunning) Department of Cardiology, University Hospital
of North Staffordshire, Stoke-on-Trent, United Kingdom
(Spratt) Department of Cardiology, Forth Valley Royal, Edinburgh, United
Kingdom
(Greenwood) Division of Cardiovascular and Diabetes Research, Leeds
Institute of Cardiovascular and Metabolic Medicine, University of Leeds,
Leeds, United Kingdom
Title
Cardiovascular Outcomes Following Rotational Atherectomy: A UK Multicentre
Experience.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 546-553),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To identify factors associated with outcomes following
rotational atherectomy (RA). Background: RA is an effective way to
mechanically modify heavily calcified lesions before stenting; however its
outcomes are not well defined. Methods and Results: Retrospective
evaluation of all patients who underwent RA in three large UK centers
(Leeds General Infirmary (LGI), Royal Infirmary of Edinburgh (RIE) and
University Hospital of North Staffordshire (UHNS)) from March 2005 to
January 2013. Five hundred and eighteen patients had RA with median
follow-up period of 22 months. About 68.3% were male, 28.7% had DM and
34.6% were treated because of ACS. Stents were deployed in 97.3% of the
patients while 30.7% of the procedures were performed transradially.
Maximum burr was <1.75 mm in 85.5% and the mean SYNTAX score was 19.5 +/-
11.6. Peri-procedural complications occurred in 6.4% and vascular access
complications in 1.9%. Outcomes in the follow-up period were: MACE 17.8%,
cardiac death 7.1%, MI 11.7%, TVR 7.5%, all-cause death 13.7%, definite
stent thrombosis (ST) 1.4% and stroke 2.9%. Patients with intermediate and
high SYNTAX scores were more likely to suffer MACE, cardiac death, MI,
all-cause death and ST. Patients with a SYNTAX score >32 were also more
likely to have a peri-procedural complication. Multiple logistic
regression analysis showed that the presence of PVD (P = 0.026, OR = 2.0),
DM (P = 0.008, OR = 2.1), ACS presentation (P = 0.011, OR = 2.1) and
SYNTAX score >23 (P = 0.02, OR = 1.9) had a significant association with
MACE. Conclusions: RA is safe and effective, with high rate of procedural
success and relatively low incidence of MACE. PVD, DM, ACS presentation
and SYNTAX score were significant predictors for MACE. &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<18>
Accession Number
608854628
Author
Khan A.R.; Khan S.; Riaz H.; Luni F.K.; Simo H.; Bin Abdulhak A.; Bavishi
C.; Flaherty M.
Institution
(Khan, Flaherty) Division of Cardiovascular Medicine, Department of
Internal Medicine, University of Louisville, Louisville, KY, United States
(Khan, Simo) Department of Internal Medicine, University of Toledo Medical
Center, Toledo, OH, United States
(Riaz) Department of Internal Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Luni) Division of Cardiovascular Medicine, Department of Internal
Medicine, Saint Vincent Mercy Hospital, Toledo, OH, United States
(Bin Abdulhak) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of Iowa, Iowa City, IA, United States
(Bavishi) Division of Cardiovascular Medicine, Department of Internal
Medicine, St Lukes Roosevelt Hospital, New York, United States
Title
Efficacy and safety of transcatheter aortic valve replacement in
intermediate surgical risk patients: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 88 (6) (pp 934-944),
2016. Date of Publication: 15 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The efficacy of transcatheter aortic valve replacement (TAVR)
in aortic stenosis patients at high surgical risk has been established.
The data on patients with intermediate risk is not conclusive. We
performed a meta-analysis of studies which compared TAVR with surgical
aortic valve replacement (SAVR) in patients at intermediate surgical risk.
Methods: Several databases searched from inception to February 2015
yielded 7 eligible studies with 2,173 participants. The measured outcome
of efficacy was all-cause mortality. Data on safety included stroke,
permanent pacemaker implantation (PPI), aortic regurgitation (AR),
vascular access complications, and major bleeding. Outcomes were pooled
and relative risk (RR) was calculated with the Mantel-Haenszel method.
Results: There was no difference in either short-term (RR, 1.02; 95% CI:
0.63-1.63; P = 0.94; I² = 0%) or medium to long-term all-cause
mortality (RR, 0.99; 95% CI: 0.81-1.21; P = 0.91; I² = 0%).
There was increased incidence of stroke (RR, 2.96; 95% CI: 0.87-10.09; P =
0.08; I² = 0%), AR (RR, 3.59; 95% CI: 2.13-7.19; P < 0.00001;
I² = 2%), PPI (RR, 6.53; 95% CI: 1.91-22.32; P < 0.003;
I² = 0%) and vascular access complications (RR, 3.84; 95% CI:
0.65-22.76; P < 0.14; I² = 48%) in patients with TAVR. There
was a small, albeit increased risk of major or life threatening bleeding
with SAVR as compared to TAVR (RR, 1.36; 95% CI: 1.04-1.80; P < 0.03;
I² = 0%). Conclusions: In this meta-analysis we found that TAVR
may be an acceptable alternative to SAVR in patients with intermediate
risk for surgery. However, we must await evidence from the current large
randomized trials before widespread adoption of this procedure is
undertaken. &#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016
Wiley Periodicals, Inc.

<19>
Accession Number
606072060
Author
Morton R.L.; Schlackow I.; Staplin N.; Gray A.; Cass A.; Haynes R.;
Emberson J.; Herrington W.; Landray M.J.; Baigent C.; Mihaylova B.
Institution
(Morton) NHMRC Clinical Trials Centre, University of Sydney, Sydney,
Australia
(Morton, Schlackow, Gray, Mihaylova) Health Economics Research Centre
(HERC), Nuffield Department of Population Health, University of Oxford,
Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, United Kingdom
(Staplin, Haynes, Emberson, Herrington, Landray, Baigent) Clinical Trial
Service Unit, Epidemiological Studies Unit, Nuffield Department of
Population Health, University of Oxford, Oxford, United Kingdom
(Cass) Menzies School of Health Research, Charles Darwin University,
Darwin, Australia
Title
Impact of Educational Attainment on Health Outcomes in Moderate to Severe
CKD.
Source
American Journal of Kidney Diseases. 67 (1) (pp 31-39), 2016. Date of
Publication: 01 Jan 2016.
Publisher
W.B. Saunders
Abstract
Background The inverse association between educational attainment and
mortality is well established, but its relevance to vascular events and
renal progression in a population with chronic kidney disease (CKD) is
less clear. This study aims to determine the association between highest
educational attainment and risk of vascular events, cause-specific
mortality, and CKD progression. Study Design Prospective epidemiologic
analysis among participants in the Study of Heart and Renal Protection
(SHARP), a randomized controlled trial. Setting & Participants 9,270
adults with moderate to severe CKD (6,245 not receiving dialysis at
baseline) and no history of myocardial infarction or coronary
revascularization recruited in Europe, North America, Asia, Australia, and
New Zealand. Predictor Highest educational attainment measured at study
entry using 6 levels that ranged from "no formal education" to "tertiary
education." Outcomes Any vascular event (any fatal or nonfatal cardiac,
cerebrovascular, or peripheral vascular event), cause-specific mortality,
and CKD progression during 4.9 years' median follow-up. Results There was
a significant trend (P < 0.001) toward increased vascular risk with
decreasing levels of education. Participants with no formal education were
at a 46% higher risk of vascular events (relative risk [RR], 1.46; 95% CI,
1.14-1.86) compared with participants with tertiary education. The trend
for mortality across education levels was also significant (P < 0.001):
all-cause mortality was twice as high among those with no formal education
compared with tertiary-educated individuals (RR, 2.05; 95% CI, 1.62-2.58),
and significant increases were seen for both vascular (RR, 1.84; 95% CI,
1.21-2.81) and nonvascular (RR, 2.15; 95% CI, 1.60-2.89) deaths. Lifestyle
factors and prior disease explain most of the excess mortality risk. Among
6,245 participants not receiving dialysis at baseline, education level was
not significantly associated with progression to end-stage renal disease
or doubling of creatinine level (P for trend = 0.4). Limitations No data
for employment or health insurance coverage. Conclusions Lower educational
attainment is associated with increased risk of adverse health outcomes in
individuals with CKD. Copyright &#xa9; 2016 The Authors. Published by
Elsevier Inc. on behalf of the National Kidney Foundation, Inc.

<20>
Accession Number
610043768
Author
Mariscalco G.; Gherli R.; Ahmed A.B.; Zanobini M.; Maselli D.; Dalen M.;
Piffaretti G.; Cappabianca G.; Beghi C.; Biancari F.
Institution
(Mariscalco) Department of Cardiovascular Sciences, Clinical Sciences
Wing, University of Leicester, Glenfield Hospital, Groby Rd, Leicester LE3
9QP, United Kingdom
(Gherli) Department of Cardiovascular Science, Cardiac Surgery Unit, S.
Camillo-Forlanini Hospital, Rome, Italy
(Ahmed) Department of Anaesthesia and Critical Care, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
(Zanobini) Department of Cardiovascular Sciences, Cardiac Surgery, Centro
Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
(Maselli) Department of Cardiovascular Surgery, Cardiac Surgery Unit, S.
Anna Hospital Catanzaro, Italy
(Dalen) Department of Cardiothoracic Surgery and Anesthesiology,
Karolinska University Hospital, Department of Molecular Medicine and
Surgery, Karolinska Institutet, Stockholm, Sweden
(Piffaretti) Department of Surgical and Morphological Sciences, Vascular
Surgery Unit, Varese University Hospital, University of Insubria, Varese,
Italy
(Cappabianca, Beghi) Department of Surgical and Morphological Sciences,
Cardiac Surgery Unit, Varese University Hospital, University of Insubria,
Varese, Italy
(Biancari) Department of Surgery, University of Oulu, Oulu, Finland
Title
Validation of the European Multicenter Study on Coronary Artery Bypass
Grafting (E-CABG) Bleeding Severity Definition.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1782-1788), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Background This study evaluated the prognostic significance of a novel
bleeding severity classification in adult patients undergoing cardiac
operations. Methods The European multicenter study on Coronary Artery
Bypass Grafting (E-CABG) bleeding severity classification proposes 4
grades of postoperative bleeding: grade 0, no need of blood products with
the exception of 1 unit of red blood cells (RBCs); grade 1, transfusion of
platelets, plasma, or 2 to 4 units of RBCs, or both; grade 2, transfusion
of 5 to 10 units of RBCs or reoperation for bleeding, or both; grade 3,
transfusion of more than 10 units of RBCs. This classification was tested
in a cohort of 7,491 patients undergoing CABG or valve operations, or
combined procedures. Results The E-CABG bleeding severity grading method
was an independent predictor of in-hospital death, stroke, acute kidney
injury, renal replacement therapy, deep sternal wound infection, atrial
fibrillation, intensive care unit stay of 5 days or more, and composite
adverse events of death, stroke, renal replacement therapy, and intensive
care unit stay of 5 days or more. The area under the receiver operating
characteristic curve of the E-CABG bleeding severity grading method for
predicting in-hospital death was 0.858 (95% confidence interval, 0.827 to
0.889). E-CABG bleeding severity grades 0 to 3 were associated with
in-hospital mortality rates of 0.2%, 1.1%, 7.9%, and 29.0%, respectively
(p <0.001), and with composite adverse events of 2.7%, 9.6%, 29.7%, and
75.8%, respectively (p <0.001). Conclusions The E-CABG bleeding severity
classification seems to be a valuable tool in the assessment of the
severity and prognostic effect of perioperative bleeding in cardiac
operations. Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<21>
Accession Number
608273894
Author
Amin S.; Pinho-Gomes A.-C.; Taggart D.P.
Institution
(Amin, Taggart) Department of Cardiovascular Surgery, University of
Oxford, John Radcliffe Hospital, Headley Way, Headington OX3 9DU, United
Kingdom
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals Trust, Oxford, United Kingdom
Title
Relationship of Intraoperative Transit Time Flowmetry Findings to
Angiographic Graft Patency at Follow-Up.
Source
Annals of Thoracic Surgery. 101 (5) (pp 1996-2006), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
Early and late graft occlusion remains a significant complication of
coronary artery bypass grafting. Transit time flowmetry is the most
commonly used imaging technique to assess graft patency intraoperatively.
Although the value of transit time flowmetry for intraoperative quality
control of coronary anastomosis is well established, its standard
variables for predicting eventual graft failure remain controversial. This
review readdresses the issue of intraoperative transit time flowmetry,
with a particular emphasis on defining cutoff values for standard
variables and correlating them with the ability to predict midterm and
long-term graft patency for arterial and venous conduits. Further research
is warranted to support clinically useful recommendations on the
intraoperative application and interpretation of transit time flowmetry.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<22>
Accession Number
609404445
Author
Wang J.; Yu W.; Gao M.; Gu C.; Yu Y.
Institution
(Wang, Yu, Gao, Gu, Yu) Department of Cardiac Surgery, Beijing An Zhen
Hospital, Capital Medical University, Beijing 100029, China
Title
Preoperative Prophylactic Intraaortic Balloon Pump Reduces the Incidence
of Postoperative Acute Kidney Injury and Short-Term Death of High-Risk
Patients Undergoing Coronary Artery Bypass Grafting: A Meta-Analysis of 17
Studies.
Source
Annals of Thoracic Surgery. 101 (5) (pp 2007-2019), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier USA
Abstract
This meta-analysis investigated the effects of preoperative prophylactic
intraaortic balloon pump placement on postoperative renal function and
short-term death of high-risk patients undergoing coronary artery bypass
grafting. We found that preoperative prophylactic intraaortic balloon pump
support reduced the incidence of coronary artery bypass
grafting-associated acute kidney injury and short-term death and
dramatically decreased the incidence of postoperative renal replacement
therapy by 82% compared with high-risk patients without the procedure.
This is the first meta-analysis to demonstrate significant beneficial
effects of preoperative prophylactic intraaortic balloon pump on renal
function in high-risk patients undergoing coronary artery bypass grafting.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<23>
Accession Number
613147849
Author
Elgendy I.Y.; Kumbhani D.J.; Mahmoud A.N.; Wen X.; Bhatt D.L.; Bavry A.A.
Institution
(Elgendy, Mahmoud, Wen, Bavry) Department of Medicine, University of
Florida, Gainesville, FL, United States
(Kumbhani) Department of Medicine, University of Texas Southwestern
Medical Center, Dallas, TX, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, MA, United States
(Bavry) North Florida/South Georgia Veterans Health System, Gainesville,
FL, United States
Title
Routine invasive versus selective invasive strategies for Non-ST-elevation
acute coronary syndromes: An Updated meta-analysis of randomized trials.
Source
Catheterization and Cardiovascular Interventions. 88 (5) (pp 765-774),
2016. Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To perform an updated systematic review comparing a routine
invasive strategy with a selective invasive strategy for patients with
non-ST-elevation acute coronary syndromes (NSTE-ACS) in the era of stents
and antiplatelet therapy. Background: Recent meta-analyses comparing both
strategies have shown conflicting results. Methods: Electronic databases
were searched for randomized trials that compared a routine invasive
strategy (i.e., routine coronary angiography +/- revascularization) versus
a selective invasive strategy (i.e., medical stabilization and coronary
angiography +/- revascularization if objective evidence of ischemia or
refractory ischemia) in patients with NSTE-ACS. Summary odds ratios (OR)
were primarily constructed using Peto's model. Results: Twelve trials with
9,650 patients were included. Compared with a selective invasive strategy,
a routine invasive strategy was associated with a reduction in the
composite of all-cause mortality or myocardial infarction (MI) [OR: 0.86,
95% confidence interval (CI) 0.77-0.96] at a mean follow-up of 39 months,
primarily due to a reduction in the risk of MI (OR: 0.78, 95% CI:
0.68-0.88). The risk of all-cause mortality was non-significantly reduced
with a routine invasive strategy (OR: 0.88, 95% CI: 0.77-1.01). The risk
of recurrent angina was reduced with a routine invasive strategy (OR:
0.55, 95% CI: 0.49-0.62), as well as the risk of future revascularization
procedures (OR: 0.35, 95% CI: 0.30-0.39). Conclusion: In patients with
NSTE-ACS, a routine invasive strategy reduced the risk of ischemic events,
including the risk of mortality or MI. Routine invasive therapy reduced
the risk of recurrent angina and future revascularization procedures.
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<24>
Accession Number
607178564
Author
Elgendy I.Y.; Wen X.; Mahmoud A.; Bavry A.A.
Institution
(Elgendy, Wen, Mahmoud, Bavry) Department of Medicine, University of
Florida, Gainesville, FL, United States
(Bavry) North Florida/South Georgia Veterans Health Systems, Gainesville,
FL, United States
Title
Complete Versus Culprit-Only Revascularization for Patients With
Multi-Vessel Disease Undergoing Primary Percutaneous Coronary
Intervention: An Updated Meta-Analysis of Randomized Trials.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 501-505),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To perform an updated meta-analysis to determine whether
complete revascularization of significant coronary lesions at the time of
primary percutaneous coronary intervention (PCI) would be associated with
better outcomes compared with culprit-only revascularization. Background:
Individual trials have demonstrated conflicting evidence regarding the
optimum revascularization strategy at the time of primary PCI. Methods:
Clinical trials that randomized ST elevation myocardial infarction (STEMI)
patients with multi-vessel disease to a complete versus culprit-only
revascularization strategy were included. Random effects summary risk
ratios (RR) were constructed using a DerSimonian-Laird model. The primary
outcome of interest was mortality or myocardial infarction (MI). Results:
A total of seven trials with 1,939 patients were included in the analysis.
Compared with culprit-only revascularization, complete revascularization
was associated with a non-significant reduction in the risk of mortality
or MI (RR 0.69, 95% confidence interval (CI) 0.42-1.12, P = 0.14).
Complete revascularization was associated with a reduced risk of major
adverse cardiac events (MACE) (RR 0.61, 95% CI 0.45-0.81, P < 0.001), due
to a significant reduction in urgent revascularization (RR 0.46, 95% CI
0.29-0.70, P < 0.001). The risk of major bleeding and contrast-induced
nephropathy was similar with both approaches (RR 0.83, 95% CI 0.41-1.71, P
= 0.62, and RR 0.94, 95% CI 0.42-2.12, P = 0.82). Conclusions: Complete
revascularization of all significant coronary lesions at the time of
primary PCI was associated with a reduction in the risk of MACE due to
reduction in the risk of urgent revascularization. This approach appears
to be safe, with no excess major bleeding, or contrast-induced
nephropathy. &#xa9; 2015 Wiley Periodicals, Inc. Copyright &#xa9; 2015
Wiley Periodicals, Inc.

<25>
Accession Number
611872944
Author
Badings E.A.; Remkes W.S.; The S.H.K.; Dambrink J.-H.E.; Tjeerdsma G.;
Rasoul S.; Timmer J.R.; van der Wielen M.L.J.; Lok D.J.A.; Hermanides R.;
van Wijngaarden J.; Suryapranata H.; van 't Hof A.W.J.
Institution
(Badings, Lok, van Wijngaarden) Deventer Ziekenhuis, Deventer, Netherlands
(Remkes, Dambrink, Timmer, Hermanides, Suryapranata, van 't Hof) Isala
Klinieken, Zwolle, Netherlands
(The, van der Wielen) Treant Zorggroep, Locatie Ziekenhuis Bethesda,
Hoogeveen, Netherlands
(Tjeerdsma) Ziekenhuis De Tjongerschans, Heerenveen, Netherlands
(Rasoul) Atrium Medisch Centrum, Heerlen, Netherlands
(Rasoul) Maastricht UMC, Netherlands
(Suryapranata) Radboudumc, Nijmegen, Netherlands
Title
Early or late intervention in patients with transient ST-segment elevation
acute coronary syndrome: Subgroup analysis of the ELISA-3 trial.
Source
Catheterization and Cardiovascular Interventions. 88 (5) (pp 755-764),
2016. Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To investigate incidence and patient characteristics of
transient ST-segment elevation (TSTE) ACS and to compare outcome of early
versus late invasive treatment. Background: Optimal timing of treatment in
TSTE-ACS patients is not outlined in current guidelines and no prospective
randomized trials have been done so far. Methods: Post hoc subgroup
analysis of patients with TSTE randomized in the ELISA 3 trial. This study
compared early (<12 h) versus late (>48 h) angiography and
revascularization in 542 patients with high-risk NSTE-ACS. Primary
endpoint was incidence of death, reinfarction, or recurrent ischemia at 30
days follow-up. Results: TSTE was present in 129 patients (24.2%) and
associated with male gender, smoking and younger age. The primary endpoint
occurred in 8.9% of patients with and 13.0% of patients without TSTE (RR =
0.681, P = 0.214). Incidence of death or MI after 2 year follow-up was 5.7
and 14.6% respectively (RR = 0.384, P = 0.008). Within the group of
patients with TSTE, incidence of the primary endpoint was 5.8% in the
early and 12.7% in the late treatment group (RR = 0.455, P = 0.213),
driven by reduction in recurrent ischemia. Enzymatic infarct size,
bleeding and incidence of death or recurrent MI at 2 years follow-up was
comparable between the treatment groups. Conclusions: In high-risk
patients with NSTE-ACS, TSTE is frequently seen. Similar to findings in
patients with high-risk NSTE-ACS, immediate angiography and
revascularization in these patients is feasible but not superior to later
treatment. Prospective randomized trials are needed to provide more
evidence in the optimal timing of treatment in patients with TSTE-ACS.
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<26>
Accession Number
605988672
Author
Yetgin T.; van Kranenburg M.; ten Cate T.; Duncker D.J.; de Boer M.-J.;
Diletti R.; van Geuns R.-J.M.; Zijlstra F.; Manintveld O.C.
Institution
(Yetgin, van Kranenburg, Duncker, Diletti, van Geuns, Zijlstra,
Manintveld) Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam,
Netherlands
(Yetgin, Duncker, Zijlstra) Interuniversity Cardiology Institute of the
Netherlands, ICIN-KNAW, Utrecht, Netherlands
(ten Cate, de Boer) Department of Cardiology, UMC St. Radboud, Nijmegen,
Netherlands
(van Geuns) Department of Radiology, Erasmus MC, Rotterdam, Netherlands
Title
Ischemic Postconditioning After Routine Thrombus Aspiration During Primary
Percutaneous Coronary Intervention: Rationale and Design of the
POstconditioning Rotterdam Trial.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 508-514),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Whether ischemic postconditioning (IPOC) immediately after
routine thrombus aspiration (TA) reduces infarct size (IS) in patients
with ST-segment elevation myocardial infarction (STEMI) undergoing primary
percutaneous coronary intervention (PPCI) has not been established. Study
design: The POstconditioning Rotterdam Trial (PORT) is a dual-center,
prospective, open-label, randomized trial with blinded endpoint evaluation
enrolling 72 subjects with first-time STEMI, and an occluded
infarct-related artery (IRA) without collaterals undergoing PPCI. Subjects
are randomized 1:1 to a strategy of IPOC immediately after TA followed by
stenting of the IRA or to conventional percutaneous coronary intervention
(PCI), including TA followed by stenting of the IRA (controls). Cardiac
magnetic resonance imaging (MRI) is performed at 3-5 days after STEMI and
at 3 months. The primary endpoint is IS at 3 months measured by delayed
enhancement MRI. Other secondary endpoints include MRI-derived
microvascular obstruction (MVO), left ventricular ejection fraction,
myocardial salvage index, enzymatic IS, ST-segment resolution, myocardial
blush grade, microcirculatory resistance, inflammation markers, and
clinical events through 3-month follow-up. Conclusions: PORT is testing
the hypothesis that adding IPOC (against lethal reperfusion injury) to TA
(against distal embolization and MVO) is cardioprotective and reduces
ultimate IS in STEMI patients undergoing PPCI (Dutch Trial Register
identifier: NTR4040). &#xa9; 2015 Wiley Periodicals, Inc. Copyright &#xa9;
2015 Wiley Periodicals, Inc.

<27>
Accession Number
607624527
Author
Tebaldi M.; Biscaglia S.; Fineschi M.; Manari A.; Menozzi M.; Secco G.G.;
Di Lorenzo E.; D'Ascenzo F.; Fabbian F.; Tumscitz C.; Ferrari R.; Campo G.
Institution
(Tebaldi, Biscaglia, Tumscitz, Ferrari, Campo) Cardiovascular Institute,
Azienda Ospedaliero-Universitaria Di Ferrara, Cona, Ferrara, Italy
(Fineschi) Department of Cardiology, University Medical Hospital of Siena,
Siena, Italy
(Manari) Department of Cardiology, Santa Maria Nuova Hospital,
Reggio-Emilia, Italy
(Menozzi) Department of Cardiology, Ospedale Degli Infermi, Rimini, Italy
(Secco) Division of Cardiology, "Santi Antonio E Biagio E Cesare Arrigo"
Hospital, Alessandria, Italy
(Di Lorenzo) Department of Heart and Vessels, S.G. Moscati Hospital,
Avellino, Italy
(D'Ascenzo) Division of Cardiology Citta Della Salute E Della Scienza,
Hospital University of Turin, Turin, Italy
(Fabbian) Clinica Medica, Departement of Medical Science, University of
Ferrara, Cona, Ferrara, Italy
(Ferrari) Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science
Foundation, Cotignola, Italy
(Campo) Laboratorio per Le Tecnologie Delle Terapie Avanzate (LTTA)
Center, Ferrara, Italy
Title
Fractional Flow Reserve Evaluation and Chronic Kidney Disease: Analysis
From a Multicenter Italian Registry (the FREAK Study).
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 555-562),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To establish if the presence of chronic kidney disease (CKD)
influences fractional flow reserve (FFR) value in patients with
intermediate coronary stenosis. Background: FFR-guided coronary
revascularization reduces cardiac adverse events in patients with coronary
artery disease. CKD impairs microcirculation and increases cardiovascular
risk. Whether CKD presence may limit FFR accuracy is unknown. Methods: We
used data from a multicenter prospective registry enrolling 1.004 patients
undergoing FFR evaluation for intermediate stenosis. We assessed the
relationship between clinical and angiographic variables and FFR
measurement. CKD was defined as CrCl value <45 ml/min. FFR value was
considered potentially flow-limiting, and therefore positive, if <0.80.
The index of microcirculatory resistance (IMR) was calculated in 20
patients stratified according CrCl value (single-center substudy).
Results: FFR measurement was positive in 395 (39%) patients. Overall, 131
(13%) patients had CKD. Patients with CrCl <45 ml/min showed significantly
higher FFR values as compared to the others (0.84 +/- 0.07 vs. 0.81 +/-
0.08, p < 0.001). Positive FFR occurrence was lower in patients with CrCl
<45 ml/min (27% vs. 41%, p < 0.01). After multivariable analysis, diabetes
(HR 1.07, 95%CI 1.008-1.13, p = 0.03), left anterior descending (HR 1.35,
95%CI 1.27-1.43, p < 0.001) and CrCl <45 ml/min (HR 0.92, 95%CI 0.87-0.97,
p = 0.005) emerged as independent predictors of FFR measurement.
Accordingly, IMR values were higher in patients with CrCl <45 ml/min (32 U
[28245] vs. 16 U [11220], p < 0.01). Conclusions: FFR and IMR measurements
differ between CKD patients and those with normal renal function.
Flow-limiting FFR is less frequent in patients with CrCl <45 ml/min.
&#xa9; 2015 Wiley Periodicals, Inc. Copyright &#xa9; 2015 Wiley
Periodicals, Inc.

<28>
Accession Number
609979964
Author
Ji T.; Feng C.; Sun L.; Ye X.; Bai Y.; Chen Q.; Qin Y.; Zhu J.; Zhao X.
Institution
(Ji) Department of Geriatrics, Shanghai First People's Hospital Affiliated
with Shanghai Jiaotong University, Shanghai, China
(Feng, Bai, Chen, Qin, Zhu, Zhao) Department of Cardiology, Changhai
Hospital, Second Military Medical University, Shanghai, China
(Sun) Department of Nephrology, Shanghai Changzheng Hospital, Second
Military Medical University, Shanghai, China
(Ye) Department of Health Statistics, Second Military Medical University,
Shanghai, China
Title
Are beta-blockers effective for preventing post-coronary artery bypass
grafting atrial fibrillation? Direct and network meta-analyses.
Source
Irish Journal of Medical Science. 185 (2) (pp 503-511), 2016. Date of
Publication: 01 May 2016.
Publisher
Springer-Verlag London Ltd
Abstract
Background: Atrial fibrillation is the most common arrhythmia in clinical
practice and is a major contributor to mortality. Recently, several
studies have reported different results for treatments aimed at reducing
the risk of postoperative AF. Aims: The aim of this study was to evaluate
the efficacy of beta-blockers (BBs) in preventing post-coronary artery
bypass grafting (CABG) AF and to compare the efficacies of different BB
treatments using a network meta-analytical approach. Methods: The PubMed,
EMBASE and Cochrane Library databases were searched (Jan 1995 to May 2014)
to identify randomized controlled trials. Two independent investigators
separately extracted the data using a seven-point scoring system to assess
randomization, allocation concealment, blinding, withdrawals and dropouts.
A direct meta-analysis of these randomized controlled trials was
conducted. Then, six trials comparing different BB treatments for the
prevention of postoperative AF were added to perform a Bayesian network
meta-analysis with mixed treatment comparisons. Results: Treatment with
BBs was associated with a significant reduction in the postoperative
incidence of AF compared with placebo/control [22.37 % compared with 34.45
%, relative risk (RR) = 0.53, 95 % confidence interval (CI): 0.37-0.75, p
< 0.00001]. Conclusions: The network meta-analysis revealed no significant
differences among eight types of BB treatments but did provide a ranking.
BB treatments could significantly reduce the occurrence of post-CABG AF.
Insufficient evidence was available to show that one BB treatment was more
effective than the others were. According to our network meta-analysis,
bisoprolol and landiolol+bisoprolol are better alternatives compared with
the other treatments. Copyright &#xa9; 2016, Royal Academy of Medicine in
Ireland.

<29>
Accession Number
613238456
Author
Mugnai G.; Benfari G.; Fede A.; Rossi A.; Chierchia G.-B.; Vassanelli F.;
Menegatti G.; Ribichini F.L.
Institution
(Mugnai, Benfari, Fede, Rossi, Vassanelli, Menegatti, Ribichini)
Department of Cardiology, University Hospital of Verona, Italy
(Chierchia) Heart Rhythm Management Centre, UZ Brussel-VUB, Belgium
Title
Tpeak-to-Tend/QT is an independent predictor of early ventricular
arrhythmias and arrhythmic death in anterior ST elevation myocardial
infarction patients.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (6) (pp 473-480),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The aim of our study was to analyse the markers of transmural
dispersion of ventricular repolarization, especially Tpeak-to-Tend and
Tpeak-to-Tend /QT ratio, in patients with anterior ST elevation myocardial
infarction on admission and to evaluate their association with in-hospital
life-threatening arrhythmias and mortality. Methods and results: A total
of 223 consecutive patients with anterior wall ST elevation myocardial
infarction admitted to our Division of Cardiology between January 2010 and
December 2012 were prospectively evaluated. A standard electrocardiogram
was obtained on admission and then analysed. The primary end point was
constituted by in-hospital ventricular arrhythmias and arrhythmic death.
At univariate analysis heart rate (odds ratio = 1.03; 95% confidence
intervals 1.006-1.05; p=0.001), maximal ST elevation (odds ratio =1.25;
95% confidence intervals 1.10-1.43; p=0.0001), QTc Bazett (odds ratio =
1.01; 95% confidence intervals 1.006-1.02; p=0.002), QT dispersion (odds
ratio = 1.02; 95% confidence intervals 1.002-1.04; p=0.02) and both
Tpeak-to-Tend and Tpeak-to-Tend/QT (odds ratio = 1.02; 95% confidence
intervals 1.01-1.03; p<0.0001 and OR = 1.07; 95% confidence intervals
1.03-1.11; p<0.0001 respectively) were significantly associated with
ventricular arrhythmias and arrhythmic mortality. Of note, Tpeak-to-Tend
/QT remained a predictor of early ventricular arrhythmias and arrhythmic
death (odds ratio = 1.04; 95% confidence intervals 1.003 - 1.10; p=0.03)
independently from heart rate and maximal ST elevation. Receiver operating
characteristic curve analysis showed that Tpeak-to-Tend /QT values <0.31
had a predictive negative value of 92% for the prediction of the composite
outcome. Conclusions: Tpeak-to-Tend /QT was an independent predictor of
early ventricular arrhythmias and arrhythmic mortality in patients with
anterior ST elevation myocardial infarction. Especially, Tpeak-to-Tend /QT
<0.31 may identify a subgroup of ST elevation myocardial infarction
patients with low risk of early arrhythmias and arrhythmic death.
Copyright &#xa9; The European Society of Cardiology 2015.

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

<31>
Accession Number
607452999
Author
Khot U.N.; Johnson-Wood M.L.; VanLeeuwen R.; Ramsey C.; Khot M.B.
Institution
(Khot, Khot) Cleveland Clinic Department of Cardiovascular Medicine,
Cleveland, OH, United States
(Johnson-Wood) Society of Cardiovascular Patient Care, Columbus, OH,
United States
(VanLeeuwen) Franciscan St. Francis Health Indianapolis, Indianapolis, IN,
United States
(Ramsey) Curtis Ramsey & Associates, Indianapolis, IN, United States
Title
A hospital-wide system to ensure rapid treatment time across the entire
spectrum of emergency percutaneous intervention.
Source
Catheterization and Cardiovascular Interventions. 88 (5) (pp 678-689),
2016. Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study's aim was to describe a hospital-wide system to
deliver rapid door-to-balloon time across the entire spectrum of emergency
percutaneous intervention. Background: Many patients needing emergency PCI
are excluded from door-to-balloon public reporting metric; these groups do
not achieve door-to-balloon times <90 min and have increased mortality
rates. Methods: We prospectively implemented a protocol for patients with
STEMI or other emergency indication for catheterization mandating (1)
emergency department physician or cardiologist activation of the
catheterization lab and (2) immediate patient transfer to an immediately
available catheterization lab by an in-house nursing transfer team.
Results: From September 1, 2005 to December 31, 2008, 526 consecutive
patients underwent emergency PCI. Median door-to-balloon time was 68 min
with 85.7% <90 min overall. Important subgroups included primary emergency
department (62.5 min), cardiorespiratory arrest (71 min), cardiogenic
shock (68 min), need for temporary pacemaker or balloon pump (67 min),
initial ECG without ST-elevation (66.5 min), transfer from another ED (84
min), in-hospital (70 min), and activation indications other than STEMI
(68 min). Patients presenting to primary ED and in transfer were compared
to historical controls. Treatment <90 min increased (28%-85%, P < 0.0001).
Mean infarct size decreased, as did hospital length-of-stay and admission
total hospital costs. Acute myocardial infarction all-cause 30-day
unadjusted mortality and risk-standardized mortality ratios were
substantially lower than national averages. Conclusion: A hospital-wide
systems approach applied across the entire spectrum of emergency PCI leads
to rapid door-to-balloon time, reduced infarct size and hospitals costs,
and low myocardial infarction 30-day all-cause mortality. &#xa9; 2015
Wiley Periodicals, Inc. Copyright &#xa9; 2015 The Authors. Catheterization
and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

<32>
Accession Number
611341677
Author
Shi W.Y.; Tatoulis J.; Newcomb A.E.; Rosalion A.; Fuller J.A.; Buxton B.F.
Institution
(Shi, Newcomb, Rosalion) Department of Cardiothoracic Surgery, St
Vincent's Hospital, Melbourne, VIC, Australia
(Tatoulis) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Tatoulis, Newcomb, Rosalion, Buxton) Department of Surgery, University of
Melbourne, Melbourne, VIC, Australia
(Fuller, Buxton) Victorian Heart Centre, Epworth Hospital, Melbourne, VIC,
Australia
(Buxton) Department of Cardiac Surgery, Austin Hospital, Melbourne, VIC,
Australia
Title
Is a third arterial conduit necessary? Comparison of the radial artery and
saphenous vein in patients receiving bilateral internal thoracic arteries
for triple vessel coronary disease.
Source
European Journal of Cardio-thoracic Surgery. 50 (1) (pp 53-60), 2016.
Article Number: ezv467. Date of Publication: 01 Jul 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The use of bilateral internal thoracic arteries (BITAs) is
associated with improved long-term survival after coronary artery bypass
grafting (CABG). However, it is unclear whether the addition of a radial
artery (RA) in patients already receiving BITA confers any additional
survival benefit over that of a saphenous vein (SV). As such, we reviewed
our multicentre experience and compared both strategies. METHODS: From
1995 to 2010, 1497 patients underwent primary isolated CABG for
three-vessel coronary disease using BITAs. An SV was used as a third
conduit in 460 (31%) patients and an RA in 1037 (69%). A total of 1258
distal anastomoses were performed using RAs and these were to the diagonal
territory in 169, the circumflex in 454 and the right coronary in 635.
Survival data were obtained using the National Death Index and
propensity-score matching was used for risk-adjustment. RESULTS: The
overall cohort was young (mean age 61 +/- 9 years). Patients receiving RAs
were more likely to be younger, and were less likely to have experienced a
prior myocardial infarction. At 30 days, mortality was similar (BITA + SV:
5, 1.1% vs BITA + RA: 9, 0.9%, P = 0.77). At 15 years, BITA + RA patients
experienced improved unadjusted survival (BITA + SV: 67 +/- 4.6% vs BITA +
RA: 82 +/- 3.2%, P < 0.0001). Multivariable Cox regression in the entire
cohort also showed the BITA + RA group to be associated with better
survival (HR 0.58, 95% CI 0.44-0.75, P < 0.001). After propensity-score
matching of 262 patient-pairs, BITA + RA experienced similar 30-day
mortality (BITA + SV: 3, 1.1% vs BITA + RA: 3, 1.1%, P > 0.99). However,
at 15 years, BITA + RA patients experienced improved risk-adjusted
survival (BITA + SV: 72 +/- 6.0% vs BITA + RA: 82 +/- 5.2%, P = 0.021).
The RA was associated with better risk-adjusted survival for grafting of
the right coronary and its branches (148 matched pairs; SV-RCA: 74 +/-
7.8% vs RA-RCA: 86 +/- 6.5%, P = 0.0046 at 15 years). CONCLUSIONS: The
addition of an RA graft even in patients already receiving BITAs is
associated with a survival benefit. In younger patients with a reasonable
long-term life expectancy, surgeons should strive to achieve total
arterial revascularization with BITAs and radial arteries. Copyright
&#xa9; The Author 2016. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<33>
Accession Number
611341673
Author
Romanov A.; Goscinska-Bis K.; Bis J.; Chernyavskiy A.; Prokhorova D.;
Syrtseva Y.; Shabanov V.; Alsov S.; Karaskov A.; Deja M.; Krejca M.;
Pokushalov E.
Institution
(Romanov, Chernyavskiy, Prokhorova, Syrtseva, Shabanov, Alsov, Karaskov,
Pokushalov) State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
(Goscinska-Bis, Bis, Deja, Krejca) Medical University of Silesia,
Katowice, Poland
Title
Cardiac resynchronization therapy combined with coronary artery bypass
grafting in ischaemic heart failure patients: Long-term results of the
RESCUE study.
Source
European Journal of Cardio-thoracic Surgery. 50 (1) (pp 36-41), 2016.
Article Number: ezv448. Date of Publication: 01 Jul 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Totally epicardial cardiac resynchronization therapy (CRT) is
a novel treatment modality for patients with heart failure (HF) and
systolic dyssynchrony undergoing coronary artery bypass grafting (CABG).
In this study, we have prospectively evaluated the long-term outcomes of
totally epicardial CRT. METHODS: Between September 2007 and June 2009, one
hundred and seventy-eight patients were randomly assigned to the CABG
alone group (n = 87) and CABG with concomitant epicardial CRT implantation
(n = 91). The primary end-point of the study was all-cause mortality in
the two groups between the day of surgery and 13 August 2013 (common
closing date). The secondary outcomes included mode of death, adverse
cardiac events and lead performance. RESULTS: The mean follow-up was 55
+/- 10.7 months. According to per-protocol analysis with treatment as a
time-dependent variable to account for conversion from CABG to CABG + CRT,
there were 24 deaths (35.8%) in the CABG group and 17 deaths (15.3%) in
the CABG + CRT group. When compared with CABG alone, concomitant CRT was
associated with reduced risk of both all-cause mortality [hazard ratio
(HR) 0.43, 95% confidence interval (CI) 0.23-0.84, P = 0.012] and cardiac
death (HR 0.39, 95% CI 0.21-0.72, P = 0.002). Eleven (12.6%) sudden deaths
were observed in the CABG group in comparison with 4 (4.4%) in the CABG +
CRT group (P = 0.048). Hospital readmission was required for 9 (9.9%)
patients in CABG + CRT group and for 25 (28.7%) patients in the CABG group
(P = 0.001). There were 4 (1.5%) epicardial lead failures. CONCLUSIONS:
The results of our study suggest that the procedure of CABG and totally
epicardial CRT system implantation is safe and significantly improves the
survival of patients with HF and dyssynchrony during long-term follow-up.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<34>
Accession Number
611341670
Author
Salmasi M.Y.; Acharya M.; Humayun N.; Baskaran D.; Hubbard S.; Vohra H.
Institution
(Salmasi, Humayun) Department of Cardiothoracic Surgery, University
Hospitals of Leicester, Leicester, United Kingdom
(Acharya) Department of Cardiac Surgery, Harefield Hospital, London,
United Kingdom
(Baskaran) Department of Surgery, Bradford Hospitals Trust, Bradford,
United Kingdom
(Hubbard) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
(Vohra) Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United
Kingdom
Title
Is valve repair preferable to valve replacement in ischaemic mitral
regurgitation? A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (1) (pp 17-28), 2016.
Article Number: ezw053. Date of Publication: 01 Jul 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Ischaemic mitral regurgitation (MR) is associated with poor survival. The
favoured surgical option remains debatable. Our aim was to perform a
meta-analysis to compare the outcomes of mitral valve repair (MVRp) with
replacement (MVR). A literature search was conducted in PubMed, Medline
and Ovid using the terms 'ischaemic mitral regurgitation', 'repair' and
'replacement'. The primary outcome measure was 30-day survival. The
secondary outcome measures were MR recurrence and reoperation. Out of 310
articles, 18 fulfilled the inclusion criteria. A total of 3978 patients
were included: 2563 (64%) MVRp cases and 1415 (36%) MVR cases. Operative
techniques included annuloplasty for MVRp and subvalvular
apparatus-sparing MVR techniques. Thirty-day mortality was lower after
MVRp compared with MVR [OR 0.42; (95% CI 0.33-0.54; P = 0.0001)]. There
was no difference in long-term survival ranging 1-5 years (HR 0.85, 95% CI
0.65-1.12). Recurrence of MR was significantly higher in the MVRp group
(OR 4.26, 95% CI 2.52-7.22), as was the rate of reoperation (OR 2.03, 95%
CI 1.49-2.77). Although MVR for ischaemic MR has a higher 30-day mortality
rate compared with MVRp, MVRp is associated with the higher rate of MR
recurrence and the need for reoperation. MVR remains an attractive option
for ischaemic MR. Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<35>
Accession Number
606669786
Author
Hamarneh A.; Sivaraman V.; Bulluck H.; Shanahan H.; Kyle B.; Ramlall M.;
Chung R.; Jarvis C.; Xenou M.; Ariti C.; Cordery R.; Yellon D.M.;
Hausenloy D.J.
Institution
(Hamarneh, Sivaraman, Bulluck, Ramlall, Chung, Cordery, Yellon, Hausenloy)
Hatter Cardiovascular Institute, University College London, 67 Chenies
Mews, London, United Kingdom
(Shanahan, Kyle, Jarvis, Xenou) Heart Hospital, London, United Kingdom
(Ariti) Nuffield Trust, London, United Kingdom
(Yellon, Hausenloy) National Institute of Health Research, University
College London, Hospitals Biomedical Research Centre, London, United
Kingdom
(Hausenloy) National Heart Research Institute Singapore, National Heart
Centre Singapore, Singapore, Singapore
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore, Singapore
Title
The effect of remote ischemic conditioning and glyceryl trinitrate on
perioperative myocardial injury in cardiac bypass surgery patients:
Rationale and design of the ERIC-GTN study.
Source
Clinical Cardiology. 38 (11) (pp 641-646), 2015. Date of Publication: 01
Nov 2015.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Remote ischemic conditioning (RIC) using transient limb
ischemia/reperfusion has been reported to reduce perioperative myocardial
injury in patients undergoing coronary artery bypass grafting and/or valve
surgery. The role of intravenous glyceryl trinitrate (GTN) therapy
administered during cardiac surgery as a cardioprotective agent and
whether it interferes with RIC cardioprotection is not clear and is
investigated in the ERIC-GTN trial (http://www.clinicaltrials.gov:
NCT01864252). The ERIC-GTN trial is a single-site, double-blind,
randomized, placebo-controlled study. Consenting adult patients (age > 18
years) undergoing elective coronary artery bypass grafting +/- valve
surgery with blood cardioplegia will be eligible for inclusion. Two
hundred sixty patients will be randomized to 1 of 4 treatment groups
following anesthetic induction: (1) RIC alone, a RIC protocol comprising
three 5-minute cycles of simultaneous upper-arm and thigh cuff
inflation/deflation followed by an intravenous (IV) placebo infusion; (2)
GTN alone, a simulated sham RIC protocol followed by an IV GTN infusion;
(3) RIC + GTN, a RIC protocol followed by an IV GTN infusion; and (4)
neither RIC nor GTN, a sham RIC protocol followed by IV placebo infusion.
The primary endpoint will be perioperative myocardial injury as quantified
by the 72-hour area-under-the-curve serum high-sensitivity troponin T. The
ERIC-GTN trial will determine whether intraoperative GTN therapy is
cardioprotective during cardiac surgery and whether it affects RIC
cardioprotection. Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<36>
[Use Link to view the full text]
Accession Number
605251856
Author
Iqbal J.; Serruys P.W.; Silber S.; Kelbaek H.; Richardt G.; Morel M.-A.;
Negoita M.; Buszman P.E.; Windecker S.
Institution
(Iqbal, Serruys) Department of Interventional Cardiology, Erasmus Medical
Centre, PO Box 2125, Rotterdam 3000, Netherlands
(Iqbal) Department of Cardiovascular Science, University of Sheffield,
United Kingdom
(Serruys) International Centre for Circulatory Health, Imperial College
London, London, United Kingdom
(Silber) Department of Cardiology, Heart Centre at the Isar, Munich,
Germany
(Kelbaek) Righshospitalet, Heart Center, Copenhagen, Denmark
(Richardt) Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany
(Morel) Cardialysis BV, Rotterdam, Netherlands
(Negoita) Department of Medtronic, Santa Rosa, CA, United States
(Buszman) Department of Cardiology, Medical University of Silesia,
Katowice, Poland
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
Title
Comparison of zotarolimus-and everolimus-eluting coronary stents: Final
5-year report of the RESOLUTE all-comers trial.
Source
Circulation: Cardiovascular Interventions. 8 (6) (no pagination), 2015.
Article Number: e002230. Date of Publication: 20 Jun 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
Newer-generation drug-eluting stents that release zotarolimus or
everolimus have been shown to be superior to the first-generation
drug-eluting stents. However, data comparing long-term safety and efficacy
of zotarolimus-(ZES) and everolimus-eluting stents (EES) are limited.
RESOLUTE all-comers (Randomized Comparison of a Zotarolimus-Eluting Stent
With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention)
trial compared these 2 stents and has shown that ZES was noninferior to
EES at 12-month for the primary end point of target lesion failure. We
report the secondary clinical outcomes at the final 5-year follow-up of
this trial. Methods and Results-RESOLUTE all-comer clinical study is a
prospective, multicentre, randomized, 2-arm, open-label, noninferiority
trial with minimal exclusion criteria. Patients (n=2292) were randomly
assigned to treatment with either ZES (n=1140) or EES (n=1152).
Patient-oriented composite end point (combination of all-cause mortality,
myocardial infarction, and any revascularizations), device-oriented
composite end point (combination of cardiac death, target vessel
myocardial infarction, and clinically indicated target lesion
revascularization), and major adverse cardiac events (combination of
all-cause death, all myocardial infarction, emergent coronary bypass
surgery, or clinically indicated target lesion revascularization) were
analyzed at 5-year follow-up. The 2 groups were well-matched at baseline.
Fiveyear follow-up data were available for 98% patients. There were no
differences in patient-oriented composite end point (ZES 35.3% versus EES
32.0%, P=0.11), device-oriented composite end point (ZES 17.0% versus EES
16.2%, P=0.61), major adverse cardiac events (ZES 21.9% versus EES 21.6%,
P=0.88), and definite/probable stent thrombosis (ZES 2.8% versus EES 1.8%,
P=0.12). Conclusions-At 5-year follow-up, ZES and EES had similar efficacy
and safety in a population of patients who had minimal exclusion criteria.
Copyright &#xa9; 2015 The Authors.

<37>
Accession Number
605234299
Author
Ahmad Y.; Nijjer S.; Cook C.M.; El-Harasis M.; Graby J.; Petraco R.;
Kotecha T.; Baker C.S.; Malik I.S.; Bellamy M.F.; Sethi A.; Mikhail G.W.;
Al-Bustami M.; Khan M.; Kaprielian R.; Foale R.A.; Mayet J.; Davies J.E.;
Francis D.P.; Sen S.
Institution
(Ahmad, Nijjer, Cook, El-Harasis, Graby, Petraco, Kotecha, Baker, Malik,
Bellamy, Sethi, Mikhail, Al-Bustami, Khan, Kaprielian, Foale, Mayet,
Davies, Francis, Sen) International Centre for Circulatory Health,
National Heart and Lung Institute, Imperial College London, 59-61 North
Wharf Road, London W2 1LA, United Kingdom
Title
A new method of applying randomised control study data to the individual
patient: A novel quantitative patient-centred approach to interpreting
composite end points.
Source
International Journal of Cardiology. 195 (pp 216-224), 2015. Date of
Publication: 22 Jul 2015.
Publisher
Elsevier Ireland Ltd
Abstract
Background Modern randomised controlled trials typically use composite
endpoints. This is only valid if each endpoint is equally important to
patients but few trials document patient preference and seek the relative
importance of components of combined endpoints. If patients weigh
endpoints differentially, our interpretation of trial data needs to be
refined. Methods and results We derive a quantitative, structured tool to
determine the relative importance of each endpoint to patients. We then
apply this tool to data comparing angioplasty with drug-eluting stents to
bypass surgery. The survey was administered to patients undergoing cardiac
catheterisation. A meta-analysis comparing coronary artery bypass grafting
(CABG) to percutaneous coronary interventuin (PCI) was then performed
using (a) standard MACE and (b) patient-centred MACE. Patients considered
stroke worse than death (stroke 102.3 +/- 19.6%, p < 0.01), and MI and
repeat revascularisation less severe than death (61.9 +/- 26.8% and 41.9
+/- 25.4% respectively p < 0.01 for both). 7 RCTs (5251 patients) were
eligible. Meta-analysis demonstrated that standard MACE occurs more
frequently with PCI than surgery (OR 1.44; 95% CI 1.10 to 1.87; p =
0.007). Re-analysis using patient-centred MACE found no significant
difference between PCI and CABG (OR 1.22, 95% CI 0.97 to 1.53; p = 0.10).
Conclusions Patients do not consider the constituent endpoints of MACE
equal. We derive a novel patient-centred metric that recognises and
quantifies the differences attributed to each endpoint. When patient
preference data are applied to contemporary trial results, there is no
significant difference between PCI and CABG. Responses from individual
patients in clinic could be used to give individual patients a
recommendation that is truly personalised. Copyright &#xa9; 2015 Elsevier
Ireland Ltd. All rights reserved.

<38>
Accession Number
614926838
Author
Sanders J.; Cooper J.; Mythen M.G.; Montgomery H.E.
Institution
(Sanders) St Bartholomew's Hospital, Barts Health NHS Trust, London,
United Kingdom
(Sanders, Mythen, Montgomery) Institute for Sport, Exercise and Health,
University College London, 1st Floor 170 Tottenham Court Rd, London W1T
7HA, United Kingdom
(Cooper) Centre for Cardiovascular Genetics, University College London,
London, United Kingdom
(Mythen) Department of Anaesthesia, University College London Hospitals
NHS Trust, London, United Kingdom
Title
Predictors of total morbidity burden on days 3, 5 and 8 after cardiac
surgery.
Source
Perioperative Medicine. 6 (1) (no pagination), 2017. Article Number: 2.
Date of Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Post-operative morbidity affects up to 36% of cardiac surgical
patients. However, few countries reliably record morbidity outcome data,
despite patients wanting to be informed of all the risks associated with
surgery. The Cardiac Post-Operative Morbidity Score (C-POMS) is a new tool
for describing and scoring (0-13) total morbidity burden after cardiac
surgery, derived by noting the presence/absence of 13 morbidity domains on
days 3, 5, 8 and 15. Identifying modifiable C-POMS risk factors may
suggest targets for intervention to reduce morbidity and healthcare costs.
Thus, we explored the association of C-POMS with previously identified
predictors of post-operative morbidity. Methods: A systematic literature
review of pre-operative risk assessment models for post-operative
morbidity was conducted to identify variables associated with
post-operative morbidity. The association of those variables with C-POMS
was explored in patients drawn from the original C-POMS study (n = 444).
Results: Seventy risk factors were identified, of which 56 were available
in the study and 49 were suitable for analysis. Numbers were too few to
analyse associations on D15. Thirty-three (67.3%) and 20 (40.8%) variables
were associated with C-POMS on at least 1 or 2 days, respectively.
Pre-operative albumin concentration, left ventricular ejection fraction
and New York Heart Association functional class were associated with
C-POMS on all days. Of the 16 independent risk factors, pre-operative
albumin and haemoglobin concentrations and weight are potentially
modifiable. Conclusions: Different risk factors are associated with total
morbidity burden on different post-operative days. Preoperative albumin
and haemoglobin concentrations and weight were independently predictive of
post-operative total morbidity burden suggesting therapeutic interventions
aimed at these might reduce both post-operative morbidity risk and
health-care costs in patients undergoing cardiac surgery. Copyright &#xa9;
The Author(s). 2017.

<39>
[Use Link to view the full text]
Accession Number
614926663
Author
Chowdhury T.; Schaller B.
Institution
(Chowdhury, Schaller) Department of Anesthesiology and Perioperative
Medicine, University of Manitoba, Winnipeg, MN, Canada
(Schaller) Department of Research, University of Southampton, Southampton,
United Kingdom
Title
The negative chronotropic effect during lumbar spine surgery: A systemic
review and aggregation of an emerging model of spinal cardiac reflex.
Source
Medicine (United States). 96 (1) (no pagination), 2017. Article Number:
e5436. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Hemodynamic perturbations in spine surgeries are predominantly
reported in cervical and thoracic level procedures. The literature related
to negative cardiovascular changes (decrease of heart rate and blood
pressure) in lumbar spine procedures is still scarce and only highlighted
in few case reports/letters until now. Methods: With the help of a
systematic literature review with predefined criteria, we, therefore,
examined and synthesized here the probable underlying common cause of
these hemodynamic disturbances in lumbar spine surgeries. Data aggregation
to a model was done by a case survey method and established by a
cause-effect relationship. Results: There are only 5 cases that met our
strict predefined criteria and that were aggregated to an emergent model
of an autonomous reflex arc. Conclusion: This review and consecutive data
aggregation provides, for the first time, a concept of spinal cardiac
reflex in lumbar spine surgeries. Copyright &#xa9; 2017 the Author(s).

<40>
Accession Number
614990956
Author
Kang S.-H.; Chung W.-Y.; Lee J.M.; Park J.-J.; Yoon C.-H.; Suh J.-W.; Cho
Y.-S.; Doh J.-H.; Cho J.M.; Bae J.-W.; Youn T.-J.; Chae I.-H.
Institution
(Kang, Park, Yoon, Suh, Cho, Youn, Chae) College of Medicine, Seoul
National University and Seoul National University Bundang Hospital, 166
Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea
(Chung) Department of Internal Medicine, Boramae Medical Center, Seoul,
South Korea
(Lee) Department of Internal Medicine, Seoul National University Hospital,
Seoul, South Korea
(Doh) Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, South
Korea
(Cho) Kyung Hee University Hospital at Gangdong, Seoul, South Korea
(Bae) Chungbuk National University Hospital, Cheongju, South Korea
Title
Angiographic outcomes of Orsiro biodegradable polymer sirolimus-eluting
stents and Resolute Integrity durable polymer zotarolimus-eluting stents:
Results of the ORIENT trial.
Source
EuroIntervention. 12 (13) (pp 1623-1631), 2017. Date of Publication: 2017.
Publisher
EuroPCR
Abstract
Aims: We performed a randomised controlled open-label non-inferiority
trial to compare angiographic outcomes between the ultra-thin strut,
biodegradable hybrid polymer Orsiro sirolimus-eluting stent (O-SES) and
the durable biocompatible polymer Resolute Integrity zotarolimus-eluting
stent (R-ZES). Methods and results: A total of 372 patients planned to
undergo percutaneous coronary revascularisation were randomly assigned 2:1
to treatment with O-SES or R-ZES (250 and 122 patients, respectively).
O-SES was non-inferior to R-ZES for the primary endpoint, in-stent late
lumen loss at nine months (median 0.06 mm [interquartile range,-0.09 to
0.24 mm] versus 0.12 mm [-0.07 to 0.32 mm]; p for non-inferiority <0.001;
p for superiority=0.205). Percent diameter stenosis was significantly
lower in the O-SES group than in the R-ZES group (15.0 [10.0 to 20.0]
versus 20.0 [13.3 to 26.0]; p=0.002). Target lesion failure occurred in
2.4% and 3.3% of the O-SES and R-ZES groups, respectively (p=0.621).
Subgroup analyses showed consistently similar outcomes between the two
groups in terms of the primary endpoint, except for the diabetic subgroup.
Conclusions: O-SES was non-inferior to R-ZES in terms of in-stent late
loss at nine months. Angiographic restenosis and clinical adverse events
were low in both groups. This study confirms the good safety and efficacy
profiles of both contemporary coronary stents. Copyright &#xa9; Europa
Digital & Publishing 2017. All rights reserved.

<41>
Accession Number
614990955
Author
Varenne O.; Cuisset T.; Chaib A.; Morice M.-C.; Sabate M.; Koh T.-H.;
Durand-Zaleski I.; Hanon O.; Bogaerts K.; Sinnaeve P.
Institution
(Varenne, Chaib) AP-HP, Hopital Cochin, Service de Cardiologie, Universite
Sorbonne Paris Cite, Faculte de Medecine, Paris 75014, France
(Varenne, Chaib, Hanon) Universite Paris Descartes, Universite Sorbonne
Paris Cite, Paris, France
(Cuisset) AP-HM, Hopital de la Timone, Service de Cardiologie, Marseille,
France
(Morice) Generale de Sante, Institut Cardiovasculaire Paris Sud, Massy,
France
(Sabate) Cardiology Department, Hospital Clinic, IDiBAPS, Universitat de
Barcelona, Barcelona, Spain
(Koh) Department of Cardiology, National Heart Center, Singapore,
Singapore
(Durand-Zaleski) AP-HP, Hopital Henri Mondor, Sante Publique, Creteil,
France
(Hanon) AP-HP, Hopital Broca, Service de Geriatrie, Paris, France
(Bogaerts) Interuniversity Institute for Biostatistics and Statistical
Bioinformatics, KU Leuven, Leuven, Belgium
(Bogaerts) Universite de Hasselt, Hasselt, Belgium
(Sinnaeve) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
Title
The SYNERGY II Everolimus elutiNg stent in patients Older than 75 years
undergoing coronary Revascularisation associated with a short dual
antiplatelet therapy (SENIOR) trial: Rationale and design of a large-scale
randomised multicentre study.
Source
EuroIntervention. 12 (13) (pp 1614-1622), 2017. Date of Publication: 2017.
Publisher
EuroPCR
Abstract
Aims: In the elderly population, bare metal stents (BMS) are often
preferred over drug-eluting stents (DES) because of the longer duration of
dual antiplatelet therapy (DAPT) associated with the latter. The SENIOR
trial is designed to determine whether one of the latest generation of DES
can reduce major cardiovascular events compared to BMS, despite a similar
short DAPT duration. Methods and results: The SENIOR trial is a
multicentre, single-blind, prospective, randomised trial comparing the
latest generation DES (SYNERGYTM II; Boston Scientific, Marlborough, MA,
USA) to BMS (RebelTM; Boston Scientific) in 1,200 patients ?75 years old.
DAPT will be given for one or six months according to clinical
presentation, irrespective of stent type. The primary outcome is the
composite of all-cause mortality, non-fatal myocardial infarction, stroke
or ischaemia-driven target lesion revascularisation at one year. Secondary
endpoints include the rate of major bleedings and the rate of stent
thrombosis at one year. Conclusions: This trial is designed to evaluate a
new revascularisation strategy combining DES and short duration DAPT in
elderly patients. It has the potential to decrease the need for target
lesion revascularisation without a significant DAPT-related increase in
bleeding compared to BMS. Copyright &#xa9; Europa Digital & Publishing
2017. All rights reserved.

<42>
[Use Link to view the full text]
Accession Number
614926737
Author
Nguyen J.; Nacpil N.
Institution
(Nguyen, Nacpil) The Center for Translational Research, Joanna Briggs
Institute Center of Excellence, Forth Worth, United States
Title
A comparison between dexmedetomidine and propofol on extubation times in
postoperative adult cardiac surgery patients: A systematic review
protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 14 (11) (pp
63-71), 2016. Date of Publication: 2016.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Review question/objective: The objective of this systematic review is to
synthesize the best available evidence regarding the effects of
dexmedetomidine compared to propofol on time to extubation, intensive care
unit (ICU) length of stay (LOS), hospital LOS and mortality in
postoperative adult cardiac surgery patients. The specific review question
is as follows: What is the effectiveness of dexmedetomidine compared to
propofol on times to extubation, ICU LOS, hospital LOS and mortality in
postoperative adults undergoing cardiac surgery?. Copyright &#xa9; 2016
Joanna Briggs Institute.

<43>
Accession Number
615007285
Author
Khaliel F.; Giambruno V.; Chu M.W.A.; Sridhar K.; Teefy P.; Kiaii B.B.
Institution
(Khaliel) From the Departments of *Cardiac Surgery and +Cardiology, London
Health Science Center, University of Western Ontario, London, Ontario,
Canada.
Title
Consequences of Hybrid Procedure Addition to Robotic-Assisted Direct
Coronary Artery Bypass.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2017. Date of Publication: 23 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
OBJECTIVE: Patients postcoronary artery revascularization surgery often
receives blood product transfusion, which could delay their intensive care
unit and hospital discharge. We investigated our robotic-assisted direct
coronary artery bypass (RADCAB) transfusion rate to determine whether
performing the minimal invasive coronary surgery with percutaneous
coronary intervention in one stage would increase the incidence of blood
transfusion, morbidity, and length of stay. METHODS: Between November 2003
and November 2015, 483 consecutive patients underwent RADCAB surgery. They
were divided into two groups. Group 1 (147 patients; mean +/- SD age, 61.2
+/- 11 years; 23% females) underwent robotic-assisted hybrid coronary
artery revascularization with left internal thoracic artery to the left
anterior descending coronary artery with percutaneous coronary
intervention to a nonleft anterior descending coronary artery vessel in
the same stage. Group 2 (336 patients; mean +/- SD age, 61.2 +/- 10.5
years; 25% females) underwent nonhybrid RADCAB. Early and late
postoperative follow-up at mean +/- SD of 83.6 +/- 11.1 months was
obtained. RESULTS: Blood transfusion rate in group 1 was statistically
different, as illustrated in Table 2. Based on the intraoperative cardiac
catheterization, the incidence of graft revision was higher in the
nonhybrid group. There was no difference between the two groups in terms
of renal failure, neurological complication, prolonged mechanical
ventilation, and gastrointestinal bleed. CONCLUSIONS: Despite similar
preoperative demographics in the two groups, we have observed a
significant difference in the blood transfusion rate in group 1. However,
this did not lead into a statistically significant re-exploration rate for
bleeding. Hence, we assume that dual antiplatelet therapy usage in the
hybrid group might be the cause of the increase in blood transfusion rate.
Nevertheless, it did not affect postoperative morbidity and length of
hospital stay. A randomized multicenter clinical trial is needed.
Copyright &#xa9;2017 by the International Society for Minimally Invasive
Cardiothoracic Surgery

<44>
Accession Number
614999893
Author
Nguyen T.-L.; Collins G.S.; Lamy A.; Devereaux P.J.; Daures J.-P.; Landais
P.; Le Manach Y.
Institution
(Nguyen, Daures, Landais) Laboratory of Biostatistics, Epidemiology,
Clinical Research and Health Economics, UPRES EA2415, University of
Montpellier, Montpellier, France
(Nguyen, Devereaux, Le Manach) Department of Clinical Epidemiology and
Biostatistics, Michael DeGroote School of Medicine, Faculty of Health
Sciences, McMaster University, Hamilton, Canada
(Nguyen, Le Manach) Department of Anesthesia, Michael DeGroote School of
Medicine, Faculty of Health Sciences, McMaster University, Hamilton,
Canada
(Nguyen, Lamy, Devereaux, Le Manach) Population Health Research Institute,
David Braley Cardiac, Vascular and Stroke Research Institute,
Perioperative Medicine and Surgical Research Unit, Perioperative Research
Group, Population Health Research Institute, McMaster University,
Hamilton, Canada
(Collins) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research
Centre, University of Oxford, Windmill Road, Oxford, United Kingdom
(Devereaux) Department of Medicine, Michael DeGroote School of Medicine,
Faculty of Health Sciences, McMaster University, Hamilton, Canada
(Landais) Department of Biostatistics, Clinical Research and Medical
Informatics, Nimes University Hospital, Nimes, France
Title
Simple randomization did not protect against bias in smaller trials.
Source
Journal of Clinical Epidemiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier USA
Abstract
Objectives: By removing systematic differences across treatment groups,
simple randomization is assumed to protect against bias. However, random
differences may remain if the sample size is insufficiently large. We
sought to determine the minimal sample size required to eliminate random
differences, thereby allowing an unbiased estimation of the treatment
effect. Study Design and Setting: We reanalyzed two published multicenter,
large, and simple trials: the International Stroke Trial (IST) and the
Coronary Artery Bypass Grafting (CABG) Off- or On-Pump Revascularization
Study (CORONARY). We reiterated 1,000 times the analysis originally
reported by the investigators in random samples of varying size. We
measured the covariates balance across the treatment arms. We estimated
the effect of aspirin and heparin on death or dependency at 30 days after
stroke (IST), and the effect of off-pump CABG on a composite primary
outcome of death, nonfatal stroke, nonfatal myocardial infarction, or new
renal failure requiring dialysis at 30 days (CORONARY). In addition, we
conducted a series of Monte Carlo simulations of randomized trials to
supplement these analyses. Results: Randomization removes random
differences between treatment groups when including at least 1,000
participants, thereby resulting in minimal bias in effects estimation.
Later, substantial bias is observed. In a short review, we show such an
enrollment is achieved in 41.5% of phase 3 trials published in the highest
impact medical journals. Conclusions: Conclusions drawn from completely
randomized trials enrolling a few participants may not be reliable. In
these circumstances, alternatives such as minimization or blocking should
be considered for allocating the treatment. Copyright &#xa9; 2017 Elsevier
Inc.

<45>
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.

<46>
[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.

<47>
Accession Number
611532826
Author
Karabayirli S.; Ugur K.S.; Demircioglu R.I.; Muslu B.; Usta B.; Sert H.;
Ark N.
Institution
(Karabayirli, Demircioglu, Muslu, Usta, Sert) Department of Anesthesiology
and Reanimation, Faculty of Medicine, Turgut Ozal University, Alparslan
Turkes Caddesi, No: 57, Emek, Ankara 06510, Turkey
(Ugur, Ark) Department of Otolaryngology and Head and Neck Surgery,
Faculty of Medicine, Turgut Ozal University, Ankara, Turkey
Title
Surgical conditions during FESS; comparison of dexmedetomidine and
remifentanil.
Source
European Archives of Oto-Rhino-Laryngology. 274 (1) (pp 239-245), 2017.
Date of Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
To compare dexmedetomidine with remifentanil in functional endoscopic
sinus surgery (FESS) in regards to intra-operative bleeding, anesthetic
consumption and post-operative recovery. Randomized, double blind study.
Tertiary care medical center. Fifty patients with nasal polyposis who had
been scheduled for FESS were randomly divided into two groups. In group D
(n = 25), dexmedetomidine 1 micro&#32;g/kg infused intravenous (IV) over
10 min before anesthesia induction, followed by a continuous of 0.7
micro&#32;g/kg/h infusion during operation. In group R (n = 25), 1
micro&#32;g/kg remifentanil IV bolus, was administered with induction of
anesthesia and continued 0.25-0.50 micro&#32;g/kg/min during operation.
Heart rates, mean arterial pressure, end tidal CO<inf>2</inf>, end tidal
sevoflurane were recorded. The amount of bleeding, surgical field
condition for bleeding and the time to reach Aldrete recovery score 9-10
were recorded. Postoperative nausea, vomiting, pain, shivering, sedation
were followed up over 24 h. There was no significant difference between
groups according to the amount of bleeding during surgery, assessment of
surgical field condition, consumption of sevoflurane, scores of
postoperative VAS, rates of nausea and vomiting, shivering, demands of
additional analgesic medication (P > 0.05). The time to reach Aldrete
recovery score 9-10, sedation scores at the postoperative first hour were
significantly higher in group D (P = 0.001). We concluded that in
comparison to remifentanil, dexmedetomidine during FESS for controlled
hypotension is of limited value as it has no additional benefits in terms
of control of hypotension and amount of bleeding in the surgical field and
it is associated with higher recovery time and first-hour postoperative
sedation scores. Copyright &#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<48>
Accession Number
614672068
Author
D'Ascenzo F.; Filippo O.D.; Bertaina M.; Iannaccone M.; Gaita F.
Institution
(D'Ascenzo, Filippo, Bertaina, Iannaccone, Gaita) Citta della Scienza e
della Salute, University of Turin, Turin, Italy
Title
"You don't need a weather man to know which way the wind blows":
Understanding differences and applications in clinical practice of
randomized controlled trials on unprotected left main.
Source
Annals of Translational Medicine. 5 (4) (no pagination), 2017. Article
Number: 77. Date of Publication: February 2017.
Publisher
AME Publishing Company (E-mail: info@amepc.org)

<49>
Accession Number
614828952
Author
Kuwata S.; Taramasso M.; Guidotti A.; Nietlispach F.; Maisano F.
Institution
(Kuwata, Taramasso, Guidotti, Maisano) UniversitatsSpital Zurich, Zurich,
Switzerland
(Nietlispach) University Heart Center Zurich, Zurich University Hospital,
Zurich, Switzerland
Title
Evaluation of Valtech's transcatheter mitral valve repair device.
Source
Expert Review of Medical Devices. 14 (3) (pp 189-195), 2017. Date of
Publication: 04 Mar 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Functional mitral regurgitation is a debilitating condition,
related to worsening of functional capacity and heart failure
symptomatology. Cardioband (Valtech Cardio, Or Yehuda, Israel) is a novel
technology designed for transcatheter repair of the mitral valve in the
treatment of functional MR. Areas covered: A brief summary to direct the
reader to important further reading, relevant websites;
www.valtechcardio.com. An article about this device, relevant websites;
www.ncbi.nlm.nih.gov/pubmed using search word 'Cardioband'. Expert
commentary: This device has been designed to be completely implantable
percutaneously in a closed beating heart fashion. The adjustability
features under the beating heart and guided by echocardiography allow to
provide a tailored therapy to each particular mitral valve and
regurgitation condition. Copyright &#xa9; 2017 Informa UK Limited, trading
as Taylor & Francis Group.

<50>
Accession Number
614112937
Author
Chakravarthy M.; Prabhakumar D.; Thimmannagowda P.; Krishnamoorthy J.;
George A.; Jawali V.
Institution
(Chakravarthy, Prabhakumar, Thimmannagowda, Krishnamoorthy, George,
Jawali) Department of Anesthesia, Critical Care and Pain Relief, Fortis
Hospitals, Bannerughatta Road, Bengaluru, Karnataka 560 076, India
Title
Comparison of two doses of heparin on outcome in off-pump coronary artery
bypass surgery patients: A prospective randomized control study.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 8-13), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: While off pump coronary artery bypass surgery is practiced
with an intention to reduce the morbidity associated with cardiopulmonary
bypass, the resultant 'hypercoagulability' needs to be addressed.
Complications such as cavitary thrombus possibly due to the hyper
coagulability after off pump coronary artery bypass surgery have been
described. Many clinicians use higher doses of heparin - up to 5 mg/kg in
order to thwart this fear. Overall, there appears to be no consensus on
the dose of heparin in off pump coronary artery bypass surgeries. Aim of
the Study: The aim of the study was understand the differences in outcome
of such as transfusion requirement, myocardial ischemia, and morbidity
when two different doses were used for systemic heparinization. Methods:
Elective patients scheduled for off pump coronary artery bypass surgery
were included. Ongoing anti platelet medication was not an exclusion
criteria, however, anti platelet medications were ceased about a week
prior to surgery when possible. Thoracic epidural anesthesia was
administered as an adjunct in patients who qualified for it. By computer
generated randomization chart, patients were chosen to receive either 2 or
3 mg/kg of intravenous unfractioned heparin to achieve systemic
heparinization with activated clotting time targeted at >240 secs.
Intraoperative blood loss, postoperative blood loss, myocardial ischemic
episodes, requirement of intraaortic balloon counter pulsation and
transfusion requirement were analyzed. Results: Sixty two patients
participated in the study. There was one conversion to cardiopulmonary
bypass. The groups had comparable ACT at baseline (138.8 vs. 146.64
seconds, P = 0.12); 3 mg/kg group had significantly higher values after
heparin, as expected. But after reversal with protamine, ACT and need for
additional protamine was similar among the groups. Intraoperative (685.56
+/- 241.42 ml vs. 675.15 +/- 251.86 ml, P = 0.82) and postoperative blood
loss (1906.29 +/- 611.87 ml vs 1793.65 +/- 663.54 ml , p value 0.49) were
similar among the groups [Table 4]. The incidence of ECG changes of
ischemia, arrhythmias, conversion to CPB, or need for intra-aortic balloon
counter pulsation were not different. Conclusions: Use of either 2 or 3
mg/kg heparin for systemic heparinization in patients undergoing OPCAB did
not affect the outcome. Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<51>
Accession Number
614112919
Author
Kapoor P.; Magoon R.; Rawat R.; Mehta Y.; Taneja S.; Ravi R.; Hote M.
Institution
(Kapoor, Magoon) Department of Cardiac Anaesthesia, Cardio Thoracic
Centre, AIIMS, New Delhi 110 029, India
(Rawat) Department of Cardiac Anaesthesiology, Salalah Heart Center,
Salalah, Oman
(Mehta) Department of Critical Care and Anaesthesiology, Medanta - the
Medicity, Gurgaon, Haryana, India
(Taneja) Department of Cardiac Anaesthesia, Naval Base Hospital, Mumbai,
Maharashtra, India
(Ravi) Department of Statistics, Lady Shri Ram College, University of
Delhi, New Delhi, India
(Hote) Department of Cardiothoracic and Vascular Surgery, AIIMS, New
Delhi, India
Title
Goal-directed therapy improves the outcome of high-risk cardiac patients
undergoing off-pump coronary artery bypass.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 83-89), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: There has been a constant emphasis on developing management
strategies to improve the outcome of high-risk cardiac patients undergoing
surgical revascularization. The performance of coronary artery bypass
surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks
associated with extra-corporeal circulation. The preliminary results of
goal-directed therapy (GDT) for hemodynamic management of high-risk
cardiac surgical patients are encouraging. The present study was conducted
to study the outcome benefits with the combined use of GDT with OPCAB as
compared to the conventional hemodynamic management. Material and Method:
Patients with the European System for Cardiac Operative Risk Evaluation >3
scheduled for OPCAB were randomly divided into two groups; the control and
GDT groups. The GDT group included the monitoring and optimization of
advanced parameters, including cardiac index (CI), systemic vascular
resistance index, oxygen delivery index, stroke volume variation;
continuous central venous oxygen saturation (ScVO <inf>2</inf> ), global
end-diastolic volume, and extravascular lung water (EVLW), using
FloTrac^TM , PreSep^TM , and EV-1000 
monitoring panels, in addition to the conventional hemodynamic management
in the control group. The hemodynamic parameters were continuously
monitored for 48 h in Intensive Care Unit (ICU) and corrected according to
GDT protocol. A total of 163 patients consented for the study. Result:
Seventy-five patients were assigned to the GDT group and 88 patients were
in the control group. In view of 9 exclusions from the GDT group and 12
exclusions from control group, 66 patients in the GDT group and 76
patients in control group completed the study. Conclusion: The length of
stay in hospital (LOS-H) (7.42 +/- 1.48 vs. 5.61 +/- 1.11 days, P < 0.001)
and ICU stay (4.2 +/- 0.82 vs. 2.53 +/- 0.56 days, P < 0.001) were
significantly lower in the GDT group as compared to control group. The
duration of inotropes (3.24 +/- 0.73 vs. 2.89 +/- 0.68 h, P = 0.005) was
also significantly lower in the GDT group. The two groups did not differ
in duration of ventilated hours, mortality, and other complications. The
parameters such as ScVO <inf>2</inf> , CI, and EVLW had a strong negative
and positive correlation with the LOS-H with r values of - 0.331, -0.319,
and 0.798, respectively. The study elucidates the role of a goal-directed
hemodynamic optimization for improved outcome in high-risk cardiac
patients undergoing OPCAB. Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<52>
Accession Number
614112857
Author
Shah K.
Institution
(Shah) Department of Cardiac Anaesthesia, Breach Candy Hospital Trust,
60A, Bhulabhai Desai Road, Mumbai, Maharashtra 400 026, India
Title
ProSeal laryngeal mask airway as an alternative to standard endotracheal
tube in securing upper airway in the patients undergoing beating-heart
coronary artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 61-66), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: ProSeal laryngeal mask airways (PLMAs) are routinely used
after failed tracheal intubation as airway rescue, facilitating tracheal
intubation by acting as a conduit and to secure airway during emergencies.
In long duration surgeries, use of endotracheal tube (ETT) is associated
with various hemodynamic complications, which are minimally affected
during PLMA use. However, except for few studies, there are no significant
data available that promote the use of laryngeal mask during cardiac
surgery. This prospective study was conducted with the objective of
demonstrating the advantages of PLMA over ETT in the patients undergoing
beating-heart coronary artery bypass graft (CABG). Methodology: This
prospective, interventional study was carried out in 200 patients who
underwent beating-heart CABG. Patients were randomized in equal numbers to
either ETT group or PLMA group, and various hemodynamic and respiratory
parameters were observed at different time points. Results: Patients in
PLMA group had mean systolic blood pressure 126.10 +/- 5.31 mmHg compared
to the patients of ETT group 143.75 +/- 6.02 mmHg. Pulse rate in the PLMA
group was less (74.52 +/- 10.79 per min) (P < 0.05) compared to ETT group
(81.72 +/- 9.8). Thus, hemodynamic changes were significantly lower (P <
0.05) in PLMA than in ETT group. Respiratory parameters such as oxygen
saturation, pressure CO <inf>2</inf> (pCO <inf>2</inf> ), peak airway
pressure, and lung compliance were similar to ETT group at all evaluation
times. The incidence of adverse events was also lower in PLMA group.
Conclusion: In experience hand, PLMA offers advantages over the ETT in
airway management in the patients undergoing beating-heart CABG. Copyright
&#xa9; 2017 Annals of Cardiac Anaesthesia Published by Wolters Kluwer -
Medknow.

<53>
Accession Number
614112849
Author
Baishya J.; George A.; Krishnamoorthy J.; Muniraju G.; Chakravarthy M.
Institution
(Baishya, George, Krishnamoorthy, Muniraju, Chakravarthy) Department of
Anesthesiology and Critical Care, Fortis Hospital, B. G. Road, Bengaluru,
Karnataka, India
Title
Minimally invasive compared to conventional approach for coronary artery
bypass grafting improves outcome.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 57-60), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Minimally invasive (MI) cardiac surgery is a rapidly gaining
popularity, globally as well as in India. We aimed to compare the outcome
of MI to the conventional approach for coronary artery bypass graft (CABG)
surgery. Methods: This prospective, comparative study was conducted at a
tertiary care cardiac surgical center. All patients who underwent CABG
surgery via MI approach (MI group) from July 2015 to December 2015 were
enrolled and were compared against same number of EuroSCORE II matched
patients undergoing CABG through conventional mid-sternotomy approach (CON
group). Demographic, intra- and post-operative variables were collected.
Results: In MI group, duration of the surgery was significantly longer (P
= 0.029). Intraoperative blood loss lesser (P = 0.002), shorter duration
of ventilation (P = 0.002), shorter Intensive Care Unit stay (P = 0.004),
shorter hospital stay (P = 0.003), lesser postoperative analgesic
requirements (P = 0.027), and lower visual analog scale scores on day of
surgery (P = 0.032) and 1 ^st postoperative day (P = 0.025). No
significant difference in postoperative blood loss, blood transfusion, or
duration of inotrope requirement observed. There was no conversion to
mid-sternotomy in any patients, 8% of patients had desaturation
intraoperatively. There was no operative mortality. Conclusion: MI surgery
is associated with lesser intraoperative blood loss, better analgesia, and
faster recovery. Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.

<54>
Accession Number
614112834
Author
Fernandes G.; Araujo Junior R.; Lima A.; Gonzaga I.; De Oliveira R.;
Nicolau R.
Institution
(Fernandes, Lima, Gonzaga, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IPandD, Universidade Do Vale Do
Paraiba, Vitorino Orthiges Fernandes Street, Bairro Uruguai, Teresina, PI
6321, Brazil
(Fernandes, Gonzaga, De Oliveira) Uninovafapi Universitary Center
(UNINOVAFAPI), Brazil
(Araujo Junior) Department of Cardiac Surgery, Santa Maria Hospital,
Bairro Centro, Brazil
(Lima, De Oliveira) Department of Physical Therapy, University of Piaui
State PI, Brazil
Title
Low-intensity laser (660 NM) has analgesic effects on sternotomy of
patients who underwent coronary artery bypass grafts.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 52-56), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: The aim of this study was to evaluate the efficacy of
low-level laser therapy for reducing the acute pain of sternotomy in
patients who underwent a coronary artery bypass graft (CABG). Methods:
This study was conducted with ninety volunteers who electively submitted
to CABG. The volunteers were randomly allocated into three groups of equal
size (n = 30): control, placebo, and laser (lambda of 660 nm and spatial
average energy fluency of 1.06 J/cm ² ). Pain when coughing was
assessed by a visual analog scale (VAS) and McGill Pain Questionnaire,
according to sensory, affective, evaluative, and miscellaneous domains.
The patients were followed for 1 month after the surgery. Results: The
laser group had a greater decrease in pain with analogous results, as
indicated by both the VAS and the McGill questionnaire (P < 0.05) on
sensory and affective scores, on days 6 and 8 postsurgery compared to the
placebo and control groups. Conclusion: Laser seems to be effective
promoting pain reduction after coronary-arterial bypass grafting.
Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia Published by Wolters
Kluwer - Medknow.

<55>
Accession Number
614112809
Author
Safaei N.; Babaei H.; Azarfarin R.; Jodati A.-R.; Yaghoubi A.;
Sheikhalizadeh M.-A.
Institution
(Safaei, Jodati, Sheikhalizadeh) Cardiovascular Research Center, School of
Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Babaei) Drug Applied Research Center, School of Pharmacy, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Azarfarin, Yaghoubi) Echocardiography Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Title
Comparative effect of grape seed extract (Vitis vinifera) and ascorbic
acid in oxidative stress induced by on-pump coronary artery bypass
surgery.
Source
Annals of Cardiac Anaesthesia. 20 (1) (pp 45-51), 2017. Date of
Publication: January-March 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: This study aimed to test the beneficial effect of grape seed
extract (GSE) (Vitis vinifera) and Vitamin C in oxidative stress and
reperfusion injury induced by cardiopulmonary bypass (CPB) in coronary
artery bypass surgery. Patients and Methods: In this randomized trial, 87
patients undergoing elective and isolated coronary bypass surgery
included. The patients were randomly assigned into three groups (n = 29
each): (1) Control group with no treatment, (2) GSE group who received the
extract 24 h before operation, 100 mg every 6 h, orally, (3) Vitamin C
group who received 25 mg/kg Vitamin C through CPB during surgery. Blood
samples were taken from coronary sinus at (T1) just before aortic cross
clamp; (T2) just before starting controlled aortic root reperfusion; and
(T3) 10 min after root reperfusion. Some clinical parameters and
biochemical markers were compared among the groups. Results: There were
significant differences in tracheal intubation times, sinus rhythm return,
and left ventricular function between treatment groups compared with
control (P < 0.05). Total antioxidant capacity was higher (P < 0.05) in
both grape seed and Vitamin C groups at T2 and T3 times. In reperfusion
period, malondialdehyde level was increased in control group; however, it
was significantly lower for the grape seed group (P = 0.04). The
differences in the mean levels of superoxide dismutase and glutathione
peroxidase among the three groups were not significant (P > 0.05 in all
cases). Conclusions: In our patients, GSE and Vitamin C had antioxidative
effects and reduced deleterious effects of CPB during coronary artery
bypass grafting surgery. Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<56>
Accession Number
614605954
Author
Zhou A.-G.; Wang X.-X.; Pan D.-B.; Chen A.-J.; Zhang X.-F.; Deng H.-W.
Institution
(Zhou, Wang, Pan, Chen, Zhang, Deng) Department of Anesthesiology, First
People's Hospital of Changde City, Changde, Hunan, China
Title
Preoperative Antihypertensive Medication in Relation to Postoperative
Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A
Meta-Analysis.
Source
BioMed Research International. 2017 (no pagination), 2017. Article Number:
1203538. Date of Publication: 2017.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. We undertake a systematic review and meta-analysis to evaluate
the effect of preoperative hypertension and preoperative antihypertensive
medication to postoperative atrial fibrillation (POAF) in patients
undergoing cardiac surgery. Methods. We searched PubMed, Embase, and
Cochrane Library (from inception to March 2016) for eligible studies. The
outcomes were the effects of preoperative hypertension, preoperative
calcium antagonists regimen, preoperative ACE inhibitors regimen, and
preoperative beta blocking agents regimen with POAF. We calculated pooled
risk ratios (OR) and 95% CIs using random- or fixed-effects models.
Results. Twenty-five trials involving 130087 patients were listed.
Meta-analysis showed that the number of preoperative hypertension patients
in POAF group was significantly higher (P < 0.05), while we found that
there are no significant differences between two groups in Asia patients
by subgroup analysis, which is in contrast to other outcomes. Compared
with the Non-POAF group, the number of patients who used calcium
antagonists and ACE inhibitors preoperatively in POAF group was
significantly higher (P < 0.05). And we found that there were no
significant differences between two groups of preoperative beta blocking
agents used (P = 0.08). Conclusions. Preoperative hypertension and
preoperative antihypertensive medication in patients undergoing cardiac
operations seem to be associated with higher risk of POAF. Copyright
&#xa9; 2017 Ai-Guo Zhou et al.

<57>
Accession Number
614900303
Author
Landes U.; Kerner A.; Segev A.; Danenberg H.; Shapira Y.; Finkelstein A.;
Kornowski R.
Institution
(Landes, Shapira, Kornowski) Department of Cardiology, Rabin Medical
Center (Beilinson Campus), Petah Tikva, Israel
(Segev) Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
(Finkelstein) Department of Cardiology, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel
(Kerner) Department of Cardiology, Rambam Health Care Campus, Haifa,
Israel
(Danenberg) Department of Cardiology, Hadassah-Hebrew University Medical
School, Jerusalem, Israel
Title
Transcatheter tricuspid valve-in-valve implantation in patients with
tricuspid bioprosthetic valve degeneration at high surgical risk: A
multicenter case series.
Source
Israel Medical Association Journal. 19 (3) (pp 156-159), 2017. Date of
Publication: March 2017.
Publisher
Israel Medical Association (2 Twin Towers,11th Floor,35 Jabotinsky
Street,PO Box 3566, Ramat Gan 52135, Israel)
Abstract
Background: Transcatheter tricuspid valve-in-valve implantation (TVIV) is
an attractive yet under-explored alternative to redo valve surgery.
Objectives: To report the multicenter TVIV experience in Israel. Methods:
We approached multiple centers and collected data regarding seven TVIV
cases. Results: The study group comprised seven participants: five females
and two males, with a mean age of 63 +/- 12 years and EuroSCORE-II 13.6
+/- 3.3%. Follow-up ranged from 3 to 21 months (mean 8 +/- 6 months). All
presented with advanced heart failure. The indication for valve
intervention was a predominant tricuspid stenosis in three patients,
significant tricuspid regurgitation in one and a mixture in three. Six
procedures were conducted via a transfemoral approach and one by
transatrial access. The Edwards SAPIENTM XT valve was used in four cases
and the SAPIENTM 3 in three. Without pre-stenting/rapid pacing, all
participants underwent successful valve implantation. Mean transvalvular
gradient decreased from 11 +/- 3 mmHg to 6 +/- 3 mmHg (P = 0.003) and
regurgitation decreased from moderate/severe (in four cases) to none/trace
(in six of the seven cases). One patient remained severely symptomatic and
died 3.5 months after the implantation. All others achieved a functional
capacity improvement and amelioration of symptoms soon after the
implantation, which persisted during follow-up. Conclusions: TVIV may be a
safe and effective strategy to treat carefully selected patients with
degenerated bioprosthetic tricuspid valve at high operative risk.
Copyright &#xa9; 2017, Israel Medical Association. All rights reserved.

<58>
Accession Number
614921852
Author
Chang H.-Y.; Wang C.-C.; Wu Y.-W.; Chu P.-H.; Wu C.-C.; Hsu C.-H.; Wen
M.-S.; Voon W.-C.; Lin W.-S.; Huang J.-L.; Chen S.-M.; Yang N.-I.; Chang
H.-C.; Chang K.-C.; Sung S.-H.; Shyu K.-G.; Lin J.-L.; Mar G.-Y.; Chan
K.-C.; Kuo J.-Y.; Wang J.-H.; Chen Z.-C.; Tseng W.-K.; Cherng W.-J.; Yin
W.-H.
Institution
(Chang, Yin) Heart Center, Cheng Hsin General Hospital and Faculty of
Medicine, School of Medicine, National Yang Ming University, Taipei,
Taiwan (Republic of China)
(Wang, Chu, Wen) Division of Cardiology, Chang Gung Memorial Hospital,
Linkou, Taiwan (Republic of China)
(Wu) Cardiology Division of Cardiovascular Medical Center, Far Eastern
Memorial Hospital, New Taipei City, Taiwan (Republic of China)
(Wu) Cardiovascular Center, National Taiwan University Hospital, Hsinchu
Branch, Hsinchu, Taiwan (Republic of China)
(Hsu) Institute of Clinical Medicine, National Cheng Kung University,
College ofMedicine, National Cheng Kung University, Tainan, Taiwan
(Republic of China)
(Voon) Division of Cardiology, Department of Internal Medicine, Kaohsiung
Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan (Republic
of China)
(Lin) Division of Cardiology, Department of Internal Medicine, Tri-Service
General Hospital and National Defense Medical Center, Taipei, Taiwan
(Republic of China)
(Huang) Cardiovascular Center, Taichung Veterans General Hospital,
Taichung, Taiwan (Republic of China)
(Chen) Section of Cardiology, Department of Internal Medicine, Kaohsiung
Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Republic of China)
(Yang, Cherng) Division of Cardiology, Department of Internal Medicine,
Chang Gung Memorial Hospital, Keelung, Taiwan (Republic of China)
(Chang) Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi
Medical Foundation, New Taipei City, Taiwan (Republic of China)
(Chang) Division of Cardiovascular Medicine and Cardiovascular Research
Laboratory, China Medical University Hospital, Taichung, Taiwan (Republic
of China)
(Sung) Division of Cardiology, Taipei Veterans General Hospital, Taiwan
(Republic of China)
(Shyu) Division of Cardiology, Shin KongWu Ho-Su Memorial Hospital, Taiwan
(Republic of China)
(Lin) Division of Cardiology, Department of Internal Medicine, National
Taiwan University Hospital, Taipei, Taiwan (Republic of China)
(Mar) Division of Cardiology, Kaohsiung Veterans General Hospital,
Kaohsiung, Taiwan (Republic of China)
(Chan) Department of Internal Medicine, Chung-Shan Medical University
Hospital, Taichung, Taiwan (Republic of China)
(Kuo) Division of Cardiology, Department of Internal Medicine, MacKay
Memorial Hospital, Taipei, Taiwan (Republic of China)
(Wang) Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi
Medical Foundation, Hualien, Taiwan (Republic of China)
(Chen) Division of Cardiovascular Medicine, Chimei Medical Center, Tainan,
Taiwan (Republic of China)
(Tseng) Division of Cardiology, Department of Internal Medicine, E-Da
Hospital, Kaohsiung, Taiwan (Republic of China)
Title
One-year outcomes of acute decompensated systolic heart failure in Taiwan:
Lessons from TSOC-HFreF registry.
Source
Acta Cardiologica Sinica. 33 (2) (pp 127-138), 2017. Date of Publication:
March 2017.
Publisher
Republic of China Society of Cardiology (E-mail: acs@tsoc.org.tw)
Abstract
Background: Heart failure (HF) is a global health problem. The Taiwan
Society of Cardiology-Heart Failure with reduced Ejection Fraction
(TSOC-HFrEF) registry was a multicenter, observational survey of patients
admitted with HFrEF in Taiwan. The aim of this study was to report the
one-year outcome in this large-cohort of hospitalized patients presenting
with acute decompensated HFrEF. Methods: Patients hospitalized for acute
HFrEF were recruited in 21 hospitals in Taiwan. A total of 1509 patients
were enrolled into the registry by the end of October 2014. Clinical
status, readmission rates and dispensed medications were collected and
analyzed 1 year after patient index hospitalization. Results: Our study
indicated that re-hospitalization rates after HFrEF were 31.9% and 38.5%
at 6 and 12 months after index hospitalization, respectively. Of these
patients, 9.7% of themwere readmittedmore than once. At 6 and 12 months
after hospital discharge, all-cause mortality rates were 9.5% and 15.9%,
respectively, and cardiovascular mortality rateswere 6.8% and 10.5%,
respectively. Twenty-three patients (1.5%) underwent heart
transplantation. During a follow-up period of 1 year, 46.4% of patients
were free from mortality, HF re-hospitalization, left ventricular assist
device use and heart transplantation. At the conclusion of follow-up,
57.5% of patients were prescribed either with angiotensin-converting
enzyme inhibitors or angiotensin receptor blockers; also, 66.3% were
prescribed with beta-blockers and 40.8% were prescribed with
mineralocorticoid receptor antagonists. Conclusions: The TSOC-HFrEF
registry showed evidence of suboptimal practice of guideline-directed
medical therapy and high HF re-hospitalization rate in Taiwan. The
one-year mortality rate of the TSOC-HFrEF registry remained high.
Ultimately, our data indicated a need for further improvement in HF care.
Copyright &#xa9; 2017, Republic of China Society of Cardiology. All rights
reserved.

<59>
Accession Number
614921851
Author
Li H.-R.; Hsu C.-P.; Sung S.-H.; Shih C.-C.; Lin S.-J.; Chan W.-L.; Wu
C.-H.; Lu T.-M.
Institution
(Li) Division of Cardiology, Department of Internal Medicine, Shuang Ho
Hospital, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Hsu, Shih) Division of Cardiovascular Surgery, Department of Surgery,
Taipei Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Hsu, Sung, Shih, Lin, Chan, Lu) School of Medicine, National Yang-Ming
University, Taipei, Taiwan (Republic of China)
(Sung, Lin, Chan, Wu, Lu) Division of Cardiology, Department of Internal
Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (Republic of
China)
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
in patients with diabetic nephropathy and left main coronary artery
disease.
Source
Acta Cardiologica Sinica. 33 (2) (pp 119-126), 2017. Date of Publication:
March 2017.
Publisher
Republic of China Society of Cardiology (E-mail: acs@tsoc.org.tw)
Abstract
Background: Patients with diabetic nephropathy and unprotected left main
(LM) coronary artery disease suffer from high cardiovascular morbidity and
mortality. Although surgical revascularization is currently recommended in
this special patient population, the optimal revascularization method for
this distinct patient group has remained unclear. Methods:We collected 99
consecutive patients with unprotected LMdisease and diabetic nephropathy,
including 46 patients who had undergone percutaneous coronary intervention
(PCI), and 53 who had coronary artery bypass grafting (CABG), with amean
age of 72 +/- 10; with 80.8% male. Diabetic nephropathywas defined as
overt proteinuria (proteinuria > 500 mg/day) and estimated glomerular
filtration rate (eGFR) by the modified Modification of Diet in Renal
Disease (MDRD) equation of less than 60 mL/min/1.73m². The
baseline characteristics, angiographic results and long-term clinical
outcomes were retrospectively analyzed. Results: The baseline
characteristic of all patients were similar except for smokers, low
density lipoprotein (LDL) level and extension of coronary artery disease
involvement. The median follow-up period was 3.8 years. There were 73
patients (74%) considered as high risk with additive European System for
Cardiac Operative Risk Evaluation (EuroSCORE) < 6. During follow-up
period, the long term rate of all-cause death (PCI vs. CABG: 45.7% vs.
58.5%, p = 0.20) and all-cause death/myocardial infarction (MI)/stroke
(PCI vs. CABG: 52.2% vs. 60.4%, p = 0.41) were comparable between the PCI
and CABG group, whereas the repeat revascularization rate was
significantly higher in the PCI group (PCI vs. CABG: 32.6% vs. 9.4%, p <
0.01). eGFR remained an independent predictor for all-cause death [hazard
ratio: 0.97, 95% confidence interval: 0.96 to 0.99; p = 0.002] in
multivariate logistic regression. Conclusions: In the real-world practice
of high-risk patients with unprotected LM disease and diabetic
nephropathy, we found that PCI was a comparable alternative to CABG in
terms of long-term risks of all-cause death/MI/stroke, with significantly
higher repeat revascularization rate. Given the small patient number and
retrospective nature, our findings should be validated by larger-scale
randomized studies. Copyright &#xa9; 2017, Republic of China Society of
Cardiology. All rights reserved.

<60>
Accession Number
614635135
Author
Tutic-Horn M.; Gambazzi F.; Rocco G.; Mosimann M.; Schneiter D.; Opitz I.;
Martucci N.; Hillinger S.; Weder W.; Jungraithmayr W.
Institution
(Tutic-Horn, Schneiter, Opitz, Hillinger, Weder, Jungraithmayr) Department
of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
(Gambazzi, Mosimann) Division of Thoracic Surgery, Cantonal Hospital
Aarau, Aarau, Switzerland
(Rocco, Martucci) Division of Thoracic Surgery, University Hospital
Naples, Naples, Italy
(Jungraithmayr) Department of Thoracic Surgery, Medical University
Brandenburg, Germany
Title
Curative resection for lung cancer in octogenarians is justified.
Source
Journal of Thoracic Disease. 9 (2) (pp 296-302), 2017. Date of
Publication: 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Due to an increased life expectancy in a healthy aging
population and a progressive incidence of lung cancer, curative pulmonary
resections can be performed even in octogenarians. The present study aims
to investigate whether surgery is justified in patients reaching the age
of 80 years and older who undergo resection for non-small cell lung cancer
(NSCLC). Methods: In this retrospective multi-centre analysis, the
morbidity, mortality and long-term survival of 88 patients (24 females)
aged =80 who underwent complete resection for lung cancer between 2000 and
2013 were analysed. Only fit patients with few comorbidities, low
cardiopulmonary risk, good quality of life and a life expectancy of at
least 5 years were included. Results: Curative resections from three
thoracic surgery centres included 61 lobectomies, 9 bilobectomies, 6
pneumonectomies and 12 segmentectomies or wide wedge resections with
additional systematic mediastinal lymphadenectomy in all cases. Final
histology revealed squamous cell carcinoma [33], adenocarcinoma [41],
large cell carcinoma [5] or other histological types [9]. Lung cancer
stage distribution was 0 [1], I [53], II [17] and IIIA [14]. The overall
90-day mortality was 1.1%. The median hospitalisation and chest drainage
times were 10 days (range, 5-27 days) and 5 days (range, 0-17 days),
respectively. Thirty-six patients were complication-free (41%). In
particular, pulmonary complications occurred in 25 patients (28%). In
addition, 23 patients (26%) developed cardiovascular complications
requiring medical intervention, while 24 patients (27%) had
cerebrovascular complications, urinary tract infection and others. The
median survival time was 51 months (range, 1-110 months), and the 5-year
overall survival reached 45% without significance between tumour stages.
Conclusions: Curative lung resections in selected octogenarians can be
safely performed up to pneumonectomy for all tumour stages with a
perioperative mortality, morbidity, and 5-year survival rate comparable to
younger cohorts. Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<61>
Accession Number
614651175
Author
Wang Z.J.; Zhang L.L.; Elmariah S.; Han H.Y.; Zhou Y.J.
Institution
(Wang, Zhang, Han, Zhou) Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart Lung and Blood Vessel Disease, The
Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of
Education, Beijing, China
(Elmariah) Cardiology Division, Department of Medicine, Massachusetts
General Hospital, Boston, United States
Title
Prevalence and Prognosis of Nonobstructive Coronary Artery Disease in
Patients Undergoing Coronary Angiography or Coronary Computed Tomography
Angiography: A Meta-Analysis.
Source
Mayo Clinic Proceedings. 92 (3) (pp 329-346), 2017. Date of Publication:
01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Objective To evaluate the prevalence, clinical characteristics, and risk
of cardiac events in patients with nonobstructive coronary artery disease
(CAD). Patients and Methods We searched PubMed, EMBASE, and the Cochrane
Library from January 1, 1990, to November 31, 2015. Studies were included
if they reported prevalence or prognosis of patients with nonobstructive
CAD (<50% stenosis) among patients with known or suspected CAD. Patients
with nonobstructive CAD were further grouped as those with no angiographic
CAD (0% or <20%) and those with mild CAD (>0% or >20% to <50%). Data were
pooled using random effects modeling, and annualized event rates were
assessed. Results Fifty-four studies with 1,395,190 participants were
included. The prevalence of patients with nonobstructive CAD was 67% (95%
CI, 63%-71%) among patients with stable angina and 13% (95% CI, 11%-16%)
among patients with non-ST-segment elevation acute coronary syndrome. The
prevalence varied depending on sex, clinical setting, and risk profile of
the population investigated. The risk of hard cardiac events (cardiac
death or myocardial infarction) in patients with mild CAD was lower than
that in patients with obstructive CAD (risk ratio, 0.28; 95% CI,
0.20-0.38) but higher than that in those with no angiographic CAD (risk
ratio, 1.85; 95% CI, 1.52-2.26). The annualized event rates of hard
cardiac events in patients with no angiographic CAD, mild CAD, and
obstructive CAD were 0.3% (95% CI, 0.1%-0.4%), 0.7% (95% CI, 0.5%-1.0%),
and 2.7% (95% CI, 1.7%-3.7%), respectively, among patients with stable
angina and 1.2% (95% CI, 0.02%-2.3%), 4.1% (95% CI, 3.3%-4.9%), and 17.0%
(95% CI, 8.4%-25.7%) among patients with non-ST-segment elevation acute
coronary syndrome. The correlation between CAD severity and prognosis is
consistent regardless of clinical presentation of all-cause death,
myocardial infarction, total cardiovascular events, and revascularization.
Conclusion Nonobstructive CAD is associated with a favorable prognosis
compared with obstructive CAD, but it is not benign. The high prevalence
and impaired prognosis of this population warrants further efforts to
improve the risk stratification and management of patients with
nonobstructive CAD. Copyright &#xa9; 2016 Mayo Foundation for Medical
Education and Research

<62>
Accession Number
614636395
Author
Yang X.-L.; Wang D.; Zhang G.-Y.; Guo X.-L.
Institution
(Yang, Wang) Affiliated Hospital of North Sichuan Medical College,
Departments of Anaesthesiology, 63# Wenhua Road, Nanchong, Sichuan,
Shunqing District 637000, China
(Zhang, Guo) Affiliated Hospital of North Sichuan Medical College,
Laboratory Medicine, Nanchong, Sichuan 637000, China
Title
Comparison of the myocardial protective effect of sevoflurane versus
propofol in patients undergoing heart valve replacement surgery with
cardiopulmonary bypass.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 37. Date
of Publication: 04 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: This study aimed to compare myocardial protective effects of
anaesthesia with intravenous infusion of propofol versus inhalation of
sevoflurane in patients undergoing heart valve replacement surgery with
cardiopulmonary bypass. Methods: Seventy-six patients undergoing valve
replacement with cardiopulmonary bypass were randomly assigned to propofol
or sevoflurane anesthesia during the surgery, respectively. For assessing
myocardial injury, cardiac troponin I (cTnI) and creatine kinase isozyme
(CK-MB) were determined before induction (T<inf>0</inf>), 0.5 h
(T<inf>1</inf>) and 3 h (T<inf>2</inf>) after aortic unclamping, and 24 h
(T<inf>3</inf>) and 48 h (T<inf>4</inf>) after surgery. The concentrations
of interleukin (IL)-6 and IL-10 as the systemic inflammatory and
anti-inflammatory markers were also measured at above time points.
Results: In the sevoflurane group, the plasma concentrations of cTnI and
CK-MB from T<inf>l</inf> to T<inf>4</inf> and the levels of IL-6 and IL-10
from T<inf>1</inf> to T<inf>2</inf> were lower than those in the propofol
group. Moreover, a higher ratio of automatic heart beat recovery and a
shorter length of intensive care unit or hospital stay were found in the
sevoflurane group comparing with the propofol group. Conclusion:
Sevoflurane anaesthesia produced more prominent myocardial protection and
attenuated inflammatory response than propofol anaesthesia in patients
with valve replacement surgery under cardiopulmonary bypass, resulting in
shorter ICU and in-hospital stay. Retrospective clinical trial
registration: Identified as ChiCTR-IOR-16009979at
http://www.chictr.org.cn/. Copyright &#xa9; 2017 The Author(s).

<63>
[Use Link to view the full text]
Accession Number
613905145
Author
Samanta A.; Dawn B.
Institution
(Samanta, Dawn) Division of Cardiovascular Diseases, Cardiovascular
Research Institute, Midwest Stem Cell Therapy Center, University of Kansas
Medical Center and Hospital, 3901 Rainbow Blvd, 1001 Eaton, MS 3006,
Kansas City, KS 66160, United States
Title
Remote Ischemic Preconditioning for Cardiac Surgery: Reflections on
Evidence of Efficacy.
Source
Circulation Research. 118 (7) (pp 1055-1058), 2016. Date of Publication:
01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Ever since its discovery more than 2 decades ago, remote ischemic
preconditioning (RIPC) has generated tremendous interest among scientists
and clinicians alike. However, two recent large, well-conducted,
randomized controlled trials (RCTs) have failed to identify any
significant benefit of RIPC during cardiac surgery. A reconciliatory yet
objective review of cumulative evidence with regard to cardiac surgery
reveals that RIPC in preclinical studies reduced infarct size after
experimental myocardial infarction (MI), which is different from cardiac
surgery; improved release of biomarkers, but not hard clinical end points,
in proof-of-concept clinical trials with discordant results; and failed to
produce significant improvement in outcomes in meta-analyses. This
difficult journey of RIPC across the valley of death underscores the
importance of scientific rigor and exercise of caution in interpreting
data at every step of the way until efficacy of a purported therapy is
proven conclusively in large RCTs. Copyright &#xa9; 2016 American Heart
Association, Inc.

<64>
[Use Link to view the full text]
Accession Number
613905052
Author
Garratt K.N.; Whittaker P.; Przyklenk K.
Institution
(Garratt) Center for Heart and Vascular Health, Christiana Care Health
System, Wilmington, DE, United States
(Whittaker, Przyklenk) Cardiovascular Research Institute, Wayne State
University School of Medicine, Elliman Bldg, Room 1107, 421 E Canfield,
Detroit, MI 48201, United States
(Whittaker, Przyklenk) Department of Emergency Medicine, Wayne State
University School of Medicine, Detroit, MI, United States
(Przyklenk) Department of Physiology, Wayne State University School of
Medicine, Detroit, MI, United States
Title
Remote Ischemic Conditioning and the Long Road to Clinical Translation:
Lessons Learned from ERICCA and RIPHeart.
Source
Circulation Research. 118 (7) (pp 1052-1054), 2016. Date of Publication:
01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Remote ischemic conditioning (RIC) is the phenomenon whereby brief
episodes of peripheral ischemia-reperfusion, typically applied to >1 limbs
by inflation-deflation of a standard blood pressure cuff, increase the
tolerance of the myocardium to a sustained ischemic episode. Compelling
preclinical evidence of infarct size reduction with RIC, together with
promising results from small, proof-of-concept phase II trials, has
yielded cautious optimism that RIC may be the long sought-after
cardioprotective strategy capable of attenuating morbidity and mortality
in patients having a spontaneous or planned period of prolonged cardiac
ischemia. Progress toward clinical translation may, however, be hindered
by the recent release of 2 eagerly anticipated phase III trials. ERICCA
(Effect of Remote Ischemic Preconditioning on Clinical Outcomes in
Patients Undergoing Coronary Artery Bypass Graft Surgery) and RIPHeart
(Remote Ischaemic Preconditioning for Heart Surgery), both published in
the New England Journal of Medicine and both designed to assess major
adverse cardiac and cerebrovascular events after cardiac surgery in
RIC-treated cohorts versus sham controls, concluded that RIC had no
benefit on clinical outcomes. Copyright &#xa9; 2016 American Heart
Association, Inc.

<65>
Accession Number
614901062
Author
Keesakul C.; Sae-Ngow P.; Euaraksakul P.; Karnjanarachata C.
Institution
(Keesakul, Sae-Ngow, Euaraksakul, Karnjanarachata) Department of
Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
Title
The effect of reverse trendelenburg position on incidence of hypotension
after spinal anesthesia for cesarean section.
Source
Journal of the Medical Association of Thailand. 99 (12) (pp 1322-1327),
2016. Date of Publication: December 2016.
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Objective: To prove if 10-degree head-up tilt position during conduction
of spinal anesthesia and continue through the operation will reduce the
incidence of hypotension comparing to horizontal position in elective
cesarean section parturient. Material and Method: In this randomized
double-blind controlled trial. Forty-four parturient were equally
allocated into 10-degree head-up tilt and horizontal position during
conduction of spinal anesthesia and continue during the operation. Blood
pressure, heart rate, incidence of hypotension, ephedrine consumption, and
anesthesia level were compared. Results: Incidence of hypotension and
percentage of parturient that required ephedrine were comparable in
control and study groups (72.73% vs. 45.45%, p = 0.066) but lower before
cord clamping in the study group (68.18% vs. 36.36%, p = 0.03). The
sensory block levels were identical but more parturient in the study group
required reposition in order to gain the required anesthetic level.
Conclusion: Ten-degree head-up tilt position during conduction and
maintenance of spinal anesthesia for cesarean section reduced incidence of
hypotension and ephedrine consumption without any adverse effect in both
parturient and newly-born babies. Copyright &#xa9; 2016, Medical
Association of Thailand. All rights reserved.

<66>
Accession Number
611339407
Author
Cassina T.; Putzu A.; Santambrogio L.; Villa M.; Licker M.
Institution
(Cassina, Putzu, Santambrogio, Villa) Department of Cardiac Anesthesia and
Intensive Care, Cardiocentro Ticino Foundation, Via Tesserete 48, Lugano
6900, Switzerland
(Licker) Department of Anesthesiology, Pharmacology and Intensive Care,
Faculty of Medicine, University Hospital of Geneva, Geneva 1206,
Switzerland
Title
Hemodynamic challenge to early mobilization after cardiac surgery: A pilot
study.
Source
Annals of Cardiac Anaesthesia. 19 (3) (pp 425-432), 2016. Date of
Publication: July-September 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Active mobilization is a key component in fast-track surgical
strategies. Following major surgery, clinicians are often reluctant to
mobilize patients arguing that circulatory homeostasis would be impaired
as a result of myocardial stunning, fluid shift, and autonomic
dysfunction. Aims: We examined the feasibility and safety of a
mobilization protocol 12-24 h after elective cardiac surgery. Setting and
Design: This observational study was performed in a tertiary nonacademic
cardiovascular Intensive Care Unit. Materials and Methods: Over a 6-month
period, we prospectively evaluated the hemodynamic response to a
two-staged mobilization procedure in 53 consecutive patients. Before,
during, and after the mobilization, hemodynamics parameters were recorded,
including the central venous oxygen saturation (ScvO <inf>2</inf> ),
lactate concentrations, mean arterial pressure (MAP), heart rate (HR),
right atrial pressure (RAP), and arterial oxygen saturation (SpO
<inf>2</inf> ). Any adverse events were documented. Results: All patients
successfully completed the mobilization procedure. Compared with the
supine position, mobilization induced significant increases in arterial
lactate (34.6% [31.6%, 47.6%], P = 0.0022) along with reduction in RAP
(-33% [-21%, -45%], P < 0.0001) and ScvO <inf>2</inf> (-7.4% [-5.9%,
-9.9%], P = 0.0002), whereas HR and SpO <inf>2</inf> were unchanged.
Eighteen patients (34%) presented a decrease in MAP > 10% and nine of them
(17%) required treatment. Hypotensive patients experienced a greater
decrease in ScvO <inf>2</inf> (-18 +/- 5% vs. -9 +/- 4%, P = 0.004) with
similar changes in RAP and HR. All hemodynamic parameters, but arterial
lactate, recovered baseline values after resuming the horizontal position.
Conclusions: Early mobilization after cardiac surgery appears to be a safe
procedure as far as it is performed under close hemodynamic and clinical
monitoring in an intensive care setting. Copyright &#xa9; 2016 Annals of
Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.

<67>
Accession Number
611339392
Author
Das D.; Sen C.; Goswami A.
Institution
(Das, Sen, Goswami) Department of Cardiac Anaesthesiology, Institute of
Postgraduate Medical Education and Research, Waves Apartment, 67 Beleghata
Main Road, Kolkata, West-Bengal 700 010, India
Title
Effect of Vitamin C on adrenal suppression by etomidate induction in
patients undergoing cardiac surgery: A randomized controlled trial.
Source
Annals of Cardiac Anaesthesia. 19 (3) (pp 410-417), 2016. Date of
Publication: July-September 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Etomidate is usually preferred in the induction of cardiac
compromised patients due to its relative cardiovascular stability.
However, the use of this drug has been limited as etomidate induces
suppression of cortisol biosynthesis as a result of blockade of
11-beta-hydroxylation in the adrenal gland, mediated by the imidazole
radical of etomidate. This study was carried out to observe the effect of
Vitamin C on adrenal suppression after etomidate induction in patients
undergoing cardiac surgery. Materials and Methods: A total of 78 patients
were randomly distributed into two groups. Group-I received oral Vitamin C
(500 mg) twice daily and Group-II received antacid tablet as placebo twice
daily instead of Vitamin C for 7 consecutive days prior to surgery till
morning of surgery. Patients of both the groups induced with etomidate
(0.1-0.3 mg/kg). Blood cortisol was estimated at different points of time
till 24 ^th postinduction hour/blood lactate, glucose,
hemodynamic parameters, and perioperative outcomes were assessed. Results:
Data of seventy patients (n = 35 in each group) were finally analyzed.
Cortisol level is statistically significantly higher in Group-I (69.51 +/-
7.65) as compared to Group-II (27.74 +/- 4.72) (P < 0.05) in the 1
^st postinduction hour. In Group-II, cortisol was consistently
lower for 1 ^st 24 postinduction hour. Total adrenaline
requirement was statistically significantly high in Group-II. Time of
extubation, length of Intensive Care Unit stay arrhythmia was similar in
both the groups. Conclusion: Vitamin C effectively inhibits
etomidate-induced adrenal suppression in cardiac patients, thereby
etomidate can be used as a safe alternative for induction in cardiac
surgery under cardiopulmonary bypass when pretreated with Vitamin C.
Copyright &#xa9; 2016 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.

<68>
Accession Number
613003206
Author
Ortega-Loubon C.; Fernandez-Molina M.; Carrascal-Hinojal Y.;
Fulquet-Carreras E.
Institution
(Ortega-Loubon, Fernandez-Molina, Carrascal-Hinojal, Fulquet-Carreras)
Department of Cardiac Surgery, Clinic University Hospital of Valladolid,
Ramon y Cajal, Valladolid 47003, Spain
Title
Cardiac surgery-associated acute kidney injury.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 687-698), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a
well-recognized complication resulting with the higher morbid-mortality
after cardiac surgery. In its most severe form, it increases the odds
ratio of operative mortality 3-8-fold, length of stay in the Intensive
Care Unit and hospital, and costs of care. Early diagnosis is critical for
an optimal treatment of this complication. Just as the identification and
correction of preoperative risk factors, the use of prophylactic measures
during and after surgery to optimize renal function is essential to
improve postoperative morbidity and mortality of these patients.
Cardiopulmonary bypass produces an increased in tubular damage markers.
Their measurement may be the most sensitive means of early detection of
AKI because serum creatinine changes occur 48 h to 7 days after the
original insult. Tissue inhibitor of metalloproteinase-2 and insulin-like
growth factor-binding protein 7 are most promising as an early diagnostic
tool. However, the ideal noninvasive, specific, sensitive, reproducible
biomarker for the detection of AKI within 24 h is still not found. This
article provides a review of the different perspectives of the CSA-AKI,
including pathogenesis, risk factors, diagnosis, biomarkers,
classification, postoperative management, and treatment. We searched the
electronic databases, MEDLINE, PubMed, EMBASE using search terms relevant
including pathogenesis, risk factors, diagnosis, biomarkers,
classification, postoperative management, and treatment, in order to
provide an exhaustive review of the different perspectives of the CSA-AKI.

<69>
Accession Number
613003194
Author
Naghipour B.; Faridaalaee G.; Shadvar K.; Bilehjani E.; Khabaz A.H.;
Fakhari S.
Institution
(Naghipour, Shadvar, Bilehjani, Khabaz, Fakhari) Department of
Anesthesiology and Intensive Care, Faculty of Medicine, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Faridaalaee) Department of Emergency Medicine, Maragheh University of
Medical Sciences, Maragheh, Iran, Islamic Republic of
Title
Effect of prophylaxis of magnesium sulfate for reduction of postcardiac
surgery arrhythmia: Randomized clinical trial.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 662-667), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Arrhythmia is a common complication after heart surgery and is
a major source of morbidity and mortality. Aims: This study aimed to study
the effect of magnesium sulfate (MgSO<inf>4</inf>) for reduction of
postcardiac surgery arrhythmia. Setting and Design: This study is
performed in the cardiac operating room and Intensive Care Unit (ICU) of
Shahid Madani Hospital of Tabriz (Iran) between January 1, 2014, and
September 30, 2014. This study is a double-blind, randomized controlled
trial. Materials and Methods: In Group 1 (group magnesium [Mg]), eighty
patients received 30 mg/kg MgSO<inf>4</inf>in 500 cc normal saline and in
Group 2 (group control), eighty patients received 500 cc normal saline
alone. Statistical Analysis: The occurrence of arrhythmia was compared
between groups by Chi-square and Fisher's exact test. In addition,
surgical time, length of ICU stay, and length of hospital stay were
compared by independent t-test. P< 0.05 was considered as significant.
Results: There was a significant difference in the incidence of arrhythmia
between two groups (P = 0.037). The length of ICU stay was 3.4 +/- 1.4 and
3.73 +/- 1.77 days in group MgSO<inf>4</inf>and control group,
respectively, and there was no statistically significant difference
between two groups (P = 0.2). Conclusion: Mg significantly decreases the
incidence of all type of postcardiac surgery arrhythmia and hospital
length of stay at patients undergo cardiac surgery. We offer prophylactic
administration of Mg at patients undergo cardiac surgery.

<70>
Accession Number
613003191
Author
Sahu M.K.; Singal A.; Menon R.; Singh S.P.; Mohan A.; Manral M.; Singh D.;
Devagouru V.; Talwar S.; Choudhary S.K.
Institution
(Sahu, Menon, Singh) Department of CTVS, Intensive Care for CTVS, All
India Institute of Medical Sciences, New Delhi 110029, India
(Singal, Mohan, Manral, Singh) Department of Dietetics, Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Devagouru, Talwar, Choudhary) Department of Cardiothoracic and Vascular
Surgery, All India Institute of Medical Sciences, New Delhi, India
Title
Early enteral nutrition therapy in congenital cardiac repair
postoperatively: A randomized, controlled pilot study.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 653-661), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background and Objectives: Adequate nutritional supplementation in infants
with cardiac malformations after surgical repair is a challenge.
Critically ill infants in the early postoperative period are in a
catabolic stress. The mismatch between estimated energy requirement (EER)
and the intake in the postoperative period is multifactorial, predisposing
them to complications such as immune deficiency, more infection, and
growth failure. This study aimed to assess the feasibility and efficacy of
enriched breast milk feed on postoperative recovery and growth of infants
after open heart surgery. Methodology: Fifty infants <6 months of age were
prospectively randomized in the trial for enteral nutrition (EN)
postoperatively from day 1 to 10, after obtaining the Institute Ethics
Committee's approval. They were equally divided into two groups on the
basis of the feed they received: Control group was fed with expressed
breast milk (EBM; 0.65 kcal/ml) and intervention group was fed with EBM +
energy supplementation/fortification with human milk fortifier (7.5 kcal/2
g)/Simyl medium-chain triglyceride oil (7.8 kcal/ml). Energy need for each
infant was calculated as per EER at 90 kcal/kg/day, as the target
requirement. The intra-and post-operative variables such as
cardiopulmonary bypass and aortic cross-clamp times, ventilation duration,
Intensive Care Unit (ICU), and hospital length of stay and mortality were
recorded. Anthropometric and hematological parameters and infection
control data were recorded in a predesigned pro forma. Data were analyzed
using Stata 14.1 software. Results: The duration of mechanical
ventilation, length of ICU stay (LOIS), length of hospital stay (LOHS),
infection rate, and mortality rate were lower in the intervention group
compared to the control group although none of the differences were
statistically significant. Infants in control group needed mechanical
ventilation for about a day more (i.e., 153.6 +/- 149.0 h vs. 123.2 +/-
107.0 h; P = 0.20) than those in the intervention group. Similarly,
infants in control group stayed for longer duration in the ICU (13.2 +/-
8.9 days) and hospital (16.5 +/- 9.8 days) as compared to the intervention
group (11.0 +/- 6.1 days; 14.1 +/- 7.0 days) (P = 0.14 and 0.17,
respectively). The LOIS and LOHS were decreased by 2.2 and 2.4 days,
respectively, in the intervention group compared to control group. The
infection rate (3/25; 5/25) and mortality rate (1/25; 2/25) were lower in
the intervention group than those in the control group. The energy intake
in the intervention group was 40 kcal more (i.e., 127.2 +/- 56.1 kcal vs.
87.1 +/- 38.3 kcal) than the control group on the 10^th
postoperative day. Conclusions: Early enteral/oral feeding after cardiac
surgery is feasible and recommended. In addition, enriching the EBM is
helpful in achieving the maximum possible calorie intake in the
postoperative period. EN therapy might help in providing adequate
nutrition, and it decreases ventilation duration, infection rate, LOIS,
LOHS, and mortality.

<71>
Accession Number
613003187
Author
Kapoor P.M.; Magoon R.; Rawat R.; Mehta Y.
Institution
(Kapoor, Magoon) Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi,
India
(Rawat) Department of Cardiac Anaesthesiology, Salalah Heart Center,
Salalah, Oman
(Mehta) Department of Anaesthesiology and Critical Care, Medanta Medicity,
Gurgaon, Haryana, India
Title
Perioperative utility of goal-directed therapy in high-risk cardiac
patients undergoing coronary artery bypass grafting: A clinical outcome
and biomarker-based study.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 638-645), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Goal-directed therapy (GDT) encompasses guidance of intravenous (IV) fluid
and vasopressor/inotropic therapy by cardiac output or similar parameters
to help in early recognition and management of high-risk cardiac surgical
patients. With the aim of establishing the utility of perioperative GDT
using robust clinical and biochemical outcomes, we conducted the present
study. This multicenter randomized controlled study included 130 patients
of either sex, with European system for cardiac operative risk evaluation
>3 undergoing coronary artery bypass grafting on cardiopulmonary bypass.
The patients were randomly divided into the control and GDT group. All the
participants received standardized care; arterial pressure monitored
through radial artery, central venous pressure (CVP) through a triple
lumen in the right internal jugular vein, electrocardiogram, oxygen
saturation, temperature, urine output per hour, and frequent arterial
blood gas (ABG) analysis. In addition, cardiac index (CI) monitoring using
FloTracTM and continuous central venous oxygen saturation
(ScVO<inf>2</inf>) using PreSepTM were used in patients in the GDT group.
Our aim was to maintain the CI at 2.5-4.2 L/min/m², stroke
volume index 30-65 ml/beat/m², systemic vascular resistance
index 1500-2500 dynes/s/cm⁵/m², oxygen delivery
index 450-600 ml/min/m², continuous ScVO<inf>2</inf> >70%, and
stroke volume variation <10%; in addition to the control group parameters
such as CVP 6-8 mmHg, mean arterial pressure 90-105 mmHg, normal ABG
values, oxygen saturation, hematocrit value >30%, and urine output >1
ml/kg/h. The aims were achieved by altering the administration of IV
fluids and doses of inotropes or vasodilators. The data of sixty patients
in each group were analyzed in view of ten exclusions. The average
duration of ventilation (19.89 +/- 3.96 vs. 18.05 +/- 4.53 h, P = 0.025),
hospital stay (7.94 +/- 1.64 vs. 7.17 +/- 1.93 days, P = 0.025), and
Intensive Care Unit (ICU) stay (3.74 +/- 0.59 vs. 3.41 +/- 0.75 days, P =
0.012) was significantly less in the GDT group, compared to the control
group. The extra volume added and the number of inotropic dose adjustments
were significantly more in the GDT group. The two groups did not differ in
duration of inotropic use, mortality, and other complications. The
perioperative continuation of GDT affected the early decline in the
lactate levels after 6 h in ICU, whereas the control group demonstrated a
settling lactate only after 12 h. Similarly, the GDT group had
significantly lower levels of brain natriuretic peptide, neutrophil
gelatinase-associated lipocalin levels as compared to the control. The
study clearly depicts the advantage of GDT for a favorable postoperative
outcome in high-risk cardiac surgical patients.

<72>
Accession Number
613003182
Author
El-Shmaa N.S.; El Amrousy D.; El Feky W.
Institution
(El-Shmaa) Department of Anesthesia and Surgical ICU, Faculty of Medicine,
Tanta University, Tanta, Egypt
(El Amrousy) Department of Pediatrics, Tanta University Hospital, Tanta,
Egypt
(El Feky) Department of Cardiothoracic Surgery, Tanta University Hospital,
Tanta, Egypt
Title
The efficacy of pre-emptive dexmedetomidine versus amiodarone in
preventing postoperative junctional ectopic tachycardia in pediatric
cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 614-620), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The objective of this study was to assess the effectiveness of
pre-emptive dexmedetomidine versus amiodarone in preventing junctional
ectopic tachycardia (JET) in pediatric cardiac surgery. Design: This is a
prospective, controlled study. Setting: This study was carried out at a
single university hospital. Subjects and Methods: Ninety patients of both
sexes, American Society of Anesthesiologists Physical Status II and III,
age range from 2 to 18 years, and scheduled for elective cardiac surgery
for congenital and acquired heart diseases were selected as the study
participants. Interventions: Patients were randomized into three groups
(30 each). Group I received dexmedetomidine 1 mcg/kg diluted in 100 ml of
normal saline intravenously (IV) over a period of 20 min, and the infusion
was completed 10 min before the induction followed by a 0.5 mcg/kg/h
infusion for 72 h postoperative, Group II received amiodarone 5 mg/kg
diluted in 100 ml of normal saline IV over a period of 20 min, and the
infusion was completed 10 min before the induction followed by a 10-15
mcg/kg/h infusion for 72 h postoperative, and Group III received 100 ml of
normal saline IV. Primary outcome was the incidence of postoperative JET.
Secondary outcomes included vasoactive-inotropic score, ventilation time
(VT), pediatric cardiac care unit stay, hospital length of stay, and
perioperative mortality. Measurements and Main Results: The incidence of
JET was significantly reduced in Group I and Group II (P = 0.004) compared
to Group III. Heart rate while coming off from cardiopulmonary bypass
(CPB) was significantly low in Group I compared to Group II and Group III
(P = 0.000). Mean VT, mean duration of Intensive Care Unit stay, and
length of hospital stay (day) were significantly short (P = 0.000) in
Group I and Group II compared to Group III (P = 0.000). Conclusion:
Perioperative use of dexmedetomidine and amiodarone is associated with
significantly decreased incidence of JET as compared to placebo without
significant side effects.

<73>
Accession Number
613003179
Author
Soliman R.; Zohry G.
Institution
(Soliman, Zohry) Department of Anesthesia, Cairo University, Cairo, Egypt
Title
The myocardial protective effect of dexmedetomidine in high-risk patients
undergoing aortic vascular surgery.
Source
Annals of Cardiac Anaesthesia. 19 (4) (pp 606-613), 2016. Date of
Publication: October-December 2016.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The aim of the study was to assess the effect of
dexmedetomidine in high-risk patients undergoing aortic vascular surgery.
Design: A randomized prospective study. Setting: Cairo University, Egypt.
Materials and Methods: The study included 150 patients undergoing aortic
vascular surgery. Intervention: The patients were classified into two
groups (n = 75). Group D: The patients received a loading dose of 1 mug/kg
dexmedetomidine over 15 min before induction and maintained as an infusion
of 0.3 mug/kg/h to the end of the procedure. Group C: The patients
received an equal volume of normal saline. The medication was prepared by
the nursing staff and given to anesthetist blindly. Measurements: The
monitors included the heart rate, mean arterial blood pressure, central
venous pressure, electrocardiogram (ECG), serum troponin I level,
end-tidal sevoflurane, and total dose of morphine in addition
transthoracic echocardiography to the postoperative in cases with elevated
serum troponin I level. Main Results: The dexmedetomidine decreased heart
rate and minimized the changes in blood pressure compared to control group
(P < 0.05). Furthermore, it decreased the incidence of myocardial ischemia
reflected by troponin I level, ECG changes, and the development of new
regional wall motion abnormalities (P < 0.05). Dexmedetomidine decreased
the requirement for nitroglycerin and norepinephrine compared to control
group (P < 0.05). The incidence of hypotension and bradycardia was
significantly higher with dexmedetomidine (P < 0.05). Conclusion: The
dexmedetomidine is safe and effective in patients undergoing aortic
vascular surgery. It decreases the changes in heart rate and blood
pressure during the procedures. It provides cardiac protection in
high-risk patients reflected by decreasing the incidence of myocardial
ischemia and serum level of troponin. The main side effects of
dexmedetomidine were hypotension and bradycardia.

<74>
Accession Number
610940970
Author
Prokopchuk-Gauk O.; Rosin M.W.; Mycyk T.R.; Lim H.J.; Brose K.
Institution
(Prokopchuk-Gauk) Department of Pathology and Laboratory Medicine,
University of Saskatchewan, Saskatoon, SK, Canada
(Rosin) Clinical Perfusion, Royal University Hospital, Saskatoon, SK,
Canada
(Mycyk) Division of Cardiac Surgery, Department of Surgery, University of
Saskatchewan, Saskatoon, SK, Canada
(Lim) Department of Community Health and Epidemiology, University of
Saskatchewan, Saskatoon, SK, Canada
(Brose) Division of Hematology, Department of Medicine, University of
Saskatchewan, Saskatoon, SK, Canada
(Prokopchuk-Gauk, Mycyk, Brose) Royal University Hospital, Saskatoon, SK,
Canada
Title
Dual-route tranexamic acid to reduce blood loss in coronary artery bypass
graft surgery: a randomized controlled trial.
Source
Canadian Journal of Anesthesia. 63 (9) (pp 1110-1111), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)

<75>
[Use Link to view the full text]
Accession Number
607794891
Author
Khan A.R.; Farid T.A.; Pathan A.; Tripathi A.; Ghafghazi S.; Wysoczynski
M.; Bolli R.
Institution
(Khan, Farid, Pathan, Tripathi, Ghafghazi, Wysoczynski, Bolli) Institute
of Molecular Cardiology, University of Louisville, 550 S Jackson St,
Louisville, KY 40292, United States
Title
Impact of cell therapy on myocardial perfusion and cardiovascular outcomes
in patients with angina refractory to medical therapy: A systematic review
and meta-analysis.
Source
Circulation Research. 118 (6) (pp 984-993), 2016. Date of Publication: 18
Mar 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Rationale: The effect of stem/progenitor cells on myocardial perfusion and
clinical outcomes in patients with refractory angina remains unclear
because studies published to date have been small phase I-II trials.
Objective: We performed a meta-analysis of randomized controlled trials to
evaluate the effect of cell-based therapy in patients with refractory
angina who were ineligible for coronary revascularization. Methods and
Results: Several data sources were searched from inception to September
2015, which yielded 6 studies. The outcomes pooled were indices of angina
(anginal episodes, Canadian Cardiovascular Society angina class, exercise
tolerance, and antianginal medications), myocardial perfusion, and
clinical end points. We combined the reported clinical outcomes
(myocardial infarction, cardiac-related hospitalization, and mortality)
into a composite end point (major adverse cardiac events). Mean difference
(MD), standardized mean differences, or odds ratio were calculated to
assess relevant outcomes. Our analysis shows an improvement in anginal
episodes (MD, -7.81; 95% confidence interval [CI], -15.22 to -0.41), use
of antianginal medications (standardized MD, -0.59; 95% CI, -1.03 to
-0.14), Canadian Cardiovascular Society class (MD, -0.58; 95% CI, -1.00 to
-0.16), exercise tolerance (standardized MD, 0.331; 95% CI, 0.08 to 0.55),
and myocardial perfusion (standardized MD, -0.49; 95% CI, -0.76 to -0.21)
and a decreased risk of major adverse cardiac events (odds ratio, 0.49;
95% CI, 0.25 to 0.98) and arrhythmias (odds ratio, 0.25; 95% CI, 0.06 to
0.98) in cell-treated patients when compared with patients on maximal
medical therapy. Conclusions: The present meta-analysis indicates that
cell-based therapies are not only safe but also lead to an improvement in
indices of angina, relevant clinical outcomes, and myocardial perfusion in
patients with refractory angina. These encouraging results suggest that
larger, phase III randomized controlled trials are in order to
conclusively determine the effect of stem/progenitor cells in refractory
angina. Copyright &#xa9; 2016 American Heart Association, Inc.

<76>
Accession Number
614982177
Author
Hinzpeter R.; Eberhard M.; Burghard P.; Tanner F.C.; Taramasso M.; Manka
R.; Feuchtner G.; Maisano F.; Alkadhi H.
Institution
(Hinzpeter, Eberhard, Manka, Alkadhi) Institute of Diagnostic and
Interventional Radiology, University Hospital Zurich, Ramistr. 100, Zurich
CH-8091, Switzerland
(Burghard, Feuchtner) Department of Radiology, Innsbruck Medical
University, Innsbruck, Austria
(Tanner, Manka) Department of Cardiology, University Heart Center Zurich,
Zurich, Switzerland
(Taramasso, Maisano) Department of Cardiovascular Surgery, University
Hospital of Zurich, Zurich, Switzerland
(Manka) Institute for Biomedical Engineering, University and ETH Zurich,
Zurich, Switzerland
Title
Computed tomography in patients with tricuspid regurgitation prior to
transcatheter valve repair: Dynamic analysis of the annulus with an
individually tailored contrast media protocol.
Source
EuroIntervention. 12 (15) (pp e1828-e1836), 2017. Date of Publication:
February 2017.
Publisher
EuroPCR
Abstract
Aims: The aim of this study is to present a contrast media (CM) protocol
for the dynamic visualisation of the tricuspid valve (TV) and tricuspid
annulus (TA) with CT. Methods and results: Fifteen patients with no
cardiac abnormalities (controls), 15 patients with functional tricuspid
regurgitation (FTR) <3+, and 13 patients with FTR ?3+ underwent a
dedicated cardiac CT protocol. Using advanced visualisation, segmentation
and analysis software, the annular area, entire annular circumference, its
three parts, and annular diameters were measured by two independent,
blinded readers. The homogeneity of attenuation in the right heart was 63
HU in the RA and 46 HU in the RV, showing a significant negative
correlation with the degree of FTR (r=-0.61, p<0.001). The annular area,
entire annulus and diameters were larger in patients with FTR compared to
controls (p<0.05). There were significant differences between systole and
diastole in controls and patients with FTR <3+ and FTR ?3+ for the annular
area and annulus (p<0.05). The annulus was significantly smaller (all,
p<0.05) in 2D compared to 3D (systematic underestimation: 1.0-1.3 mm), the
difference decreasing with increasing FTR grades. Conclusions: This study
introduces an individually tailored CM protocol for optimised
visualisation of the TV with CT. We found dynamic changes of the geometry
within the cardiac cycle and between 3D and 2D measurements, the latter
systematically underestimating the true size of the TA. Use of this CM
protocol enables accurate imaging of the dynamic geometry of the TA prior
to transcatheter valve repair. Copyright &#xa9; Europa Digital &
Publishing 2017. All rights reserved.

<77>
Accession Number
614976424
Author
Siontis G.C.M.; Praz F.; Pilgrim T.; Mavridis D.; Verma S.; Salanti G.;
Sondergaard L.; Juni P.; Windecker S.
Institution
(Siontis, Praz, Pilgrim, Windecker) Department of Cardiology, INSELSPITAL,
Bern University Hospital, University of Bern, Bern 3010, Switzerland
(Mavridis, Salanti) Department of Hygiene and Epidemiology, University of
Ioannina, School of Medicine, Ioannina, Greece
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Salanti) Institute of Social and Preventive Medicine, Clinical Trials
Unit, University of Bern, Bern, Switzerland
(Salanti) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
(Sondergaard) Department of Cardiology, Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute, St. Michael's Hospital, Toronto, Canada
Title
Transcatheter aortic valve implantation vs. surgical aortic valve
replacement for treatment of severe aortic stenosis: A meta-analysis of
randomized trials.
Source
European Heart Journal. 37 (47) (pp 3503-3512a), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims In view of the currently available evidence from randomized trials,
we aimed to compare the collective safety and efficacy of transcatheter
aortic valve implantation (TAVI) vs. surgical aortic valve replacement
(SAVR) across the spectrum of risk and in important subgroups. Methods and
results Trials comparing TAVI vs. SAVR were identified through Medline,
Embase, and Cochrane databases. The primary outcome was death from any
cause at 2 years.We performed random-effects meta-analyses to combine the
available evidence and to evaluate the effect in different subgroups. This
systematic review and meta-analysis is registered with PROSPERO
(CRD42016037273). We identified four eligible trials including 3806
participants, who were randomly assigned to undergo TAVI (n = 1898) or
SAVR (n = 1908). For the primary outcome of death from any cause, TAVI
when compared with SAVR was associated with a significant 13% relative
risk reduction [hazard ratio (95% CI): 0.87 (0.76-0.99); P = 0.038] with
homogeneity across all trials irrespective of TAVI device (Pinteraction =
0.306) and baseline risk (Pinteraction = 0.610). In subgroup analyses,
TAVI showed a robust survival benefit over SAVR for patients undergoing
transfemoral access [0.80 (0.69-0.93); P = 0.004], but not transthoracic
access [1.17 (0.88-1.56); P = 0.293] (Pinteraction = 0.024) and in female
[0.68 (0.50-0.91); P = 0.010], but not male patients [0.99 (0.77-1.28); P
= 0.952] (Pinteraction = 0.050). Secondary outcomes of kidney injury,
new-onset atrial fibrillation, and major bleeding favoured TAVI, while
major vascular complications, incidence of permanent pacemaker
implantation, and paravalvular regurgitation favoured SAVR. Conclusion
Compared with SAVR, TAVI is associated with a significant survival benefit
throughout 2 years of follow-up. Importantly, this superiority is observed
irrespective of the TAVI device across the spectrum of intermediate and
high-risk patients, and is particularly pronounced among patients
undergoing transfemoral TAVI and in females. Copyright &#xa9; The Author
2016.

<78>
Accession Number
614979232
Author
Delaney M.; Stark P.C.; Suh M.; Triulzi D.J.; Hess J.R.; Steiner M.E.;
Stowell C.P.; Sloan S.R.
Institution
(Delaney) From the *Medical Division and Department of Laboratory
Medicine, University of Washington, Seattle, Washington; +Center for
Epidemiological and Statistical Research, New England Research Institutes
(Data Coordinating Center), Watertown, Massachusetts; ++Division of
Transfusion Medicine, Department of Pathology, University of Pittsburgh,
Pittsburgh, Pennsylvania; Harborview Medical Center, Department of
Laboratory Medicine and Division of Hematology, University of Washington,
Seattle, Washington; ||Department of Pediatrics, University of Minnesota,
Minneapolis, Minnesota; PDepartment of Pathology, Massachusetts General
Hospital, Harvard Medical School, Boston, Massachusetts; and #Department
of Laboratory Medicine, Boston Children's Hospital and Depart
Title
Massive Transfusion in Cardiac Surgery: The Impact of Blood Component
Ratios on Clinical Outcomes and Survival.
Source
Anesthesia and Analgesia. (no pagination), 2017. Date of Publication: 22
Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: Cardiac surgery is the most common setting for massive
transfusion in medically advanced countries. Studies of massive
transfusion after injury suggest that the ratios of administered plasma
and platelets (PLT) to red blood cells (RBCs) affect mortality. Data from
the Red Cell Storage Duration Study (RECESS), a large randomized trial of
the effect of RBC storage duration in patients undergoing complex cardiac,
were analyzed retrospectively to investigate the association between blood
component ratios used in massively transfused patients and subsequent
clinical outcomes. METHODS:: Massive transfusion was defined as those who
had >6 RBC units or >8 total blood components. For plasma, high ratio was
defined as >1 plasma unit:1 RBC unit. For PLT transfusion, high ratio was
defined as >0.2 PLT doses:1 RBC unit; PLT dose was defined as 1 apheresis
PLT or 5 whole blood PLT equivalents. The clinical outcomes analyzed were
mortality and the change in the Multiple Organ Dysfunction Score
(DELTAMODS) comparing the preoperative score with the highest composite
score through the earliest of death, discharge, or day 7. Outcomes were
compared between patients transfused with high and low ratios. Linear and
Cox regression were used to explore relationships between predictors and
continuous outcomes and time to event outcomes. RESULTS:: A total of 324
subjects met the definition of massive transfusion. In those receiving
high plasma:RBC ratio, the mean (SE) 7- and 28-day DELTAMODS was 1.24
(0.45) and 1.26 (0.56) points lower, (P = .007 and P = .024),
respectively, than in patients receiving lower ratios. In patients
receiving high PLT:RBC ratio, the mean (SE) 7- and 28-day DELTAMODS were
1.55 (0.53) and 1.49 (0.65) points lower (P = .004 and P = .022),
respectively. Subjects who received low-ratio plasma:RBC transfusion had
excess 7-day mortality compared with those who received high ratio (7.2%
vs 1.7%, respectively, P = .0318), which remained significant at 28 days
(P = .035). The ratio of PLT:RBCs was not associated with differences in
mortality. CONCLUSIONS:: This analysis found that in complex cardiac
surgery patients who received massive transfusion, there was an
association between the composition of blood products used and clinical
outcomes. Specifically, there was less organ dysfunction in those who
received high-ratio transfusions (plasma:RBCs and PLT:RBCs), and lower
mortality in those who received high-ratio plasma:RBC transfusions.
Copyright &#xa9; 2017 International Anesthesia Research Society

<79>
Accession Number
614965856
Author
Barrett C.S.; Chan T.T.; Wilkes J.; Bratton S.L.; Thiagarajan R.R.
Institution
(Barrett) +Seattle Children's Hospital, University of Washington,
Assistant Professor Pediatric Critical Care Medicine ++ Intermountain
Healthcare Data Analyst University of Utah, Professor Pediatric Critical
Care Medicine P Boston Children's Hospital and Harvard Medical School,
Associate Professor of Pediatrics
Title
Association of Pediatric Cardiac Surgical Volume and Mortality after
Cardiac ECMO.
Source
ASAIO Journal. (no pagination), 2017. Date of Publication: 20 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Centers with higher surgical and ECMO volume have improved survival for
children undergoing pediatric cardiac surgery and ECMO respectively. We
examined the relationship between both cardiac surgical and cardiac ECMO
volumes, with survival. Using data from the Pediatric Health Information
System, we reviewed patients who underwent ECMO during the hospitalization
for cardiac surgery or heart transplantation from January 2003- June 2014.
Among 106,967 patients in 43 centers undergoing a Risk Adjustment for
Congenital Heart Surgery-1 (RACHS) 1-6 procedure (n =104,951) and/or
cardiac transplantation (n=2016), 2.9% (n=3069) underwent ECMO support.
Centers were categorized into volume-quartiles based on annual ECMO and
cardiac surgical volume. Multivariable logistic regression models
controlling for clustering by center and adjusting for factors associated
with mortality were constructed. Although mortality was lower in ECMO
centers that performed >7 ECMO runs (Odds Ratio [(OR): 0.44, 95%
Confidence Interval (CI): 0.22-0.88)] and centers performing >158 cardiac
surgical cases (OR: 0.37, 95% CI: 0.22-0.63), surgical volume was more
strongly associated with ECMO mortality. Centers with higher cardiac
surgical volume had fewer ECMO complications. Cardiac surgical volume
compared to ECMO volume, is more strongly associated with cardiac ECMO
survival. Copyright &#xa9; 2017 by the American Society for Artificial
Internal Organs

<80>
Accession Number
614964780
Author
Lundgren J.; Soderlund C.; Radegran G.
Institution
(Lundgren, Soderlund, Radegran) Department of Clinical Sciences Lund,
Cardiology, Lund University, Lund, Sweden
(Lundgren, Soderlund, Radegran) The Hemodynamics Laboratory, Section for
Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skane
University Hospital, Lund, Sweden
Title
Impact of postoperative pulmonary hypertension on outcome after heart
transplantation.
Source
Scandinavian Cardiovascular Journal. (pp 1-10), 2017. Date of Publication:
22 Mar 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Objectives: We wanted to investigate the effects of postoperative
pulmonary hypertension (PH<inf>postop</inf>: mean pulmonary artery
pressure [MPAP]>25mmHg), diastolic pressure gradient (DPG), pulmonary
vascular resistance (PVR), and repeated hemodynamic measurements on
long-term survival after heart transplantation (HT). Design: Eighty-nine
patients who underwent HT at Skane University Hospital in Lund in the
period 1988-2010 and who were evaluated with right-heart-catheterization
at rest, prior to HT and repeatedly during the first postoperative year,
were grouped based on their MPAP, DPG, and PVR. Results: One year after
HT, survival was lower in patients with PH<inf>postop</inf> than in those
without, in patients with DPG>7mmHg than in those with DPG<7mmHg, and in
patients with PVR>3 WU than in those with PVR<3 WU. Moreover, compared to
patients with no PH<inf>postop</inf> or with PH<inf>postop</inf> at one
evaluation during the first year after HT, PH<inf>postop</inf> at repeated
evaluations was associated with higher mortality (hazard ratio 3.4, 95% CI
1.4-8.0). There was no significant difference in acute cellular rejection
between patients with and without PH<inf>postop</inf>, but postoperative
kidney function was worse in patients with repeated PH<inf>postop</inf>.
Conclusions: When defined according to present guidelines, PH one year
after HT may emerge as a prognostic marker for long-term outcome after HT.
Moreover, PH<inf>postop</inf> at repeated evaluations during the first
year after HT had stronger prognostic value than PH<inf>postop</inf> at a
single examination, illustrating a means of identifying a high-risk
population. However, confirmation in larger multi-center studies is
warranted. Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor &
Francis Group

<81>
Accession Number
614732653
Author
Bilecen S.; De Groot J.A.H.; Kalkman C.J.; Spanjersberg A.J.; Brandon
Bravo Bruinsma G.J.; Moons K.G.M.; Nierich A.P.
Institution
(Bilecen, Kalkman, Moons) Division of Anesthesiology, Intensive Care and
Emergency Medicine, University Medical Center Utrecht, PO Box 85500,
Utrecht 3508 GA, Netherlands
(Bilecen, Spanjersberg, Nierich) Department of Cardiothoracic Anesthesia
and Intensive Care, Isala Zwolle, Netherlands
(De Groot, Moons) Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht, Netherlands
(Brandon Bravo Bruinsma) Department of Cardiothoracic Surgery, Isala
Zwolle, Netherlands
Title
Effect of fibrinogen concentrate on intraoperative blood loss among
patients with intraoperative bleeding during high-risk cardiac surgery: A
randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 317 (7) (pp 738-747),
2017. Date of Publication: 21 Feb 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Fibrinogen concentrate might partly restore coagulation
defects and reduce intraoperative bleeding. Objective: To determine
whether fibrinogen concentrate infusion dosed to achieve a plasma
fibrinogen level of 2.5 g/L in high-risk cardiac surgery patients with
intraoperative bleeding reduces intraoperative blood loss. Design,
Setting, and Participants: A randomized, placebo-controlled, double-blind
clinical trial conducted in Isala Zwolle, the Netherlands (February
2011-January 2015), involving patients undergoing elective, high-risk
cardiac surgery (ie, combined coronary artery bypass graft [CABG] surgery
and valve repair or replacement surgery, the replacement of multiple
valves, aortic root reconstruction, or reconstruction of the ascending
aorta or aortic arch) with intraoperative bleeding (blood volume between
60 and 250 mL suctioned from the thoracic cavity in a period of 5 minutes)
were randomized to receive either fibrinogen concentrate or placebo.
Interventions: Intravenous, single-dose administration of fibrinogen
concentrate (n = 60) or placebo (n = 60), targeted to achieve a
postinfusion plasma fibrinogen level of 2.5 g/L. Main Outcomes and
Measures: The primary outcomewas blood loss in milliliters between
intervention (ie, after removal of cardiopulmonary bypass) and closure of
chest. Safety variables (within 30 days) included: in-hospital mortality,
myocardial infarction, cerebrovascular accident or transient ischemic
attack, renal insufficiency or failure, venous thromboembolism, pulmonary
embolism, and operative complications. Results: Among 120 patients (mean
age; 71 [SD, 10] years, 37women [31%]) included in the study, combined
CABG and valve repair or replacement surgery comprised 72%of procedures
and had a mean (SD) cardiopulmonary bypass time of 200 minutes (83)
minutes. For the primary outcome, median blood loss in the fibrinogen
groupwas 50mL (interquartile range [IQR], 29-100 mL) compared with 70 mL
(IQR, 33-145 mL) in the control group (P = .19), the absolute difference
20 mL (95%CI, -13 to 35 mL). Therewere 6 cases of stroke or transient
ischemic attack (4 in the fibrinogen group); 4myocardial infarctions (3 in
the fibrinogen group); 2 deaths (both in the fibrinogen group); 5 cases
with renal insufficiency or failure (3 in the fibrinogen group); and 9
cases with reoperative thoracotomy (4 in the fibrinogen group).
Conclusions and Relevance: Among patients with intraoperative bleeding
during high-risk cardiac surgery, administration of fibrinogen
concentrate, compared with placebo, resulted in no significant difference
in the amount of intraoperative blood loss. Copyright &#xa9; 2017 American
Medical Association. All rights reserved.

<82>
Accession Number
614004331
Author
Engoren M.; Brown R.R.; Dubovoy A.
Institution
(Engoren, Dubovoy) Department of Anesthesiology, University of Michigan,
1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
(Brown) Department of Anesthesiology, Mercy St. Vincent Medical Center,
Toledo, OH, United States
(Brown) Department of Information Technology Services, Promedica Health
System, Toledo, OH, United States
Title
A retrospective analysis of the effect of blood transfusion on cerebral
oximetry entropy and acute kidney injury.
Source
Perfusion (United Kingdom). 32 (1) (pp 35-43), 2017. Date of Publication:
01 Jan 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Purpose: Acute anemia is associated with both cerebral dysfunction and
acute kidney injury and is often treated with red blood cell transfusion.
We sought to determine if blood transfusion changed the cerebral oximetry
entropy, a measure of the complexity or irregularity of the oximetry
values, and if this change was associated with subsequent acute kidney
injury. Methods: This was a retrospective, case-control study of patients
undergoing cardiac surgery with cardiopulmonary bypass at a tertiary care
hospital, comparing those who received a red blood cell transfusion to
those who did not. Acute kidney injury was defined as a perioperative
increase in serum creatinine by >3/426.4 mumol/L or by >3/450% increase.
Entropy was measured using approximate entropy, sample entropy, forbidden
word entropy and basescale4 entropy in 500-point sets. Results: Forty-four
transfused patients were matched to 88 randomly selected non-transfused
patients. All measures of entropy had small changes in the transfused
group, but increased in the non-transfused group (p<0.05, for all
comparisons). Thirty-five of 132 patients (27%) suffered acute kidney
injury. Based on preoperative factors, patients who suffered kidney injury
were similar to those who did not, including baseline cerebral oximetry
levels. After analysis with hierarchical logistic regression, the change
in basescale4 entropy (odds ratio = 1.609, 95% confidence interval =
1.057-2.450, p = 0.027) and the interaction between basescale entropy and
transfusion were significantly associated with subsequent development of
acute kidney injury. Conclusions: The transfusion of red blood cells was
associated with a smaller rise in entropy values compared to
non-transfused patients, suggesting a change in the regulation of cerebral
oxygenation, and these changes in cerebral oxygenation are also associated
with acute kidney injury. Copyright &#xa9; The Author(s) 2016.

<83>
Accession Number
612365074
Author
Cavalcante R.; Sotomi Y.; Zeng Y.; Lee C.W.; Ahn J.-M.; Collet C.;
Tenekecioglu E.; Suwannasom P.; Onuma Y.; Park S.-J.; Serruys P.W.
Institution
(Cavalcante, Zeng, Tenekecioglu, Suwannasom, Onuma) Erasmus University
Medical Center, Rotterdam, Netherlands
(Cavalcante) Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Sotomi, Collet, Suwannasom) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Lee, Ahn, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Serruys) International Center for Circulatory Health, Imperial College
London, London, United Kingdom
Title
Coronary bypass surgery versus stenting in multivessel disease involving
the proximal left anterior descending coronary artery.
Source
Heart. 103 (6) (pp 428-433), 2017. Date of Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective In patients with multivessel disease and proximal left anterior
descending artery (LAD) involvement, the best revascularisation strategy
is still unclear. We assess outcomes after coronary artery bypass graft
surgery (CABG) and percutaneous coronary intervention (PCI) with
drug-eluting stents in a pooled analysis of individual patient-level data
of the SYNTAX and BEST randomised trials. Design Proximal LAD involvement
was defined by any lesion > 50% diameter stenosis in the arterial segment
starting from the left-main bifurcation up to (and including) the origin
of the first major septal branch. The primary endpoint was the composite
of all-cause death, myocardial infarction (MI) or stroke at 5 years of
follow-up. Results The present study population comprises 1166 patients of
which 577 were randomised to PCI and 589 to CABG. Baseline characteristics
were well balanced across study arms. The primary endpoint occurred in 94
(16.3%) patients in the PCI arm and in 68 (11.5%) patients in the CABG arm
(HR 1.43; 95%CI 1.05 to 1.95; p=0.026). CABG was also associated with a
significantly lower rate of cardiac death (p=0.007), MI (p<0.001),
all-cause revascularisation (p<0.001) and major adverse cardiovascular and
cerebrovascular events (all-cause death, MI, stroke, revascularisation)
(p<0.001). The rates of all-cause mortality (p=0.06) and stroke (p=0.09)
were not statistically different between the two groups. The overall study
results for the primary outcome were consistent across several subgroups.
Conclusions In patients with multivessel disease with proximal LAD
involvement, CABG is associated with lower rates of the safety composite
endpoint of death, MI or stroke as compared with PCI with drug-eluting
stents at 5 years of follow-up (number needed to treat=21). Copyright
&#xa9; Published by the BMJ Publishing Group Limited.

<84>
Accession Number
613751708
Author
Ring A.; Morris T.; Wozniak M.; Sullo N.; Dott W.; Verheyden V.; Kumar T.;
Brunskill N.; Vaja R.; Murphy G.J.
Institution
(Ring) University of the Free State, Bloemfontein, South Africa
(Ring) medac GmbH, Wedel, Germany
(Ring, Morris) Leicester Clinical Trials Unit, Leicester General Hospital,
Leicester, United Kingdom
(Wozniak, Sullo, Dott, Verheyden, Kumar, Murphy) University of Leicester,
Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit,
Glenfield Hospital, Leicester, United Kingdom
(Brunskill, Vaja) University Hospitals Leicester NHS Trust, Leicester,
United Kingdom
Title
A Phase I study to determine the pharmacokinetic profile, safety and
tolerability of sildenafil (Revatio) in cardiac surgery: the
REVAKI-1 study.
Source
British Journal of Clinical Pharmacology. 83 (4) (pp 709-720), 2017. Date
of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims: Acute kidney injury (AKI) is a common and severe complication of
cardiac surgery. There is no effective prevention or treatment. Sildenafil
citrate (Revatio, Pfizer Inc.), a phosphodiesterase type 5
inhibitor, prevents post cardiac surgery AKI in pre-clinical studies,
however its use is contraindicated in patients with symptomatic
cardiovascular disease. The aim of this study is to assess the safety and
pharmacokinetics of intravenous sildenafil in cardiac surgery patients.
Methods: We conducted an open label, dose escalation study with six
patients per dose level. The six doses were 2.5 mg, 5 mg or 10 mg as a
bolus, either alone or followed by an additional 2 h infusion of 2.5 mg
sildenafil. Results: Thirty-six patients entered the trial, of which 33
completed it. The mean age was 69.9 years. One patient died during
surgery, two others were removed from the trial before dosing (all at dose
level 5 mg + 2.5 mg). The pharmacokinetic profile of sildenafil was
similar to previously published studies. For a dose of 10 mg administered
as a bolus followed by 2.5 mg administered over 2 h the results were
AUC<inf></inf> 537 ng h ml^-1, C<inf>max</inf> 189.4 ng
ml^-1 and t<inf>1/2</inf> 10.5 h. The drug was well tolerated
with no serious adverse events related to drug administration. Higher
sildenafil doses stabilized post-surgery nitric oxide bioavailability.
Conclusions: Pharmacokinetics of sildenafil during cardiopulmonary bypass
were comparable to those of other patient groups. The drug was well
tolerated at therapeutic plasma levels. These results support the further
evaluation of sildenafil for the prevention of AKI in cardiac surgery.
Copyright &#xa9; 2016 The British Pharmacological Society

<85>
Accession Number
614875246
Author
Salamati A.; Mashouf S.; Mojab F.
Institution
(Salamati, Mashouf) Faculty of Nursing and Midwifery, Islamic Azad
University (Tehran Medical Branch), Tehran, Iran, Islamic Republic of
(Mojab) School of Pharmacy, Pharmaceutical Sciences Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Title
Effect of inhalation of lavender essential oil on vital signs in open
heart surgery ICU.
Source
Iranian Journal of Pharmaceutical Research. 16 (1) (pp 404-409), 2017.
Date of Publication: Winter 2017.
Publisher
Iranian Journal of Pharmaceutical Research (E-mail: info@ijpr-online.com)
Abstract
This study evaluated the effects of inhalation of Lavender essential oil
on vital signs in open heart surgery ICU. The main complaint of patients
after open-heart surgery is dysrhythmia, tachycardia, and hypertension due
to stress and pain. Due to the side effects of chemical drugs, such as
opioids, use of non-invasive methods such as aromatherapy for relieving
stress and pain parallel to chemical agents could be an important way to
decrease the dose and side effects of analgesics. In a multicenter,
single-blind trial, 40 patients who had open-heart surgery were recruited.
Inclusion criteria were full consciousness, lack of hemorrhage, heart rate
>60 beats/min, systolic blood pressure > 100 mmHg, and diastolic blood
pressure > 60 mmHg, not using beta blockers in the operating room or ICU,
no history of addiction to opioids or use of analgesics in regular,
spontaneous breathing ability and not receiving synthetic opioids within 2
h before extubation. Ten minutes after extubation, the patients> vital
signs [including BP, HR, Central Venous Pressure (CVP), SPO2, and RR] were
measured. Then, a cotton swab, which was impregnated with 2 drops of
Lavender essential oil 2%, was placed in patients' oxygen mask and
patients breathed for 10 min. Thirty minutes after aromatherapy, the vital
signs were measured again. Main objective of this study was the change in
vital sign before and after aromatherapy. Statistical significance was
accepted for P < 0.05. There was a significant difference in systolic
blood pressure (p 0.001 >), diastolic blood pressure (p = 0.001), and
heart rate (p = 0.03) before and after the intervention using paired
t-test. Although, the results did not show any significant difference in
respiratory rate (p = 0.1), SpO2 (p = 0.5) and CVP (p = 0.2) before and
after inhaling Lavender essential oil. Therefore, the aromatherapy could
effectively reduce blood pressure and heart rate in patients admitted to
the open heart surgery ICU and can be used as an independent nursing
intervention in stabilizing mentioned vital signs. The limitations of our
study were sample size and lack of control group. Randomized clinical
trials with larger sample size are recommended. Copyright &#xa9; 2017 by
School of Pharmacy.

<86>
Accession Number
611879776
Author
Hioki H.; Watanabe Y.; Kozuma K.; Nara Y.; Kawashima H.; Kataoka A.;
Yamamoto M.; Takagi K.; Araki M.; Tada N.; Shirai S.; Yamanaka F.;
Hayashida K.
Institution
(Hioki, Watanabe, Kozuma, Nara, Kawashima, Kataoka) Division of
Cardiology, Department of Internal Medicine, Teikyo University Hospital,
2-11-1 Kaga, Itabashi-ku, Tokyo 173-0003, Japan
(Yamamoto) Division of Cardiovascular Medicine, Toyohashi Heart Center,
Aichi, Japan
(Takagi) Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
(Araki) Department of Cardiovascular Medicine, Yokohama City Eastern
Hospital, Kanagawa, Japan
(Tada) Department of Cardiovascular Center, Sendai Kosei Hospital, Miyagi,
Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
Japan
(Yamanaka) Department of Cardiovascular Medicine, Shonan Kamakura General
Hospital, Kanagawa, Japan
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Title
Pre-procedural dual antiplatelet therapy in patients undergoing
transcatheter aortic valve implantation increases risk of bleeding.
Source
Heart. 103 (5) (pp 361-367), 2017. Date of Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate the clinical benefit of pre-procedural antiplatelet
therapy in patients undergoing transfemoral (TF) transcatheter aortic
valve implantation (TAVI). Methods OCEAN (Optimized transCathEter vAlvular
interveNtion)-TAVI is a prospective, multicentre, observational cohort
registry, enrolling 749 patients who underwent TAVI from October 2013 to
August 2015 in Japan. We identified 540 patients (median age 85 years,
68.1% female) undergoing TF-TAVI; of these, 80 had no pre-procedural
antiplatelet therapy and 460 had antiplatelet therapy. The endpoints were
any bleeding (life-threatening, major, and minor bleeding) and thrombotic
events (stroke, myocardial infarction, and valve thrombosis) during
hospitalisation. Results Patients with dual antiplatelet therapy (DAPT)
had a significantly higher incidence of any bleeding than those with
single antiplatelet therapy (SAPT) (36.5% vs 27.5%, p=0.049) and no
antiplatelet therapy (36.5% vs 21.3%, p=0.010). Patients without
pre-procedural antiplatelet therapy did not experience an increased risk
of thrombotic events. In multivariable logistic regression analysis, DAPT
before TF-TAVI significantly increased any bleeding compared with SAPT (OR
2.05, 95% CI 1.16 to 3.65) and no antiplatelet therapy (OR 2.30, 95% CI
1.08 to 4.90). Conclusions The current study demonstrated that DAPT before
TF-TAVI increased the risk of bleeding compared with single or no
antiplatelet therapy. Lower intensity antiplatelet therapy was not
associated with thrombotic events. In modern practice, it might be
reasonable to perform TAVI using single or no pre-procedural antiplatelet
therapy with an expectation of no increase of adverse events. Copyright
&#xa9; Published by the BMJ Publishing Group Limited.

<87>
Accession Number
614659366
Author
Zhu Z.G.; Xiong W.; Ding J.L.; Chen J.; Li Y.; Zhou J.L.; Xu J.J.
Institution
(Zhu, Chen, Li, Zhou, Xu) Department of Cardiothoracic Surgery, Second
Affiliated Hospital of Nanchang University, Nanchang, China
(Xiong) Guangxi University of Chinese Medicine, Nanning, China
(Ding) Department of Gastroenterology, Second Affiliated Hospital of
Nanchang University, Nanchang, China
Title
Comparison of outcomes between off-pump versus on-pump coronary artery
bypass surgery in elderly patients: A meta-analysis.
Source
Brazilian Journal of Medical and Biological Research. 50 (3) (no
pagination), 2017. Article Number: e5711. Date of Publication: 2017.
Publisher
Associacao Brasileira de Divulgacao Cientifica (E-mail:
bjournal@fmrp.usp.br)
Abstract
The aim of this study was to analyze if off-pump coronary artery bypass
surgery (CABG) is associated with better treatment outcomes in elderly
patients (>70 years of age) than on-pump CABG, using meta-analysis.
Medline, PubMed, Cochrane and Google Scholar databases were searched until
September 13, 2016. Sensitivity and quality assessment were performed.
Twenty-two studies, three randomized control trials (RCTs) and 20 non-RCTs
were included with 24,127 patients. The risk of death associated with
on-pump or off-pump CABG in the RCTs were similar (pooled OR=0.945,
95%CI=0.652 to 1.371, P=0.766). However, in the non-RCTs, mortality risk
was lower in patients treated with off-pump CABG than on-pump CABG (pooled
OR=0.631, 95%CI=0.587 to 0.944, P=0.003). No differences were observed
between the two treatment groups in terms of the occurrence of 30-day
post-operative stroke or myocardial infarction (P>0.147). In the non-RCTs,
off-pump CABG treatment was associated with a shorter length of hospital
stay (pooled standardized difference in means=-0.401, 95%CI=-0.621 to
-0.181, P<0.001). The meta-analysis with pooled data from non-RCTs, but
not RCTs, found that mortality was lower with off-pump compared with
on-pump CABG, and suggested that there may be some benefit of off-pump
CABG compared with on-pump CABG in the risk of mortality and length of
hospital stay. Copyright &#xa9; 2017, Associacao Brasileira de Divulgacao
Cientifica. All rights reserved.

<88>
Accession Number
614654024
Author
Checchia P.A.; Paes B.; Bont L.; Manzoni P.; Simoes E.A.F.; Fauroux B.;
Figueras-Aloy J.; Carbonell-Estrany X.
Institution
(Checchia) Baylor College of Medicine, Texas Children's Hospital Houston,
Houston, TX, United States
(Paes) Neonatal Division, Department of Paediatrics, McMaster University,
Hamilton, Canada
(Bont) University Medical Center Utrecht, Utrecht, Netherlands
(Manzoni) Sant'Anna Hospital, Turin, Italy
(Simoes) University of Colorado School of Medicine, Aurora, CO, United
States
(Fauroux) Necker University Hospital and Paris 5 University, Paris, France
(Figueras-Aloy) Hospital Clinic, Catedratic de Pediatria, Universitat de
Barcelona, Barcelona, Spain
(Carbonell-Estrany) Hospital Clinic, Institut d'Investigacions Biomediques
August Pi Suner (IDIBAPS), Barcelona, Spain
Title
Defining the Risk and Associated Morbidity and Mortality of Severe
Respiratory Syncytial Virus Infection Among Infants with Congenital Heart
Disease.
Source
Infectious Diseases and Therapy. 6 (1) (pp 37-56), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Springer Healthcare
Abstract
Introduction: The REGAL (RSV Evidence-a Geographical Archive of the
Literature) series provide a comprehensive review of the published
evidence in the field of respiratory syncytial virus (RSV) in Western
countries over the last 20 years. This fourth publication covers the risk
and burden of RSV infection in infants with congenital heart disease
(CHD). Methods: A systematic review was undertaken for articles published
between January 1, 1995 and December 31, 2015 across PubMed, Embase, The
Cochrane Library, and Clinicaltrials.gov. Studies reporting data for
hospital visits/admissions for RSV infection among children with CHD as
well as studies reporting RSV-associated morbidity, mortality, and
healthcare costs were included. The focus was on children not receiving
RSV prophylaxis. Study quality and strength of evidence (SOE) were graded
using recognized criteria. Results: A total of 1325 studies were
identified of which 38 were included. CHD, in particular hemodynamically
significant CHD, is an independent predictor for RSV hospitalization
(RSVH) (high SOE). RSVH rates were generally high in young children (<4
years) with CHD (various classifications), varying between 14 and 357/1000
(high SOE). Children (<6 years) with RSV infection spent 4.4-14 days in
hospital, with up to 53% requiring intensive care (high SOE). Infants (<2
years) with CHD had a more severe course of RSVH than those without CHD
(high SOE). Case fatality rates of up to 3% were associated with RSV
infection in children with CHD (high SOE). RSV infection in the
perioperative period of corrective surgery and nosocomial RSV infection in
intensive care units also represent important causes of morbidity
(moderate SOE). Conclusion: CHD poses a significant risk for RSVH and
subsequent morbidity and mortality. RSV infection often complicates
corrective heart surgery. To reduce the burden and improve outcomes,
further research and specific studies are needed to determine the
longer-term effects of severe RSV infection in young children with CHD.
Copyright &#xa9; 2017, The Author(s).

<89>
Accession Number
614638917
Author
Hellenkamp K.; Becker A.; Gabriel Y.D.; Hasenfuss G.; Hunlich M.;
Jacobshagen C.; Schillinger W.; Schroeter M.R.
Institution
(Hellenkamp, Becker, Gabriel, Hasenfus, Hunlich, Jacobshagen, Schillinger,
Schroeter) Clinic for Cardiology & Pneumology/Heart Center, University
Medical Center Gottingen, DZHK - German Center for Cardiovascular
Research, Germany
(Becker) Clinic for Cardiology, Robert-Bosch Hospital, Stuttgart, Germany
(Schillinger) Medical Clinic I, Helios Albert-Schweitzer Clinic Northeim,
Northeim, Germany
Title
Mid- to long-term outcome of patients treated with everolimus-eluting
bioresorbable vascular scaffolds: Data of the BVS registry Gottingen
predominantly from ACS patients.
Source
International Journal of Cardiology. 234 (pp 58-63), 2017. Date of
Publication: 01 May 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Bioresorbable vascular scaffolds (BVS) are widely used in
routine clinical practice. While previous studies reported acceptable
short- to midterm outcome after BVS implantation, data on longer-term
outcome are rare. Methods Patients treated with at least one Absorb-BVS
were consecutively enrolled. Follow-up data were assessed after 834.0
[769.0-1026.0] days. The primary device-oriented composite endpoint (DOCE)
was defined as cardiovascular death, myocardial infarction (MI) and/or
target lesion revascularization (TLR). Results Between 2012 and 2014, 195
patients were included into study analysis. Overall, 244 BVS were
implanted. Mean patient age was 64.0[54.3-74.0] years. Three-quarter of
patients had an ACS; of those 42.9% had ST-elevation-MI and 40.8% had
non-ST-elevation-MI. DOCE occurred in 3.1%, 6.7%, 11.8% and 15.4% of
patients during hospital stay, within 6-months, 18-months or during the
complete follow-up period, respectively. In those patients, median time
until DOCE was 211.5[43.25-567.25] days. In 11 (36.7%) patients DOCE
occurred after > 12 months. Using univariable analysis, bifurcation
stenting was associated with a hazard ratio (HR) of 11.8[2.38-58.57] for
TLR (p = 0.002) and 2.1[1.02-4.49] for DOCE (p = 0.045). Similarly, in ACS
patients, bifurcation stenting was associated with an increased risk for
TLR (HR = 10.4[2.01-53.56]; p = 0.005) and for DOCE (HR = 2.4[1.09-5.32];
p = 0.029) and in multivariable analysis, it remained an independent
predictor of DOCE (HR = 3.0; p = 0.018). Conclusions Although, the rates
of (potentially) device-related complications following BVS implantation
are acceptable, they are nonetheless not negligible. Interestingly, they
did not decline over time. Bifurcation stenting could be found as relevant
procedure-related predictor of DOCE, especially in ACS patients.
Randomized trials are warranted to confirm these findings. Copyright
&#xa9; 2017 Elsevier B.V.

<90>
[Use Link to view the full text]
Accession Number
614297940
Author
Gaudino M.; Puskas J.D.; Di Franco A.; Ohmes L.B.; Iannaccone M.; Barbero
U.; Glineur D.; Grau J.B.; Benedetto U.; D'Ascenzo F.; Gaita F.; Girardi
L.N.; Taggart D.P.
Institution
(Gaudino, Di Franco, Ohmes, Girardi) Department of Cardio-Thoracic
Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, United
States
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Iannaccone, Barbero, D'Ascenzo, Gaita) Citta della Scienza e della
Salute, Department of Cardiology, University of Turin, Italy
(Glineur, Grau) Division of Cardiac Surgery, University of Ottawa Heart
Institute, ON, Canada
(Benedetto) Bristol Heart Institute, University of Bristol, United Kingdom
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital,
University of Oxford, United Kingdom
Title
Three Arterial Grafts Improve Late Survival: A Meta-Analysis of
Propensity-Matched Studies.
Source
Circulation. 135 (11) (pp 1036-1044), 2017. Date of Publication: 14 Mar
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Little evidence shows whether a third arterial graft provides
superior outcomes compared with the use of 2 arterial grafts in patients
undergoing coronary artery bypass grafting. A meta-analysis of all the
propensity score-matched observational studies comparing the long-term
outcomes of coronary artery bypass grafting with the use of 2-arterial
versus 3-arterial grafts was performed. Methods: A literature search was
conducted using MEDLINE, EMBASE, and Web of Science to identify relevant
articles. Long-term mortality in the propensity score-matched populations
was the primary end point. Secondary end points were in-hospital/30-day
mortality for the propensity score-matched populations and long-term
mortality for the unmatched populations. In the matched population,
time-to-event outcome for long-term mortality was extracted as hazard
ratios, along with their variance. Statistical pooling of survival
(time-to-event) was performed according to a random effect model,
computing risk estimates with 95% confidence intervals. Results: Eight
propensity score-matched studies reporting on 10 287 matched patients
(2-arterial graft: 5346; 3-arterial graft: 4941) were selected for final
comparison. The mean follow-up time ranged from 37.2 to 196.8 months. The
use of 3 arterial grafts was not statistically associated with early
mortality (hazard ratio, 0.93; 95% confidence interval, 0.71-1.22;
P=0.62). The use of 3 arterial grafts was associated with statistically
significantly lower hazard for late death (hazard ratio, 0.8; 95%
confidence interval, 0.75-0.87; P<0.001), irrespective of sex and diabetic
mellitus status. This result was qualitatively similar in the unmatched
population (hazard ratio, 0.57; 95% confidence interval, 0.33-0.98;
P=0.04). Conclusions: The use of a third arterial conduit in patients with
coronary artery bypass grafting is not associated with higher operative
risk and is associated with superior long-term survival, irrespective of
sex and diabetic mellitus status. Copyright &#xa9; 2017 American Heart
Association, Inc.

<91>
Accession Number
613878529
Author
Zoumot Z.; Davey C.; Jordan S.; McNulty W.H.; Carr D.H.; Hind M.D.; Polkey
M.I.; Shah P.L.; Hopkinson N.S.
Institution
(Zoumot) NIHR Respiratory Disease, Biomedical Research Unit, Royal
Brompton and Harefield NHS Foundation Trust, Imperial College London,
London, United Kingdom
(Zoumot, Davey, Jordan, McNulty, Carr, Hind, Polkey, Shah, Hopkinson)
Respiratory and Critical Care Institute, Cleveland Clinic, Abu Dhabi,
United Arab Emirates
(Hopkinson) Royal Brompton Hospital, Fulham Road, London SW3 6NP, United
Kingdom
Title
Endobronchial valves for patients with heterogeneous emphysema and without
interlobar collateral ventilation: Open label treatment following the
BeLieVeR-HIFi study.
Source
Thorax. 72 (3) (pp 277-279), 2017. Date of Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Outcomes in early trials of bronchoscopic lung volume reduction using
endobronchial valves for the treatment of patients with advanced emphysema
were inconsistent. However improvements in patient selection with focus on
excluding those with interlobar collateral ventilation and homogeneous
emphysema resulted in significant benefits in the BeLieVeR-HIFi study
compared with sham treated controls. In this manuscript we present data
from the control patients in the BeLieVeR-HIFi study who went on to have
open label endobronchial valve treatment after completion of the clinical
trial (n=12), combined with data from those in the treatment arm who did
not have collateral ventilation (n=19). Three months after treatment
FEV<inf>1</inf> increased by 27.3 (36.4)%, residual volume reduced by 0.49
(0.76) L, the 6 min walk distance increased by 32.6 (68.7) m and the St
George Respiratory Questionnaire for COPD score improved by 8.2 (20.2)
points. These data extend the evidence for endobronchial valve placement
in appropriately selected patients with COPD. Copyright &#xa9; BMJ
Publishing Group Limited 2017.

<92>
Accession Number
608303090
Author
Shimbo D.; Abdalla M.; Falzon L.; Townsend R.R.; Muntner P.
Institution
(Shimbo, Abdalla, Falzon) Department of Medicine, Columbia University
Medical Center, 622 West 168th Street, New York, NY 10032, United States
(Townsend) Department of Medicine, Perelman School of Medicine, University
of Pennsylvania, PA, United States
(Muntner) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
Title
Studies comparing ambulatory blood pressure and home blood pressure on
cardiovascular disease and mortality outcomes: A systematic review.
Source
Journal of the American Society of Hypertension. 10 (3) (pp 224-234),
2016. Date of Publication: 01 Mar 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Ambulatory blood pressure monitoring (ABPM) is more commonly recommended
for assessing out-of-clinic blood pressure (BP) than home blood pressure
monitoring (HBPM). We conducted a systematic review to examine whether
ABPM or HBPM is more strongly associated with cardiovascular disease
events and/or mortality. Of 1007 abstracts published through July 20,
2015, nine articles, reporting results from seven cohorts, were
identified. After adjustment for BP on HBPM, BP on ABPM was associated
with an increased risk of outcomes in two of four cohorts for systolic
blood pressure and two of three cohorts for diastolic blood pressure.
After adjustment for BP on ABPM, systolic blood pressure on HBPM was
associated with outcomes in zero of three cohorts; an association was
present in one of two cohorts for diastolic blood pressure on HBPM. There
is a lack of strong empiric evidence supporting ABPM or HBPM over the
other approach for predicting cardiovascular events or mortality.
Copyright &#xa9; 2016 American Society of Hypertension. All rights
reserved.

<93>
Accession Number
611653431
Author
Zhou Y.; Shan J.; Guo Y.; Li S.; Long D.; Li Y.; Feng L.
Institution
(Zhou, Shan, Guo, Li, Long, Li, Feng) Key Laboratory of Transplant
Engineering and Immunology of the Ministry of Health, Regenerative Medical
Research Centre, West China Hospital, Sichuan University, Chengdu 610041,
China
(Li) Chinese Cochrane Centre, Chinese Evidence-Based Medicine Centre, West
China Hospital, Sichuan University, Chengdu 610041, China
Title
Effects of Adoptive Transfer of Tolerogenic Dendritic Cells on Allograft
Survival in Organ Transplantation Models: An Overview of Systematic
Reviews.
Source
Journal of Immunology Research. 2016 (no pagination), 2016. Article
Number: 5730674. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Objective. To dissect the efficacy of Tol-DC therapy with or without IS in
multiple animal models of transplantation. Methods and Results. PubMed,
Medline, Embase, and the Cochrane Library were searched for reviews
published up to April 2015. Six systematic reviews and a total of 61
articles were finally included. Data were grouped by organ transplantation
models and applied to meta-analysis. Our meta-analysis shows that Tol-DC
therapy successfully prolonged allograft survival to varying extents in
all except the islet transplantation models and with IS drugs further
prolonged the survival of heart, skin, and islet allografts in mice, but
not of heart allografts in rats. Compared with IS drugs alone, Tol-DC
therapy with IS extended islet allograft survival in rats but failed to
influence the survival of skin, small intestine, and heart allografts in
rats or of heart and skin allografts in mice. Conclusion. Tol-DC therapy
significantly prolonged multiple allograft survival and further prolonged
survival with IS. However, standardized protocols for modification of
Tol-DC should be established before its application in clinic. Copyright
&#xa9; 2016 Yanni Zhou et al.

<94>
Accession Number
609366415
Author
El-Hamamsy M.H.; Elsisi G.H.; Eldessouki R.; Elmazar M.M.; Taha A.S.; Awad
B.F.; Elmansy H.
Institution
(El-Hamamsy) Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
(Elsisi) Faculty of Pharmacy, German University in Cairo, Cairo, Egypt
(Elsisi) Pharmacoeconomic Unit, Central Administration for Pharmaceutical
Affairs, Cairo, Egypt
(Eldessouki) Faculty of Medicine, Fayoum University, Fayoum, Egypt
(Elmazar) Faculty of Pharmacy, The British University in Egypt (BUE),
Cairo, Egypt
(Taha, Awad) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Taha, Awad) Cardiothoracic Surgery Unit, Ain Shams University Hospitals,
Cairo, Egypt
(Elmansy) Faculty of Business Administration, Canadian International
College, Cairo, Egypt
Title
Economic Evaluation of the Combined Use of Warfarin and Low-dose Aspirin
Versus Warfarin Alone in Mechanical Valve Prostheses.
Source
Applied Health Economics and Health Policy. 14 (4) (pp 431-440), 2016.
Date of Publication: 01 Aug 2016.
Publisher
Springer International Publishing
Abstract
Background: The use of combined therapy of antiplatelet and anticoagulant
versus anticoagulant alone to reduce instances of thromboembolic events in
patients with heart valve prostheses is an established standard of care in
many countries but not in Egypt. A previous Markov model
cost-effectiveness study on Egyptian patients aged 50-60 years
demonstrated that the combined therapy reduces the overall treatment cost.
However, due to the lack of actual real-world data on cost-effectiveness
and the limitation of the Markov model study to 50- to 60-year-old
patients, the Egyptian medical community is still questioning whether the
added benefit is worth the cost. Objective: To assess, from the
perspective of the Egyptian health sector, the cost-effectiveness of the
combined use of warfarin and low-dose aspirin (75 mg) versus that of
warfarin alone in patients with mechanical heart valve prostheses who
began therapy between the age of 15 and 50 years. Methods: An economic
evaluation was conducted alongside a randomized, controlled trial to
assess the cost-effectiveness of the combined therapy in patients with
mechanical valve prostheses. A total of 316 patients aged between 15 and
50 years were included in the study and randomly assigned to a group
treated with both warfarin and aspirin or a group treated with warfarin
alone. Results: The patients in the combined therapy group exhibited a
significantly longer duration of protection against the first event. Fewer
primary events were observed in the patients treated with warfarin plus
aspirin than in those treated with warfarin alone (1.4 %/year, vs. 4.8
%/year), and a higher mean quality-adjusted life-years (QALYs) value over
4 years was obtained for the group treated with warfarin plus aspirin
(difference 0.058; 95 % CI 0.013-0.118), although this difference did not
reach a conventional level of statistical significance. The total costs
over a 4-year period were lower with the combined therapy (difference
-US$244; 95 % CI -US$483.1 to -US$3.8), which yielded an incremental
cost-effectiveness ratio of -US$4206 per QALY gained. Thus, the combined
therapy was dominant. All costs were reported in US dollars (USD) for the
financial year 2014. Conclusions: The results of this analysis indicate
that from the perspective of the Egyptian health sector, the addition of
aspirin to the typical warfarin therapy is more effective and less costly
for patients with mechanical valve prostheses than treatment with warfarin
alone. This combined strategy could be adopted to prevent the
complications of mechanical valve prostheses. Our study adds to the body
of evidence supporting the option of warfarin-plus-aspirin therapy for
patients with mechanical valve prostheses. Copyright &#xa9; 2016, Springer
International Publishing Switzerland.

<95>
Accession Number
614854872
Author
Negargar S.; Naghipour B.; Anvari S.; Enamzadeh E.; Shirizadeh M.
Institution
(Negargar, Naghipour, Anvari, Enamzadeh, Shirizadeh) Cardiovascular
Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
Title
Effects of pre and post-pump tranexamic acid on bleeding after coronary
artery bypass graft surgery.
Source
Acta Medica Mediterranea. 32 (SpecialIssue4) (pp 1231-1235), 2016. Date of
Publication: 2016.
Publisher
A. CARBONE Editore (E-mail: carbone@imd.it)
Abstract
Introduction and objective: Bleeding caused by coagulopathy after
Cardiopulmonary Bypass (CPB) leads to morbidity and mortality. Research
results suggest that Tranexamic Acid (TA) plays a major role in reducing
bleeding after heart surgery. The objective of this study was to compare
the effect of preoperative TA and post-CPB TA on the decrease in bleeding
after heart surgery. Materials and methods: A total of 60 patients, who
were candidates for Coronary Artery Bypass Graft (CABG), were randomly
categorized into two groups after their written consent was obtained.
First, before the surgery, TA was added to the serum of group I and normal
saline was added to the serum of group II. After detachment from CPB,
normal saline was injected to group I and TA was injected to group II.
Postoperative bleeding was measured based on the volume of blood flowing
into the chest bottle of patients and the number of blood units transfused
to patients after surgery was recorded. Results: Investigation results
revealed that although bleeding during surgery in the pre-pump group was
higher than the postpump group, the difference was not significant. The
average volume of bleeding in the pre-pump group was higher than the
postpump group, but the difference was not statistically significant
either. Moreover, pre-pump TA did not lead to a reduction in the need for
transfusion during surgery. The level of bleeding in the first 2 hours
after hospitalization in ICU was significant lower in the prepump group.
However, no significant difference was observed between the duration stay
of the groups in ICU. Conclusion: Pre-pump administration of TA did not
result in a significant decrease in bleeding during surgery, need for
transfusion, duration of stay in ICU, and duration of hospitalization as
compared to post-pump TA administration.

<96>
Accession Number
609405133
Author
Maree A.O.; Margey R.J.; Selzer F.; Bajrangee A.; Jneid H.; Marroquin
O.C.; Mulukutla S.R.; Laskey W.K.; Jacobs A.K.
Institution
(Maree, Jacobs) Division of Cardiology, Boston Medical Center and Boston
University School of Medicine, United States
(Margey) Division of Cardiology, Massachusetts General Hospital and
Harvard Medical School, United States
(Selzer) Department of Epidemiology, Division of Cardiology, University of
Pittsburgh, United States
(Maree, Bajrangee) Division of Cardiology, St James's Hospital and Trinity
College, Dublin, Ireland
(Jneid) Division of Cardiology, Michael E. DeBakey VA Medical Center and
Baylor College of Medicine, United States
(Marroquin, Mulukutla) Division of Cardiology, University of Pittsburgh
Medical Center, United States
(Laskey) Division of Cardiology, The University of New Mexico School of
Medicine, United States
Title
Renal insufficiency, bleeding and prescription of discharge medication in
patients undergoing percutaneous coronary intervention in the National
Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry.
Source
Cardiovascular Revascularization Medicine. 17 (5) (pp 302-307), 2016. Date
of Publication: 01 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Aims To establish the relationship between renal insufficiency, bleeding
and prescription of cardiovascular medication. Methods and results This
was a prospective, multi-center, cohort study of consecutive patients
undergoing PCI during three NHLBI Dynamic Registry recruitment waves.
Major and minor bleeding, access site bleeding and rates of prescription
of cardiovascular medication at discharge were determined based on
estimated glomerular filtration rate (eGFR). Renal insufficiency was an
independent predictor of major adverse cardiovascular events (MACE).
Bleeding events and access site bleeding requiring transfusion were
significantly associated with degrees of renal insufficiency (p < 0.001).
There was an incremental decline in prescription of cardiovascular
medication at discharge proportionate to the degree of renal impairment
(aspirin, thienopyridine, statin, coumadin (overall p < 0.001), beta
blocker (overall p = 0.003), ACE inhibitor (overall p = 0.02). Bleeders
were less likely to be discharged on a thienopyridine (95.4% versus 89.9%
for bleeding, p < 0.001 and 95.3% versus 87.9% for access site bleeding, p
= 0.005), but not aspirin (96.3% versus 96.2%, p = 0.97 and 96.3% versus
93.6%, p = 0.29 respectively). Failure to prescribe anti-platelet therapy
at discharge was strongly associated with increased MACE at one year.
Conclusions Renal insufficiency is associated with bleeding in patients
undergoing PCI. Patients with renal insufficiency are less likely to
receive recommended discharge pharmacotherapy. Copyright &#xa9; 2016
Elsevier Inc.

<97>
Accession Number
610081407
Author
Graham J.J.; Yan A.T.; Tan M.K.; Cantor W.J.; DiMario C.; Jolly S.S.;
Halvorsen S.; Fernandez-Aviles F.; Le May M.R.; Scheller B.; Borgia F.;
Piscione F.; Madan M.; Goodman S.G.
Institution
(Graham, Yan, Goodman) Terrance Donnelly Heart Centre, St. Michael's
Hospital, Toronto, Canada
(Graham, Yan, Cantor, Goodman) University of Toronto, Toronto, Canada
(Tan, Goodman) Canadian Heart Research Centre, Toronto, Canada
(Cantor) Southlake Regional Health Centre, Newmarket, Canada
(DiMario) Royal Brompton Hospital and Imperial College, London, United
Kingdom
(Jolly) Population Health Research Institute, Hamilton Health Sciences,
McMaster University, Hamilton, Canada
(Halvorsen) Oslo University Hospital Ulleval, Oslo, Norway
(Fernandez-Aviles) Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Le May) University of Ottawa Heart Institute, Ottawa, Canada
(Scheller) Innere Medizin III, Universitat des Saarlandes, Homburg,
Germany
(Borgia) Federico II University, Naples, Italy
(Piscione) University Hospital San Giovanni di Dio e Ruggi d'Aragona,
Salerno, Italy
(Madan) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, Canada
Title
Radial versus femoral access for percutaneous coronary intervention in
ST-elevation myocardial infarction patients treated with fibrinolysis:
Results from the randomized routine early invasive clinical trials.
Source
Cardiovascular Revascularization Medicine. 17 (5) (pp 295-301), 2016. Date
of Publication: 01 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background To investigate the relationship between arterial access site
choice (radial versus femoral) and clinical outcomes among STEMI patients
undergoing routine PCI after fibrinolysis. Methods Patient-level data from
trials of STEMI patients evaluating routine PCI after fibrinolysis were
included. The primary endpoint was 30-day major bleeding; secondary
endpoints included 30-day death and re-infarction. Results 1891 patients
underwent PCI (trans-radial n = 338, trans-femoral n = 1553). Trans-radial
PCI patients were less likely to be > 75 years (2% vs. 8%, p = 0.0001),
heavier (median weight 82 [72-90] vs. 80 [70-90] kg, p = 0.0013) and more
likely in Killip class I at presentation (87% vs. 82%, p = 0.03). At 30
days, trans-radial PCI was associated with a similar unadjusted risk for
major bleeding (3.7% vs. 1.2%, Odds Ratio [OR] 0.43 [95% CI 0.13-1.48], p
= 0.18), mortality (3.4% vs. 1.2%, OR 0.34 [0.09-1.28], p = 0.11) and
re-infarction (3.9% vs. 4.7%, OR 1.25 [0.60-2.58], p = 0.56). In
multivariable analysis, radial access was associated with similar
estimates for bleeding and death/reinfarction risk. Conclusions In STEMI
patients treated with fibrinolysis and undergoing an early routine
invasive strategy, radial compared to femoral PCI is chosen in younger,
less ill patients and is independently associated with similar risk of
bleeding, re-infarction, and mortality. Summary This study evaluated the
relationship between arterial access choice (radial versus femoral) and
in-hospital and 30-day outcomes in patients undergoing routine PCI after
fibrinolysis for STEMI. We included patient-level data from trials
evaluating a strategy of routine PCI after fibrinolysis for STEMI. Of 1891
patients undergoing PCI, trans-radial access (n = 338) was chosen in
younger, lower risk patients. At 30 days, trans-radial access was
associated with a similar unadjusted and adjusted risk of major bleeding,
re-infarction and mortality. Copyright &#xa9; 2016 Elsevier Inc.

<98>
Accession Number
612012500
Author
Lagny M.-G.; Gothot A.; Hans G.A.; Koch J.-N.; Blaffart F.; Hella D.;
Donneau A.-F.; Roediger L.; Lecut C.; Pincemail J.; Cheramy-Bien J.-P.;
Defraigne J.-O.
Institution
(Lagny, Koch, Blaffart, Hella, Pincemail, Cheramy-Bien, Defraigne)
Division of Cardio-vascular and Thoracic Surgery, University of Liege
Hospital (ULg CHU), Avenue de lHopital, 1, Liege B-4000, Belgium
(Gothot, Lecut) Haematology Department, University of Liege Hospital,
Liege, Belgium
(Hans, Roediger) Division of Anaesthesiology, University of Liege
Hospital, Liege, Belgium
(Donneau) Biostatistics, Public Health Department, University of Liege,
Liege, Belgium
Title
Efficacy of the RemoweLL cardiotomy reservoir for fat and leucocyte
removal from shed mediastinal blood: A randomized controlled trial.
Source
Perfusion (United Kingdom). 31 (7) (pp 544-551), 2016. Date of
Publication: 01 Oct 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Introduction: Re-transfusion of lipid particles and activated leucocytes
with shed mediastinal blood (SMB) can aggravate cardiopulmonary
bypass-associated inflammation and increase the embolic load. This study
evaluated the fat and leucocyte removal capacity of the RemoweLL
cardiotomy reservoir. Methods: Forty-five patients undergoing elective
on-pump cardiac surgery were randomly allocated to filtration of SMB using
the RemoweLL or the Admiral cardiotomy reservoir. The primary outcome was
a drop in leucocytes and lipid particles obtained with the two filters.
The effect of the filters on other blood cells and inflammatory mediators,
such as myeloperoxidase (MPO), was also assessed. Results: The RemoweLL
cardiotomy filter removed 16.5% of the leucocytes (p<0.001) while no
significant removal of leucocytes was observed with the Admiral (p=0.48).
The percentage reductions in lipid particles were similar in the two
groups (26% vs 23%, p=0.2). Both filters similarly affected the level of
MPO (p=0.71). Conclusion: The RemoweLL filter more effectively removed
leucocytes from SMB than the Admiral. It offered no advantage in terms of
lipid particle clearance. Copyright &#xa9; SAGE Publications.

<99>
Accession Number
612012419
Author
Soylu E.; Harling L.; Ashrafian H.; Attaran S.; Athanasiou C.; Punjabi
P.P.; Casula R.; Athanasiou T.
Institution
(Soylu, Harling, Ashrafian, Attaran, Athanasiou, Punjabi, Casula,
Athanasiou) Department of Surgery and Cancer, Imperial College London,
QEQM Building, St. Marys Hospital, Praed Street, London W2 1NY, United
Kingdom
Title
A systematic review of the safety and efficacy of distal coronary artery
anastomotic devices in MIDCAB and TECAB surgery.
Source
Perfusion (United Kingdom). 31 (7) (pp 537-543), 2016. Date of
Publication: 01 Oct 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Minimally invasive direct coronary artery bypass (MIDCAB) and
totally endoscopic coronary artery bypass (TECAB) techniques may improve
recovery and reduce hospital stay following coronary artery bypass surgery
(CABG). However, working in a limited space with indirect visualisation
would greatly benefit from a simple, high-quality and reproducible
automated distal anastomotic method. Several devices have been developed;
however, their uptake has been limited due to uncertainty around their
impact on patient outcomes. Methods: A systematic review of the literature
identified six studies, incorporating 139 subjects undergoing MIDCAB or
TECAB surgery using a distal anastomotic device. Results: The overall
30-day mortality was 0.7% (1/137). No cardiac specific mortality was
observed. For each outcome of perioperative myocardial infarction (MI),
postoperative stroke and haemorrhage, only a single event was observed for
each (n=1/136, 1/138 and 1/136, respectively). The overall device failure
rates were low, with the use of additional sutures only reported in a
single case with the Magnetic Vascular Port (MVP) device. Anastomotic time
ranged from a mean of 3.32 minutes with the MVP device to 20 minutes with
the C-Port device. Conclusions: These results demonstrate the overall
acceptable early outcomes of distal anastomotic devices for use in
minimally invasive coronary bypass surgery. Future research should focus
on designing adequately powered, comparative, randomised trials, focusing
on major adverse cardiac and cerebrovascular events (MACCE) outcomes in
both the short and long-term, with clear case-by-case reasons for device
failure and a comparison of anastomotic times. In this way, we may
determine whether such devices will facilitate the minimal access and
robotic coronary procedures of the future. Copyright &#xa9; SAGE
Publications.

<100>
Accession Number
608828277
Author
Kim M.H.; Mitsudo K.; Jin C.D.; Kim T.H.; Cho Y.-R.; Park J.-S.; Park K.;
Park T.-H.; Serebruany V.
Institution
(Kim, Jin, Cho, Park, Park, Park) Department of Cardiology, College of
Medicine, Dong-A University, Busan, South Korea
(Kim, Jin, Kim) Global Clinical Trial Center, Dong-A University Hospital,
Busan, South Korea
(Mitsudo) Department of Cardiology, Kurashiki General Hospital, Okayama,
Japan
(Serebruany) Johns Hopkins University, Baltimore, MD, United States
Title
Long-term clinical outcomes after successful and failed recanalization to
native chronic Total occlusion: Insights from the Busan chronic Total
occlusion (B-CTO) Registry.
Source
Cardiovascular Revascularization Medicine. 17 (4) (pp 229-232), 2015. Date
of Publication: 22 Oct 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective To assess hard major adverse clinical events (HMACE) after
successful versus failed percutaneous coronary intervention for chronic
total occlusion (PCI-CTO). Background There are limited data regarding
long-term HMACE risks based on PCI-CTO success. Methods First-time PCI was
performed in 438 consecutive patients with 473 target CTO lesions.
Patients after procedural success (n = 355; 378 CTO lesions) and failure
(n = 83; 95 CTO lesions) were followed for an average 40 months (7-77
months range). We compared HMACE (composite of cardiac death, non-fatal
myocardial infarction (MI), and stroke) dependent on the success of PCI.
Results The incidence of HMACE was low, with a total of 16 events, and did
not differ {6% vs.3.1%, HR = 0.47; CI [0.16-1.35; p = 0.162} dependent on
the success of PCI-CTO. There were less cardiac deaths {0.3% vs. 1.2%, RR
= 0.22; CI [0.01-3.50];p = 0.283}, non fatal MI {1.1% vs.3.6%, RR = 0.27;
CI [0.06-1.22], p = 0.089}, but more strokes {1.7% vs.1.2%, RR = 1.32; CI
[0.16-10.99], p = 0.795} after successful PCI-CTO. Conclusions The risks
of HMACE after PCI-CTO over long-term follow-up were minimal, and do not
depend on the procedure success. This unexpected finding somewhat
challenge the aggressive interventional approach, and should be confirmed
in the adequately powered randomized trial. Copyright &#xa9; 2016 Elsevier
Inc.

<101>
Accession Number
608822441
Author
Bhatheja S.; Panchal H.B.; Barry N.; Mukherjee D.; Uretsky B.F.; Paul T.
Institution
(Bhatheja, Panchal, Paul) Division of Cardiology, Department of Internal
Medicine, East Tennessee State University, 329 N State of Franklin Rd,
Johnson City, TN 37604, United States
(Barry) Department of Internal Medicine, East Tennessee State University,
VA Building #1, Johnson City, TN, United States
(Mukherjee) Division of Cardiology, Department of Internal Medicine, Texas
Tech University, 4800 Alberta, El Paso, TX 79905, United States
(Uretsky) Division of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, United
States
Title
Valvular performance and aortic regurgitation following transcatheter
aortic valve replacement using Edwards valve versus CoreValve for severe
aortic stenosis: A Meta-analysis.
Source
Cardiovascular Revascularization Medicine. 17 (4) (pp 248-255), 2015. Date
of Publication: 02 Oct 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives To compare incidence of aortic regurgitation (AR), paravalvular
AR and valvular performance with Doppler hemodynamic parameters following
transcatheter aortic valve replacement (TAVR) with Edwards valve (EV)
versus CoreValve (CV). Currently, there are scarce data on post-TAVR
echocardiographic outcomes comparing EV and CV. Methods PubMed and the
Cochrane Center Register of Controlled Trials were searched through May
2015. Twenty studies (n = 11,244) comparing TAVR procedure that used EV (n
= 6445) and CV (n = 4799) were included. End points were post-TAVR
moderate to severe AR and paravalvular AR, effective orifice area (EOA),
mean trans-aortic pressure gradient (MPG), peak trans-aortic pressure
gradient (PPG) and left ventricular ejection fraction (LVEF). The mean
difference (MD) or relative risk (RR) with 95% confidence interval (CI)
was computed and p < 0.05 was considered as a level of significance.
Results Moderate to severe AR and paravalvular AR were significantly lower
in EV group (RR: 0.57, CI: 0.52-0.63, p < 0.00001 and RR: 0.40, CI:
0.25-0.63, p < 0.0001 respectively) compared to CV group. EOA and PPG were
not significantly different between EV and CV groups. MPG was
significantly lower among patients in CV group (MD: 1.08, CI: 0.05-2.10, p
= 0.04). LVEF was significantly higher in patients in EV group (MD: 2.26,
CI: 0.77-3.74, p = 0.03). Conclusions This study showed CV is associated
with higher incidence of post-TAVR moderate to severe paravalvular AR.
Echocardiographic valvular performance measures (MPG, LVEF) showed minimal
but significant difference, which may not be clinically significant.
Copyright &#xa9; 2016 Elsevier Inc.

<102>
Accession Number
610208866
Author
Otsuki S.; Brugaletta S.; Sabate M.; Shiratori Y.; Gomez-Monterrosas O.;
Scalone G.; Romero-Villafane S.; Hernandez-Enriquez M.; Freixa X.;
Martin-Yuste V.; Masotti M.
Institution
(Otsuki, Brugaletta, Sabate, Shiratori, Gomez-Monterrosas, Scalone,
Romero-Villafane, Hernandez-Enriquez, Freixa, Martin-Yuste, Masotti)
Thorax Institute, Department of Cardiology, Hospital Clinic, IDIBAPS,
University of Barcelona, Spain
Title
Overtime evaluation of the vascular HEALing process after
everolimus-eluting stent implantation by optical coherence tomography. The
HEAL-EES study.
Source
Cardiovascular Revascularization Medicine. 17 (4) (pp 241-247), 2015. Date
of Publication: 31 Oct 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Purpose Second-generation drug-eluting stent (DES) have shown a better
safety and efficacy as compared to first generation DES due to an improved
vascular healing process. This process has not been so far evaluated in
vivo in an overtime fashion by optical coherent tomography (OCT). We
sought to evaluate the vascular healing process after everolimus-eluting
stent (EES) implantation at 6, 9 and 12 months, by OCT. Methods
Consecutive 36 patients undergoing percutaneous coronary intervention with
EES were randomized 1:1:1 to receive OCT imaging at 6 (group A), 9 (group
B) or 12-month follow-up (group C). One patient from group C was excluded
because of target lesion revascularization at 1-month, whereas 5 patients
withdraw the informed consent. Finally, 30 patients were analyzed. Results
Neointimal thickness was not different between 3 groups (group A: 99.50
[94.06-127.79] mum, group B: 107.26 [83.48-133.59] mum, group C: 127.67
[102.51-138.49] mum; p = 0.736). Although the percentage of "uncovered
struts" was significantly higher in group A as compared to the other
groups (8.0% vs. 4.4% vs. 2.9%, respectively; p = 0.180), the ratio of
uncovered to total struts per section < 30% was similar between 3 groups
(0.3% vs. 0.3% vs. 0%, respectively; p = 1.000). Conclusion Healing
process following EES implantation seems almost completed at 6-month
follow-up. These data, which need to be confirmed in a larger study, may
support the decision to shorten dual antiplatelet therapy. Copyright
&#xa9; 2016 Elsevier Inc.

<103>
Accession Number
614943039
Author
Gao L.; Wang Y.; Liu Y.; Cao F.; Chen Y.
Institution
(Gao, Wang, Liu, Cao, Chen) Department of Cardiology, Chinese PLA General
Hospital, Beijing 100853, China
Title
Long-term clinical outcomes of successful revascularization with
drug-eluting stents for chronic total occlusions: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 89 (pp 574-581), 2017.
Date of Publication: 01 Mar 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To determine whether successful percutaneous coronary
intervention (PCI) using drug-eluting stents (DESs) have beneficial
effects on long-term outcomes in patients with chronic total occlusions
(CTOs) compared with failed PCIs for CTOs. Background: Several
observational studies have evaluated the long-term clinical outcomes of
successful PCIs using DESs for CTOs. However, the results of these studies
were inconsistent and inconclusive. Methods: We searched five online
electronic databases to identify all the publications assessing the
long-term outcomes of successful and failed PCIs using DESs for CTOs. Odds
ratios (ORs) with 95% confidence intervals (CIs) were calculated by STATA
software. Results: A total of nine studies involving 5958 CTO patients who
underwent successful PCI and 1511 CTO patients who underwent failed PCI
were included in this meta-analysis. The results of the analysis indicated
that successful CTO PCIs using DESs were associated with lower long-term
all-cause mortality(OR = 0.55, 95% CI = 0.45-0.67, P < 0.001), lower risk
of myocardial infarction (OR = 0.45, 95% CI = 0.23-0.74, P = 0.002), lower
risk of major adverse cardiac events (MACEs, OR = 0.44, 95% CI =
0.27-0.72, P = 0.001), and less incidence of subsequent coronary artery
bypass grafting (OR = 0.10, 95% CI = 0.05-0.21, P < 0.001) than failed CTO
PCIs. However, there was no difference in the incidence of target vessel
revascularization (OR = 1.06, 95% CI = 0.17-6.60, P > 0.05) between the
two groups. Conclusion: Successful CTO PCI using DESs can reduce long-term
all-cause mortality and the risks of MI, MACEs, and CABG in patients with
CTOs. &#xa9; 2017 Wiley Periodicals, Inc. Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<104>
Accession Number
614950722
Author
Ailawadi G.; Chang H.L.; O'Gara P.T.; O'Sullivan K.; Woo Y.J.; DeRose
J.J.; Parides M.K.; Thourani V.H.; Robichaud S.; Gillinov A.M.;
Taddei-Peters W.C.; Miller M.A.; Perrault L.P.; Smith R.L.; Goldsmith L.;
Horvath K.A.; Doud K.; Baio K.; Gelijns A.C.; Moskowitz A.J.; Bagiella E.;
Alexander J.H.; Iribarne A.
Institution
(Ailawadi) Cardiothoracic Surgery, University of Virginia,
Charlottesville, Va
(Chang, O'Sullivan, Parides, Gelijns, Moskowitz, Bagiella) Population
Health Science and Policy, Icahn School of Medicine at Mount Sinai, New
York, NY
(O'Gara) Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
Mass
(Woo) Department of Cardiothoracic Surgery, Stanford University, Stanford,
Calif
(DeRose) Cardiovascular and Thoracic Surgery, Montefiore-Einstein Heart
Center, Bronx, NY
(Thourani, Baio) Cardiothoracic Surgery, Emory University Hospital
Midtown, Atlanta, Ga
(Robichaud, Perrault) Montreal Heart Institute, Montreal, Canada
(Gillinov) Thoracic and Cardiovascular Surgery, Cleveland Clinic,
Cleveland, Ohio
(Taddei-Peters, Miller) Division of Cardiovascular Sciences, National
Heart, Lung, and Blood Institute, Bethesda, Md
(Smith) Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Tex
(Goldsmith) Division of Cardiothoracic Surgery, Columbia University
Medical Center, New York, NY
(Horvath) NIH Heart Center at Suburban Hospital, Bethesda, Md
(Doud) Cardiothoracic Research, Cleveland Clinic, Cleveland, Ohio
(Alexander) Division of Cardiology and Duke Clinical Research Institute,
Duke Medicine, Durham, NC
(Iribarne) Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon,
NH
Title
Pneumonia after cardiac surgery: Experience of the National Institutes of
Health/Canadian Institutes of Health Research Cardiothoracic Surgical
Trials Network.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: July 27, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Rationale: Pneumonia remains the most common major infection after cardiac
surgery despite numerous preventive measures. Objectives: To prospectively
examine the timing, pathogens, and risk factors, including modifiable
management practices, for postoperative pneumonia and estimate its impact
on clinical outcomes. Methods: A total of 5158 adult cardiac surgery
patients were enrolled prospectively in a cohort study across 10 centers.
All infections were adjudicated by an independent committee. Competing
risk models were used to assess the association of patient characteristics
and management practices with pneumonia within 65 days of surgery.
Mortality was assessed by Cox proportional hazards model and length of
stay by a multistate model. Measurements and Main Results: The cumulative
incidence of pneumonia was 2.4%, 33% of which occurred after discharge.
Older age, lower hemoglobin level, chronic obstructive pulmonary disease,
steroid use, operative time, and left ventricular assist device/heart
transplant were risk factors. Ventilation time (24-48 vs <24 hours; hazard
ratio [HR], 2.83; 95% confidence interval [95% CI], 1.72-4.66; >48 hours
HR, 4.67; 95% CI, 2.70-8.08), nasogastric tubes (HR, 1.80; 95% CI,
1.10-2.94), and each unit of blood cells transfused (HR, 1.16; 95% CI,
1.08-1.26) increased the risk of pneumonia. Prophylactic use of
second-generation cephalosporins (HR, 0.66; 95% CI, 0.45-0.97) and
platelet transfusions (HR, 0.49, 95% CI, 0.30-0.79) were protective.
Pneumonia was associated with a marked increase in mortality (HR, 8.89;
95% CI, 5.02-15.75) and longer length of stay of 13.55 +/- 1.95 days
(bootstrap 95% CI, 10.31-16.58). Conclusions: Pneumonia continues to
impose a major impact on the health of patients after cardiac surgery.
After we adjusted for baseline risk, several specific management practices
were associated with pneumonia, which offer targets for quality
improvement and further research. Copyright &#xa9; 2017 The American
Association for Thoracic Surgery.

<105>
Accession Number
612771058
Author
MacKay E.J.; Patel P.A.; Gutsche J.T.; Weiss S.J.; Augoustides J.G.
Institution
(MacKay, Patel, Gutsche, Weiss, Augoustides) Cardiovascular and Thoracic
Section, Anesthesiology and Critical Care, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA, United States
Title
Contemporary Clinical Niche for Intra-Aortic Balloon Counterpulsation in
Perioperative Cardiovascular Practice: An Evidence-Based Review for the
Cardiovascular Anesthesiologist.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 309-320),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders

<106>
Accession Number
612901782
Author
Narula J.; Kiran U.; Malhotra Kapoor P.; Choudhury M.; Rajashekar P.;
Kumar Chowdhary U.
Institution
(Narula, Kiran, Malhotra Kapoor, Choudhury) Departments of Cardiac
Anesthesiology and, Cardio and Neurosciences Centre, All India Institute
of Medical Sciences, New Delhi, India
(Rajashekar, Kumar Chowdhary) Cardio-Thoracic and Vascular Surgery, Cardio
and Neurosciences Centre, All India Institute of Medical Sciences, New
Delhi, India
Title
Assessment of Changes in Hemodynamics and Intrathoracic Fluid Using
Electrical Cardiometry During Autologous Blood Harvest.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 84-89),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of autologous blood harvest (ABH)-induced
volume shifts using electrical cardiometry (EC) in patients with pulmonary
artery hypertension secondary to left heart disease. Design Prospective,
randomized, controlled trial. Setting A tertiary care hospital.
Participants The study comprised 50 patients scheduled to undergo heart
valve replacement. Interventions Patients were divided randomly into 2
experimental groups that were distinguished by whether ABH was performed.
Blood volume extracted in the test group was replaced simultaneously with
1:1 colloid (Tetraspan; B Braun Melsungen, Melsungen, Germany).
Hemodynamic, respiratory, and EC-derived parameters were recorded at
predefined set points (T1 [post-induction/pre-ABH] and T2 [20 minutes
post-ABH]). Measurements and Main Results Withdrawal of 15% of blood
volume in the ABH group caused significant reductions in thoracic fluid
content (TFC) (-10.1% [-15.0% to -6.1%]); right atrial pressure (-23%
[-26.6% to -17.6%]); mean arterial pressure (-12.6% [-22.2% to -3.8%]);
airway pressures: (peak -6.2% [-11.7% to -2.8%] and mean -15.4% [-25.0% to
-8.3%]); and oxygenation index (-10.34% [-16.4% to -4.8%]). Linear
regression analysis showed good correlation between the percentage change
in TFC after ABH and the percentage of change in right atrial pressure,
stroke volume variation, autologous blood extracted, peak and mean airway
pressures, and oxygen index. Conclusions In addition to its proven role in
blood conservation, therapeutic benefits derived from ABH include
decongestion of volume-loaded patients, decrease in TFC, and improved gas
exchange. EC tracks beat-to-beat fluid and hemodynamic fluctuations during
ABH and helps in the execution of an early patient-specific, goal-directed
therapy, allowing for its safe implementation in patients with pulmonary
hypertension secondary to left heart disease. Copyright &#xa9; 2017
Elsevier Inc.

<107>
Accession Number
614031385
Author
Olper L.; Bignami E.; Di Prima A.L.; Albini S.; Nascimbene S.; Cabrini L.;
Landoni G.; Alfieri O.
Institution
(Olper, Bignami, Di Prima, Albini, Nascimbene, Cabrini, Landoni, Alfieri)
Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Landoni, Alfieri) Vita-Salute San Raffaele University, Milan, Italy
Title
Continuous Positive Airway Pressure Versus Oxygen Therapy in the Cardiac
Surgical Ward: A Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 115-121),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Background Noninvasive ventilation (NIV) is a common technique to manage
patients with acute respiratory failure in the intensive care unit.
However, use of NIV in general wards is less well described. The authors'
aim was to demonstrate efficacy of NIV, applied in a cardiac surgery ward,
in improving oxygenation in patients who developed hypoxemic acute
respiratory failure after being discharged from the intensive care unit.
Design Randomized, open-label trial. Setting University hospital.
Participants Sixty-four patients with hypoxemia
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio between 100 and 250)
admitted to the main ward after cardiac surgery. Interventions Patients
were randomized to receive standard treatment (oxygen, early mobilization,
a program of breathing exercises and diuretics) or continuous positive
airway pressure in addition to standard treatment. Continuous positive
airway pressure was administered 3 times a day for 2 consecutive days.
Every cycle lasted 1 to 3 hours. All patients completed their 1-year
follow-up. Data were analyzed according to the intention-to-treat
principle. Measurements and Main Results The primary endpoint was the
number of patients with PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf><200 48
hours after randomization. Continuous positive airway pressure use was
associated with a statistically significant reduction in the number of
patients with PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf><200 (4/33 [12%] v
14/31 [45%], p = 0.003). One patient in the control group died at the
30-day follow-up. Conclusions Among patients with acute respiratory
failure following cardiac surgery, administration of continuous positive
airway pressure in the main ward was associated with improved respiratory
outcome. This was the first study that was performed in the main ward of
post-surgical patients with acute respiratory failure. Copyright &#xa9;
2017 Elsevier Inc.

<108>
Accession Number
613367741
Author
Gu J.; Andreasen J.J.; Melgaard J.; Lundbye-Christensen S.; Hansen J.;
Schmidt E.B.; Thorsteinsson K.; Graff C.
Institution
(Gu, Andreasen, Thorsteinsson) Department of Cardiothoracic Surgery,
Aalborg, Denmark
(Gu, Andreasen, Schmidt, Thorsteinsson) Clinical Medicine, Aalborg
University Hospital, Aalborg, Denmark
(Gu) Department of Cardiovascular Surgery, Heart Centre of General
Hospital, Ningxia Medical University, Yinchuan, Ningxia, China
(Gu, Andreasen, Lundbye-Christensen, Schmidt) Atrial Fibrillation Study
Group, Aalborg University Hospital, Aalborg, Denmark
(Melgaard, Hansen, Graff) Department of Health Science and Technology,
Aalborg University, Aalborg, Denmark
(Lundbye-Christensen) Unit of Clinical Biostatistics and Bioinformatics,
Aalborg University Hospital, Aalborg, Denmark
(Schmidt) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
Title
Preoperative Electrocardiogram Score for Predicting New-Onset
Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 69-76),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objective To investigate if electrocardiogram (ECG) markers from routine
preoperative ECGs can be used in combination with clinical data to predict
new-onset postoperative atrial fibrillation (POAF) following cardiac
surgery. Design Retrospective observational case-control study. Setting
Single-center university hospital. Participants One hundred consecutive
adult patients (50 POAF, 50 without POAF) who underwent coronary artery
bypass grafting, valve surgery, or combinations. Interventions
Retrospective review of medical records and registration of POAF.
Measurements and Main Results Clinical data and demographics were
retrieved from the Western Denmark Heart Registry and patient records.
Paper tracings of preoperative ECGs were collected from patient records,
and ECG measurements were read by two independent readers blinded to
outcome. A subset of four clinical variables (age, gender, body mass
index, and type of surgery) were selected to form a multivariate clinical
prediction model for POAF and five ECG variables (QRS duration, PR
interval, P-wave duration, left atrial enlargement, and left ventricular
hypertrophy) were used in a multivariate ECG model. Adding ECG variables
to the clinical prediction model significantly improved the area under the
receiver operating characteristic curve from 0.54 to 0.67 (with
cross-validation). The best predictive model for POAF was a combined
clinical and ECG model with the following four variables: age,
PR-interval, QRS duration, and left atrial enlargement. Conclusion ECG
markers obtained from a routine preoperative ECG may be helpful in
predicting new-onset POAF in patients undergoing cardiac surgery.
Copyright &#xa9; 2017 Elsevier Inc.

<109>
Accession Number
613487706
Author
Kavrut Ozturk N.; Kavakli A.S.
Institution
(Kavrut Ozturk, Kavakli) Department of Anesthesiology and Reanimation,
Antalya Education and Research Hospital, Antalya, Turkey
Title
Use of McGrath MAC Videolaryngoscope to Assist Transesophageal
Echocardiography Probe Insertion in Intubated Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 191-196),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives Transesophageal echocardiography (TEE) probe insertion with the
conventional blind insertion technique may be difficult in anesthetized
and intubated patients. The use of a videolaryngoscope may facilitate the
insertion of the TEE probe. The aim of this study was to compare the
conventional technique with the use of the McGrath MAC videolaryngoscope
for TEE probe insertion in terms of success rate, duration of insertion,
and complications in patients undergoing cardiovascular surgery. Design A
prospective, randomized study. Setting Training and research hospital.
Participants Eighty-six adult patients undergoing cardiovascular surgery
were included. Interventions Eighty-six adult patients were randomized
into 2 groups: conventional group (n = 43) and McGrath videolaryngoscope
group (n = 43). Success rates, duration of insertion, complications, and
hemodynamic changes during insertion were recorded. Measurements and Main
Results The success rate of TEE probe insertion at the first attempt was
higher in the McGrath videolaryngoscope group (90.5%) than in the
conventional group (43.9%) (p = 0.012). The mean duration for successful
insertion of the TEE probe at the first attempt was longer in the McGrath
videolaryngoscope group (24 s v 11 s) (p = 0.016). The total time for
successful insertion of the TEE probe was similar in both groups.
Pharyngeal injuries were observed more frequently in the conventional
group (17.1% v 2.4%) (p = 0.037). The rate of blood presence on the probe
tip in the conventional group was higher than in the McGrath group (21.9%
v 4.8%). There were no statistical differences between the 2 groups in
systolic blood pressure, mean arterial pressure, diastolic blood pressure,
and heart rate before and after TEE insertion. Conclusions The use of the
McGrath MAC videolaryngoscope for TEE insertion in cardiovascular surgery
patients increases the success rate and reduces pharyngeal injuries
compared to the conventional technique. The use of the McGrath MAC
videolaryngoscope for TEE insertion causes similar hemodynamic changes as
in the conventional blind insertion technique. Copyright &#xa9; 2017
Elsevier Inc.

<110>
Accession Number
614953716
Author
Mac Craith E.; Davis N.F.; Browne C.; Mohan P.; Hickey D.
Institution
(Mac Craith, Davis, Browne, Mohan, Hickey) Department of Urology and
Transplant Surgery, Beaumont Hospital, Dublin, Ireland
Title
Simultaneous pancreas and kidney transplantation: Incidence and risk
factors for amputation after 10 years follow-up.
Source
Irish Journal of Medical Science. Conference: 25th Sylvester O'Halloran
Perioperative Scientific Symposium. Ireland. Conference Start: 20170302.
Conference End: 20170304. 186 (3 Supplement 1) (pp S134), 2017. Date of
Publication: March 2017.
Publisher
Springer London
Abstract
Introduction: The incidence of amputation after simultaneous pancreas and
kidney (SPK) transplantation is approximately 5-10% after 5 years
follow-up. The objective of this study was to investigate the incidence
and risk factors for amputation in SPK transplant patients after a minimum
follow-up of 10 years. Methods: An analysis was performed on a
prospectively maintained database of 81 SPK transplants consecutively
performed in one centre for insulin dependent diabetes mellitus between
December 1992 and January 2006. Primary outcome variables were incidence
of amputation per patient, total number of amputations and type of
amputation performed after 10 years follow-up. Data are presented as a
mean +/- standard deviation. Results: The mean age at transplantation was
39.77 +/- 6.88 years and the duration of long-term follow-up
post-transplantation was 161.18 +/- 67.04 months. Seven patients (9%)
underwent amputation and 1 amputee had pancreas allograft failure prior to
amputation. Fourteen amputations were performed in total and 4 patients
required >2 amputations. The latency period between SPK transplantation
and amputation was 133.57 +/- 49.43 months and the risk factors for
amputation included coronary stenosis requiring coronary stents (n = 3),
coronary artery bypass graft (n = 1) and smoking (n = 1). The commonest
form of amputation was below-knee amputation (n = 5), followed by toes (n
= 4), trans-metatarsal (n = 2), fingers (n = 2) and forearm (n = 1).
Conclusions: The incidence of amputation after SPK transplantation is
approximately 9% after 10 years follow-up. Patients undergoing amputation
after SPK transplantation are at an increased risk of multiple amputations
during their follow-up despite insulin independence.

<111>
Accession Number
614954236
Author
Rogers C.; Pike K.; Sterne J.; Reeves B.
Institution
(Rogers, Pike, Sterne, Reeves) University of Bristol, Bristol, United
Kingdom
Title
Estimating the effect of "treatment in the treated"-instrumental variable
analysis vs conventional regression methods in the titre-2 trial in
cardiac surgery.
Source
Trials. Conference: 3rd International Clinical Trials Methodology
Conference. United Kingdom. Conference Start: 20151116. Conference End:
20151117. 16 (no pagination), 2015. Date of Publication: 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: Perioperative anaemia is associated with adverse outcomes
after cardiac surgery but, paradoxically, observational analyses have
shown that red cell transfusion is associated with worse clinical
outcomes. TITRe2 tested the hypothesis that a restrictive threshold for
transfusion would reduce post-operative morbidity compared to a liberal
threshold. Methods: Adults undergoing cardiac surgery with post-operative
haemoglobin <9g/dL were recruited. Participants were randomised to
transfusion if haemoglobin <7.5g/dL (restrictive) or <9g/dL (liberal). The
primary analyses were by intention-to-treat. A secondary analysis of a
composite outcome (serious infection or ischaemic event or death in the
3-months after randomisation) to assess the effect of receiving a
transfusion was pre-specified. Two methods for handling confounding were
applied: adjustment conventionally for covariates (CA) or using randomised
allocation as an instrumental variable (IV). Results: 2003 patients were
randomised (1000 restrictive group, 1003 liberal group. Transfusion rates
were 53.4% and 92.2% in the restrictive and liberal groups, respectively.
The primary intention-to-treat analysis suggested a similar outcome in the
two groups (odds ratio=1.11, 95%CI 0.91-1.34, p=0.30). In the CA analysis
the odds of morbidity/mortality increased with transfusion (odds
ratio=1.28 95%CI 1.03 to 1.60, p=0.028), but the IV analysis was in the
opposite direction (relative risk=0.78, 95%CI 0.53-1.14, p=0.20).
Discussion: CA analysis supports previous observational analyses and
contradicting the primary analysis. IV analysis suggested a marginally
protective effect of RBC transfusion consistent with the ITT analysis of
the RCT. We conclude that the CA results are explained by residual
confounding.

<112>
Accession Number
614954111
Author
Clayton G.; Pike K.; Angelini G.D.; Rogers C.A.
Institution
(Clayton, Pike, Angelini, Rogers) Clinical Trials and Evaluation Unit,
School of Clinical Sciences, University of Bristol, Bristol, United
Kingdom
Title
Analysis of repeated measures of multiple surgical sites within a
factorial randomised controlled trial.
Source
Trials. Conference: 3rd International Clinical Trials Methodology
Conference. United Kingdom. Conference Start: 20151116. Conference End:
20151117. 16 (no pagination), 2015. Date of Publication: 2015.
Publisher
BioMed Central Ltd.
Abstract
Background: In heart bypass surgery, pieces of artery or vein ("conduits")
taken from elsewhere in the patients' body are used to bypass the blocked
or narrowed coronary arteries and improve the blood supply to the heart.
The "Hyperplasia and Atherogenesis in Bypass Vein Grafts Following
Different Surgical Preparation Techniques" (HArVeST) trial, is a
single-centre study investigating if new methods of taking and preparing
the conduit can improve the outcome for patients. Design: The study has a
2 x 2 factorial design: (a) the method of taking the vein (pedicle harvest
(leg vein and surrounding fat) versus conventional harvest (surrounding
fat stripped from vein)) and (b) method for checking the vein is not
damaged (low versus high pressure test). The primary outcome is the
patency of the vein graft(s) 12 months after surgery, i.e. thickness of
the wall of the graft and size of the lumen, assessed using intravascular
ultrasound (IVUS). Multiple measurements are taken as the IVUS machine
moves along the graft. Baseline measurements are assessed from a
histological analysis of vein harvested. Statistical analysis: Analyses of
the co-primary outcomes, which are both continuous measures, are on-going.
Mixed regression models with different correlation structures are being
explored to account for correlation arising from: (a) multiple grafts and
conduits from one patient, (b) grafts taken from the same conduit, and (c)
the repeated measures nature of the IVUS measurements within a graft.
Methodological considerations are multi-faceted; our aim is to make
maximal use of the data within a hierarchical framework. Disclaimer: This
research is supported by a National Institute for Health Research (NIHR)
Bristol Cardiovascular Biomedical Research Unit. The views and opinions
expressed therein are those of the authors and do not necessarily reflect
those of the NIHR, NHS or the Department of Health.

<113>
Accession Number
614953700
Author
Greenberg B.; Butler J.; Felker G.M.; Ponikowski P.; Voors A.A.; Jaski B.;
Lyon A.R.; Pogoda J.M.; Rudy J.J.; Zsebo K.M.
Institution
(Greenberg) UCSD Medical Center, San Diego, CA, United States
(Butler) Stony Brook University, Stony Brook, NY, United States
(Felker) Duke University, School of Medicine, Durham, NC, United States
(Ponikowski) Wroclaw Medical University, Wroclaw, Poland
(Voors) University of Groningen, Groningen, Netherlands
(Jaski) San Diego Cardiac Center, San Diego, CA, United States
(Lyon) Imperial College London, London, United Kingdom
(Pogoda, Rudy, Zsebo) Celladon Corporation, San Diego, CA, United States
Title
CUPID 2: A phase 2B trial investigating the efficacy and safety of the
intracoronary administration of AAV1/SERCA2a in patients with advanced
heart failure.
Source
Journal of Cardiac Failure. Conference: 20th Annual Scientific Meeting,
Heart Failure Society of America. United States. Conference Start:
20160917. Conference End: 20160920. 21 (11) (pp 939-940), 2015. Date of
Publication: November 2015.
Publisher
Churchill Livingstone Inc.
Abstract
Background: Despite use of optimised guideline-directed therapies, heart
failure (HF) patients often experience worsening of their condition,
recurrent hospitalizations and premature mortality. Molecular studies have
identified that a deficiency in the sarco-endoplasmic reticulum Ca2+
ATPase 2a (SERCA2a) enzyme in cardiomyocytes impairs cardiac relaxation
and contractility. In animal models of HF, increasing SERCA2a expression
by genetic enzyme replacement therapy improves cardiac function and
survival. In patients, the phase 2a CUPID 1 trial reported that SERCA2a
enzyme replacement with a novel recombinant adeno-associated viral vector
containing human SERCA2a cDNA (AAV1/SERCA2a) promoted reverse left
ventricular remodelling and improved symptoms, functionality and the
clinical course. Purpose: CUPID 2 was a multinational, multicenter,
double-blind, placebo controlled, randomized phase 2b trial in 250
patients designed to determine if a single intracoronary infusion of
AAV1/SERCA2a, in addition to optimal HF therapy, reduced the rate of HF
associated recurrent events (hospitalizations and ambulatory treatment) in
patients with moderate to advanced systolic HF. Methods: Patients enrolled
in CUPID 2 were between the ages of 18 and 80 years, had a diagnosis of
NYHA class II-IV chronic HF of either ischemic or non-ischemic etiology
and a left ventricular ejection fraction (EF) of #35% and were at high
risk for HF hospitalizations. Patients with circulating neutralizing AAV
antibodies (O1.2) were excluded. Eligible patients were randomized in a
1:1 ratio to receive a single intracoronary infusion of either
AAV1/SERCA2a or placebo. The primary endpoint was time from treatment to
HF-associated recurrent events in the modified intentto- treat population
(n=243), defined as patients who received MYDICAR or placebo. Analysis was
done using a semi-parametric joint frailty model to account for
withinsubject correlated events and informative censoring from terminal
events. The secondary efficacy endpoint was time to first terminal event
(all-cause death, heart transplant, or LVAD implantation). The study had
80% power at the 0.05 two-sided significance level to detect a 45%
recurrent event risk reduction. CUPID2 exceeded the pre-specified 186
adjudicated recurrent events by the time all patients had completed at
least 12 months of follow-up (or had terminated early) post-randomization.
Results: Treatment with MYDICAR did not result in an improvement in the
primary endpoint of recurrent HF events compared to placebo (HR 5 0.93,
95% confidence interval 0.53-1.65; p=0.81). The MYDICAR to placebo
comparison of the secondary endpoint of all-cause death, need for a
mechanical circulatory support device, or heart transplant, likewise
failed to show a significant treatment effect. No safety issues were
noted. Conclusion: The results of CUPID 2 failed to support the hypothesis
that AAV1/SERCA2a improves the clinical course of high risk HF patients
with reduced EF.

<114>
Accession Number
613833926
Author
Bavishi C.; Sardar P.; Chatterjee S.; Khan A.R.; Shah A.; Ather S.; Lemos
P.A.; Moreno P.; Stone G.W.
Institution
(Bavishi, Chatterjee, Shah, Moreno) Mount Sinai St Luke's & Mount Sinai
West Hospitals, New York, NY, United States
(Sardar) University of Utah, Salt Lake City, UT, United States
(Khan) University of Louisville, Louisville, KY, United States
(Ather) University of Alabama at Birmingham, Birmingham, AL, United States
(Lemos) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Stone) Columbia University Medical Center, New York-Presbyterian Hospital
and the Cardiovascular Research Foundation, New York, NY, United States
Title
Intravascular ultrasound-guided vs angiography-guided drug-eluting stent
implantation in complex coronary lesions: Meta-analysis of randomized
trials.
Source
American Heart Journal. 185 (pp 26-34), 2017. Date of Publication: 01 Mar
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
The relative outcomes of intravascular ultrasound (IVUS)-guided
percutaneous coronary intervention (PCI) compared with angiography-guided
PCI with drug-eluting stent (DES) in complex lesions have not been
established. We sought to compare the efficacy and safety of IVUS-guided
PCI with angiography-guided PCI in patients with complex coronary lesions
treated with DES. Methods Electronic databases were searched to identify
all randomized trials comparing IVUS-guided vs angiography-guided DES
implantation. We evaluated major adverse cardiac events (MACE), all-cause
and cardiovascular death, myocardial infarction, target lesion
revascularization (TLR), target vessel revascularization (TVR), and stent
thrombosis outcomes at the longest reported follow-up. Random-effects
modeling was used to calculate pooled relative risk (RR) and 95% CIs.
Results Eight trials comprising 3,276 patients (1,635 IVUS-guided and
1,641 angiography-guided) enrolling only patients with complex lesions
were included. Mean follow-up was 1.4 +/- 0.5 years. Compared with
angiography-guided PCI, patients undergoing IVUS-guided PCI had
significantly lower MACE (RR 0.64, 95% CI 0.51-0.80, P = .0001), TLR (RR
0.62, 95% CI 0.45-0.86, P = .004), and TVR (RR 0.60, 95% CI 0.42-0.87, P =
.007). There were no significant differences for stent thrombosis,
cardiovascular death, or all-cause death. In meta-regression analysis,
IVUS-guided PCI was of greatest benefit in reducing MACE in patients with
acute coronary syndromes, diabetes, and long lesions. Conclusions The
present meta-analysis demonstrates a significant reduction in MACE, TVR,
and TLR with IVUS-guided DES implantation in complex coronary lesions.
Copyright &#xa9; 2016 Elsevier Inc.

<115>
Accession Number
613961578
Author
Wikkelso A.; Wetterslev J.; Moller A.M.; Afshari A.
Institution
(Wikkelso) Department of Anaesthesia and Intensive Care Medicine, Hvidovre
Hospital, Copenhagen University Hospital, Hvidovre, Denmark
(Wetterslev) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, University of Copenhagen, Copenhagen, Denmark
(Moller) Department of Anaesthesia and Intensive Care Medicine, Herlev
Hospital, Herlev, Denmark
(Afshari) Department of Paediatric and Obstetric Anaesthesia, Juliane
Marie Center, Copenhagen University Hospital, Copenhagen, Denmark
Title
Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to
monitor haemostatic treatment in bleeding patients: a systematic review
with meta-analysis and trial sequential analysis.
Source
Anaesthesia. 72 (4) (pp 519-531), 2017. Date of Publication: 01 Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Coagulopathy and severe bleeding are associated with high mortality. We
evaluated haemostatic treatment guided by the functional viscoelastic
haemostatic assays, thromboelastography or rotational thromboelastometry
in bleeding patients. We searched for randomised, controlled trials
irrespective of publication status, publication date, blinding status,
outcomes published or language from date of inception to 5 January 2016 in
six bibliographic databases. We included 17 trials (1493 participants),
most involving cardiac surgery. Thromboelastography or rotational
thromboelastometry seemed to reduce overall mortality compared to any of
our comparisons (3.9% vs. 7.4%, RR (95% CI) 0.52 (0.28-0.95);
I² = 0%, 8 trials, 717 participants). However, the quality of
evidence is graded as low due to the high risk of bias, heterogeneity,
imprecision and low event rate. Thromboelastography or rotational
thromboelastometry significantly reduced the proportion of patients
transfused with red blood cells (RR (95% CI) 0.86 (0.79-0.94);
I² = 0%, 10 trials, 832 participants), fresh frozen plasma (RR
(95% CI) 0.57 (0.33-0.96); I² = 86%, 10 trials, 832
participants) and platelets (RR (95% CI) 0.73 (0.60-0.88); I² =
0%, 10 studies, 832 participants). There was no difference in proportion
needing surgical re-interventions (RR (95% CI) 0.75 (0.50-1.10);
I² = 0%, 9 trials, 887 participants). Trial sequential analysis
of mortality suggests that only 54% of the required information size has
been reached so far. Transfusion strategies guided by thromboelastography
or rotational thromboelastometry may reduce the need for blood products in
patients with bleeding, but the results are mainly based on trials of
elective cardiac surgery involving cardiopulmonary bypass, with
low-quality evidence. Copyright &#xa9; 2017 The Association of
Anaesthetists of Great Britain and Ireland

<116>
Accession Number
614723733
Author
Lawall H.; Huppert P.; Espinola-Klein C.; Zemmrich C.S.; Ruemenapf G.
Institution
(Lawall) Akademie fur Gefaskrankheiten Ettlingen, Max Grundig Klinik,
Buhlerhohe, Germany
(Huppert) Institut fur Radiologie, Klinikum Darmstadt, Germany
(Espinola-Klein) Zentrum fur Kardiologie, Abt. Angiologie,
Universitatsmedizin Mainz, Germany
(Zemmrich) Institute for Pharmacology and Preventive Medicine, Mahlow,
Germany
(Ruemenapf) Klinik fur Gefaschirurgie, Diakonissen-Stiftungs-Krankenhaus
Speyer, Germany
Title
German guideline on the diagnosis and treatment of peripheral artery
disease - a comprehensive update 2016.
Source
Vasa - European Journal of Vascular Medicine. 46 (2) (pp 79-86), 2017.
Date of Publication: March 2017.
Publisher
Verlag Hans Huber AG (E-mail: verlag@hanshuber.com)
Abstract
The prevalence of peripheral artery disease (PAD) is increasing worldwide
and is strongly age-related, affecting about 20 % of Germans over 70 years
of age. Recent advances in endovascular and surgical techniques as well as
clinical study results on comparative treatment methods strengthened the
need for a comprehensive review of the published evidence for diagnosis,
management, and prevention of PAD. The interdisciplinary guideline
exclusively covers distal aorta and atherosclerotic lower extremity artery
disease. A systematic literature review and formal consensus finding
process, including delegated members of 22 medical societies and two
patient self-support organisations were conducted and supervised by the
Association of Scientific Medical Societies in Germany, AWMF. Three levels
of recommendation were defined, A = is recommended/ indicated", B = should
be considered", C = "may be considered", means agreement of expert
opinions due to lack of evidence. Altogether 294 articles, including 34
systematic reviews and 98 RCTs have been analysed. The key diagnostic
tools and treatment basics have been defined. In patients with
intermittent claudication endovascular and/or surgical techniques are
treatment options depending on appropriate individual morphology and
patient preference. In critical limb ischaemia, revasculari-sation without
delay by means of the most appropriate technique is key. If possible and
reasonable, endovascular procedures should be applied first. The TASC
classification is no longer recommended as the base of therapeutic
decision process due to advances in endovascular techniques and new crural
therapeutic options. Limited new data on rehabilitation and follow-up
therapies have been integrated. The article summarises major new aspects
of PAD treatment from the updated German Guidelines for Diagnosis and
Treatment of PAD. Limited scientific evidence still calls for randomised
clinical trials to close the present gap of evidence. Copyright &#xa9;
2017 Hogrefe.

<117>
Accession Number
614518952
Author
Mitaka C.; Ohnuma T.; Murayama T.; Kunimoto F.; Nagashima M.; Takei T.;
Iguchi N.; Tomita M.
Institution
(Mitaka) Department of Anesthesiology, Tokyo Medical and Dental University
Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
(Mitaka) Department of Anesthesiology and Pain Medicine, Juntendo
University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Ohnuma, Murayama) Intensive Care Unit, Department of Anesthesiology,
Saitama Medical Center, Jichi Medical University, 1-847 Amanuma,
Ohmiya-ku, Saitama 330-8503, Japan
(Kunimoto) Intensive Care Unit, Gunma University Hospital, 3-39-15 Shouwa,
Maebashi, Gunma 371-8511, Japan
(Nagashima, Takei) Intensive Care Unit, Yokohama City Minato Red Cross
Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama, Kanagawa 231-8682,
Japan
(Iguchi) Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka,
Suita, Osaka 565-0871, Japan
(Tomita) Clinical Research Center, Tokyo Medical and Dental University
Hospital of Medicine 1-5-45 Yushima, Tokyo 113-8519, Japan
Title
Effects of low-dose atrial natriuretic peptide infusion on cardiac
surgery-associated acute kidney injury: A multicenter randomized
controlled trial.
Source
Journal of Critical Care. 38 (pp 253-258), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Purpose To evaluate the effects of atrial natriuretic peptide (ANP) on
renal function and medical costs in patients with acute kidney injury
(AKI) associated with cardiac surgery. Materials and methods The Japanese
trial for AKI in Post-cardiovascular surgery patients by ANP (JAPAN) was a
prospective, multicenter, randomized, double-blind, placebo-controlled
study conducted in 11 hospitals in Japan. Acute kidney injury was defined
as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours.
The patients were randomly assigned to receive ANP (0.02 mug
kg^-1 min^-1) or placebo. The primary end point was a
change in renal function. The secondary end points were a need for renal
replacement therapy, the lengths of intensive care unit and hospital
stays, and medical costs incurred over the 90-day follow-up. Results Of
the 77 randomized patients, 37 were in the ANP group and 40 were in the
placebo group. Although ANP significantly (P =.018) increased urine
output, it did not significantly improve renal function compared with
placebo. There were no significant differences between the groups in the
renal replacement therapy rate, the lengths of the intensive care unit and
hospital stays, or medical costs. Conclusion Atrial natriuretic peptide
infusion did not show a renoprotective effect or cost-saving effect in the
treatment of cardiac surgery-associated AKI. Copyright &#xa9; 2016 The
Authors

<118>
Accession Number
614828959
Author
Azarfarin R.; Dashti M.; Totonchi Z.; Ziyaeifard M.; Mehrabanian M.;
Alizadehasl A.; Gorjipour F.
Institution
(Azarfarin, Alizadehasl) Echocardiography Research Center, Rajaie
Cardiovascular, Medical, and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Dashti) Department of Anesthesiology, Sadoughi University of Medical
Sciences, Yazd, Iran, Islamic Republic of
(Totonchi, Ziyaeifard, Mehrabanian, Gorjipour) Rajaie Cardiovascular,
Medical, and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Efficacy of the "head-up position" in returning cardiopulmonary bypass
blood to the patient and reducing the required blood transfusion: A
randomized trial.
Source
Iranian Heart Journal. 18 (1) (pp 6-15), 2017. Date of Publication: 2017.
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: All intraoperative strategies that may assist an
anesthesiologist with lowering the blood transfusion rate must be
considered. We assessed the efficacy of the 30degree head-up position at
the end of cardiopulmonary bypass (CPB) in returning CPB reservoir blood
to patients, reducing the transfusion rate, and conferring hemodynamic
stability after the transfer of patients to the intensive care unit (ICU).
Methods: In a single-center clinical trial, 88 adult patients undergoing
elective isolated coronary artery bypass graft surgery were randomly
allocated to the head-up group (n=44), in which the 30degree head-up
position was applied during separation from CPB, and the supine group
(n=44), in which weaning from CPB was performed in the supine position.
All the patients had left ventricular ejection fractions > 35%. The
primary end point was the returned volume of filtered CPB blood to the
patients. The secondary outcome measures were intraoperative and early
postoperative hemodynamic parameters. Additionally, blood products
transfused during surgery and in the 1st 6 hours following ICU admission
were recorded. Results: There were no statistically significant
differences in intraoperative and early postoperative hemodynamics between
the 2 groups except in the returned blood volume to the patients after
separation from CPB (714 +/- 99 mL in the head-up position group vs 285
+/- 78 mL in the supine group; P = 0.0001). There were no significant
differences between the 2 groups regarding the transfused blood products
during surgery and the 1st 6 hours following ICU admission. Conclusions:
Using the 30degree head-up position at the end of CPB conferred a higher
return of blood to the patients but did not significantly reduce
postoperative transfusion. Copyright &#xa9; 2017, Iranian Heart
Association. All rights reserved.

<119>
Accession Number
614764383
Author
Kong D.F.; Saito S.; Nakamura S.; Mehran R.; Rowland S.M.; Handler A.;
Al-Khalidi H.R.; Krucoff M.W.
Institution
(Kong, Saito, Nakamura, Mehran, Rowland, Handler, Al-Khalidi, Krucoff)
Duke University Medical Center and Duke Clinical Research Institute,
Durham, NC, United States
Title
Rationale and design of the Japan-USA harmonized assessment by randomized,
multicenter study of OrbusNEich's combo StEnt (Japan-USA HARMONEE):
Assessment of a novel DES platform for percutaneous coronary
revascularization in patients with ischemic coronary disease and
non-ST-elevation acute coronary syndrome.
Source
American Heart Journal. 187 (pp 112-121), 2017. Date of Publication: 01
May 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Tissue trauma associated with stent implantation continues to generate
early thrombosis rates of 0.9% to 1.3% for both bare-metal and
drug-eluting stent platforms. The Combo sirolimus-eluting stent combines
an abluminal, bioabsorbable polymer with a luminal CD34+ antibody designed
to capture endothelial progenitor cells. This article describes the design
and methods of the HARMONEE trial (NCT02073565), which represents the
first randomized controlled trial of the Combo design against a
best-in-class contemporary everolimus-eluting stent. Up to 50 sites in
Japan and the United States will enroll 286 subjects (271 evaluable) in
each of 2 arms, for a total sample size of 572 subjects (542 evaluable).
The statistical plan includes both superiority to imputed bare-metal stent
control and noninferiority to everolimus-eluting stent on a primary
clinical end point of target vessel failure at 1 year. In addition,
fractional flow reserve assessment to evaluate the physiology of target
vessels in the entire population will augment the end point definition of
ischemia-driven target vessel revascularization. Finally, key safety
considerations will be evaluated with a subpopulation with optical
coherence tomography imaging for strut coverage, late strut malapposition,
and plaque volume, as well as serial human antimurine antibody
assessments. As the first international prospective randomized coronary
intervention study under the "Harmonization by Doing" program, this study
represents a unique collaboration between regulators and investigators in
Japan and the United States. Copyright &#xa9; 2017 Elsevier Inc.

<120>
Accession Number
614764382
Author
Lemmert M.E.; Oldroyd K.; Barragan P.; Lesiak M.; Byrne R.A.; Merkulov E.;
Daemen J.; Onuma Y.; Witberg K.; van Geuns R.-J.
Institution
(Lemmert, Oldroyd, Barragan, Lesiak, Byrne, Merkulov, Daemen, Onuma,
Witberg, van Geuns) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
Title
Reduced duration of dual antiplatelet therapy using an improved
drug-eluting stent for percutaneous coronary intervention of the left main
artery in a real-world, all-comer population: Rationale and study design
of the prospective randomized multicenter IDEAL-LM trial.
Source
American Heart Journal. 187 (pp 104-111), 2017. Date of Publication: 01
May 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Continuous improvements in stent technology make percutaneous
coronary intervention (PCI) a potential alternative to surgery in selected
patients with unprotected left main coronary artery (uLMCA) disease. The
optimal duration of dual antiplatelet therapy (DAPT) in these patients
remains undetermined, and in addition, new stent designs using a
bioabsorbable polymer might allow shorter duration of DAPT. Study design
IDEAL-LM is a prospective, randomized, multicenter study that will enroll
818 patients undergoing uLMCA PCI. Patients will be randomized in a 1:1
fashion to intravascular ultrasound-guided PCI with the novel
everolimus-eluting platinum-chromium Synergy stent with a biodegradable
polymer (Boston Scientific, Natick, MA) followed by 4 months of DAPT or
the everolimus-eluting cobalt-chromium Xience stent (Abbott Vascular,
Santa Clara, CA) followed by 12 months of DAPT. The total follow-up period
will be 5 years. A subset of 100 patients will undergo optical coherence
tomography at 3 months. End points The primary end point will be major
adverse cardiovascular events (composite of all-cause mortality,
myocardial infarction, and ischemia-driven target vessel
revascularization) at 2 years. Secondary end points will consist of the
individual components of the primary end point, procedural success, a
device-oriented composite end point, stent thrombosis as per Academic
Research Consortium criteria, and bleeding as per Bleeding Academic
Research Consortium criteria. Summary IDEAL-LM is designed to assess the
safety and efficacy of the novel Synergy stent followed by 4 months of
DAPT vs the Xience stent followed by 12 months of DAPT in patients
undergoing uLMCA PCI. The study will provide novel insights regarding
optimal treatment strategy for patients undergoing PCI of uLMCA disease
(www.clinicaltrials.gov, NCT 02303717). Copyright &#xa9; 2017

<121>
Accession Number
614526764
Author
Brooks L.
Institution
(Brooks) University of Maryland, School of Medicine, Baltimore, MD, United
States
Title
Effect of PCSK9 inhibitors on coronary artery disease progression.
Source
Journal of Clinical Outcomes Management. 24 (2) (pp 58-60), 2017. Date of
Publication: February 2017.
Publisher
Turner White Communications Inc.

<122>
Accession Number
614806068
Author
Williams B.; Bernstein W.
Institution
(Williams, Bernstein) Department of Anesthesiology, University of Maryland
School of Medicine, Baltimore, MD, United States
Title
Review of venoarterial extracorporeal membrane oxygenation and development
of intracardiac thrombosis in adult cardiothoracic patients.
Source
Journal of Extra-Corporeal Technology. 48 (4) (pp 162-167), 2016. Date of
Publication: 2016.
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become an
indispensable treatment option for adult cardiothoracic patients
experiencing acute refractory cardiogenic shock. VA ECMO is not without
inherent complications as in-hospital mortality has ranged from 45% to 65%
(1-3). Intracardiac thrombosis (ICT) is a rare but life-threatening
complication associated with VA ECMO. VA ECMO cases complicated by ICT
were searched for using the MEDLINE (PubMed and OVID), Society of
Cardiovascular Anesthesiology Headquarters, and Google Scholar databases.
Twelve cases of VA ECMO-associated ICT were discovered for review.
Indications for VA ECMO were postcardiotomy cardiogenic shock and heart
failure. The primary location of thrombus was the left ventricle and
aortic root. Majority of the cases did not report subtherapeutic systemic
anticoagulation. Two patients survived after the development of ICT. VA
ECMO-associated ICT is a devastating consequence with high mortality. The
majority of ICT occurred in cases with perceived adequate anticoagulation,
but this may not result in complete suppression of the coagulation
response. Continued exposure to procoagulant stimuli and worsening
ventricular function and intracardiac stasis can shift the balance toward
a hypercoagulable state and development of thrombosis.

<123>
[Use Link to view the full text]
Accession Number
611201860
Author
Van Aelbrouck C.; Jorquera-Vasquez S.; Beukinga I.; Pradier O.; Ickx B.;
Barvais L.; Van Obbergh L.; Faraoni D.
Institution
(Van Aelbrouck, Jorquera-Vasquez, Ickx, Barvais, Van Obbergh) Department
of Anaesthesiology, Erasme University Hospital, Route de Lennik 808,
Brussels 1070, Belgium
(Beukinga, Pradier) Department of Haematology and Haemostasis, Erasme
University Hospital, Free University of Brussels, Brussels, Belgium
(Faraoni) Department of Anesthesiology, Peri-operative and Pain Medicine,
Boston Children's Hospital, Harvard Medical School, Boston, MA, United
States
Title
Tranexamic acid decreases the magnitude of platelet dysfunction in
aspirin-free patients undergoing cardiac surgery with cardiopulmonary
bypass: A pilot study.
Source
Blood Coagulation and Fibrinolysis. 27 (8) (pp 855-861), 2016. Date of
Publication: 13 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
This study sought to compare the effect of tranexamic acid (TXA)
administration on cardiopulmonary bypass-induced platelet dysfunction in
patients who received preoperative aspirin or not. We performed a
prospective, randomized, double-blind pilot study, including patients
undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).
Patients without aspirin interruption were enrolled in the 'group ASPIRIN'
(n U 18) and those who had never been treated with aspirin were included
in the 'group NO ASPIRIN' (n U 10). Patients were then randomized to
receive either TXA or the same infusion of normal saline. Multiple
electrode aggregometry was used to assess platelet function at the
different time points throughout the surgery: baseline, post-TXA loading
dose, aortic unclamping (End CPB), and 5 min after protamine (Protamine).
Compared to those included in the group NO ASPIRIN, patients included in
the group ASPIRIN presented a decreased baseline platelet function
measured by ASP test (P < 0.01) and collagen test (P < 0.01). In the group
NO ASPIRIN, treatment group (TXA vs. placebo) significantly influenced the
results for ADP test (P < 0.01), thrombin receptor-activating peptide test
(P U 0.01), and ASP test (P U 0.01). We observed that TXA improved
platelet function, as measured using multiple electrode aggregometry on
ADP test, thrombin receptoractivating peptide test, and ASP test, at the
end of CPB (P < 0.05). TXA might decrease the magnitude of platelet
dysfunction in aspirin-free patients undergoing cardiac surgery. Further
studies are needed to confirm these results and assess a potential
relationship with clinical endpoints. Copyright &#xa9; 2016 Wolters Kluwer
Health, Inc. All rights reserved.

<124>
Accession Number
613497324
Author
Waheed S.; Pollack S.; Roth M.; Reichek N.; Guerci A.; Cao J.J.
Institution
(Waheed, Pollack, Roth, Reichek, Guerci, Cao) Saint Francis Hospital,
Roslyn, NY, United States
(Waheed) University of Kansas Medical Center, Kansas City, KS, United
States
(Pollack) St. John's University, Queens, New York, United States
(Reichek, Cao) State University of New York at Stony Brook, New York,
United States
Title
Collective impact of conventional cardiovascular risk factors and coronary
calcium score on clinical outcomes with or without statin therapy: The St
Francis Heart Study.
Source
Atherosclerosis. 255 (pp 193-199), 2016. Date of Publication: 01 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims The efficacy of statin therapy remains unknown in
patients eligible for statin therapy with and without elevated coronary
calcium score (CAC). The study sought to evaluate how cardiovascular risk
factors, expressed in terms of statin eligibility for primary prevention,
and CAC modify clinical outcomes with and without statin therapy. Methods
We conducted a post-hoc analysis of the St. Francis Heart Study treatment
trial, a double-blind, placebo-controlled randomized controlled trial of
atorvastatin (20 mg), vitamin C (1 g), and vitamin E (1000 U) daily,
versus placebos in 990 asymptomatic individuals with CAC > 80th percentile
for age and gender. Primary cardiovascular outcomes included non-fatal
myocardial infarction or coronary death, coronary revascularization,
stroke, and peripheral arterial revascularization. We further stratified
the treatment and placebo groups by eligibility (eligible when statin
indicated) for statin therapy based on 2013 ACC/AHA guidelines and based
on CAC categories. Results After a median follow-up of 4.8 years,
cardiovascular events had occurred in 3.9% of the statin treated but not
eligible, 4.6% of the untreated and not eligible, 8.9% of the treated and
eligible and 13.4% of the untreated and eligible groups, respectively
(p<0.001). Low CAC (<100) occurred infrequently in statin eligible
subjects (<4%) and was associated with low 10-year event rate (<1 per 100
person-years). In contrast, high CAC (>300) occurred frequently in more
than 35% of the statin not eligible subjects and was associated with a
high 10-year event rate (>17 per 100 person-years). Risk prediction
improved significantly when both clinical risk profile and CAC score were
combined (net reclassification index p = 0.002). Conclusions Under the
current statin treatment guidelines a small number of statin eligible
subjects with low CAC might not benefit from statin therapy within 5
years. However, the statin not eligible subjects with high CAC have high
event rate attributing to loss of opportunity for effective primary
prevention. Copyright &#xa9; 2016 Elsevier Ireland Ltd

<125>
Accession Number
614913078
Author
Zhang J.; Wang S.
Institution
(Zhang) Department of Anesthesia, The East Area of the Central Hospital of
Xinxiang, Xinxiang, PR China
(Wang) Quality and Technical Supervision and Inspection Center of
Xinxiang, Xinxiang, PR China
Title
Effects of sevoflurane on cardiopulmonary function in patients undergoing
coronary artery bypass.
Source
Journal of biological regulators and homeostatic agents. 30 (4) (pp
1079-1083), 2016. Date of Publication: 01 Oct 2016.
Abstract
The objective of the current study was to investigate effects of
sevoflurane on cardiopulmonary function in patients undergoing coronary
artery bypass grafting (CABG). In this study, 60 cases of patients with
coronary heart disease (CHD) were selected and randomly divided into the
sevoflurane group (group S) and the control group C (group C) with 30
cases in each group. The two groups received intravenous anesthesia. The
patients of group C were only given oxygen mask and physiological saline
to keep vein open; while the patients of group S were administered with 1%
sevoflurane immediately after the beginning of cardiopulmonary bypass
(CPB) until the end of the treatment. The cardiopulmonary functions at 30
min before operation (T0), postoperative 2 h (T1), 6h (T2), 24h (T3) and
48 (T4) were observed. The mean arterial pressure (MAP) of the group S at
T1, T2, T3 was lower than that of the group C, as were the heart rate (HR)
and left ventricular ejection fraction (LVEF). The creatine kinase
isoenzyme (CK-MB) during T1 to T4 in the group S was less than that of the
group C, and there were significant differences between the two groups (P
less than 0.05). The tidal volume (Vt), vital capacity (Vc) and
oxygenation index (PaO2/FiO2) of the two groups during T1 and T2 were
decreased, while respiratory frequency (RR) and alveolar-arterial blood
oxygen partial pressure (PA-aO2) were increased and they began to decrease
during T3 and T4. Vt and Vc of the group S were higher during T1 and T2
periods than those of the group C, while RR was lower than that of the
group C; PaO2 / FiO2 during T1 to T4 period of group S was higher than
that of group C, while PA-aO2 was significantly lower than that of the
control group (P less than 0.05). In conclusion, although LVEF was not
improved in the sevoflurane group, sevoflurane may contribute to
stabilizing the cardiopulmonary function and preventing from myocardial
injury.

<126>
Accession Number
614925142
Author
Van Mieghem N.M.; Latib A.; van der Heyden J.; van Gils L.; Daemen J.;
Sorzano T.; Ligthart J.; Witberg K.; de Kroon T.; Maor N.; Mangieri A.;
Montorfano M.; de Jaegere P.P.; Colombo A.; Roubin G.
Institution
(Van Mieghem, van Gils, Daemen, Ligthart, Witberg, de Jaegere) Department
of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Latib, Mangieri, Montorfano, Colombo) Department of Interventional
Cardiology, San Raffaele Scientific Institute, Milan, Italy
(Latib, Colombo) Department of Interventional Cardiology, EMO-GVM Centro
Cuore, Milan, Italy
(van der Heyden, de Kroon) Department of Cardiology and Cardiac Surgery,
St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Sorzano, Maor, Roubin) Essential Medical, Inc., Malvem, Pennsylvania,
United States
(Roubin) Cardiovascular Associates, Birmingham, Alabama, United States
Title
Percutaneous Plug-Based Arteriotomy Closure Device for Large-Bore Access:
A Multicenter Prospective Study.
Source
JACC: Cardiovascular Interventions. 10 (6) (pp 613-619), 2017. Date of
Publication: 27 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to study the safety and efficacy of the
MANTA Vascular Closure Device (VCD), a novel collagen-based technology
dedicated to closure of large-bore arteriotomies. Background Novel
transfemoral therapeutic interventions requiring large-bore catheters have
become valid minimally invasive options but have inherent access
management challenges. To date, no dedicated vascular closure devices
exist for large arteriotomies. Methods A prospective, single-arm clinical
investigation enrolling patients who underwent elective percutaneous
interventions with large-bore catheters and planned percutaneous
arteriotomy closure in 3 European institutions. Results A total of 50
patients with a mean age of 79.5 +/- 8.3 years underwent high-risk
percutaneous coronary intervention, balloon aortic valvuloplasty, or
transcatheter aortic valve replacement with large-bore catheters sized
12-F to 19-F. MANTA closure was performed by 9 different operators. The
14-F MANTA VCD was deployed in one-third of the overall cohort (16 of 50,
32%), and the 18-F MANTA VCD in the remainder. The MANTA VCD was deployed
successfully in all patients. The mean time to hemostasis was 2 min, 23 s.
One patient had a major vascular and major bleeding complication with
prolonged femoral bleeding that was successfully treated with a covered
stent and eventual surgical repair. There were no other access
site-related complications. Conclusions This first multicenter experience
demonstrates rapid and reliable hemostasis and low complication rates with
the use of the plug-based MANTA VCD for large-bore arteriotomy closure.
Copyright &#xa9; 2017 American College of Cardiology Foundation

<127>
Accession Number
614922115
Author
Guerra G.G.; Joffe A.R.; Seal R.; Phillipos E.; Wong M.; Moez E.K.; Dinu
I.A.; Duff J.P.; Ross D.; Rebeyka I.; Robertson C.M.T.
Institution
(Guerra, Joffe, Phillipos, Duff, Robertson) Department of Pediatrics,
University of Alberta, Edmonton, Canada
(Seal) Department of Anesthesia and Pain Medicine, University of Alberta,
Edmonton, Canada
(Wong) Stollery Children's Hospital, Edmonton, Canada
(Moez, Dinu) School of Public Health, University of Alberta, Edmonton,
Canada
(Ross, Rebeyka) Department of Surgery, University of Alberta, Edmonton,
Canada
Title
Pilot randomized controlled trial on early and late remote ischemic
preconditioning prior to complex cardiac surgery in young infants.
Source
Paediatric Anaesthesia. 27 (4) (pp 433-441), 2017. Date of Publication: 01
Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Remote ischemic preconditioning involves providing a brief
ischemia-reperfusion event to a tissue to create subsequent protection
from a more severe ischemia-reperfusion event to a different tissue/organ.
The few pediatric remote ischemic preconditioning studies in the
literature show conflicting results. Aim: We conducted a pilot randomized
controlled trial to determine the feasibility of conducting a larger trial
and to gather provisional data on the effect of early and late remote
ischemic preconditioning on outcomes of infants after surgery for
congenital heart disease. Methods: This single-center, double-blind
randomized controlled trial of remote ischemic preconditioning vs control
(sham-remote ischemic preconditioning) in young infants going for surgery
for congenital heart disease at the Stollery Children's Hospital. Remote
ischemic preconditioning was performed at 24-48 h preoperatively and
immediately prior to cardiopulmonary bypass. Remote ischemic
preconditioning stimulus was performed with blood pressure cuffs around
the thighs. Primary outcomes were feasibility and peak blood lactate level
on day 1 postoperatively. Results: Fifty-two patients were randomized but
seven patients became ineligible after randomization leaving 45 patients
included in the study. In the included patients, 7 (15%) had protocol
deviations (five infants did not have the preoperative intervention and
two did not receive the intervention in the operating room). From a
comfort point of view, only one subject in the control group and two in
the Remote ischemic preconditioning group received sedation during the
preoperative intervention. There were no study-related adverse events and
no complications to the limbs subjected to preconditioning. There were no
significant differences between the Remote ischemic preconditioning group
and the control group in the highest blood lactate level on day 1
postoperatively (mean difference, 1.28; 95%CI, -0.22, 2.78; P-value =
0.093). Conclusion: In infants who underwent surgery for congenital heart
disease, our pilot randomized controlled trial on early and late remote
ischemic preconditioning proved to be feasible but did not find any
significant difference in acute outcomes. A larger trial may be necessary.
Copyright &#xa9; 2017 John Wiley & Sons Ltd

<128>
Accession Number
614921778
Author
Rusch D.; Koch T.; Seel F.; Eberhart L.
Institution
(Rusch, Koch, Seel, Eberhart) Department of Anesthesia and Intensive Care,
University Hospital Giessen - Marburg, Marburg Campus, Marburg, Germany
Title
Vapocoolant Spray Versus Lidocaine Infiltration for Radial Artery
Cannulation: A Prospective, Randomized, Controlled Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 77-83),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives Local infiltration with lidocaine is a frequently used measure
to prevent pain during arterial cannulation. Its administration is
associated with pain. Vapocoolants like ethyl chloride or alkanes also
affect rapid-onset anesthesia. However, their administration causes less
discomfort compared with administration of lidocaine. The effectiveness of
vapocoolants in mitigating discomfort associated with arterial cannulation
never has been studied. The authors therefore compared vapocoolant with
lidocaine for reducing discomfort caused by arterial cannulation. Design
Prospective, randomized, controlled study. Setting University hospital,
single center. Participants One hundred sixty adult patients requiring
arterial cannulation before induction of general anesthesia for cardiac
surgery or carotid endarterectomy. Interventions Patients received either
lidocaine infiltration or vapocoolant spray prior to arterial cannulation.
Overall discomfort resulting from the whole procedure (applying
local/topical anesthesia followed by arterial puncture) was rated on a 0
to 10 numerical rating scale. Puncture failure rate and time required for
the intervention also were recorded. Measurements and Main Results One
hundred forty-three patients were included in the per-protocol analysis.
Mean pain scores in the vapocoolant group were 3.4 (+/-1.58) compared with
4.5 (+/-2.29) in the lidocaine group (difference 1.1+/-0.33; p = 0.032;
Mann-Whitney U-test). The higher puncture failure rate in the lidocaine
group (n = 11 v 4) was not significant (p = 0.06; Fisher's exact test).
The time required for the intervention was longer in the lidocaine group
(138+/-44 s v 128+/-44 s; p = 0.019; Mann-Whitney U-test). Conclusions
Vapocoolant spray is an alternative to lidocaine infiltration to mitigate
discomfort associated with arterial cannulation. Copyright &#xa9; 2017
Elsevier Inc.

<129>
Accession Number
614921131
Author
Anonymous
Title
Erratum: Percutaneous coronary angioplasty versus coronary artery bypass
grafting in treatment of unprotected left main stenosis (NOBLE): a
prospective, randomised, open-label, non-inferiority trial (The Lancet
(2016) 388(10061)
(2743-2752)(S0140673616320529)(10.1016/S0140-6736(16)32052-9)).
Source
The Lancet. 389 (10074) (pp 1102), 2017. Date of Publication: 18 Mar 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Makikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty
versus coronary artery bypass grafting in treatment of unprotected left
main stenosis (NOBLE): a prospective, randomised, open-label,
non-inferiority trial. Lancet 2016; 388: 2743-52-Due to administrative and
coding errors, the Kaplan-Meier estimates, graph figures, and table 2 data
are incorrect in this Article and have been updated. The affiliation for M
Corbascio and the appendix has also been updated. These corrections have
been made to the online version as of March 16, 2017. Copyright &#xa9;
2017 Elsevier Ltd

<130>
Accession Number
614924738
Author
Dieleman J.M.; de Wit G.A.; Nierich A.P.; Rosseel P.M.; van der Maaten
J.M.; Hofland J.; Diephuis J.C.; de Lange F.; Boer C.; Neslo R.E.; Moons
K.G.; van Herwerden L.A.; Tijssen J.G.; Kalkman C.J.; van Dijk D.
Institution
(Dieleman, Kalkman, van Dijk) Department of Anesthesiology and Intensive
Care University Medical Center Utrecht the Netherlands
(de Wit, Neslo, Moons) Julius Center for Health Sciences and Primary Care
University Medical Center Utrecht the Netherlands
(Nierich) Department of Cardiothoracic Anesthesia Isala Klinieken Zwolle
the Netherlands
(Rosseel) Department of Cardiothoracic Anesthesia Amphia Ziekenhuis Breda
the Netherlands
(van der Maaten) Department of Anesthesiology University Medical Center
Groningen the Netherlands
(Hofland) Department of Cardiothoracic Anesthesia Erasmus Medical Center
Rotterdam the Netherlands
(Diephuis) Department of Cardiothoracic Anesthesia Medisch Spectrum Twente
Enschede the Netherlands
(de Lange) Department of Cardiothoracic Anesthesia Medical Center
Leeuwarden the Netherlands
(Boer) Department of Anesthesiology Vrije Universiteit University Medical
Center Amsterdam the Netherlands
(van Herwerden) Department of Cardiothoracic Surgery University Medical
Center Utrecht the Netherlands
(Tijssen) Department of Cardiology Academic Medical Center Amsterdam the
Netherlands
Title
Long-term outcomes and cost effectiveness of high-dose dexamethasone for
cardiac surgery: A randomised trial.
Source
Anaesthesia. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Prophylactic intra-operative administration of dexamethasone may improve
short-term clinical outcomes in cardiac surgical patients. The purpose of
this study was to evaluate long-term clinical outcomes and cost
effectiveness of dexamethasone versus placebo. Patients included in the
multicentre, randomised, double-blind, placebo-controlled DExamethasone
for Cardiac Surgery (DECS) trial were followed up for 12 months after
their cardiac surgical procedure. In the DECS trial, patients received a
single intra-operative dose of dexamethasone 1 mg.kg^-1 (n =
2239) or placebo (n = 2255). The effects on the incidence of major
postoperative events were evaluated. Also, overall costs for the 12-month
postoperative period, and cost effectiveness, were compared between
groups. Of 4494 randomised patients, 4457 patients (99%) were followed up
until 12 months after surgery. There was no difference in the incidence of
major postoperative events, the relative risk (95%CI) being 0.86
(0.72-1.03); p = 0.1. Treatment with dexamethasone reduced costs per
patient by 921 [1084] (95%CI -1672 to -137; p = 0.02), mainly through
reduction of postoperative respiratory failure and duration of
postoperative hospital stay. The probability of dexamethasone being cost
effective compared with placebo was 97% at a threshold value of 17,000
[20,000] per quality-adjusted life year. We conclude that intra-operative
high-dose dexamethasone did not have an effect on major adverse events at
12 months after cardiac surgery, but was associated with a reduction in
costs. Routine dexamethasone administration is expected to be cost
effective at commonly accepted threshold levels for cost effectiveness.
Copyright &#xa9; The Association of Anaesthetists of Great Britain and
Ireland.

<131>
Accession Number
614921740
Author
Ohman E.M.; Roe M.T.; Steg P.G.; James S.K.; Povsic T.J.; White J.;
Rockhold F.; Plotnikov A.; Mundl H.; Strony J.; Sun X.; Husted S.; Tendera
M.; Montalescot G.; Bahit M.C.; Ardissino D.; Bueno H.; Claeys M.J.;
Nicolau J.C.; Cornel J.H.; Goto S.; Kiss R.G.; Guray U.; Park D.-W.; Bode
C.; Welsh R.C.; Gibson C.M.
Institution
(Ohman, Roe, Povsic, White, Rockhold) Duke Clinical Research Institute,
Duke University School of Medicine, Durham, NC, USA
(Steg) DHU FIRE, Universite Paris-Diderot, AP-HP and Inserm U-1148, Paris,
France
(Steg) NHLI Royal Brompton Hospital, Imperial College London, London, UK
(James) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Plotnikov, Strony, Sun) Janssen Research and Development, Raritan, NJ,
USA
(Mundl) Bayer AG, Wuppertal, Germany
(Husted) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Tendera) 3rd Division of Cardiology, Medical University of Silesia,
Katowice, Poland
(Montalescot) Institut de Cardiologie, Groupe Hospitalier
Pitie-Salpetriere, Paris, France
(Bahit) INECO Neurociencias Orono, Rosario, Santa Fe, Argentina
(Ardissino) Divisione di Cardiologia, Policlinico San Matteo, Pavia, Italy
(Bueno) Spanish National Centre for Cardiovascular Research, Madrid, Spain
(Claeys) University Hospital Antwerp, Edegem, Belgium
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Cornel) Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar and
Dutch Network for Cardiovascular Research (WCN), Netherlands
(Goto) Department of Medicine (Cardiology), Tokai University School of
Medicine, Isehara, Japan
(Kiss) Department of Cardiology, Military Hospital, Budapest, Hungary
(Guray) Numune Education and Research Hospital, Department of Cardiology,
Ankara, Turkey
(Park) Division of Cardiology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, Korea
(Bode) University of Freiburg, Freiburg, Germany
(Welsh) Mazankowski Alberta Heart Institute and University of Alberta,
Edmonton, AB, Canada
(Gibson) PERFUSE Study Group, Beth Israel Deaconess Hospital, Harvard
Medical School, Boston, MA, USA
Title
Clinically significant bleeding with low-dose rivaroxaban versus aspirin,
in addition to P2Y12 inhibition, in acute coronary syndromes
(GEMINI-ACS-1): A double-blind, multicentre, randomised trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Dual antiplatelet therapy (DAPT), aspirin plus a P2Y12
inhibitor, is the standard antithrombotic treatment following acute
coronary syndromes. The factor Xa inhibitor rivaroxaban reduced mortality
and ischaemic events when added to DAPT, but caused increased bleeding.
The safety of a dual pathway antithrombotic therapy approach combining
low-dose rivaroxaban (in place of aspirin) with a P2Y12 inhibitor has not
been assesssed in acute coronary syndromes. We aimed to assess rivaroxaban
2.5 mg twice daily versus aspirin 100 mg daily, in addition to clopidogrel
or ticagrelor (chosen at investigator discretion before randomisation),
for patients with acute coronary syndromes started within 10 days after
presentation and continued for 6-12 months. Methods: In this double-blind,
multicentre, randomised trial (GEMINI-ACS-1) done at 371 clinical centres
in 21 countries, eligible patients were older than 18 years with unstable
angina, non-ST segment elevation myocardial infarction (NSTEMI) or ST
segment elevation myocardial infarction (STEMI), with positive cardiac
biomarkers and either ischaemic electrocardiographic changes or an
atherosclerotic culprit lesion identified during angiography. Participants
were randomly assigned (1:1) within 10 days after admission for the index
acute coronary syndromes event to either aspirin or rivaroxaban based on a
computer-generated randomisation schedule. Randomisation was balanced by
using randomly permuted blocks with size of four and was stratified based
on the background P2Y12 inhibitor (clopidogrel or ticagrelor) intended to
be used at the time of randomisation. Investigators and patients were
masked to treatment assignment. Patients received a minimum of 180 days of
double-blind treatment with rivaroxaban 2.5 mg twice daily or aspirin 100
mg daily. The choice of clopidogrel or ticagrelor during trial conduct was
not randomised and was based on investigator preference. The primary
endpoint was thrombolysis in myocardial infarction (TIMI) clinically
significant bleeding not related to coronary artery bypass grafting (CABG;
major, minor, or requiring medical attention) up to day 390. Primary
analysis was by intention to treat. This study is registered with
ClinicalTrials.gov, number NCT02293395. Findings: Between April 22, 2015,
and Oct 14, 2016, 3037 patients with acute coronary syndromes were
randomly assigned; 1518 to receive aspirin and 1519 to receive
rivaroxaban. 1704 patients (56%) were in the ticagrelor and 1333 (44%) in
the clopidogrel strata. Median duration of treatment was 291 days (IQR
239-354). TIMI non-CABG clinically significant bleeding was similar with
rivaroxaban versus aspirin therapy (total 154 patients [5%]; 80
participants [5%] of 1519 vs 74 participants [5%] of 1518; HR 1.09 [95% CI
0.80-1.50]; p=0.5840). Interpretation: A dual pathway antithrombotic
therapy approach combining low-dose rivaroxaban with a P2Y12 inhibitor for
the treatment of patients with acute coronary syndromes had similar risk
of clinically significant bleeding as aspirin and a P2Y12 inhibitor. A
larger, adequately powered trial would be required to definitively assess
the efficacy and safety of this approach. Funding: Janssen Research &
Development and Bayer AG. Copyright &#xa9; 2017 Elsevier Ltd.

<132>
Accession Number
614916923
Author
Manfredini V.; Leone O.; Agostini V.; Potena L.
Institution
(Manfredini) aHeart and Lung Transplant Program bPathology Department,
Bologna University Hospital S.Orsola-Malpighi, Bologna, Italy
Title
Antibody-mediated rejection in heart transplantation: new developments and
old uncertainties.
Source
Current Opinion in Organ Transplantation. (no pagination), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE OF REVIEW: Antibody-mediated rejection (AMR) currently represents
one of the main problems for clinical management of heart transplant
because of its diagnostic complexity and poor evidences supporting
treatments. RECENT FINDINGS: Disorder-based diagnosis is a cornerstone in
defining AMR. The limitations of the current classification have been
partially overcome by novel studies improving the description of the
immune-pathological graft abnormalities, and by new molecular approaches
allowing a better understanding of the mechanisms behind AMR and of its
relationship with cellular rejection and chronic vasculopathy. In-depth
characterization of donor-specific antibodies showed to provide additional
prognostic information and guide for treatment. Clinical relevance of AMR
is bound to appropriate detection of graft dysfunction. In addition to
traditional longitudinal evaluation by echocardiogram, cardiac magnetic
resonance and detection of cell-free DNA may represent novel sensitive
markers for graft injury that could prompt treatment before dysfunction
becomes clinically manifest. SUMMARY: Despite improvements in the
diagnostic process, therapeutic strategies made little progress in
addition to the consolidation of practices supported by limited evidences.
Novel complement inhibitors appear promising in changing this scenario.
Nevertheless, collaborative multicenter studies are needed to develop
standardized approaches tailored to the highly variable clinical and
laboratory features of AMR. Copyright &#xa9; 2017 Wolters Kluwer Health,
Inc. All rights reserved.

<133>
Accession Number
614928911
Author
Horwitz L.I.; Bernheim S.M.; Ross J.S.; Herrin J.; Grady J.N.; Krumholz
H.M.; Drye E.E.; Lin Z.
Institution
(Horwitz) *Department of Population Health, Division of Healthcare
Delivery Science, New York University School of Medicine +Center for
Healthcare Innovation and Delivery Science, New York University Langone
Medical Center ++Department of Medicine, Division of General Internal
Medicine and Clinical Innovation, New York University School of Medicine,
New York, NY Center for Outcomes Research and Evaluation, Yale New Haven
Health Department of Internal Medicine, Section of General Internal
Medicine, Yale School of Medicine PDepartment of Medicine, Robert Wood
Johnson Foundation Clinical Scholars Program, Yale School of Medicine
#Department of Health Policy and Management, Yale School of Public Health
**Department of Medicine, Section of Cardiovascular Medicine, Yale S
Title
Hospital Characteristics Associated With Risk-standardized Readmission
Rates.
Source
Medical Care. (no pagination), 2017. Date of Publication: 17 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: Safety-net and teaching hospitals are somewhat more likely to
be penalized for excess readmissions, but the association of other
hospital characteristics with readmission rates is uncertain and may have
relevance for hospital-centered interventions. OBJECTIVE:: To examine the
independent association of 8 hospital characteristics with hospital-wide
30-day risk-standardized readmission rate (RSRR). DESIGN:: This is a
retrospective cross-sectional multivariable analysis. SUBJECTS:: US
hospitals. MEASURES:: Center for Medicare and Medicaid Services
specification of hospital-wide RSRR from July 1, 2013 through June 30,
2014 with race and Medicaid dual-eligibility added. RESULTS:: We included
6,789,839 admissions to 4474 hospitals of Medicare fee-for-service
beneficiaries aged over 64 years. In multivariable analyses, there was
regional variation: hospitals in the mid-Atlantic region had the highest
RSRRs [0.98 percentage points higher than hospitals in the Mountain
region; 95% confidence interval (CI), 0.84-1.12]. For-profit hospitals had
an average RSRR 0.38 percentage points (95% CI, 0.24-0.53) higher than
public hospitals. Both urban and rural hospitals had higher RSRRs than
those in medium metropolitan areas. Hospitals without advanced cardiac
surgery capability had an average RSRR 0.27 percentage points (95% CI,
0.18-0.36) higher than those with. The ratio of registered nurses per
hospital bed was not associated with RSRR. Variability in RSRRs among
hospitals of similar type was much larger than aggregate differences
between types of hospitals. CONCLUSIONS:: Overall, larger, urban, academic
facilities had modestly higher RSRRs than smaller, suburban, community
hospitals, although there was a wide range of performance. The strong
regional effect suggests that local practice patterns are an important
influence. Disproportionately high readmission rates at for-profit
hospitals may highlight the role of financial incentives favoring
utilization. Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All rights
reserved.

<134>
Accession Number
614921635
Author
Karjalainen P.P.; Nammas W.
Institution
(Karjalainen, Nammas) Heart Center, Satakunta Central Hospital, Pori,
Finland
Title
Percutaneous revascularization of coronary chronic total occlusion: Toward
a reappraisal of the available evidence.
Source
Journal of Cardiology. (no pagination), 2016. Date of Publication:
November 02, 2016.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Chronic total occlusion (CTO) is a challenging subset of coronary artery
disease that is commonly encountered in real-world practice; it is
associated with worse long-term prognosis. Observational studies suggest
that percutaneous coronary intervention (PCI) for CTO is associated with
reduction in myocardial ischemia and improvement in quality of life and
left ventricular function. Some observational studies suggested that
CTO-PCI is associated with improvement of the 'hard' clinical endpoints;
others did not. Nearly all these studies compared the clinical outcome of
successful versus failed PCI, rather than comparing the outcome of a whole
CTO-PCI cohort versus a 'true' control group. Interestingly, in
observational studies that compared the outcome of CTO-PCI versus optimal
medical treatment, long-term mortality was comparable between the two
strategies. In patients with multi-vessel disease and CTO, complete
revascularization is more often achieved by coronary artery bypass
grafting than by PCI; the SYNTAX score of these patients often favors
surgical revascularization according to the current guidelines. The
current guidelines reflect the divergence of opinion on the
usefulness/benefit of CTO-PCI, mainly due to the lack of randomized
trials. Evidence is awaited from three ongoing randomized controlled
trials comparing PCI versus optimal medical treatment in the setting of
CTO. Copyright &#xa9; 2016 Japanese College of Cardiology.

<135>
Accession Number
614929399
Author
Machan L.; Churilov L.; Hu R.; Peyton P.; Tan C.; Pillai P.; Ellard L.;
Harley I.; Story D.; Hayward P.; Matalanis G.; Roubos N.; Seevanayagam S.;
Weinberg L.
Institution
(Machan) University of Melbourne, Victoria, Australia
(Churilov) Florey Institute of Neuroscience and Mental Health, University
of Melbourne, Victoria, Australia
(Hu, Peyton, Tan, Pillai, Ellard, Harley) Department of Anesthesia, Austin
Hospital, Heidelberg, Victoria, Australia
(Story, Weinberg) Department of Anesthesia, University of Melbourne,
Victoria, Australia
(Story, Weinberg) Department of Surgery and Centre for Anesthesia,
Perioperative and Pain Medicine, University of Melbourne, Victoria,
Australia
(Hayward, Matalanis, Roubos, Seevanayagam) Department of Cardiac Surgery,
Austin Hospital, Heidelberg, Victoria, Australia
Title
Apneic Oxygenation Versus Low-Tidal-Volume Ventilation in Anesthetized
Cardiac Surgical Patients: A Prospective, Single-Center, Randomized
Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2016.
Date of Publication: 2016.
Publisher
W.B. Saunders
Abstract
Objectives: To compare the physiology of apneic oxygenation with
low-tidal-volume (VT) ventilation during harvesting of the left internal
mammary artery. Design: Prospective, single-center, randomized trial.
Setting: Single-center teaching hospital. Participants: The study
comprised 24 patients who underwent elective coronary artery bypass
grafting surgery. Interventions: Apneic oxygenation (apneic group: 12
participants) and low-VT ventilation (low-VT group: 12 participants) (2.5
mL/kg ideal body weight) for 15 minutes during harvesting of the left
internal mammary artery. Measurement and Main Results: The primary
endpoint was an absolute change in partial pressure of arterial carbon
dioxide (PaCO<inf>2</inf>). Secondary endpoints were changes in arterial
pH, pulmonary artery pressures (PAP), cardiac index, and pulmonary artery
acceleration time and ease of surgical access. The mean (standard
deviation) absolute increase in PaCO<inf>2</inf> was 31.8 mmHg (7.6) in
the apneic group and 17.6 mmHg (8.2) in the low-VT group
(baseline-adjusted difference 14.2 mmHg [95% confidence interval
21.0-7.3], p<0.001). The mean (standard deviation) absolute decrease in pH
was 0.15 (0.03) in the apneic group and 0.09 (0.03) in the low-VT group
baseline-adjusted difference 0.06 [95% confidence interval 0.03-0.09],
p<0.001. Differences in the rate of change over time between groups
(time-by-treatment interaction) were observed for PaCO<inf>2</inf>
(p<0.001), pH (p<0.001), systolic PAP (p = 0.002), diastolic PAP (p =
0.023), and mean PAP (p = 0.034). Both techniques provided adequate ease
of surgical access; however, apneic oxygenation was preferred
predominantly. Conclusions: Apneic oxygenation caused a greater degree of
hypercarbia and respiratory acidemia compared with low-VT ventilation.
Neither technique had deleterious effects on PAP or cardiac function. Both
techniques provided adequate ease of surgical access. Copyright &#xa9;
2016 Elsevier Inc.

<136>
Accession Number
613755577
Author
Morrison L.J.; Devlin S.M.; Kontos M.C.; Cheskes S.; Aufderheide T.P.;
Christenson J.; Ornato J.P.; Stiell I.G.; Rac V.E.; Thomas A.J.; Wigginton
J.G.; Dorian P.
Institution
(Morrison) Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital,
Division of Emergency Medicine, Department of Medicine, University of
Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
(Devlin) Department of Epidemiology and Biostatistics, Memorial
Sloan-Kettering Cancer Center, 307 East 63rd Street, 3rd Floor, New York,
NY, United States
(Kontos) Pauley Heart Center, Division of Cardiology, Virginia
Commonwealth University, Richmond, VA, United States
(Cheskes) Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital,
Sunnybrook Centre for Prehospital Medicine, Division of Emergency
Medicine, Department of Family and Community Medicine University of
Toronto, 77 Browns Line, Suite 100, Toronto, Ontario M8W 3S2, Canada
(Aufderheide) Medical College of Wisconsin, Department of Emergency
Medicine, 9200W. Wisconsin Avenue, Pavilion 1P, Milwaukee, WI 53226,
United States
(Christenson) University of British Columbia, Department of Emergency
Medicine, Room 3300 3rd Floor, 910 West 10th Avenue, Vancouver, British
Columbia V5Z 1M9, Canada
(Ornato) Department of Emergency Medicine, Virginia Commonwealth
University, Richmond, VA, United States
(Stiell) Department of Emergency Medicine, Ottawa Hospital Research
Institute, University of Ottawa, Clinical Epidemiology Unit, F6 1053
Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
(Rac) THETA (Toronto Health Economics and Technology Assessment)
Collaborative, Toronto General Research Institute, University Health
Network and Leslie Dan Pharmacy Building, 6th Floor, Room 651, 144 College
Street, Toronto, Ontario M5S 3M2, Canada
(Thomas) School of Medicine, Oregon Health & Science University, 3181 SW
Sam Jackson Park Rd, Portland, OR 97239-3098, United States
(Wigginton) University of Texas Southwestern Medical Center, 5323 Harry
Hines Boulevard, Dallas, TX 75390, United States
(Dorian) Division of Cardiology, Department of Medicine, St Michael's
Hospital and University of Toronto, Toronto, Ontario, Canada
Title
The association of maximum Troponin values post out-of-hospital cardiac
arrest with electrocardiographic findings, cardiac reperfusion procedures
and survival to discharge: A sub-study of ROC PRIMED.
Source
Resuscitation. 111 (pp 82-89), 2017. Date of Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The role of Troponin (Tn) levels in the management of patients
post out-of-hospital cardiac arrest (OHCA) is unclear. Methods All OHCA
patients enrolled in the Resuscitation Outcomes Consortium Prehospital
Resuscitation using an IMpedance valve and Early versus Delayed analysis
trial and admitted to hospital with a Tn level and a 12-lead
electrocardiogram were stratified by ST elevation (STE) or no STE in a
regression model for survival to discharge adjusted for Utstein predictors
and site. Results Of the 15,617 enrolled OHCA patients, 4118 (26%)
survived to admission to hospital; 17% (693) were STE and 77% (3188) were
no STE with 6% unknown; 83% (3460) had at least one Tn level. Reperfusion
rates were higher when Tn level >2 ng/ml (p > 0.1 ng/ml) improved with a
diagnostic cardiac catheterization (p < 0.001). Conclusions Elevated Tn
levels >2 ng/ml were associated with improved survival to discharge in
patients post OHCA with STE. Survival in patients with no STE and Tn
values >0.1 ng/ml was higher when associated with diagnostic cardiac
catheterization or treated with reperfusion or revascularization.
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<137>
[Use Link to view the full text]
Accession Number
368001911
Author
Haroutiunian S.; Nikolajsen L.; Finnerup N.B.; Jensen T.S.
Institution
(Haroutiunian, Nikolajsen, Finnerup, Jensen) Danish Pain Research Center,
Aarhus University Hospital, Building 1A, Norrebrogade 44, DK-8000 Aarhus,
Denmark
(Nikolajsen) Department of Anesthesiology, Aarhus University Hospital,
Aarhus, Denmark
(Jensen) Department of Neurology, Aarhus University Hospital, Aarhus,
Denmark
Title
The neuropathic component in persistent postsurgical pain: A systematic
literature review.
Source
Pain. 154 (1) (pp 95-102), 2013. Date of Publication: January 2013.
Publisher
Elsevier B.V. (E-mail: agents@lww.com)
Abstract
Persistent postsurgical pain (PPSP) is a frequent and often disabling
complication of many surgical procedures. Nerve injury-induced neuropathic
pain (NeuP) has repeatedly been proposed as a major cause of PPSP.
However, there is a lack of uniformity in NeuP assessment across studies,
and the prevalence of NeuP may differ after various surgeries. We
performed a systematic search of the PubMed, CENTRAL, and Embase databases
and assessed 281 studies that investigated PPSP after 11 types of surgery.
The prevalence of PPSP in each surgical group was examined. The prevalence
of NeuP was determined by applying the recently published NeuP probability
grading system. The prevalence of probable or definite NeuP was high in
patients with persistent pain after thoracic and breast surgeries - 66%
and 68%, respectively. In patients with PPSP after groin hernia repair,
the prevalence of NeuP was 31%, and after total hip or knee arthroplasty
it was 6%. The results suggest that the prevalence of NeuP among PPSP
cases differs in various types of surgery, probably depending on the
likelihood of surgical iatrogenic nerve injury. Because of large
methodological variability across studies, a more uniform approach is
desirable in future studies for evaluating persistent postsurgical NeuP.
&#xa9; 2012 International Association for the Study of Pain. All rights
reserved.

<138>
Accession Number
610288866
Author
Edwards J.P.; Dharampal N.; Chung W.; Brar M.S.; Ball C.G.; Seto J.;
Grondin S.C.
Institution
(Edwards, Chung, Grondin) Division of Thoracic Surgery, University of
Calgary, Calgary, Canada
(Dharampal, Brar, Ball) Division of General Surgery, University of
Calgary, Calgary, Canada
(Seto) Division of General Surgery, University of Saskatchewan, Saskatoon,
Canada
Title
Has the quality of reporting of randomized controlled trials in thoracic
surgery improved?.
Source
European Journal of Cardio-thoracic Surgery. 49 (5) (pp 1476-1482), 2016.
Article Number: ezv375. Date of Publication: 01 May 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: To evaluate the quality of reporting of randomized controlled
trials (RCTs) in the thoracic surgery literature according to Consolidated
Standard for Reporting of Trials (CONSORT) and to determine predictors of
quality. METHODS: All RCTs published in four principal journals between
1998 and 2013 were identified in PubMed. Two independent reviewers
assessed each trial using the CONSORT checklist (1996) with discrepancies
resolved by a third reviewer. Mean checklist scores were compared between
trials published from 1998 to 2005 and 2006 to 2013. The K statistic for
inter-rater agreement was calculated. Stepwise multivariable linear
regression was then performed to identify independent predictors of
quality. RESULTS: After 2 rounds of review, 203 of the 2838 identified
articles met inclusion criteria. The overall K coefficient was 0.95
indicating very good agreement between reviewers. The mean CONSORT score
was significantly higher in 2006-13 [mean 10.8; 95% confidence interval
(CI): 10.3-11.2] than in 1998-2005 (mean 9.3; 95% CI: 8.7-9.6). On
multivariable analysis, there was strong evidence of an increased mean
CONSORT score in studies comparing non-surgical interventions, multicentre
trials, publications after 2006, studies with increased number of authors
and studies funded by industries. CONCLUSIONS: Our study suggests that the
quality of reporting in the thoracic surgery literature is improving with
time and is predicted by factors including number of authors, multicentre
trials, type of comparison, time period of publication and industry
sponsorship. Ongoing efforts should be made to improve the quality of
reporting in thoracic surgery. Copyright &#xa9; The Author 2015.

<139>
Accession Number
610288859
Author
Axelsson T.A.; Mennander A.; Malmberg M.; Gunn J.; Jeppsson A.;
Gudbjartsson T.
Institution
(Axelsson, Gudbjartsson) Department of Cardiothoracic Surgery, Landspitali
University Hospital and Faculty of Medicine, University of Iceland,
Reykjavik, Iceland
(Mennander) Heart Centre, Tampere University Hospital, Tampere, Finland
(Malmberg, Gunn) Heart Centre, Turku University Hospital and University of
Turku, Turku, Finland
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Goteborg, Sweden
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
Title
Is emergency and salvage coronary artery bypass grafting justified? The
Nordic Emergency/Salvage coronary artery bypass grafting study.
Source
European Journal of Cardio-thoracic Surgery. 49 (5) (pp 1451-1456), 2016.
Article Number: ezv388. Date of Publication: 01 May 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: According to the EuroSCORE-II criteria, patients undergoing
emergency coronary artery bypass grafting (CABG) are operatedon before the
beginning of the next working day after decision to operate while salvage
CABG patients require cardiopulmonary resuscitationen route to the
operating theatre. The objective of this multicentre study was to
investigate the efficacy of emergency and salvage CABG.METHODS: A
retrospective analysis of all patients that underwent emergency or salvage
CAGB at four North-European university hospitalsfrom 2006 to 2014.RESULTS:
A total of 614 patients; 580 emergency and 34 salvage CABG patients (mean
age 67 +/- 10 years, 56% males) were included. Allpatients had an acute
coronary syndrome: 234 (38%) had an ST segment elevation myocardial
infarction (STEMI) and 289 (47%) had a non-STEMI. Haemodynamic instability
requiring inotropic drugs and/or intra-aortic balloon pump preoperatively
occurred in 87 (14%) and 82(13%) of the patients, respectively. Three
hundred and thirty-one patient (54%) were transferred to the operating
room immediately afterangiography and 205 (33%) had a failure of an
attempted percutaneous coronary intervention. Cardiopulmonary
resuscitation within 1 hbefore the operation was performed in 49 patients
(8%), and 9 patients (1%) received cardiac massage during sternotomy.
Hospital mortalityfor emergency and salvage operations was 13 and 41%,
respectively. Early complications included reoperation for bleeding (15%),
postoperativestroke (6%) and de novo dialysis for acute kidney injury
(6%). Overall 5-year survival rate was 79% for emergency operations and
46%for salvage operations. Only one out of 9 patients receiving cardiac
massage during sternotomy survived.CONCLUSIONS: Early mortality in
patients undergoing emergent and salvage CABG is substantial, especially
in salvage patients. Long-termsurvival is acceptable in both emergent and
salvage patients. Life-saving emergency and salvage CABG is justified in
most patients but salvagepatients have dismal prognosis if cardiac massage
is needed during sternotomy. Copyright &#xa9; The Author 2015.

<140>
Accession Number
610288854
Author
Kowalewski M.; Pawliszak W.; Raffa G.M.; Malvindi P.G.; Kowalkowska M.E.;
Zaborowska K.; Kowalewski J.; Tarelli G.; Taggart D.P.; Anisimowicz L.
Institution
(Kowalewski, Pawliszak, Zaborowska, Anisimowicz) Department of Cardiac
Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz,
Bydgoszcz, Poland
(Kowalewski) Faculty of Health Sciences, Collegium Medicum, Nicolaus
Copernicus Univeristy in Torun, Torun, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per iTrapianti e Terapie ad alta specializzazione), Palermo, Italy
(Malvindi) University Hospital Southampton NHS Foundation Trust, Wessex
Cardiothoracic Centre, Southampton, United Kingdom
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology and
Oncological Gynecology, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
(Kowalewski) Department of Lung Cancer and Thoracic Surgery, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
(Tarelli) Department of Cardiac Surgery, Humanitas Clinical and Research
Center, Rozzano, Milan, Italy
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
Title
Safety and efficacy of miniaturized extracorporeal circulation when
compared with off-pump and conventional coronary artery bypass grafting:
Evidence synthesis from a comprehensive Bayesian-framework network
meta-analysis of 134 randomized controlled trials involving 22 778
patients.
Source
European Journal of Cardio-thoracic Surgery. 49 (5) (pp 1428-1440), 2016.
Article Number: ezv387. Date of Publication: 01 May 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Coronary artery bypass grafting (CABG) remains the standard of
care in patients with extensive coronary artery disease. Yet the use of
cardiopulmonary bypass (CPB) is believed to be a major determinant of
perioperative morbidity. Novel techniques are sought to tackle the
shortcomings of CPB, among them off-pump coronary artery bypass (OPCAB)
and miniaturized extracorporeal circulation (MECC) systems have been
extensively tested in randomized controlled trials (RCTs). To assess
perioperative safety and efficacy of MECC and OPCAB when compared with
conventional extracorporeal circulation (CECC). METHODS: Published
literature and major congress proceedings were screened for RCTs
evaluating the safety and efficacy of MECC, OPCAB and CECC. Selected
end-points such as 30-day all-cause mortality, myocardial infarction (MI),
cerebral stroke, postoperative atrial fibrillation (POAF) and renal
dysfunction were assessed in a Bayesian-framework network meta-analysis.
RESULTS: A total of 134 studies with 22 778 patients were included. When
compared with CECC, both OPCAB and MECC significantly reduced 30-day
all-cause mortality [odds ratios (95% credible intervals): 0.75
(0.51-0.99) and 0.46 (0.22-0.91)], respectively. No differences in respect
to MI were demonstrated with either strategy. OPCAB, when compared with
CECC, reduced the odds of cerebral stroke [0.57 (0.34-0.80)]; 60%
reduction was observed with MECC when compared with CECC [0.40
(0.19-0.78)]. Both OPCAB and MECC reduced the odds of POAF [0.66
(0.48-0.90) and 0.62 (0.35-0.98), respectively] when compared with CECC.
OPCAB conferred over 30% reduction of renal dysfunction when compared with
CECC [0.69 (0.46-0.92)]. MECC reduced these odds by more than 50% [0.47
(0.24-0.89)]. Ranking of treatments emerging from the probability analysis
(highest to lowest SUCRA values) was MECC followed by OPCAB and CECC.
CONCLUSIONS: MECC and OPCAB both improve perioperative outcomes following
coronary bypass surgery when compared with conventional CABG performed
with extracorporeal circulation. MECC may represent an attractive
compromise between OPCAB and CECC. Copyright &#xa9; The Author 2015.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<141>
Accession Number
610288847
Author
Walavalkara V.; Eversb E.; Pujara S.; Viralama K.; Maiyaa S.; Frerichc S.;
Johnd C.; Raod S.; Reddyd C.; Sproncke B.; Prinzenb F.W.; Delhaasc T.;
Vanagt W.Y.
Institution
(Walavalkara, Pujara, Viralama, Maiyaa) Department of Pediatric
Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
(Eversb, Prinzenb, Vanagt) Department of Physiology, Cardiovascular
Research Institute Maastricht CARIM, Maastricht University, Maastricht,
Netherlands
(Frerichc, Delhaasc, Vanagt) Department of Pediatric Cardiology,
Cardiovascular Research Institute Maastricht CARIM, Maastricht University,
Maastricht, Netherlands
(Johnd, Raod, Reddyd) Department of Pediatric Cardiac Surgery, Narayana
Institute of Cardiac Sciences, Bangalore, India
(Sproncke, Delhaasc) Department of Biomedical Engineering, Cardiovascular
Research Institute Maastricht CARIM, Maastricht University, Maastricht,
Netherlands
Title
Preoperative sildenafil administration in children undergoing cardiac
surgery: A randomized controlled preconditioning study.
Source
European Journal of Cardio-thoracic Surgery. 49 (5) (pp 1403-1410), 2016.
Article Number: ezv353. Date of Publication: 01 May 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Sildenafil has strong cardiac preconditioning properties in
animal studies and has a safe side-effect profile in children. Therefore,
we evaluated the application of Sildenafil preconditioning to reduce
myocardial ischaemia/reperfusion injury in children undergoing surgical
ventricular septal defect (VSD) closure. METHODS: This is a randomized,
double-blind study. Children (1-17 years) undergoing VSD closure were
randomized into three groups: placebo (Control group), preconditioning
with 0.06 mg/kg (Sild-L group) and 0.6 mg/kg Sildenafil (Sild-H group).
Primary endpoint: troponin release. CK-MB, Troponin I, inflammatory
response (IL-6 and TNF-alpha ), bypass and ventilation weaning times,
inotropy score and echocardiographic function were assessed. Data
expressed as median (range), and a value of P < 0.05 was considered
significant. RESULTS: Thirty-nine patients were studied (13/group). Aortic
cross-clamp time was similar [27 (18-85) and 27 (12-39) min] in the
Control and Sild-L groups, respectively, but significantly longer [39
(20-96) min] in the Sild-H group when compared with the Control group.
Area under the curve of CK-MB release was 1105 (620-1855) h ng/ml in the
Control group, 1672 (564-2767) h ng/ml in the Sild- L group and was
significantly higher in the Sild-H group [1695 (1252-3377) h ng/ml] when
compared with the Control group. There were no significant differences in
inflammatory response markers, cardiopulmonary bypass and ventilation
weaning times, inotropy scores and echocardiographic function between the
groups. CONCLUSIONS: In this small study, Sildenafil failed to reduce
myocardial injury in children undergoing cardiac surgery, nor does it
alter cardiac function, inotropic needs or postoperative course. A
subclinical increase in cardiac enzyme release after Sildenafil
preconditioning cannot be excluded. Clinical Trials Registry:
CTRI/2014/03/004468. Copyright &#xa9; The Author 2015.

<142>
Accession Number
614399494
Author
Izzat M.B.; Almohammad F.; Raslan A.F.
Institution
(Izzat, Almohammad, Raslan) Damascus University, Cardiac Surgery Hospital,
PO Box 33831, Damascus, Syrian Arab Republic
Title
Off-pump grafting does not reduce postoperative pulmonary dysfunction.
Source
Asian Cardiovascular and Thoracic Annals. 25 (2) (pp 113-117), 2017. Date
of Publication: 01 Feb 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objectives Pulmonary dysfunction is a recognized postoperative
complication that may be linked to use of cardiopulmonary bypass. The
off-pump technique of coronary artery bypass aims to avoid some of the
complications that may be related to cardiopulmonary bypass. In this
study, we compared the influence of on-pump or off-pump coronary artery
bypass on pulmonary gas exchange following routine surgery. Methods Fifty
patients (mean age 60.4 +/- 8.4 years) with no preexisting lung disease
and good left ventricular function undergoing primary coronary artery
bypass grafting were prospectively randomized to undergo surgery with or
without cardiopulmonary bypass. Alveolar/arterial oxygen pressure
gradients were calculated prior to induction of anesthesia while the
patients were breathing room air, and repeated postoperatively during
mechanical ventilation and after extubation while inspiring 3 specific
fractions of oxygen. Results Baseline preoperative arterial blood gases
and alveolar/arterial oxygen pressure gradients were similar in both
groups. At both postoperative stages, the partial pressure of arterial
oxygen and alveolar/arterial oxygen pressure gradients increased with
increasing fraction of inspired oxygen, but there were no statistically
significant differences between patients who underwent surgery with or
without cardiopulmonary bypass, either during ventilation or after
extubation. Conclusions Off-pump surgery is not associated with superior
pulmonary gas exchange in the early postoperative period following routine
coronary artery bypass grafting in patients with good left ventricular
function and no preexisting lung disease. Copyright &#xa9; SAGE
Publications.

<143>
Accession Number
614399489
Author
Patel J.; Prajapati M.; Patel H.; Gandhi H.; Deodhar S.; Pandya H.
Institution
(Patel, Prajapati, Gandhi, Deodhar) Department of Cardiac Anesthesia, UN
Mehta Institute of Cardiology and Research Center (Affiliated to BJ
Medical College), New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat
380016, India
(Patel) Department of Medical Officer, UN Mehta Institute of Cardiology
and Research Center, Ahmedabad, Gujarat, India
(Pandya) Department of Research, UN Mehta Institute of Cardiology and
Research Center, Ahmedabad, Gujarat, India
Title
Topical and low-dose intravenous tranexamic acid in cyanotic cardiac
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 25 (2) (pp 118-122), 2017. Date
of Publication: 01 Feb 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Coagulopathy is a major problem in surgery for cyanotic
congenital heart disease. Tranexamic acid has been used both topically and
systemically and plays a vital role in pediatric cardiac surgery by
reducing blood loss and blood product requirement. We aimed to determine
the anti-fibrinolytic effectiveness of low-dose systemic or topical
tranexamic acid or a combination of both. Methods Seventy-five patients
were divided in 3 groups of 25. Group A patients were given tranexamic
acid 20 mg kg^-1 intravenously after sternotomy and 20 mg
kg^-1 after heparin reversal. Group B patients were given
tranexamic acid 50 mg kg^-1 in 20 mL of saline
intrapericardially before sternal closure, with the drain clamped for 20
min. Group C patients were given tranexamic acid 20 mg kg^-1
intravenously after sternotomy and 50 mg kg^-1
intrapericardially before sternal closure. A number of clinical variables
were recorded in the first 3 postoperative days. Ventilator time,
intensive care unit stay, and outcome were also recorded. Results Chest
tube drainage and blood product requirements were lowest in group C. Blood
urea and serum creatinine levels were higher in groups A and C (p < 0.05).
Intensive care unit stay and ventilator time were similar in all 3 groups.
No patient died and none had a seizure or other neurological event or
thromboembolic complication postoperatively. Conclusion The combination of
low-dose intravenous and topical tranexamic acid reduces postoperative
blood loss and blood product requirement without incurring neurological,
renal or thromboembolic complications. We recommend the routine use of
topical and low-dose systemic tranexamic acid in cyanotic pediatric
cardiac surgery. Copyright &#xa9; SAGE Publications.

<144>
Accession Number
613411210
Author
Njuguna B.; Gardner A.; Karwa R.; Delahaye F.
Institution
(Njuguna) Department of Pharmacy, Moi Teaching and Referral Hospital, PO
Box 3, Eldoret 30100, Kenya
(Gardner) Department of Medicine, Indiana University School of Medicine,
340 West 10th Street #6200, Indianapolis, IN 46202, United States
(Njuguna, Karwa) Department of Pharmacy Practice, Purdue University
College of Pharmacy, 575 Stadium Mall Dr, West Lafayette, IN 47907, United
States
(Delahaye) Department of Cardiology, Hospices civils de Lyon, Universite
Claude Bernard, Equipe d'Accueil HESPER 7425, Hopital Louis Pradel, 28,
avenue du Doyen Lepine, Bron, Lyon 69677, France
Title
Infective Endocarditis in Low- and Middle-Income Countries.
Source
Cardiology Clinics. 35 (1) (pp 153-163), 2017. Date of Publication: 01 Feb
2017.
Publisher
W.B. Saunders
Abstract
Infective endocarditis (IE) is a rare, life-threatening disease with a
mortality rate of 25% and significant debilitating morbidities. Although
much has been reported on contemporary IE in high-income countries,
conclusions on the state of IE in low- and middle-income countries (LMICs)
are based on studies conducted before the year 2000. Furthermore, unique
challenges in the diagnosis and management of IE persist in LMICs. This
article reviews IE studies conducted in LMICs documenting clinical
experiences from the year 2000 to 2016. Presented are the causes of IE,
management of patients with IE, and prevailing challenges in diagnosis and
treatment of IE in LMICs. Copyright &#xa9; 2016 Elsevier Inc.

<145>
Accession Number
613456820
Author
Landes U.; Barsheshet A.; Finkelstein A.; Guetta V.; Assali A.; Halkin A.;
Vaknin-Assa H.; Segev A.; Bental T.; Ben-Shoshan J.; Barbash I.M.;
Kornowski R.
Institution
(Landes, Barsheshet, Assali, Vaknin-Assa, Bental, Kornowski) Department of
Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
(Finkelstein, Halkin, Ben-Shoshan) Department of Cardiology, Tel Aviv
Medical Center, Israel
(Guetta, Segev, Barbash) Leviev Heart Center, Sheba Medical Center, Ramat
Gan, Israel
(Guetta, Segev, Barbash) Sackler Faculty of Medicine, Tel Aviv University,
Israel
Title
Temporal trends in transcatheter aortic valve implantation, 2008-2014:
patient characteristics, procedural issues, and clinical outcome.
Source
Clinical Cardiology. 40 (2) (pp 82-88), 2017. Date of Publication: 01 Feb
2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: About a decade past the first transcatheter aortic valve
implantation (TAVI), data are limited regarding temporal trends
accompanying its evolution from novel technology to mainstream therapy. We
evaluated these trends in a large multicenter TAVI registry. Hypothesis:
TAVI is changing and improving with time. Methods: Patients who underwent
TAVI between January 2008 and December 2014 at 3 high-volume Israeli
centers were divided into 5 time quintiles according to procedure date.
Outcomes were analyzed and reported according to Valve Academic Research
Consortium-2. Results: A total of 1285 patients were studied (43% male;
mean age, 83 +/- 3 years; mean Society of Thoracic Surgeons [STS] score,
5.5 +/- 3.6). Over time, there was a shift toward treating patients at
lower STS score, increased use of conscious sedation and transfemoral
approach, and decreased use of balloon predilatation. The
balloon-expandable to self-expandable valve utilization ratio decreased,
the valve-in-valve experience increased from 4% to 17% of all TAVI volume,
and length of hospital stay was halved (P = 0.006). Kaplan-Meier survival
curves showed gradual decrease in mortality risk (P = 0.031), but there
was no significant 1-year mortality decrease by multivariable analysis.
Each year increment was associated with an adjusted 20%, 15%, and 12%
decrease in new pacemaker obligation (P = 0.004), new pacemaker obligation
or left bundle branch block (P = 0.008), and in-hospital infections (P =
0.082), respectively. Conclusions: Temporal trends accompanying TAVI
evolution include its utilization in lower-risk patients, procedural
simplification, improved overall survival, decreased pacemaker obligation,
and shorter hospital stay. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<146>
Accession Number
614607940
Author
Jorgensen T.H.; Thyregod H.G.H.; Tarp J.B.; Svendsen J.H.; Sondergaard L.
Institution
(Jorgensen, Tarp, Svendsen, Sondergaard) Department of Cardiology, The
Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen
2100, Denmark
(Thyregod) Department of Cardiothoracic Surgery, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
(Svendsen, Sondergaard) Department of Clinical Medicine, University of
Copenhagen, Copenhagen 2100, Denmark
(Svendsen) Danish Arrhythmia Research Centre, University of Copenhagen,
Copenhagen 2100, Denmark
Title
Temporal changes of new-onset atrial fibrillation in patients randomized
to surgical or transcatheter aortic valve replacement.
Source
International Journal of Cardiology. 234 (pp 16-21), 2017. Date of
Publication: 01 May 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Temporal development of new-onset atrial fibrillation (NOAF)
after aortic valve replacement is unclear, and opportunistic screening has
limited diagnostic accuracy. This is the first study to investigate the
incidence and temporal development of NOAF detected by implantable loop
recorder (ILR) in patients with aortic stenosis, randomized to surgical
aortic valve replacement (SAVR) or transcatheter aortic valve replacement
(TAVR). Method An ILR was implanted in a subgroup of patients without
pre-procedural atrial fibrillation (AF), randomized to SAVR or TAVR in the
NOTION trial. Data from the ILR were transmitted in intervals of 2 weeks
for 12 weeks post-procedurally and analyzed. Results The study included 25
and 27 patients who underwent SAVR and TAVR, respectively. The cumulative
rate of NOAF was 100% and 81.5% for patients undergoing SAVR and TAVR,
respectively (P = 0.06). TAVR patients without NOAF 6 weeks
post-procedurally remained free from NOAF. The prevalence of AF after SAVR
decreased significantly after 8 weeks when compared with the first 2 weeks
(50.0% vs. 84.0%, respectively; P < 0.05). The prevalence of AF after TAVR
did not change significantly during follow-up. The median AF burden
(percentage of time with AF) was 2.8% and 0.04% during the first 2 weeks
after SAVR and TAVR, respectively (P = 0.01) and it decreased
significantly over time after SAVR but not after TAVR. Conclusion NOAF
subsided 6 weeks after TAVR. AF prevalence and burden decreased
significantly over time after SAVR, but remained stable after TAVR. These
findings may be considered for post-procedural anti-coagulation strategy.
Copyright &#xa9; 2017 Elsevier B.V.

<147>
Accession Number
612933208
Author
Abe S.; Ishida K.; Masuda M.; Ueda H.; Kohno H.; Matsuura K.; Tamura Y.;
Watanabe M.; Matsumiya G.
Institution
(Abe, Ishida, Ueda, Kohno, Matsuura, Tamura, Watanabe, Matsumiya)
Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba
University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
(Masuda) Department of Cardiovascular Surgery, Chiba Medical Center, 4-1-2
Tsubakimori, Chuo-ku, Chiba 260-0042, Japan
Title
A prospective, randomized study of inhaled prostacyclin versus nitric
oxide in patients with residual pulmonary hypertension after pulmonary
endarterectomy.
Source
General Thoracic and Cardiovascular Surgery. 65 (3) (pp 153-159), 2017.
Date of Publication: 01 Mar 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objectives: Pulmonary endarterectomy (PEA) is an effective treatment for
chronic thromboembolic pulmonary hypertension (CTEPH), but postoperative
residual hypertension leads to in-hospital mortality. Inhaled epoprostenol
sodium (PGI<inf>2</inf>) and NO are administered for pulmonary
hypertension after cardiothoracic surgery. This prospective study provides
the first comparative evaluation of the effects of inhaled PGI<inf>2</inf>
and NO on pulmonary hemodynamics, systemic hemodynamics, and gas exchange
in patients developing residual pulmonary hypertension after PEA. Methods:
Thirteen patients were randomized to receive either NO (n = 6) or PGI2 (n
= 7) inhalation when pulmonary hypertension persisted after weaning from
cardiopulmonary bypass. Hemodynamic and respiratory variables were
measured before inhalation of the agent (T0); 30 min (T1), 3 h (T2), and 6
h after inhalation (T3); and the next morning (T4). The NO dose was
started at 20 ppm and gradually tapered until extubation, and
PGI<inf>2</inf> was administered at a dose of 10 ng kg^-1
min^-1. Results: In both groups, mean pulmonary artery pressure
(PAP) and pulmonary vascular resistance (PVR) significantly decreased over
time until T4 (mean PAP: p < 0.0001; PVR: p = 0.003), while mean systemic
arterial blood pressure significantly increased (p = 0.028). There were no
significant between-group differences in patient characteristics, cardiac
index, left atrial pressure, or ratio of arterial oxygen tension to
fraction of inspired oxygen. There were no in-hospital deaths.
Conclusions: Both inhaled PGI<inf>2</inf> and NO significantly reduced PAP
and PVR without adverse effects on systemic hemodynamics in patients who
developed residual pulmonary hypertension after PEA. Inhaled
PGI<inf>2</inf> can be offered as alternative treatment option for
residual pulmonary hypertension. Copyright &#xa9; 2016, The Author(s).

<148>
Accession Number
612595972
Author
Ivy D.
Institution
(Ivy) Section of Pediatric Cardiology, Children's Hospital Colorado,
University of Colorado School of Medicine, 13123 East 16th Avenue, B100,
Aurora, CO 80045, United States
Title
Pulmonary Hypertension in Children.
Source
Cardiology Clinics. 34 (3) (pp 451-472), 2016. Date of Publication: 01 Aug
2016.
Publisher
W.B. Saunders
Abstract
The prevalence of PH is increasing in the pediatric population, because of
improved recognition and increased survival of patients, and remains a
significant cause of morbidity and mortality. Recent studies have improved
the understanding of pediatric PH, but management remains challenging
because of a lack of evidence-based clinical trials. The growing
contribution of developmental lung disease requires dedicated research to
explore the use of existing therapies as well as the creation of novel
therapies. Adequate study of pediatric PH will require multicenter
collaboration due to the small numbers of patients, multifactorial disease
causes, and practice variability. Copyright &#xa9; 2016 Elsevier Inc.

<149>
Accession Number
608528069
Author
O'Sullivan K.E.; Bargenda S.; Sugrue D.; Hurley J.
Institution
(O'Sullivan, Bargenda, Hurley) Department of Cardiothoracic Surgery, Mater
Private Hospital, Eccles St., Dublin 7, Ireland
(Sugrue) Department of Cardiology, Mater Private Hospital, Dublin, Ireland
Title
Advances in the management of severe aortic stenosis.
Source
Irish Journal of Medical Science. 185 (2) (pp 309-317), 2016. Date of
Publication: 01 May 2016.
Publisher
Springer-Verlag London Ltd
Abstract
Background: Recent developments in the management of severe aortic
stenosis have resulted in a paradigm shift in the way we view the
condition. Patients previously denied intervention in the form of surgical
aortic valve replacement (SAVR) are now candidates for transcatheter
aortic valve implantation and the risk and age profiles of those
undergoing SAVR are rising with the ageing population. This review article
is designed to provide an overview of developments in the surgical
management of severe aortic stenosis. We also discuss the expanding role
of minimally invasive surgical approaches to outline the current
techniques available to treat patients with severe aortic stenosis.
Methods: PubMed was searched using the terms 'severe aortic stenosis',
'surgical aortic valve replacement', 'transcatheter aortic valve
replacement', 'mechanical aortic valve replacement' and 'sutureless aortic
valve replacement'. Selection of articles was based on peer review,
journal and relevance. Where possible articles from high-impact factor
peer review journals were included. Results: Minimally invasive operative
approaches include mini-sternotomy and mini-thoracotomy. Sutureless aortic
prostheses reduce aortic cross-clamp time and cardiopulmonary bypass time;
however, long-term follow-up data are unavailable at this time. Mechanical
prostheses are advised for those under 60. Conclusion: Multiple advances
in the surgical management of aortic stenosis have occured in the past
decade. An evolving spectrum of surgical and transcatheter interventions
is now available depending on patient age and operative risk. Copyright
&#xa9; 2016, Royal Academy of Medicine in Ireland.

<150>
Accession Number
613308547
Author
Omerovic E.
Institution
(Omerovic) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16,
Gothenburg, Sweden
(Omerovic) Department of Cardiology, Sahlgrenska University Hospital,
Bruna straket 16, Gothenburg 413 45, Sweden
Title
Takotsubo Syndrome-Scientific Basis for Current Treatment Strategies.
Source
Heart Failure Clinics. 12 (4) (pp 577-586), 2016. Date of Publication: 01
Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Takotsubo syndrome (TS) is characterized by severe reversible left
ventricular (LV) wall motion abnormality in the absence of explanatory
coronary lesion. Despite an increasing number of patients diagnosed with
TS worldwide, there are no randomized clinical trials. In mild cases, no
treatment or a short course of limited anticoagulation therapy may be
sufficient. Positive inotropic and vasodilating agents should be avoided.
In severe cases with refractory cardiogenic shock, early treatment with
mechanical support using venoarterial extracorporeal membrane oxygenation
or a LV assist device should be considered. Copyright &#xa9; 2016 Elsevier
Inc.

<151>
Accession Number
611187465
Author
Martinez-Sanchez C.; Borrayo G.; Carrillo J.; Juarez U.; Quintanilla J.;
Jerjes-Sanchez C.
Institution
(Martinez-Sanchez, Borrayo, Carrillo, Juarez, Quintanilla, Jerjes-Sanchez)
RENASICA III, Mexico
(Jerjes-Sanchez) Mexico
(Martinez-Sanchez) Emergency Department and Coronary Critical Care,
Instituto Nacional de Cardiologia 'Ignacio Chavez', Mexico
(Borrayo) Hospital de Cardiologia, Centro Medico Nacional Siglo XXI,
Mexico
(Carrillo) Cardiology Department, Hospital Central Dr. Ignacio Morones
Prieto, San Luis Potosi, Mexico
(Juarez) Instituto Nacional de Cardiologia Ignacio Chavez, Mexico
(Quintanilla) Hemodynamic Laboratory, Hospital San Jose, Instituto de
Cardiologia y Medicina Vascular, TEC Salud, Mexico
(Jerjes-Sanchez) Instituto de Cardiologia y Medicina Vascular, TEC Salud,
Mexico
(Jerjes-Sanchez) Translational Research Center, Escuela de Medicina,
Tecnologico de Monterrey, Mexico
Title
Clinical management and hospital outcomes of acute coronary syndrome
patients in Mexico: The third national registry of acute coronary
syndromes (RENASICA III).
Source
Archivos de Cardiologia de Mexico. 86 (3) (pp 221-232), 2016. Date of
Publication: July-September 2016.
Publisher
Instituto Nacional de Cardiologia Ignazio Chavez (E-mail:
archivos@cardiologia.org.mx)
Abstract
Objective: To describe current management and clinical outcomes in
patients hospitalized with an acute coronary syndrome (ACS) in Mexico.
Methods: RENASICA III was a prospective multicenter registry of
consecutive patients hospitalized with an ACS. Patients had objective
evidence of ischemic heart disease; those with type II infarction or
secondary ischemic were excluded. Study design conformed to current
quality recommendations. Results: A total of 123 investigators at 29
tertiary and 44 community hospitals enrolled 8296 patients with an ACS
(4038 with non-ST-elevation myocardial infarction/unstable angina
[NSTEMI/UA], 4258 with ST-elevation myocardial infarction [STEMI]). The
majority were younger (62 +/- 12 years) and 76.0% were male. On admission
80.5% had ischemic chest pain lasting >20 min and clinical stability. Left
ventricular dysfunction was more frequent in NSTEMI/UA than in those with
STEMI (30.0% vs. 10.7%, p < 0.0001). In STEMI 37.6% received thrombolysis
and 15.0% primary PCI. PCI was performed in 39.6% of NSTEMI/UA (early
strategy in 10.8%, urgent strategy in 3.0%). Overall hospital death rate
was 6.4% (8.7% in STEMI vs. 3.9% in NSTEMI/UA, p < 0.001). The strongest
independent predictors of hospital mortality were cardiogenic shock (odds
ratio 22.4, 95% confidence interval 18.3---27.3) and ventricular
fibrillation (odds ratio 12.5, 95% confidence interval 9.3---16.7).
Conclusion: The results from RENASICA III establish the urgent need to
develop large-scale regional programs to improve adherence to guideline
recommendations in ACS, including rates of pharmacological thrombolysis
and increasing the ratio of PCI to thrombolysis. Copyright &#xa9; 2016
Instituto Nacional de Cardiologia Ignacio Chavez.

<152>
Accession Number
614321458
Author
Ahmadizad S.; Nouri-Habashi A.; Rahmani H.; Maleki M.; Naderi N.; Lotfian
S.; Salimian M.
Institution
(Ahmadizad, Nouri-Habashi, Rahmani) Department of Sport and Exercise
Physiology, Faculty of Sports Sciences, Shahid Beheshti University,
Velenjak Square, Tehran 1983963113, Iran, Islamic Republic of
(Maleki, Naderi, Lotfian) Rajaie Cardiovascular Medical and Research
Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Salimian) Platelet Research Laboratory, Kashan University of Medical
Sciences, Kashan, Iran, Islamic Republic of
Title
Platelet activation and function in response to high intensity interval
exercise and moderate continuous exercise in CABG and PCI patients.
Source
Clinical Hemorheology and Microcirculation. 64 (4) (pp 911-919), 2016.
Date of Publication: 2016.
Publisher
IOS Press (Nieuwe Hemweg 6B, Amsterdam 1013 BG, Netherlands)
Abstract
BACKGROUND: The effects of high intensity interval training (HIIT) on
inflammatory markers and endothelial function have been extensively shown.
However, the acute effect of HIIT on platelet activation and function in
patients with recent revascularization is unclear. OBJECTIVE: The purpose
of present study was to compare the responses of platelet activation
(CD62P) and function (platelet aggregation) to high intensity interval
exercise (HIIE) and moderate continuous exercise (MCE) in coronary artery
bypass grafting (CABG) and percutaneous coronary interventions (PCI)
patients. METHODS: Thirty patients who had CABG or PCI were randomly
divided into HIIE, MCE and control groups. After determining the
VO<inf>2peak</inf>, subjects in the MCE group carried out 30min of
continuous exercise at 60 of VO<inf>2peak</inf>, whereas, the subjects in
HIIE group performed an interval protocol consisted of 8 repetitions of
2min activity (running on treadmill) at 90 of VO<inf>2peak</inf>
interspersed by 2min of active recovery between repetitions at 30 of
VO<inf>2peak</inf> Subjects in control group were seated and had no
activity for the same period of time. Two blood samples were collected
before and immediately after exercise and were analyzed for markers of
platelet activation and function. RESULTS: Data analyzes revealed that
increases in platelet aggregation induced by ADP and corrected for
increases in platelet count in response to MCE trial was significantly
lower than HIIE group (P<0.05). In addition, responses of CD62P to MCE
trial was significantly lower compared to HIIE group (P<0.05). Changes in
plateletcrit and platelet distribution width were significantly different
among the three trials where the PCT and PDW following the HIIE were
higher than MCE. Platelet count increased significantly (P<0.05) by 13
following HIIE trial. CONCLUSIONS: Based on the findings of the present
study it could be concluded that the risk of exercise-induced thrombosis
is higher during HIIE than MCE in patients with recent revascularization.
Copyright &#xa9; 2016 - IOS Press and the authors. All rights reserved.

<153>
Accession Number
603508477
Author
Ruiz-Garcia J.; Teles R.; Rumoroso J.-R.; Cyrne Carvalho H.; Goicolea
F.J.; Moreu J.; Mauri J.; Mainar V.; Garcia E.; Moreno R.
Institution
(Ruiz-Garcia, Moreno) Seccion de Hemodinamica y Cardiologia
Intervencionista, Servicio de Cardiologia, Hospital Universitario La Paz,
Madrid, Spain
(Ruiz-Garcia) Servicio de Cardiologia, Hospital Universitario Quiron,
Madrid, Spain
(Ruiz-Garcia) Servicio de Cardiologia, Hospital Universitario de Torrejon,
Madrid, Spain
(Teles) Servicio de Cardiologia, Hospital de Santa Cruz, Lisboa, Portugal
(Rumoroso) Servicio de Cardiologia, Hospital de Galdakao, Bilbao, Spain
(Cyrne Carvalho) Servicio de Cardiologia, Hospital de Santo Antonio,
Porto, Portugal
(Goicolea) Servicio de Cardiologia, Hospital Puerta de Hierro,
Majadahonda, Spain
(Moreu) Servicio de Cardiologia, Hospital Virgen de la Salud, Toledo,
Spain
(Mauri) Servicio de Cardiologia, Hospital German Trias i Pujol, Badalona,
Spain
(Mainar) Servicio de Cardiologia, Hospital General, Alicante, Spain
(Garcia) Servicio de Cardiologia, Hospital Clinico San Carlos, Madrid,
Spain
Title
Comparison between diabetic and non-diabetic patients after successful
percutaneous coronary intervention for chronic total occlusions in the
drug-eluting stent era.
Source
Revista Portuguesa de Cardiologia. 34 (4) (pp 263-270), 2015. Article
Number: 619. Date of Publication: 01 Apr 2015.
Publisher
Sociedade Portuguesa de Cardiologia (E-mail: secretariado@mail.spc.pt)
Abstract
Abstract Objective Diabetes mellitus and chronic total occlusions are
associated with unfavorable outcome after percutaneous coronary
intervention. We sought to assess the clinical and angiographic outcomes
of diabetic and non-diabetic patients who underwent successful
percutaneous revascularization of chronic total occlusions with
drug-eluting stents. Methods Baseline clinical and angiographic
characteristics, procedural details, nine-month angiographic follow-up and
clinical events at 12 months were compared between 75 diabetic and 132
non-diabetic patients included in a clinical trial that randomized
successful recanalization of chronic total occlusions to receive
sirolimus- or everolimus-eluting stents. Results In both diabetic and
non-diabetic groups there was a favorable non-significantly different
angiographic result at nine months, with low in-stent late loss
(0.14+/-0.60 mm vs. 0.25+/-0.68 mm, p=0.305) and rates of binary
restenosis (4.0% vs. 10.6%, p=0.180) and reocclusion (0.0% vs. 2.3%,
p=0.334). During follow-up similar survival from death (97.3+/-1.9% vs.
99.2+/-0.8%, log-rank p=0.273), acute myocardial infarction (100.0+/-0.0%
vs. 97.7+/-1.3%, log-rank p=0.192), target vessel revascularization
(88.7+/-3.8% vs. 88.2+/-2.9%, log-rank p=0.899) and stent thrombosis
(100.0+/-0.0% vs. 97.7+/-1.3%, log-rank p=0.192) was observed.
Furthermore, the presence of more diffuse peripheral and coronary artery
disease and higher frequency of calcified lesions in diabetic patients did
not lead to significant differences in the approach (20.0% vs. 25.0%
radial approach, p=0.413), strategy (6.7% vs. 3.8% retrograde strategy,
p=0.353), total stent length (48.1+/-24.6 mm vs. 49.2+/-23.9 mm, p=0758)
or contrast volume (261.3+/-116.4 ml vs. 297.4+/-135.9 ml, p=0.109)
required for revascularization. Conclusions In the drug-eluting stent era,
diabetic and non-diabetic patients have comparable favorable clinical and
angiographic outcomes after successful percutaneous revascularization of
chronic total occlusions. Copyright &#xa9; 2014 Sociedade Portuguesa de
Cardiologia.

<154>
Accession Number
614830258
Author
Redden M.D.; Chin T.Y.; van Driel M.L.
Institution
(Redden) Ipswich Hospital, Ipswich, QLD, Australia
(Chin) The Prince Charles Hospital, Rode Road, Chermside, QLD 4032,
Australia
(Chin) The University of Queensland, School of Medicine, 288 Herston Road,
Brisbane, QLD 4006, Australia
(van Driel) The University of Queensland, Primary Care Clinical Unit,
Faculty of Medicine, Brisbane, QLD 4029, Australia
Title
Surgical versus non-surgical management for pleural empyema.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD010651. Date of Publication: 17 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Empyema refers to pus in the pleural space, commonly due to
adjacent pneumonia, chest wall injury, or a complication of thoracic
surgery. A range of therapeutic options are available for its management,
ranging from percutaneous aspiration and intercostal drainage to
video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage.
Intrapleural fibrinolytics may also be administered following intercostal
drain insertion to facilitate pleural drainage. There is currently a lack
of consensus regarding optimal treatment. Objectives: To assess the
effectiveness and safety of surgical versus non-surgical treatments for
complicated parapneumonic effusion or pleural empyema. Search methods: We
searched the Cochrane Central Register of Controlled Trials (CENTRAL)
(2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015
to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015),
Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS
(1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov
and WHO International Clinical Trials Registry Platform for ongoing
studies (December 2016). Selection criteria: Randomised controlled trials
that compared a surgical with a non-surgical method of management for all
age groups with pleural empyema. Data collection and analysis: Two review
authors independently assessed trials for inclusion and risk of bias,
extracted data, and checked the data for accuracy. We contacted trial
authors for additional information. We assessed the quality of the
evidence using the GRADE approach. Main results: We included eight
randomised controlled trials with a total of 391 participants. Six trials
focused on children and two on adults. Trials compared tube thoracostomy
drainage (non-surgical), with or without intrapleural fibrinolytics, to
either VATS or thoracotomy (surgical) for the management of pleural
empyema. Assessment of risk of bias for the included studies was generally
unclear for selection and blinding but low for attrition and reporting
bias. Data analyses compared thoracotomy versus tube thoracostomy and VATS
versus tube thoracostomy. We pooled data for meta-analysis where
appropriate. We performed a subgroup analysis for children along with a
sensitivity analysis for studies that used fibrinolysis in non-surgical
treatment arms. The comparison of open thoracotomy versus thoracostomy
drainage included only one study in children, which reported no deaths in
either treatment arm. However, the trial showed a statistically
significant reduction in mean hospital stay of 5.90 days for those treated
with primary thoracotomy. It also showed a statistically significant
reduction in procedural complications for those treated with thoracotomy
compared to thoracostomy drainage. We downgraded the quality of the
evidence for length of hospital stay and procedural complications outcomes
to moderate due to the small sample size. The comparison of VATS versus
thoracostomy drainage included seven studies, which we pooled in a
meta-analysis. There was no statistically significant difference in
mortality or procedural complications between groups. This was true for
both adults and children with or without fibrinolysis. However, mortality
data were limited: one study reported one death in each treatment arm, and
seven studies reported no deaths. There was a statistically significant
reduction in mean length of hospital stay for those treated with VATS. The
subgroup analysis showed the same result in adults, but there was
insufficient evidence to estimate an effect for children. We could not
perform a separate analysis for fibrinolysis for this outcome because all
included studies used fibrinolysis in the non-surgical arms. We downgraded
the quality of the evidence to low for mortality (due to wide confidence
intervals and indirectness), and moderate for other outcomes in this
comparison due to either high heterogeneity or wide confidence intervals.
Authors' conclusions: Our findings suggest there is no statistically
significant difference in mortality between primary surgical and
non-surgical management of pleural empyema for all age groups.
Video-assisted thoracoscopic surgery may reduce length of hospital stay
compared to thoracostomy drainage alone. There was insufficient evidence
to assess the impact of fibrinolytic therapy. A number of common outcomes
were reported in the included studies that were not directly examined in
our primary and secondary outcomes. These included duration of chest tube
drainage, duration of fever, analgesia requirement, and total cost of
treatment. Future studies focusing on patient-centred outcomes, such as
patient functional scores, and other clinically relevant outcomes, such as
radiographic improvement, treatment failure rates, and amount of fluid
drainage, are needed to inform clinical decisions. Copyright &#xa9; 2017
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<155>
Accession Number
614805231
Author
Al-Khudairy L.; Flowers N.; Wheelhouse R.; Ghannam O.; Hartley L.;
Stranges S.; Rees K.
Institution
(Al-Khudairy, Flowers, Wheelhouse, Ghannam, Hartley, Stranges, Rees)
Warwick Medical School, University of Warwick, Division of Health
Sciences, Coventry CV4 7AL, United Kingdom
Title
Vitamin C supplementation for the primary prevention of cardiovascular
disease.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD011114. Date of Publication: 16 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Vitamin C is an essential micronutrient and powerful
antioxidant. Observational studies have shown an inverse relationship
between vitamin C intake and major cardiovascular events and
cardiovascular disease (CVD) risk factors. Results from clinical trials
are less consistent. Objectives: To determine the effectiveness of vitamin
C supplementation as a single supplement for the primary prevention of
CVD. Search methods: We searched the following electronic databases on 11
May 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) in
the Cochrane Library; MEDLINE (Ovid); Embase Classic and Embase (Ovid);
Web of Science Core Collection (Thomson Reuters); Database of Abstracts of
Reviews of Effects (DARE); Health Technology Assessment Database and
Health Economics Evaluations Database in the Cochrane Library. We searched
trial registers on 13 April 2016 and reference lists of reviews for
further studies. We applied no language restrictions. Selection criteria:
Randomised controlled trials of vitamin C supplementation as a single
nutrient supplement lasting at least three months and involving healthy
adults or adults at moderate and high risk of CVD were included. The
comparison group was no intervention or placebo. The outcomes of interest
were CVD clinical events and CVD risk factors. Data collection and
analysis: Two review authors independently selected trials for inclusion,
abstracted the data and assessed the risk of bias. Main results: We
included eight trials with 15,445 participants randomised. The largest
trial with 14,641 participants provided data on our primary outcomes.
Seven trials reported on CVD risk factors. Three of the eight trials were
regarded at high risk of bias for either reporting or attrition bias, most
of the 'Risk of bias' domains for the remaining trials were judged as
unclear, with the exception of the largest trial where most domains were
judged to be at low risk of bias. The composite endpoint, major CVD events
was not different between the vitamin C and placebo group (hazard ratio
(HR) 0.99, 95% confidence interval (CI) 0.89 to 1.10; 1 study; 14,641
participants; low-quality evidence) in the Physicians Health Study II over
eight years of follow-up. Similar results were obtained for all-cause
mortality HR 1.07, 95% CI 0.97 to 1.18; 1 study; 14,641 participants; very
low-quality evidence, total myocardial infarction (MI) (fatal and
non-fatal) HR 1.04 (95% CI 0.87 to 1.24); 1 study; 14,641 participants;
low-quality evidence, total stroke (fatal and non-fatal) HR 0.89 (95% CI
0.74 to 1.07); 1 study; 14,641 participants; low-quality evidence, CVD
mortality HR 1.02 (95% 0.85 to 1.22); 1 study; 14,641 participants; very
low-quality evidence, self-reported coronary artery bypass grafting
(CABG)/percutaneous transluminal coronary angioplasty (PTCA) HR 0.96 (95%
CI 0.86 to 1.07); 1 study; 14,641 participants; low-quality evidence,
self-reported angina HR 0.93 (95% CI 0.84 to 1.03); 1 study; 14,641
participants; low-quality evidence. The evidence for the majority of
primary outcomes was downgraded (low quality) because of indirectness and
imprecision. For all-cause mortality and CVD mortality, the evidence was
very low because more factors affected the directness of the evidence and
because of inconsistency. Four studies did not state sources of funding,
two studies declared non-commercial funding and two studies declared both
commercial and non-commercial funding. Authors' conclusions: Currently,
there is no evidence to suggest that vitamin C supplementation reduces the
risk of CVD in healthy participants and those at increased risk of CVD,
but current evidence is limited to one trial of middle-aged and older male
physicians from the USA. There is limited low- and very low-quality
evidence currently on the effect of vitamin C supplementation and risk of
CVD risk factors. Copyright &#xa9; 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<156>
Accession Number
614904228
Author
Machelart I.; Greib C.; Wirth G.; Camou F.; Issa N.; Viallard J.F.;
Pellegrin J.L.; Lazaro E.
Institution
(Machelart, Greib, Viallard, Pellegrin, Lazaro) Department of Internal
Medicine and Infectious Diseases, Haut-Leveque Hospital, Pessac, France
(Wirth) Department of Infectious Diseases, Pellegrin Hospital, Bordeaux,
France
(Camou, Issa) Medical Intensive Care Unit, Saint Andre Hospital, Bordeaux,
France
Title
Graft infection after a Bentall procedure: A case series and systematic
review of the literature.
Source
Diagnostic Microbiology and Infectious Disease. (no pagination), 2017.
Date of Publication: November 27, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: The Bentall procedure is a cardiac surgery involving graft
replacement of the aortic valve, aortic root and ascending aorta. Graft
infection after Bentall's procedure (BGI) is infrequent but severe, and
often difficult to diagnose and treat. Patients and Methods: A
retrospective cohort study was performed using the Bordeaux endocarditis
database of adult patients admitted to the Bordeaux University Medical
Hospital for BGI between 2008 and 2014. Published case reports were
identified in the literature. Results: We identified 10 BGI patients in
the database and 13 in the literature. The majority of infections were
late-onset (20/23) and occurred as a result of gram positive cocci
bacterial infection (16/22). Detailed diagnoses of the described BGI were
determined using echocardiography, computed tomography (CT) and positron
emission tomography/CT (PET/CT). Labeled-leukocyte scintigraphy was not
reported in any case. Prolonged antibiotic therapy and surgery were found
to be the treatment of choice for BGI; however it was not always possible
to perform a surgical intervention. Clinical relapses occurred even with a
negative PET/CT, while PET/CT consistently positive for BGI occurred in
the absence of clinical relapse. This suggests that the use of PET/CT for
follow-up is questionable. Conclusion: Diagnosis of BGI is difficult, due
to the combination of clinical, biological, and radiological observations
obtained through transesophageal echocardiography and CT. PET/CT is an
alternative method to diagnosis BGI, but its impact on clinical management
remains unclear. Current data suggests that if surgical replacement of the
prosthesis is not possible, patients should be treated with prolonged
antibiotic therapy. Copyright &#xa9; 2017 Elsevier Inc.

<157>
Accession Number
614894944
Author
Roberts J.K.; Rao S.V.; Shaw L.K.; Gallup D.S.; Marroquin O.C.; Patel U.D.
Institution
(Roberts, Patel) Division of Nephrology, Duke University Medical Center,
Durham, North Carolina
(Roberts, Rao, Shaw, Gallup, Patel) Duke University School of Medicine,
Durham, North Carolina
(Rao, Patel) Duke Clinical Research Institute, Durham, North Carolina
(Marroquin) Department of Medicine, University of Pittsburgh Medical
Center, Pittsburgh, Pennsylvania
Title
Comparative Efficacy of Coronary Revascularization Procedures for
Multivessel Coronary Artery Disease in Patients With Chronic Kidney
Disease.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: September 27, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with chronic kidney disease (CKD) are at increased risk of
cardiovascular disease and death, yet little data exist regarding the
comparative efficacy of coronary revascularization procedures in CKD
patients with multivessel disease. We created a cohort of 4,687 adults who
underwent cardiac catheterization, had a serum creatinine value measured
within 30 days, and had more than one vessel with >50% stenosis. We used
Cox proportional hazard regression modeling weighted by the inverse
probability of treatment to examine the association between 4 treatment
strategies (medical management, percutaneous coronary intervention [PCI]
with bare metal stent, PCI with drug-eluting stent, and coronary artery
bypass grafting [CABG]) and mortality among patients across categories of
estimated glomerular filtration rate; secondary outcome was a composite of
mortality, myocardial infarction, or revascularization. Compared with
medical management, CABG was associated with a reduced risk of death for
patients of any nondialysis CKD severity (hazard ratio [HR] range 0.43 to
0.59). There were no significant mortality differences between CABG and
PCI, except a decreased death risk in CABG-treated CKD patients (HR range
0.54 to 0.55). Compared with medical management and PCI, CABG was
associated with a lower risk of death, myocardial infarction, or
revascularization in nondialysis CKD patients (HR range 0.41 to 0.64).
There were similar associations between decreased estimated glomerular
filtration rate and increased mortality across all multivessel coronary
artery disease patient treatment groups. When accounting for treatment
propensity, surgical revascularization was associated with improved
outcomes in patients of all CKD severities. A prospective randomized trial
in CKD patients is required to confirm our findings. Copyright &#xa9; 2017
Elsevier Inc.

<158>
Accession Number
614894903
Author
Jhaveri K.D.; Saratzis A.N.; Wanchoo R.J.; Sarafidis P.A.
Institution
(Jhaveri, Wanchoo) Division of Nephrology, Northwell Health, Hofstra
Northwell School of Medicine, Great Neck, New York, USA
(Saratzis) Leicester NIHR Cardiovascular Biomedical Research Unit,
University of Leicester, UK
(Sarafidis) Department of Nephrology, Hippokration Hospital, Aristotle
University of Thessaloniki, Greece
Title
Endovascular aneurysm repair (EVAR)- and transcatheter aortic valve
replacement (TAVR)-associated acute kidney injury.
Source
Kidney International. (no pagination), 2017. Date of Publication: July 14,
2016.
Publisher
Elsevier B.V.
Abstract
Acute kidney injury (AKI) after surgery or intervention is an important
complication that may impact mortality, morbidity, and health care costs.
Endovascular procedures are now performed routinely for a variety of
pathologies that were traditionally treated with open surgery because
randomized trials comparing endovascular and open surgery have shown at
least equally good results and reduced complication and hospitalization
rates with endovascular techniques. However, endovascular procedures have
been associated with an increased risk for postoperative AKI,
predominantly owing to contrast nephrotoxicity. Over the years,
endovascular techniques have progressively been applied for the treatment
of complex cardiovascular pathologies, and in recent years, nephrologists
have increasingly encountered patients who developed AKI after
endovascular aneurysm repair or transcatheter aortic valve replacement.
These 2 procedures typically involve high-risk patients who have several
established AKI risk factors prior to intervention. Several studies have
investigated the incidence, risk factors, and natural course of AKI after
endovascular aneurysm repair and transcatheter aortic valve replacement.
This review summarizes current data on incidence, risk factors,
pathophysiology, prognostic implications, and treatment of AKI associated
with endovascular aneurysm replacement and transcatheter aortic valve
replacement. Copyright &#xa9; 2017 International Society of Nephrology.